Expanding the possibilities: Using suresmile® aligner design therapy to enhance patient care

Dr. J. Peter Kierl discusses how his practice incorporates aligner therapy

As suresmile® users since 2005 with over 4,000 finished suresmile cases, we first incorporated suresmile elemetrix aligner therapy into our practice in 2013. We are a multi-doctor practice since 2011, with three locations. My co-practitioners are Dr. Philip Kierl and Dr. Heather Kierl.

Getting real in today’s market

In case you haven’t noticed, aligners are a reality in today’s orthodontic (and general dental) market. In our practice, we sought to determine what aligners can do well, and how we can feel comfortable in delivering quality care that our patients should expect from a specialist. As with any practice, we also keep an eye on cost management and achieving cost-effectiveness with aligner care.

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Just to give you an idea of the road we’ve traveled, in 2013, aligners made up exactly 0% of our cases; today, some aligner therapy is used in about 25% of them. The cost factor is just not there with suresmile, which is why we are not afraid of multiple scans. Most patients will accept a short period of time of fixed appliance therapy. Think what is achievable, and what will limit your time in treatment. Patients will say “yes” if you explain treatment times and therapeutics to them. If it makes sense, they will accept the case plan.

Simplicity is our approach

In this context, we determined that our fundamental goal was to limit patient time in fixed appliances. We introduced a hybrid approach when appropriate to our case planning, usually treating with fixed appliances for a short period of time (approximately 3 months).

Our aligner practice is based on finishing cases in aligners, using aligners prior to fixed appliance therapy and, when appropriate, using aligners as the sole tooth-moving appliance. We also try to limit the number of attachments we need for each case.

To summarize, here are our principle applications of this versatile appliance:

  • Phase 1 treatment with aligners
  • As active retention appliances
  • In combination with the use of attachments


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Combination or hybrid therapy

When clinically appropriate, we use fixed appliances for approximately 3 months for one or both arches. In our experience, fixed appliances are best used in cases with large rotations or those cases requiring extrusion/intrusion of the anterior teeth. We have found that teeth respond well to aligner therapy after fixed appliances due to the activation of cellular activity in the tooth-moving process. This patient population resides in your practice and gives you an effective clinical approach to meeting the demand for aligner therapy while maintaining your commitment to high quality treatment.


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Active retention by design

When our cases are near finishing, we scan prior to the deband. We add tooth movements to the model, if necessary, and retention aligners are prepared and ready at the deband appointment.

Case 1 statistics (Figures 1-10)

  • 6 months’ treatment time
  • 10 weeks in fixed appliances
  • 10 total visits

Case 2 statistics (Figures 11-25)

  • 2 scans
  • 28 aligners
  • 7 months’ treatment time
  • 11 total visits


Figure 10

This article was provided by suresmile® and previously published in suresmile IN PRACTICE, Issue 4, Summer 2017.


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J. Peter Kierl, DDS, MS, graduated from the University of Oklahoma College of Dentistry, completed his orthodontic residency at the University of Iowa, and received his master’s degree in Orthodontic Sciences. He has been in private practice for more than 33 years in Edmond, Oklahoma. Dr. Kierl has been a clinical professor in the Graduate Clinic in the Department of Orthodontics at the University of Oklahoma College of Dentistry since 1982. He achieved his certification with the American Board of Orthodontics in 1993. Dr. Kierl has been a 100% suresmile® practice since July 2006. He has completed more than 3,000 suresmile cases and more than 250 lingual cases using the suresmile system.

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