Doctor Instructions for Case Selection

Orthodontic Diagnostic Photographic Criteria – Quick Guide

Intraoral Photos

Frontal:

• Use cheek retractors to expose teeth and gingiva
• Center teeth in frame, capturing full arches
• Incisal edges and occlusal plane parallel to bottom of the frame

Right Retracted:

• Use cheek retractors and a mirror to capture right side
• Ensure a clear view of posterior teeth and buccal corridors
• Molars should be in contact, and teeth should be in focus

Left Retracted:

• Same as Right Lateral, but for the left side

Occlusal Upper:

• Use occlusal photography device or mirror to capture the upper arch
• Center teeth in frame, capturing full arch and palate
• Ensure teeth, gingiva, and palate are in focus
• Assure adequate lighting by avoiding shadows of nose or chin

Occlusal Lower:

• Same as Occlusal Lower, but for the lower arch

Frontal Resting

• Patient simply turns to face the camera
• Eyes are open and looking into camera
• Ears exposed
• No distracting eyewear or jewelry
• Inter-pupillary line horizontal to frame
• Approximate center of frame is the tip of nose

Lateral Profile

• Teeth in occlusion
• Lips relaxed and in contact
• Natural head position with eyes looking forward
• Entire head and neck displayed
• Left/Right eyelash slightly visible
• Approximate center of frame is 1.0cm anterior to tragus
• White, or light background

Frontal Smiling

• Use the same format as the non-smiling photograph adding a natural smile (Social Smile)

Photo Tips

• Use a high-resolution camera for clear images.
• Ensure proper focus and lighting for all images.
• Review images immediately to confirm quality and retake if necessary. Obtain patient consent and maintain patient privacy when handling images.

Scan Strategy Full Arch

Much like in other areas of dentistry, the final product accuracy is highly dependent on a detailed and accurate impression. Your patients VAKT Clear Orthodontic Aligners are no different. To assure well fitted, comfortable, and accurate aligners are produced for your patients’ orthodontic journey, we have assembled the following recommendations:

• Orthodontic scanning is different than typical restorative scanning in that it takes longer and attention must be paid to the entire arch of teeth as well as significant soft tissue detail apical to the tooth crowns.
• The operator should confirm the centric occlusion bite position PRIOR to scanning. Have the patient reproduce this position of maximum intercuspation 2-3 times while observing cuspal relationships. This is the position you will look for during the bite scan.
• Most scanner companies provide a user guide that outlines best practices. The recommended scanning protocol described above will apply to most scanner types. If your scanner manufacturer recommends a different sequence or capture protocol, we recommend you utilize the manufacturers method. Capture and model generation algorithms are unique to each scanner and using your scanner manufacturers protocol will lead to the most accurate digital impression.
• Full arch scanning may be infrequent in many preventative/restorative offices; therefore, a learning curve should be anticipated. We have found it helpful to have team members “practice scan” each other several times prior to scanning actual patients. Doctors should evaluate these “practice” scans for accuracy and precision, especially the bite registration.
• In offices scanning infrequently, we have found it helpful to “assign” scanning duties to a team member or two. As frequency of scanning increases in the office, proficiency increases, and the time necessary to scan typically decreases for the operator.

General recommendations that apply to all scanner models

1. Place patient in ergonomic position with arms relaxed and scanner on dominant side of operator.
2. Start scanner and wait 10 seconds for defogging as indicated. While awaiting defogging, assure that teeth are dry. Light saliva is acceptable, but copious, loose, ropy saliva will ruin the scan accuracy.
3. The recommended scanning protocol for a full arch is occlusal, lingual, buccal, incisal edges, and the bite registration.
4. Start on the lower left side terminal molar and slowly advance (slower actually captures the data more rapidly) over occlusal surfaces around to the midline, then start on the lower right molar moving to the midline, assuring that the distal side of each terminal tooth is captured fully. Camera should be parallel to occlusal surfaces at all times.
5. Tilt camera 45 degrees lingually such that the complete lingual surface of the molar plus 2-3 mm of soft tissue below it appears in the display and advance slowly to the midline of the mouth watching as interproximal areas fill in. Do not advance until interproximal areas are complete. As you advance, assure tongue retraction using the camera head as your retractor. Complete lingual surfaces of the right side as you did for the left.
6. Roll camera over to facial surface of lower left molar and establish a 45 degree angle with camera that captures full facial surface of the tooth plus 2-3mm of soft tissue below it. Advance from molar to midline slowly, allowing interproximal fill to occur before moving. Utilize your free hand to retract the cheeks and lip as you advance the scanner tip, capturing the detail free of any movable tissue. Oral tissue outside of gingival tissue and 3mm of loose alveolar fold is not desirable. Complete right side similarly.
7. Finish the arch by “rolling” the camera lens over the anterior teeth from 45 degrees lingual to 45 degrees buccal, making sure to capture canines and laterals. This is a critical step in assuring dimensional and positional accuracy of the scans “stitched” segments.
8. Repeat steps 4 through 7 on the upper arch, paying careful attention to moving slowly and allowing complete interproximal fill in of the scan data. Make sure to complete incisal edge “roll” as on the lower arch to assure dimensional and spatial accuracy.
9. To complete the scan, capture the bite previously examined by having the patient open while you place the scanner wand inside the cheek to use as a retractor. Watch as the patient bites into firm centric occlusion position (while you visually confirm matches your pre-scan observation). Capture 3-4 teeth buccally that correspond to a previously captured area of your scans. Repeat the same sequence on the opposite side of the mouth.

Clinical Case Selection Criteria for VAKT Clear Aligners

We want your patients, you, and your practice to benefit from the technological advances in dentistry and orthodontics! An easy, predictable, and affordable orthodontic experience with VAKT clear aligners promises that!

Because we have designed the VAKT solution as a limited orthodontic solution, it is important for success that you and your team, as well as your patients, understand and are mindful of these important clinical case selection criteria.

The submission of orthodontic records suitable for assessment, diagnosis, planning, and manufacturing of your VAKT clear aligner case is one of the most important steps in your patients orthodontic journey.

Accurate, well constructed records provide (a) a critical pre-treatment record of your patients condition, (b) a digital collage of patient condition for our orthodontists to assess, and plan, your patients care,, and (c) a digital impression for our laboratory use in fabricating your patients custom aligners.

The following are the required minimum clinical records that you must include with any case submission:

• A full arch maxillary and mandibular digital scan of your patients’ dentition, including an accurate scanned bite registration with teeth in maximum intercuspation in centric occlusion. We have attached a best practices document for you and your staff to follow when making and submitting your scans.
• A complete set of 8 (3 extraoral and 5 intraoral) clinical orthodontic images taken as described in the attached criteria document. These photographs must be well focused, exhibit proper lighting, and provide a complete view of all structures necessary for our orthodontic team to assess, and plan the treatment. We have attached a sample diagnostic photo collage for your clinical teams reference.

It is important to remember that you, as the treating clinician, are responsible for determining the suitability of your patient for VAKT clear aligners, or any other form of orthodontic treatment.

What to Look For?

Within your practice you likely already have many patients who desire and would benefit from limited orthodontic treatment. These patients often have common conditions that you and your clinical team see every day. Some of the most frequently seen conditions that are ideal for VAKT clear aligners are:

• Minor orthodontic relapse crowding or spacing due to poor retainer wear
• Up to 3mm of crowding within the anterior teeth
• Up to 4mm of localized or generalized spacing within the anterior teeth
• Midline discrepancies with associated asymmetric crowding or spacing
• Teeth tipped mesially or distally with associated crowding or spacing present
• Mild overjet of up to 3mm when spacing is present in the maxillary arch
• Labiolingual discrepancies between incisors of up to 3mm
• Incisal edge discrepancies between anterior teeth of 1.5-2.0mm with crowding or spacing present
• Mild cases of anterior open bite (up to 2mm) when spacing is present
• Midline diastemas of up to 3mm with excess overjet present
• Anterior crossbites classified as end to end improvements limited to the anterior teeth
• Limited anterior esthetic improvements in mixed dentition patients

What to Avoid

• Cases requiring more total tooth movement than described above
• Deep bites of 3+mm, especially with spacing present
• Crowding greater than 3mm in an arch
• Spacing greater than 4mm per arch
• Open bites greater than 2mm without spacing
• Open bites with significant crowding
• Deep bites over 3mm in association with generalized spacing
• Incisal edge length discrepancies without crowding or space

Disqualifying Criteria for Case Submission

• Posterior tooth movement
• True crossbites, anterior or posterior
• Implants in the tooth movement zone
• Poor or questionably stable restorations, especially full coverage crowns
• Fixed bridges
• Requests for bite changes
• Comprehensive movement plans
• Previously traumatized or ankylosed teeth