Reviewing a 3D setup: what to check before you approve

The 3D setup is where the treatment plan becomes real. Once you approve it, aligners are manufactured to that plan, so a careful clear aligner 3D setup review is the most valuable time you will spend on the case. This guide accompanies the video and gives you a systematic checklist to work through before you approve.

Start with your diagnosis

Before opening the setup, re-read your own records and goals. The question is not "does this look nice?" but "does this match what I diagnosed and what I agreed with the patient?" Keep your treatment goals beside you as you review.

Clear aligner 3D setup review: the final position

Look at the final stage first, then work backwards.

• Arch form. Is it symmetrical and appropriate for the patient? Watch for excessive expansion, especially in the lower arch.
• Midlines. Are they where you intended, relative to each other and to the face?
• Overjet and overbite. Are they within a healthy range? A plan that resolves crowding but leaves an edge-to-edge bite or a deep bite may not be acceptable.
• Incisor inclination. Look at torque on the upper and lower incisors. Excessive proclination is a common way setups gain space.
• Posterior occlusion. Check intercuspation, crossbites and contacts in the buccal segments.
• Contacts. All planned spaces closed, or deliberately kept with the correct width.

Check the space sources

If the case involved crowding, ask where the space came from. Compare expansion, proclination, IPR and distalisation in the setup against your plan. If the setup relies heavily on one source you did not intend, request a revision. See planning moderate crowding in adults.

Review the staging

Step through the stages. You are looking for movements that are sequenced sensibly:

• Space is created before teeth move into it.
• Difficult movements, such as rotations of rounded teeth and extrusions, are spread over enough stages.
• Anchor teeth are not moving at the same time as the teeth they are anchoring.
• There are no collisions between teeth in the middle stages.
• The number of stages is reasonable for the complexity of the case.

Check the attachments

Look at the attachment chart and each attachment on the model:

• Does every difficult movement have an attachment designed for it, from the stage it begins?
• Are attachments placed on sound enamel, clear of the gingival margin and opposing teeth?
• Are visible upper anterior attachments necessary, and has the patient been told?
• Are there attachments on crowns or veneers you would rather avoid?

For principles, read attachment design fundamentals.

Check the IPR chart

The IPR chart shows which contacts are reduced, by how much and at which stage. Check that:

• Amounts are within safe limits for each contact.
• IPR is spread across contacts rather than concentrated.
• It is staged when the contact will be accessible, not while teeth still overlap.
• It avoids teeth with restorations or concerns you have noted.

Check auxiliaries

Depending on the case, the plan may include bite ramps, elastic cutouts, precision hooks, pontics or a virtual C-chain. Confirm each is where you expect it, and that you are ready to manage elastics if they are part of the plan. Make sure the patient is likely to comply with them.

Think about predictability

Some movements are less predictable with aligners: large extrusions, rotations of rounded teeth, significant bodily movement and corrections that depend on growth. If the setup relies on these, consider whether to accept a planned refinement, add auxiliaries, or reconsider the approach. Skeletal problems may need other treatment.

Request revisions or approve

If anything does not match your plan, request a revision through the portal with clear, specific instructions, for example "reduce lower incisor proclination and use IPR between canines and premolars instead". Vague requests lead to more rounds. When the setup matches your diagnosis, approve it. Nothing is manufactured until you approve. After that, models are 3D printed, aligners are thermoformed, trimmed, checked, packaged in sequence and shipped to your clinic. See how it works and our clear aligner lab.

Check the soft tissues and aesthetics

The setup shows teeth, not faces. Bring your photos into the review. Consider how the planned incisor position will sit relative to the lips at rest and in a smile, whether the smile arc is improved or flattened, and whether gingival margins on the upper anteriors will be level. Where expansion is planned, think about the buccal corridors and the gingival tissue over the roots. If the patient has thin gingiva or existing recession, be cautious about buccal movement in that area.

Share the plan with your patient

The 3D setup is also a powerful consultation tool. Showing the patient their start and end positions helps them understand what is planned, why attachments or IPR are needed, and why retention matters.

Frequently asked questions

How many revisions can I request?

Request as many as you need to reach a plan you are confident in. Specific, combined requests reduce the number of rounds.

Who designs the setup?

Setups are prepared by the lab and reviewed by an orthodontist before they reach you. You remain the treating clinician and make the final decision.

Can I approve one arch and change the other?

Request the change on the case before approving. The plan is approved as a whole so that both arches work together.

Should I show the setup to my patient?

Yes, it helps consent. Make clear it is a planned outcome, not a guarantee.

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