Dr Terry Sellke shares how adopting FXClear aligners allowed his apply to reduce refinements, enhance monitoring, and obtain a superior scientific end.
By Terry Sellke, DDS, MS
By 2015, clear aligner remedy represented roughly 30% of our high-volume orthodontic apply, with 1000’s of sufferers handled. Nevertheless, widespread challenges continued, together with discomfort with aligner modifications, staining, inconsistent finishes, and aligner unseats regardless of in depth use of attachments.
The problems we encountered dropped at thoughts a high quality management idea from the car trade used to explain and measure high quality: “match and end.” Throughout meeting, elements should come along with extraordinarily excessive precision to attain optimum match, fashion, and efficiency. In braces, orthodontists purpose to enhance the match between the bracket slot and the wire. An identical idea applies to aligner remedy, the place the match of the aligner—each at preliminary insertion and as tooth transfer—is vital to precisely specific the tooth actions prescribed within the remedy plan. As new rivals entered the market, we started trying to find an aligner system that higher met our requirements of high quality.
A Efficiency Comparability
We evaluated 5 aligner manufacturers earlier than choosing OrthoFX in 2019. Its flagship materials, FXClear, was designed to deal with limitations of the main model by delivering lighter, extra managed forces over a broader vary of tooth motion. The advantages we noticed (outlined under) led us to transition all new aligner begins to OrthoFX inside three months.
- Expanded match vary: FXClear successfully doubles the match vary in comparison with the main model, permitting a single aligner to accommodate as much as two phases of deliberate motion (Determine 1). This implies aligners proceed to suit even when compliance or particular person organic responses differ, serving to actions keep on observe.
- Improved monitoring: The higher vary improves total monitoring, and the fabric higher resists everlasting deformation from the stresses of repeated aligner insertion and elimination.
- Improved consolation and compliance: Sufferers who transitioned from SmartTrack to FXClear reported elevated consolation with the brand new aligner materials. This was related to improved compliance and, in flip, higher remedy predictability.
- Sustained pressure supply: As documented in a third-party in vitro research (Determine 2), FXClear stays lively longer to maintain tooth transferring to their vacation spot for every stage.
- Minimal unseating: Virtually no unseats have been noticed, even throughout quite a lot of case varieties.
Clinically, these properties translated into fewer refinements and attachments, improved remedy effectivity, and the next high quality end.
Sustained Power Supply—A Third Occasion Examine
To judge sustained pressure supply, testing carried out by an unbiased laboratory in contrast FXClear with a typical trade aligner, as proven within the side-by-side graphs (Determine 2). Every curve represents the efficient pressure delivered by a single aligner designed for one-week put on, measured on Day 1, Day 2, and Day 4.
Optimum Power Zone—The inexperienced areas on every graph symbolize the pressure vary for optimum tooth motion (roughly 60 to 200 g-f throughout all motion varieties). Forces inside this vary assist keep away from PDL hyalinization and the undermining resorption course of1,2, which might result in aligner unseating and lack of management.
Normal Business Power Profile—Within the left graph, discover the usual trade aligner exerts very excessive pressure on Day 1 (orange curve),with a speedy decline in pressure and exercise because the tooth start to maneuver because of the inelasticity of the plastic. On Day 2 (yellow curve), the remaining forces now drop under the minimal forces required for tooth motion. By Day 4, the aligner is now not lively. When efficient pressure or match is misplaced, lag can happen, which might result in refinement.
FXClear Power Profile—In the fitting graph, FXClear stays lively for all days measured. Even on Day 4, adequate forces stay for all tooth motion varieties.
Affected person Compliance Elements
As a result of equipment efficiency depends upon affected person put on, OrthoFX additionally thought of affected person compliance within the design of FXClear aligners. One inherent benefit is the decrease pressure profile, which boosts affected person consolation. In scientific use, complaints have been decreased, and a ache reliever was now not wanted at stage modifications.
FXClear aligners additionally reveal excessive stain resistance, which is necessary to our sufferers. In testing with espresso, tea, and crimson wine, FXClear maintained wonderful colour stability over seven days, whereas the main model confirmed seen staining inside 12 hours (Determine 3). Primarily based on these outcomes, we advise sufferers that they might drink black espresso (with out sugar) throughout aligner put on.
Case Report
By 2023, affected person desire in our apply had flipped relative to 2015, with roughly 70% now selecting aligners. Remedy effectivity had been optimized, with outcomes similar to—and generally exceeding—these achieved with braces, permitting sufferers to decide on both possibility on the identical price. The next case illustrates the speedy, secure, and high-quality outcomes achieved with FXClear aligners.
Prognosis & Remedy Plan
This affected person was an grownup Edge on Class III case with higher and decrease crowding (Determine 4). Her chief criticism was jaw locking and ache, not unusual for a affected person with out anterior steering. As an grownup, she most well-liked remedy with aligners (Determine 5), which our apply has discovered to be the best equipment for open chunk circumstances.
Class III elastics have been deliberate to create the wanted overjet and enhance condylar place in centric occlusion. With full occlusal protection supplied by aligners and ensuing posterior occlusal assist, Class III elastics have been effectively tolerated in our TMD circumstances. In our expertise, this method has produced extra secure overbite correction than remedy relying solely on anterior vertical elastics, which has demonstrated the next tendency towards relapse.
Remedy Plan Abstract
- Growth of higher, decrease arches
- IPR of decrease 3-3 earlier than stage 20
- Hooks (reduce notches) at higher second molars in addition to decrease canines
- Rotation of canines and incisors
- Appropriate crossbite #7, 10, 11
- Class III elastics to resolve posterior condyles, Class I cuspid relationships, anterior steering
- Variety of phases: 31
Deliberate Refinement (#1)
The primary refinement was initially deliberate to happen at aligner #31. The affected person’s case progressed so properly, the primary refinement started at aligner #26 to carry out vital enameloplasty sooner and obtain the very best esthetic consequence (Figures 6 and seven).
Refinement targets:
- Proceed mechanics
- Tackle posterior displaced condyles with extra C3 elastics
- Molar despair by way of aligners to create wanted overbite
- Add 2 extra attachments to higher arch for retention with C3 elastics
- Variety of phases: 14
Final Refinement (#2)
Refinement targets:
- End anterior steering
- Ultimate verify condylar place by way of new tomograms
- Enhance proper posterior occlusion
- Variety of phases: 12
Remedy Outcomes
All remedy targets have been achieved (Determine 8), with the open chunk resolved with out using vertical elastics. Utilizing FXClear aligners on this Class III open chunk case supplied higher management of vertical, transverse, and AP in contrast with mounted home equipment. Whereas stopping undesirable tooth motion, all rotations have been corrected and crowding eradicated effectively to attain a high-quality end.
Remedy metrics:
- Remedy Time: 15 months
- Complete Variety of Levels: 46
- Complete Variety of Refinements: 2
- Complete Variety of Workplace Remedy Visits: 3
Together with FXClear aligner remedy, the apply remotely displays match and progress with AI-driven expertise from DentalMonitoring. Common distant evaluations have allowed a major discount within the variety of required in-office visits whereas enhancing scientific management and remedy high quality.
Normal retention consists of a mandibular bonded retainer (3=3) and a maxillary Essix retainer. For our open-bite circumstances, a mandibular Essix retainer is moreover prescribed and worn over the bonded retainer for about 10 hours nightly to stop posterior eruption that would end in relapse of the open chunk.
Conclusion
Since adopting the FXClear aligner system from OrthoFX, we now constantly observe superior finishes in far fewer aligners and attachments. Optimum remedy outcomes look like strongly influenced by the traits of the polymer.
First, FXClear aligners ship lighter forces that enhance affected person acceptance whereas permitting a higher vary of motion per aligner. This leads to higher management of tooth motion in all planes and allows extra motion per stage.
Second, these materials properties enable considerably much less overcorrection to be constructed into the equipment, supporting extra environment friendly motion and extra detailed finishes.
Third, the polymer hugs the tooth so effectively and delivers forces so successfully that refinements as a result of aligner unseating have primarily turn into a factor of the previous. In an in-office assessment of 100 circumstances, refinements associated to unseating occurred in solely 4 sufferers, every requiring only one refinement.
Moreover, our expertise is in keeping with the preliminary findings of an unbiased research indicating that FXClear provides fewer workplace visits, fewer aligners, and higher predictability than the Invisalign aligner system.3 We might additionally add that, along with the colour stability and luxury our sufferers recognize, we routinely end with wonderful posterior occlusion.
When mixed with distant monitoring, FXClear represents a major development in aligner remedy in a apply with greater than 20 years of aligner expertise. Much like the automotive trade’s idea of match and end as a technique to outline and measure high quality, these developments enable the very best “match and end” for aligner remedy. OP
All pictures courtesy of Dr Terry Sellke.
References
- Vijayashree, U., & Raghavan, R. (2015). Organic response on the mobile degree throughout the periodontal ligament on software of orthodontic pressure – An replace. Journal of Worldwide Oral Well being, 7(9), 1–5.
- Wu, J. L., Liu, Y. F., Peng, W., Dong, H. Y., & Zhang, J. X. (2018). A biomechanical case research on the optimum orthodontic pressure on the maxillary canine tooth primarily based on finite aspect evaluation. Journal of Zhejiang College. Science. B, 19(7), 535–546. https://doi.org/10.1631/jzus.B1700195
- Werner A. New research finds OrthoFX aligners could supply higher effectivity and predictability. Orthodontic Merchandise. April 14, 2026. Obtainable at: Orthodontic Merchandise article.
Terry Sellke, DDS, MS, has non-public practices in Grayslake, Antioch, and Gurnee, Illinois. He relentlessly incorporates new applied sciences and methods enhancements to attain distinctive outcomes with shorter and fewer appointments and fewer months in remedy. Sellke served as a scientific professor and co-director of the orthodontic clinic at College of Illinois at Chicago for 36 years and continues to lecture on the college and worldwide on improvements in orthodontics.
