Updating the CA Clear Aligner Therapy
Pablo Echarri, D.D.S. – Director of the Master in Orthodontics and Dentofacial Orthopedics of Athenea Dental Institute, San Jorge University, Spain, President of the Iberoamerican Association of Orthodontists, Chairman of the congress of the World Society of Lingual Orthodontics
Javier Echarri, D.D.S. – Student of the Master in Orthodontics and Dentofacial Orthopedics of Athenea Dental Institute, San Jotge University, Spain
In this article the author explain the particular characteristics that makes the CA Clear Aligner system different that the others as well as the special tools that allow the clinicians to reduce the treatment time and increase the effectiveness of the therapy.
Keywords: CA Clear Aligner, Screws, Pliers, Power grip
Actually CA Clear Aligner through CA Digital offer a complete solution for the doctors that want to digitalize their offices. In fact from one scan (directly from the patient with an intraoral scanner or scanning the plaster models), the CA Digital software can offer:
• digital or printed study models
• digital storage of the models
• diagnosis including study and radiographic analysis
• set-up models and correction of the set-up models
• Aligners therapy (CA Clear Aligner)
• Indirect labial or lingual bonding (Individua)
• CAD-CAM Retainers (Memotain)
In this article the author will focus only in the CA Clear Aligner Therapy characteristics due to the extension of this paper.
Characteristics of the CA Clear Aligner Therapy
1- CA Clear Aligner prepare 1 to 3 steps from one digital or traditional impression
As we don’t manufactures all the aligners from the first impression, we can:
• Make the control of the treatment periodically and not only at the end of the treatment. This characteristic allow us to reduce the treatment time and avoid the final refinements of the cases. The system is a continuous control of the evolution of the case called PTMA (Plan – Treat – Monitor – Active) that means that we active the treatment according to the evolution of the case. Also we can adapt the treatment to the possible relapse due to the fault of use of the aligners, adapt to the changes in the mouth during the mixed dentition and to the stripping changes.
2- We use three different thickness of aligners
One step includes 3 aligners adapted to the same set-up but with different thickness (soft, medium and hard) that activates the treatment every week. As we change the aligners every 5 to 7 seven days according to the individual evolution, we maintain a good range of dental movement.
3- CA Clear Aligners cover 2mm of the gingival tissues.
In 2013, in the University of Nevada, they published that the aligners with no attachment and scallop margins has
significant less retention. Less retention means less anchorage
and less effectiveness in the dental movements. Covering 2mm of the gingival tissues we increase the aligners’ retention without the use of attachments. On the other side, the Clinical Center of Munich demonstrated that the extension of the aligners get less inclination in the dental movements because the force application is near of the dental center of rotation. In this way we get a better effectiveness of the movement but as the changes in the soft tissues are not so predictable we can not prepare all the aligners from the first impression.
4- We use a lot of tools or aids in the CA Clear Aligner Therapy to reduce the
treatment time and increase the efficiency of the appliances.
a- CA Vector Screws for transversal
expansion (anterior (CA Vector 40), posterior (CA Vector 50) or lateral-oblique (CA Vector 30)), Screws for distalization (CA Distalizer Kit), to close spaces (CA Tractive Screw) and for individual
movements (Piston Screws).
b- CA Tip Pliers. We have 4 cold pliers to activate the aligners (1- to increase the retention, 2- for activation points, 3- for inclination activation,
4- for torque activation).
c- CA Power Grip. We have 9 different shapes to increase the effectiveness of the treatment (1- for forced extrusion and forced ; 2 and 3 for
mesio-distal angulation; 4 and 5 for torque
control; 6 and 7 for posterior build-ups and 8 and 9 for anterior build-ups),
d- plastic buttons as anchorage for elastics
To complete de system we have another tools like stripping kits, etc.
In the pictures 1 to 5 we can observe a case with good occlusion of the posterior teeth but with crowding and rotation of the anterior teeth. The case was treated in 6 steps/months of treatment with stripping.
In the pictures 6 to 8 we can observe the CA Clear Aligner covering 2mm of the soft tissues and in the pictures 9-13 the stripping performed with the Progressive Stripping Technique.
In the following pictures we can observe the
evolution of the case step by step:
• pictures 14 to 18, Progress 1
• pictures 19 to 23, Progress 2
• pictures 24 to 28, Progress 3
• pictures 29 to 33, Progress 4
• pictures 34 to 38, Progress 5
The final pictures can be observed in the pictures 39 to 43 and the fixed retention in the pictures 44 to 48.
The CA Clear Aligner is a complete system that includes
individual characteristics that makes the difference with other systems. The system also includes special tools, like screws,
pliers, plastic buttons and power grip that helps in the
reduction of the treatment time and the effectiveness of
1. Echarri P. Clear Aligner. 1ª Edición. Madrid (España): Ripano Médica; 2012 (español, inglés, alemán, chino)
2. Echarri P. Tratamiento con Clear Aligner. 10 años de experiencia. En: Libro de ExpoOrtho 2009, Madrid (España): Ripano Médica; 2009. pp. 29-40.
3. Echarri P. CA Clear Aligner. Puesta al día. En: Padrós Serrat E. Manual de ortodoncia plástica. Madrid (España): Ripano Médica 2013. pp. 93-106.
4. Echarri P. Clear Aligner Advanced. Ladent S.L. Barcelona España 2016 (español, inglés, aleman, chino, coreano).
5. Kim TW, Echarri P. Posibilidades terapéuticas del Clear Aligner. Korean J Clin Orthod 2004;10:54-65. (publicado en coreano)
6. Kim TW, Echarri P. Tratamiento de la mordida profunda anterior con Clear Aligner. Ortod Clin 2005; 8(1): 34-43.
7. Kim TW, Echarri P. Clear Aligner como parte de otros tratamientos de ortodoncia. Gerencia Dental 2007;14:46-50.
8. Kim TW, Echarri P. Clear Aligner: An efficient, esthetic, and comfortable option for an adult patient. World J Orthod 2007;8:13-18.
9. Echarri P, Pedernera M. Clear Aligner, tratamiento de la recidiva en ortodoncia. Cúspide 2012;15(25):30-2.
10. Echarri P. Posibilidades terapéutica del CA Clear Aligner. Dental Tribune 2013;8(3):3-9
11. Echarri P, Pedernera M. El protocolo clínico CA Clear Aligner y por qué es así. Dental Tribune 2013;8(3):10-1
12. Wysokinska-Miszczuk J, Kwiatkowska M, Michalak I, Michalak M, Kwiatkowski M, Paulo M, Echarri P. Clear Aligner – estetyczne rozwiązanie problemów ortodontycznzch u dorosłych. Magazyin Stomatologiczny 2013;23(10):74-9.
13. Echarri P. CA Clear Aligner therapeutic possibilities. Dental News Magazine 2014;21(2):48-58.
14. Echarri P. Indicações terapéuticas do CA Clear Aligner. O J Dentistry, febrero 2015;2(15):28-32.
15. Echarri P, Pedernera M. CA Clear Aligner clinical protocol and why it is as it is. Dental News Magazine, September 2015;26-36.