Tech Tip: Gaps between aligners & teeth

Intrusions and extrusions are some of the most unpredictable movements to achieve with aligners. Often everything goes as hoped, but other times, those teeth will just stubbornly stay put, causing small gaps between those teeth and the aligner.

Example of gap between tooth and clear aligner

Doctors have several options for dealing with this situation. Here are some of the solutions we've encountered:

  1. Leave it alone. If that particular movement isn't essential to the appearance or function of the teeth, you might just decide it's not worth complicating the treatment to deal with it. (You might need to remove the engager from that tooth if it gets in the way.)
  2. Wait it out. If you have unused phases remaining, you can just stay on schedule until the final step, then target those stubborn teeth by themselves with a refinement.
  3. Bring out the band. Extrusions are particularly difficult for aligners; there's just not much leverage to work with. You can apply some extra force by improvising an auxiliary with some brackets and an elastic band, as shown in this how-to. This is often surprisingly effective.
  4. Let Chewie be your co-pilot. One of the best tools for helping with intrusions are Chewies. Patients love these things. Chewing on those for a few times each day can really help to seat the aligners, relieve pressure, and help to intrude the teeth.
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