Generally, excellent clear aligner results can only be achieved with informed and cooperative patients. Clear aligner treatment is an elective procedure and, like any other treatment of the body, has some inherent risks and limitations. These risks are seldom serious enough to contra-indicate orthodontic treatment, but should be considered when you decide to begin clear retainer orthodontic treatment.
You are therefore urged to read the following information, ask any questions which come to mind, then consent to our treating you or your child by signing at the bottom of the form.
As your dentist, I feel that the benefits from clear aligners do outweigh the risks; however, I need you to make your own decision.
• PATIENT COOPERATION
The total time required to complete treatment may exceed our estimate. Excessive bone growth, poor oral hygiene or poor cooperation in wearing the trays 21 to 22 hours per day, broken or distorted trays and missed appointments can lengthen the treatment time, increase treatment costs, and affect the quality of the end results.
• DENTAL DISEASE, DECALCIFICATION
Tooth decay, gum disease and permanent markings on teeth are fully preventable, but can occur if patients eat food containing excessive sugar and/or do not clean their teeth frequently and properly. Teeth should be brushed and flossed after meals and before putting your trays back in your mouth.
• NON-VITAL TOOTH
An injured tooth can die over a period of time with or without orthodontic treatment and it may not be obvious that a tooth was previously injured. This tooth may flare up during orthodontic movement and require root canal treatment. This occurrence is seldom due to clear retainers and is more frequently related to a previous accident. Your general dentist would need to perform a root canal treatment if the tooth should flare up before, during, or after orthodontic treatment.
• ROOT RESORPTION – SHORTENING OF THE ROOTS
This can occur with or without clear retainer orthodontic treatment. Under healthy conditions, the shortened roots usually are not a problem. In very rare cases, shortened roots can be a cause of loose teeth.
• PERIODONTAL PROBLEMS
Swollen, inflamed and bleeding gums can usually be prevented by proper and regular flossing, waterpiking and brushing. Periodontal disease (loss of bone surrounding the teeth) can become serious and cause the loss of teeth. Should the condition become uncontrollable, orthodontic treatment may have to be discontinued short of completion. This would be rare, as we do not recommend treatment on patients with pre-existing periodontal disease.
• RELAPSE
Teeth have a tendency to partially rebound toward their original positions after treatment. Rotations and crowding of lower anterior teeth are most common examples. Teeth also tend to drift forward in the mouth over the years. We advise wearing retainers all day every day for 6 months after completing treatment and then every night thereafter. Usually a high percentage of the correction and good cosmetics can be maintained when retainers are worn in this manner.
• SLENDERIZING AND RESHAPING TEETH
In attempting to straighten the teeth, but keep the removal of any teeth to a minimum, we often reshape between teeth to give the teeth room for movement. This is called IPR.
• ALLERGIC REACTIONS
Allergies to clear retainer materials may occur during treatment. If you are aware of these allergies they can be avoided, but of they are unknown to you, it is impossible to predict any reaction.
Patients who are already allergic to certain foods are more prone to allergies to materials. Some allergies that we are aware of include latex (gloves and rubber bands) and metals (such as Nickel).
• TEMPORO-MANDIBULAR JOINT DISFUNCTION (TMJ)
Patients with malocclusions may have a high potential for TMJ (or temporo-mandibular) problems, which may become evident before, during or after orthodontic treatment. These may include joint pain, ear pain, and/or headaches. Clear retainer orthodontic treatment may help remove the dental causes of the TMJ
Syndrome but not the non-dental causes. TMJ problems can be both painful and expensive to treat.
We may need to refer you to a doctor who specializes in TMJ problems, and this would be a separate fee at that doctor’s office.
• IF THE PATIENT IS STILL GROWING
Occasionally, unexpected or abnormal changes in the growth of the jaws or shape and size of the teeth may limit our ability to achieve the desired result. If growth becomes disproportionate, the bite may CHANGE, requiring additional treatment or, in some cases, oral surgery. Growth disharmony is a biological process beyond the dentist’s control.
• UNUSUAL OCCURRENCES
Sometimes clear retainer appliances may be accidentally swallowed or aspirated, or may irritate or damage the oral tissue. Teeth may be chipped or restorations (fillings or crowns) dislodged.
• CLEAR BUTTONS and TOOTH COLORED ATTACHMENTS
If attachments or buttons are needed on the front teeth, they do show more than if we do not need them. These auxiliaries are commonly needed and we request your permission to use these when needed. There is a very slight risk that some of the tooth’s enamel may be removed inadvertently. These buttons can also stain easily, therefore please consider foods/beverages that cause staining (red wine, coffee, berries) and make sure your oral hygiene is good.
• DENTAL CHECK-UPS
It is essential that orthodontic patients have regular dental check-ups and cleanings. Many times, we suggest that patients with clear aligners come every 3-4 months while in treatment.
• SPACES BETWEEN TEETH
Completion of orthodontic treatment, especially in adults, can result in slight spaces between some teeth. This is especially true if teeth were extracted, or if the widths of individual teeth are inconsistent. Also, in some adults with very crowded teeth, the gum tissues do not fill in, so there appears to be a space between teeth due to missing gum tissue.
I have read, understood, and have had all my questions regarding the risks and limitations of clear retainer orthodontic treatment answered. I further understand that one of the alternatives is no treatment. I also understand that should any of the above conditions threaten my health, treatment may be terminated.