Case selection for new aligner providers

The first cases you treat with clear aligners shape your confidence, your team's workflow and your patients' trust. Good aligner case selection is the most reliable way to start well. This guide, based on the webinar, sets out a practical approach for dentists beginning to offer aligners: which cases tend to be predictable, which need more experience, and how to grow from one to the other.

Why case selection matters early

Aligners are a prescription appliance, and you are responsible for diagnosis, consent and supervision. Starting with predictable cases lets you learn the workflow, from scanning and submission to setup review, attachment bonding, IPR and monitoring, without also managing difficult biomechanics. Complexity can come later.

Aligner case selection: start with these

Cases that tend to suit new providers share some features: mostly tipping movements, healthy periodontium, good compliance and goals that are clear.

Mild crowding that can be resolved with small amounts of expansion or IPR.
Mild spacing with normal tooth sizes and no periodontal cause.
Minor relapse after previous orthodontic treatment. See teeth moved after braces.
Pre-restorative alignment where small movements improve the position for veneers or crowns.
Cases with a Class I molar relationship and a normal overbite and overjet.

Plan carefully or seek support

These cases can be treated with aligners, but they need more planning experience and closer monitoring:

Moderate crowding needing planned IPR and staging. See planning moderate crowding in adults.
Deep bite needing intrusion, with bite ramps in the plan.
Single-tooth crossbites and mild posterior crossbites.
Significant rotations of canines and premolars.
Larger anterior spaces needing root control. See planning anterior space closure.

Refer or consider other treatment

Skeletal discrepancies, including significant Class II or Class III skeletal patterns, which may need orthopaedic or surgical treatment.
Severe crowding likely to need extractions with bodily space closure.
Large open bites, particularly with habits or skeletal causes.
Impacted teeth needing surgical exposure.
Uncontrolled periodontal disease, until it is treated and stable.
Growing patients where growth modification is the main goal.

Referral is not failure. Treating within your experience protects patients and your reputation. As your experience grows, cases move from this list into the middle group, but the decision should follow your own results and training rather than the patient's wish for a quicker or cheaper option.

Patient factors matter as much as teeth

Aligners only work when worn. Assess the patient as well as the malocclusion:

Can they wear aligners for most of the day, including at work and during meals out?
Are their expectations realistic? Check they understand attachments, IPR, possible refinements and retention.
Are there practical factors, such as Ramadan fasting, frequent travel or wedding season, that affect wear and appointments? Plan around them.
Is oral hygiene good enough?

A simple screening workflow

Examine, including periodontal status, restorations and bite.
Take scans and photos, and X-rays where indicated.
Place the case in one of the three groups above.
For borderline cases, submit with your questions and ask the lab for their view before committing.
Review the 3D setup carefully. See reviewing a 3D setup.
Discuss the plan, the alternatives and retention with the patient before consent.

Patients who come through the smile check

Patients who find you through Alignova's online smile check have answered a few screening questions, but that is not a diagnosis. Every patient still needs your examination. Treat the smile check as a lead, not a suitability decision.

Records that support good selection

Case selection is only as good as the records behind it. Scans alone do not show bone levels, root positions or unerupted teeth. Take radiographs where clinically indicated, record periodontal findings, and photograph the face and smile as well as the teeth. Note functional findings such as shifts on closure, which can turn an apparently simple crossbite into a different problem. A few extra minutes at the records stage often reveal why a case that looks easy on a scan is not.

Setting expectations at consent

Even for simple cases, explain clearly:

That attachments may be bonded to some teeth and IPR may be needed.
That a refinement with additional aligners is sometimes required.
That results depend on wearing aligners as instructed.
That retainers are needed afterwards to keep the result.
That suitability may change if new findings emerge during treatment.

Patients who understand these points from the start are easier to treat and more satisfied at the end.

Building experience

Treat a number of simple cases before moving to moderate complexity.
Use regular progress photos to learn what tracking looks like. With Alignova, the patient app asks for three photos in fixed poses at every aligner change. See aligner monitoring.
Keep notes on each case: what tracked well, what needed a refinement, and why.
Use the case messaging with the lab to ask questions.

Frequently asked questions

Should my first case be a simple one even if the patient wants more?

Start with cases you can treat confidently. If a patient's needs exceed your current experience, refer or seek support.

Are teenagers good first cases?

They can be if permanent teeth are erupted and compliance is good, but growth and compliance add variables. Many new providers start with adults.

Can the lab tell me if a case is suitable?

The lab can give a view on feasibility from the records, but suitability is a clinical decision made by you after examination.

Partner with Alignova to plan and manufacture your clear aligner cases in Pakistan.