Clear aligner therapy procedures and protocols of orthodontists in New Zealand

Abstract Objective To survey clear aligner therapy (CAT) procedures and protocols of orthodontists in New Zealand. Methods One hundred and ten full members of the New Zealand Association of Orthodontists were invited to complete an e-survey. The questions related to respondent demographics, aligner choice and use, CAT planning and treatment protocols, case selection, patient-reported CAT problems and relevant respondent opinions. The reasons for respondents not providing CAT were also surveyed. Results The response rate was 70%. Most respondents (88.3%; N = 68) reported that they used CAT as a treatment modality with 43.15% (N = 29) treating between 1 and 20 patients per year. The predominant CAT system was the Invisalign appliance (70.3%; N = 45) with 49.2% (N = 32) stating that they used more than one CAT system. The respondents reported the areas which were always or mostly in need of amendment prior to acceptance of the CAT treatment plan were attachments (75.6%; N = 50) and final tooth positions (62.1%; N = 41). A median of 0% (IQR: 0, 1) of initial digital treatment plans were approved without changes according to the respondents with a median of 90% (IQR: 80, 99) of CAT patients requiring an additional aligner phase. Almost 80% (78.1%; N = 50) indicated that they were not comfortable in treating cases with increased overbite and 66.7% (N = 44) rarely or never carried out premolar extractions when using CAT. A remote monitoring system was mostly or always used by 32.4% (N = 21) of respondents in conjunction with CAT. Concern regarding patient compliance with CAT protocols was expressed by 43.5% (N = 22). That fixed appliances provided better treatment outcomes was a moderate or major influence on the decision of all respondents (N = 8) who did not provide CAT. Conclusion Although CAT provision by orthodontists is commonplace among orthodontists in New Zealand, there is wide variation in its usage and procedures.