Increase clear aligner compliance, results, and patient trust

Dr. Diane Milberg says that esthetic treatment is improved by patients’ clear aligner compliance. Here’s how she sets expectations.

Dr. Diane Milberg discusses achieving compliance through making the right choices

In the field of esthetic orthodontics, helping patients make educated decisions regarding their treatment is essential. So many patients come through my door with a preconceived notion of what they want when a different esthetic treatment would better suit their clinical needs as well as their lifestyle.

The big push in our practice, plus one of our biggest differentiators, is that we spend significant time communicating with patients in order to understand their goals for treatment while also effectively building trusting relationships with patients. While I can provide a thorough treatment plan for my patient, it’s only beneficial if the patient follows the steps precisely; therefore, compliance is a pivotal part of a treatment plan.

Whether I’m using traditional brackets or clear aligners, I’m here to help patients achieve their goals and provide expertise to ensure they end up with the smile they want and need.

Uncovering the lifestyle

Discussing a patient’s lifestyle early in the process helps us determine together what treatment plan would be the best fit. We also work jointly to create a wish list of how they would like to look during treatment and afterward.

Generally, I have a list of questions that I walk through with the patient to determine the best course of action, including:

  • What would you like to change?
  • Have you had orthodontic treatment before? If so, how did that process go for you?
  • Are you willing to wear rubber bands or have teeth extracted if needed?
  • What is the time frame you would like to be finished with treatment?
  • What do you do for work?

Discussing what a patient does for work may not seem like the most important question for orthodontists and patients during this initial intake meeting. However, it’s quite important when it comes to compliance. Many of my patients, both adults and adolescents, are in the media or spend time in front of a camera and would prefer the most discreet treatment option possible. Factoring in this lifestyle component can help us decide what makes the most sense for treatment without interfering in patients’ day-to-day lives and, in turn, ensure that they’re more likely to follow the treatment plan more closely.

Flexibility is a key need for many of my patients during their treatment. Obviously, that flexibility needs to fit within the confines of the treatment itself, but knowing these potential lifestyle or work-related needs can help determine specific next steps.

Throughout the entire duration of the treatment, I work with my patients to better understand what curveballs may emerge and impact the plan. For example, if a patient has a professional conference coming up, I will stress the importance of wearing aligners to bed and will recommend we hold off on changing them before the event for maximum comfort. This flexibility to meld to the patient’s routine makes clear aligners a popular esthetic choice in my practice.

Setting expectations; explaining limitations

Are you looking for “better” or “perfect?” While I always want to strive for perfect, sometimes that isn’t always possible for a patient if compliance is a challenge. By asking this question up front, I’ve found that we can effectively discuss patients’ potential challenges with aligner compliance, and even determine if the level of incompliance means they are better suited for a different esthetic treatment. Explaining that clear aligners have limitations and setting a level of expectations of the results is a crucial conversation that I have up front with all patients that request clear aligners — and really any treatment option in general.

Several years ago a patient came to our office for a second opinion, concerned that his teeth were not perfectly straight after using aligners from another orthodontist. After listening to him and explaining the limitations of aligners, I asked him to return to the other orthodontist to discuss his concerns. When I spoke with the other orthodontist to tell him about his patient’s visit and his concerns, the orthodontist mentioned that he had not reviewed the limitations of aligners with his patient and would review refinements and other treatment options with him.

This example is just one reason why explaining a treatment in full detail is essential to a patient’s success and satisfaction. By skipping this step, orthodontists put themselves and their patient at a disadvantage.

Beyond compliance, it is important for an orthodontist to discuss timing in detail with patients and explain that if additional refinements are needed along the way, treatment can take longer than anticipated. While that’s not an ideal situation, it can happen, and it can be a letdown for patients who are anxiously waiting for their “perfect smile.”

During our initial conversation, I aim to be transparent with timing expectations and stress the importance of compliance as incompliance can result in the need for refinements. For example, when I tell patients that it is very important to wear aligners 22 hours a day, this means 22 hours a day.

Understanding the unpredictability

Like many orthodontists, I’m a bit of a control freak; I want each step and mechanism to work exactly as I planned. I initially waited a few years before integrating aligners into my practice because I wanted to ensure that whatever products I implemented produced the best possible results. By ensuring the products I used were going to help me transform smiles and help patients achieve the best-looking result possible and thoroughly communicating with patients throughout their entire treatment, I’ve been able to set up a solid base for my patients and treatment plans.

My clear aligner system of choice is 3M™ Clarity™ Aligners as they are more optically clear than other products I’ve seen, and the attachments are more esthetic in shape and size while being easier to place. When patients are already concerned with appearance during treatment, it’s essential that the products you use get the job done while matching their esthetic needs and expectations.

Results are paramount

Esthetic orthodontic solutions are a wonderful option we can offer our patients. Through these solutions, we’re able to provide them the freedom to look how they want and maintain their confidence and appearance during treatment. However, communicating with patients and setting expectations to ensure compliance are essential. By choosing products that work best for my patients’ needs and establishing a meaningful dialogue, I’m able to give them the smile they’ve wanted their whole life — that opportunity is an absolute privilege.

I encourage all orthodontists to review how they communicate with their patients and incorporate real changes to set expectations and ensure compliance throughout patients’ entire treatment. Through this communication, you will be able to ensure esthetic and effective treatment plans more easily for all patients.

Dr. Adam Schulhof uses combination treatment for more predictable treatment when clear aligner compliance is involved. Read more about it:

Diane Milberg, DDS, MSD, is an orthodontist at Milberg Orthodontics located in San Diego, California. Dr. Milberg received her undergraduate degree from the University of California at Los Angeles, her Doctorate of Dental Surgery at the University of California at Los Angeles School of Dentistry, and her Master’s degree at the University of Washington, Seattle. Dr. Milberg is a proud member of the Edward H. Angle Society of Orthodontists and is a Diplomate of the American Board of Orthodontics.


Disclosure: Dr. Diane Milberg is a key opinion leader for 3M™.

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