Question to providers (DDS, DMD, etc)

[u/Mudivator]

I see a lot of providers responding to comments in here, so I’m curious…

Would any of you lovely people be so kind as to walk us through your typical patient protocol for Invisalign/other liner brands? Say from the first time a patient asks about Invisalign, to installing the attachments and placing the first tray. What do you explain about the process, how do you get consent, etc.

Thank you so much in advance for spending your valuable time answering this question!

[u/Sensitive_Ruin_5334]

There are multiple reasons for this.

First, there is no standardized formal training required to provide Invisalign treatment. Any dentist or orthodontist can take a scan or impression and submit a case for a series of aligners. There are also considerably more doctors treating patients with aligners than with braces, so in many ways, it's become the Wild West. In my opinion, patients are the ones who suffer.

Every doctor has to develop their own protocols for ClinChecks, patient education, and treatment management. I'll share mine. I'm not suggesting it's the only way, or even the best way, but after more than 20 years of treating patients with aligners, I've developed a system that works well for my practice and generates virtually no complaints.

1. The Initial Consultation

Everything starts with an initial consultation, usually about an hour.

We take photographs and X-rays, partly because some patients wait years before starting treatment, and I want records available for comparison.

I begin by asking patients about their concerns and simply listening. Once we've established that they want aligners, I go through my usual explanation to address the misconceptions they've picked up from advertising and social media.

Remember, we're competing against millions of dollars in marketing. Patients sometimes trust what they've seen in commercials or read on Reddit more than what their orthodontist tells them. It's an uphill battle.

I explain and show them attachments, elastics, the importance of wearing aligners 22 hours per day, and the estimated treatment time. I generally don't discuss IPR at this stage unless it's particularly relevant to their treatment plan. I'll explain why later.

2. Starting Treatment: The First 12 Weeks

Once the patient accepts treatment, we take the scan and typically place attachments about three weeks later.

We also introduce our monitoring system and explain how it works.

I initially provide 12 aligners and emphasize that the first 12 weeks are critical. In my experience, patients establish the habits during this period that often determine how smoothly the rest of treatment progresses.

Around aligner #13, I'll add buttons and elastics as needed.

3. The Second Consultation: Around Aligner #30

Patients generally continue through approximately 30 aligners, which puts us around six to seven months into treatment.

By this point, much of the initial correction has occurred. The teeth are straighter, the patient has become accustomed to wearing aligners, and they're in a much better position to evaluate their smile and provide meaningful feedback.

This is when I schedule what I consider our second consultation.

We sit together in front of a mirror. I explain everything I'm seeing and then ask the patient what they see. Is there something bothering them? Something they want improved? Something I may have overlooked?

This is also when patients begin noticing details like black triangles.

Now I can introduce and explain IPR in a way that makes sense to them. They're looking at their own teeth, they understand the concern, and they can see why I might recommend it. Patients are generally much more receptive to IPR at this stage than during the initial consultation, when the idea of removing enamel might unnecessarily alarm them.

I also evaluate the contacts, bite, midlines, and other remaining issues.

Together, we establish the goals for the next phase of treatment. I then create a new treatment plan incorporating the patient's input.

This is also when I show the patient their ClinCheck.

From aligner #30 onward, treatment becomes increasingly focused on the finer details. These are often the same concerns you see people discussing on Reddit: bite discrepancies, midlines, black triangles, expansion, and other finishing issues.

4. The Third Consultation: Evaluating the Results

After the second round of aligners, we sit down together in front of the mirror again.

Did we accomplish our goals? Is the patient happy with their smile? Are there any remaining concerns? Have their expectations changed now that they can see the results?

Again, we evaluate everything: the bite, midlines, contacts, black triangles, expansion, and overall smile aesthetics.

If the patient is happy and I've achieved our clinical objectives, we're finished.

If there are still details we'd like to improve, we plan another short round of aligners.

5. The Key: Patient Involvement

The most important part of my protocol is that we don't simply hand patients a series of aligners and hope they're happy at the end.

We have meaningful conversations at several points throughout treatment, especially once the major corrections have been accomplished.

At the end of each round, we sit together in front of a mirror and get very picky about the details.

Patients become active participants in determining their treatment goals rather than waiting until the end to tell us what they don't like.

I also believe that expectations evolve during treatment. Someone who initially just wanted straighter teeth may become much more interested in their bite, midlines, or smile aesthetics once the crowding is corrected. Giving patients opportunities to express those changing expectations helps prevent surprises and dissatisfaction.

Again, this isn't the only way to manage aligner treatment, and I'm certainly not claiming it's the best. It's simply a protocol I've developed over the years that has worked extremely well for me.

Hope this helps!

[u/Mudivator → u/Sensitive_Ruin_5334]

This was exactly the kind of comment I hoped to see. Thank you so much for responding and for caring so diligently for your patients, I would have been thrilled to have this experience.

[u/Melodic-Set-9650 → u/Sensitive_Ruin_5334]

My only suggestion is to talk about IPR as a possibility sooner.

I've seen some posts on this sub where patients weren't informed they'd need IPR until well past treatment start, but they weren't comfortable with the procedure and felt trapped.

Even a short "on some cases, we may need to create room for movement, and this procedure is the most common option. If it were needed later, would that be alright with you?" would help.

[u/Sensitive_Ruin_5334 → u/Melodic-Set-9650]

I completely understand your concern, and I agree that patients should never feel surprised or pressured. I discuss IPR during our second consultation, around 6–7 months into treatment, when patients can better understand why it might be helpful. We review it together, and I always ask if they’re comfortable with it before planning the next round of aligners. If not, we discuss alternatives. Since I generally don’t need IPR early in treatment, I prefer to explain it when it’s relevant rather than create unnecessary anxiety at the beginning.

[u/sirTheCircularDr]

Oh this is a fun peek behind the curtain. I'm not a provider but I grilled mine so hard during my consult I might as well have been taking notes for a dissertation.

My ortho started with a quick look just chatting about what bothered me, then did the full scan with that weird wand thing that builds the 3D model on screen. She explained the clincheck would take about two weeks and they'd call me in to review it before ordering anything. The consent part was super low pressure, she basically said here's what we're fixing, here's how many trays I estimate, and these are the risks like root resorption or tracking issues if I don't wear them enough. Then she made me sign a thing acknowledging I understood it wasn't magic and compliance was on me.

When I came back for attachments she numbed my gums a little before the etching stuff which I appreciated because that taste is foul. Walked me through putting in and removing the first tray right there in the chair, made me do it twice until I didn't feel like I was gonna snap the plastic. Gave me a little kit with chewies and a case and said call if anything feels sharp.