Patient Clear Aligner Consent and Compliance Agreement

Our specialized orthodontic team is dedicated to providing exceptional patient care. To ensure your treatment progresses on schedule, it is imperative you understand the procedures involved in your treatment.

1. WEAR TIME: For maximum efficacy, aligners must be worn ~22 hours a day, except to eat, drink, brush, and floss. Drinking or eating with aligners can cause cavities and staining.

2. ATTACHMENTS: Small clear or white attachments and/or buttons may be bonded to some of your teeth—including the front teeth if needed—to move them properly. Attachments are usually placed on the second visit and more may be added as needed later in treatment. Attachments are an essential part of successful aligner treatment for most patients.

3. INTERPROXIMAL REDUCTION (IPR): IPR/Reproximation/Slenderizing is removal of tenths of millimeters (.1 mm to .5 mm) of enamel at dental contact points with a fine file, disk, or bur to slightly reduce the widths of teeth. It is sometimes required to resolve crowding, facilitate tooth movement by reducing interferences, or to allow for other desired changes in a patient’s bite. It is not harmful to teeth and generally is done quickly and painlessly as part of a regular adjustment visit.

4. ELASTICS: Elastics or “rubber bands” worn from the upper aligner to the lower aligner may be prescribed to improve the bite. For optimal results, they must be worn whenever aligners are worn (~22 hours per day) when instructed.

5. ALIGNER CARE: Aligners must always be stored in their case when not being worn to avoid loss. If an aligner is lost, please call our office as soon as possible and we will instruct you how to proceed. It may cost $125 to replace a lost aligner. All aligners should be kept until the end of treatment.

6. APPOINTMENTS: Keep your scheduled appointments. This is the only way we can ensure your treatment is progressing as planned. Always wear your current aligner to your appointment.

7. ALIGNER BATCHES: Aligners will be made and given to you in batches. After the first batch of aligners, additional aligners and refinement treatment (possibly including fixed braces for a short period of time) may be recommended to add detailed touches to your smile and bite.

8. RETENTION: At the end of orthodontic treatment, retainers must be worn as prescribed by your orthodontist to maintain your beautiful new smile. Retention is for life.

I have read and understand the procedures necessary for the success of my clear aligner orthodontic treatment. If I do not agree to or comply with any of the above items, I understand my treatment results may be compromised.