Monitoring and troubleshooting Graham Gardner. Episode 80 June 2nd 2021

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Hosted by
Farooq Ahmed

Join me for Graham Gardner’s lecture where he describes changes virtual monitoring has made for him, and how he manages problems with aligners specifically the usual suspect in the lateral incisor losing tracking


Clincheck is key to avoiding problems.

  • Bespoke
  • Realistic
  • Staging
    • Velocity for adult / children treatment



Monitoring intervals

  • Before virtual monitoring
    • Stage 4, every 8 weeks thereafter
  • Virtual monitoring: Weekly
    • If los of tracing: Wear for another ½ week, another photo review midweek


Loss of tracking upper lateral incisors: 5 common reasons

  1. Wear – check adjacent teeth and fitting
  2. Central incisor intrusion
    • Clincheck – if not intrude express as aligner not seating on U2
    • Solution – chewies and slow change of aligners
  3. IPR/ Space
    • Expansion not complete
    • Squeezes smallest tooth and intrudes
    • Solution: IPR 0.05 strip check if tight even if not requested, to offset space not delivered from expansion
    • Virtual monitoring: build in space to expansion 0.2mm on 3 sites
  4. Attachment: If proclining, tooth naturally intrudes, place attachments to resist intrusive force
    • Solution: Flipper elastic cut out labial and palatal, tooth extrudes into aligner
    • Requires some IPR to allow vertical movement
  5. Combination of reasons



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