How to overcome the 5 biggest obstacles

This post is about getting started with clear aligners.

The content may also inspire colleagues who do not want to work with orthodontics. The content is written with a focus on keeping a cool head and focusing on elements that add value to the dental practice.

Once we have decided to implement clear aligners as part of our treatment offer to our patients, we face 5 hurdles. Of these, 2 are relatively manageable and 3 are very challenging.

In this post I describe the 5 obstacles and ways you can overcome them. There is not just one path, but several. After reading the post here, you will be able to choose from several different ways to get past the 5 obstacles.

The guide is based on observations from over 1500 dental clinics in 15 different countries.

Woman steps over a fence


There are a number of challenges related to treating with clear aligners.

First of all, it is important to realise that there is no difference in principle between the aligners you use. As long as you are able to make the correct diagnoses, know what you want to achieve so that you can draw up an ideal treatment plan and have a grasp of the orthodontic principles, as well as knowing the challenges associated with using the orthodontic appliance you have chosen to work with.

When I describe clear aligners as a type of orthodontic appliance, it's because the industry has generally wanted to make it seem like aligners are a safer choice than fixed appliances. It isn't!

Respect for material selection

Clear aligners can in principle do the same as brackets and wires and should be treated with the same respect as fixed appliances. Therefore, I think it is important to realise that some of the patients we see who CAN be treated with clear aligners should not be treated in general practice, but referred to an orthodontist. Of course, it can be difficult to assess which patients should be referred and which can be treated on one's own. I have described part of the solution in this post on clear aligners in a general dental practice.

Although clear aligners should be seen as a tool on a par with fixed braces, there are ways to make it easier and safer to treat patients with clear aligners in general practice. I have written about how to do this here.

Want to know more about everything we didn't learn in dental school ( practice optimization, patient communication, branding & marketing)? Then follow us on LinkedIn.

The 5 biggest obstacles

When you're about to start working with clear aligners, it's good to have an overview of the challenges you'll face BEFORE you get started.

  • Below, I've listed the 5 biggest challenges.

  • Visualization of the desired end result

  • Patient communication & treatment acceptance

  • The orthodontic treatment plan

  • Modification of the digital setup

  • The clinical handling

Below is a description of each obstacle and how you can deal with them.

Visualization of the desired end result

This is within most dentists' comfort zone.

In reality, it's a matter of developing a comprehensive treatment plan. When we send a patient to an orthodontist, it's usually with an idea of how we want to finish treating the patient after ortho. We "just" have to do the same exercise when we treat patients ourselves orthodontically. So here it is relatively easy, to implement clear aligners.

Hatt KaVo articulator with mounted models of waxup of anterior front teeth

Most patients who have their teeth straightened have a need for some form of restorative treatment after their orthodontic procedure. In addition, this is a good time to introduce patients to anything else that may need to be done in order for the patient to achieve optimal oral health.


I prefer to straighten the anterior teeth so that the gingival margin is lined up optimally. I find it a lot easier to change the incisal edges and/or the shape of the teeth to achieve optimal function and aesthetics. Than obtaining ideal function and aesthetics aligning everything after the incisal edges and then change the contour of the soft tissue.

In addition, I will always present any need for fixed prosthodontics in conjunction with an aligner treatment. But that belongs to the next challenge.

Patient communication & treatment acceptance

When it comes to both simple and complex treatments, most dentists have challenges presenting treatments in a way that makes patients want to invest in optimal oral health.

On the one hand, patient communication is not part of the curriculum in dental schools, on the other hand, patient communication is a taboo subject among dentists in general.

If it were super easy to get patients to accept complex treatment, everyone would already be doing it. This is where further education is needed if clear aligners are to be successfully implemented. There are very few continuing education offerings that can actually be used directly in practice. At AlignerService you will find useful continuing education in patient communication.

The orthodontic treatment plan

This is where it starts to get challenging for most.

As I've written in the last 2 blog posts, there's a reason it takes 3-4 years on top of our basic training to become an orthodontist. It is naive to think that in a weekend course or 2 you can acquire the knowledge to perform advanced orthodontic treatments.

Choice of patients

Most dentists who want to start treating patients with clear aligners ask for guidelines on case selection so that they can select the simple treatments. The challenge is that no such guideline can be provided. You can get very broad guidelines, but there will always be deviations. Just as biology can make a treatment that looks simple difficult.

It takes experience from somewhere between 200-500 clear aligned treatments that you have done yourself to have a good overview. It takes time and costs a lot (planning time and extra chair time)

Access the latest content on the blog. Sign up - it's easy and free.

Click on "login" in the top right corner and follow the instructions. Then you'll receive a weekly email notification when we post new content.

The treatment plan

Most general dentists do not have a problem laying out a comprehensive treatment plan. It's like the cornerstone of our training and one of the few disciplines we'll never be able to delegate.