Dr Andy Toy FCGDent, a general dental practitioner and educator with a special interest in occlusion, highlights the fundamental link between occlusion and the long-term stability of aligner therapy.

Simply aligning a few anterior teeth can significantly alter a patient’s occlusion. Whilst many patients seem to cope with their ‘new bite’, there are others who suffer from TMD, chronic pain or mobile teeth because of their aligner therapy. There are also patients presenting with challenging occlusal problems that could be resolved with the right type of aligner orthodontics. Every aligner case requires the dentist to understand how to diagnose, plan and finish their patients with a healthy functional occlusion.
I will be delivering a half-day lecture at the Perio-Occlusion Symposium on Saturday 20 September, to address issues like these. My presentation will provide a clear and simple approach to occlusion and clear aligner therapy based on over 40 years of learning and teaching. My aim is to help you:
- Differentiate between easy and challenging aligner cases
- Assess the patient’s TM Joint and occlusion and create a treatment plan to deliver a healthy, functional bite
- Know how to finish and retain your aligner cases
Why is Cassie easier to treat than Jim?


If Cassie and Jim walked into your practice, in my experience most novice orthodontists would steer clear of Cassie and see Jim as an easy win. Jim has mild crowding with some wear that’s crying out for your best bonding technique. What a great Align-Bleach-Bond case! Ker-ching!! Cassie has more crowding and, even worse, an anterior open bite? What a nightmare!
In fact, once you do a thorough assessment of TMJ function and occlusion, combined with discovering the patient’s wishes, you would find that Cassie is much easier to treat than Jim.
Why is this? Jim has an edge-to-edge occlusion on a class III base – these cases are often much more difficult than they first appear. The challenge is creating enough overjet to give you space for your bonding and create a healthy envelope of function. You will need to: a) create lots of space in the lower arch with inter-proximal reduction; and b) control the anchorage to maximise the lower anterior retraction.




Cassie simply wants to align her teeth and isn’t bothered by her anterior open bite. Comprehensive assessment of her TMJ and functional occlusion indicates that her bite is healthy. She just needs some levelling and aligning. Simple!





Correct biomechanics ensures successful aligner therapy
Jeff is another class III case. I used Invisalign Go™ (that is moving 5-5 only and up to 25 aligners) combined with class III elastics to support anchorage and we finished with a great looking result and healthy occlusion. In fact, Jeff is easier to treat than Jim. Can you see why? It’s all down to how you assess a cross-bite. Once you know how, it’s much easier to choose your winners and avoid creating an occlusal cripple.





Aligner therapy can eliminate occlusal dysfunction
Brenda is not too concerned about her appearance, but she is very worried about the pain she is experiencing and the possibility of losing her teeth. She’s also in her 70s and not overly keen on dental treatment.
Brenda has multiple crossbites, tilted teeth and missing molars. Where do you start? My approach is: thorough assessment and diagnosis of her TMJ function and dynamic occlusion; careful planning of her Invisalign Comprehensive™ treatment; and a patient-centred consent process. That way Brenda knows what the problem is, how we may treat it and what benefits and risks she may encounter as a result. This gives Brenda the confidence to go ahead with the plan and enjoy a healthy, comfortable bite for the rest of her life. Come along to the Symposium and I’ll show you how I used aligner biomechanics on Brenda’s case so that you can apply them on your own patients.







If you are able to attend the symposium, you’ll be better placed to avoid cases that are beyond your experience level; feel confident that the cases you do treat will have a healthy, functional bite; and sleep better at night. You can find out more and book your place here.
Read our blog on Pink Aesthetics to find out more about the topics included in the morning lecture, delivered by Dr Reena Wadia.