Part 1 — equipment and consumables list
- Scanners
- 3D Printers
- Lab equipment
- Aligner Sheets
Part 2 — eXceed aligners order
- Clinical indications
- Clinical preferences
- Diagnostic records
- Impression taking
- 3D model quality requirements
- Treatment plan
- review/approve aligners plan
- case info
- Product types
- IPR
- Attachments
- Power Ridges
Part 3 — in-office aligners production
Model printing
Aligners manufacturing
Part 4 — Chair-side
Performing IPR
Placing attachments
Part 5 — Refinements
5.1 – Submitting refinements
Introduction
eXceed Aligners is an orthodontic treatment module utilizing a sequence of transparent, removable splints to treat the malocclusion. The eXceed software is used to simulate the final result of the treatment, allowing to calculate the estimated number of aligners necessary. The program also serves as a 3D communication tool between the clinician and eXceed, helping to facilitate an effective and efficient discussion concerning treatment planning.
eXceed Aligners must be worn for 20-22 hours/day and removed only for eating and brushing. The aligners have a minimal impact on speech and diction. This method can be used in combination with or as part of other orthodontic therapies, including removable and/or fixed appliances (brackets).
Process
Aligner Sheets
The items below have been identified and tested by eXceed but the list is by no means conclusive, other foils may be suitable for the tasks involved. Please contact eXceed support desk for more information.
| Name | Type | Maker |
| Biolon | Aligner/matrix/retainer sheet | Dreve |
| Duran+ 0.75 mm | Aligner sheet | Scheu Dental |
| Duran+ 0.50 mm | Matrix sheet | Scheu Dental |
| Duran+ 1.00 mm | Retainer sheet | Scheu Dental |
| Track A 0.80 mm | Aligner sheet | Forestadent |
| Track A 0.50 mm | Matrix sheet | Forestadent |
| Zendura 0.76mm X 125mm | Aligner sheet | Bay Materials |
Diagnostic records
To be able to provide a high-quality and realistic aligner plan, all necessary records must be uploaded as part of My eXceed aligner order submission. Such records include at least the following:
- 1 X 3D model in an STL format, acquired through and intra-oral scan or scanning physical impressions or models.
Prior to obtaining impressions or 3D models, it is critical to perform the following; 1) prevention and removal of plaque; 2) verification of proper brushing and dental hygiene habits; 3) elimination of caries; 4) prosthetics; 5) elimination of gingivitis; 6) removal of wisdom teeth.
In extraction cases, impressions must be taken no earlier than 4 weeks following extraction due to potential occlusion changes. In case attachments are to be fitted, impressions must be taken after the fitting appointment.
- 1 X facial and 3 X intra-oral images OR 1 X composite image
- 1 X panoramic X-ray image.
If possible, it is highly recommended (but not obligatory) to upload additional facial/intra-oral images and a cephalometric X-ray image. Below is an example of a full records set after uploading to the eXceed order:
3D model quality
Scans must be in STL file format only.
Both arches, upper and lower, to be saved as a separate file using the following naming convention X_upper.STL and X_lower.STL (X=eXceed order ID).
Both arches must be scanned and positioned in occlusion. Not less than 80,000 triangles per single arch.
Both arches should be submitted, even if service requested is for one arch only. Visible border between soft and hard tissues.
No scratches on tooth vestibular surface. Avoid any scan errors (see examples below)
All teeth must have complete surfaces
Avoid large voids on model surface
Treatment Plan
Together with the diagnostic records, a detailed treatment plan is necessary to provide the eXceed team with instructions on case objectives. The information provided will be combined with the clinical preferences prescribed in the “Profile” section to create a clinically viable plan that conforms with your orthodontic preferences.
Review and approve an Aligners plan
Once ready, you will be prompted to review via My eXceed Page:
Case information
A summary of all case information can be obtained by clicking the “Additional data” button (see above)
Product types
eXceed Aligners fall into two categories – Express and Full.
A. Express – up and including 20 aligners. Treatment typically lasts about 2-6 months. Treatments can range from minor displacements of individual teeth to relapses, small size diastemas, minor rotations or crowding.
B. Full – from 21 aligners and up. treatment lasts about 7-20 months including pronounced crowding, larger diastemas and other dental anomalies.
IPR (interproximal reduction)
IPR is a clinical method whereby the mesiodistal diameter of one or a few teeth is reduced in a controlled fashion by removing precise amounts of tooth enamel. IPR represents an alternative to extraction or expansion in cases where creating additional space is necessary for treating the malocclusion.
When needed, the eXceed Aligners plan indicates the amount of IPR required for each tooth, as well as the step when the IPR has to be performed.
- IPR must be performed after teeth alignment, to prevent damage to the vestibular tooth surface.
- It is recommended to use progressive IPR (0.2 mm in each area of contact at a follow-up visit).
- The IPR in each diameter is limited to 0.75 mm in the upper arch and 0.5 mm on the lower.
- Total IPR is limited to 1.0 mm every 3 weeks.
- After each procedure, use soothing materials to reduce sensitivity.
- For effective IPR, it is recommended to assess the shape and size of the tooth in question. Basic tooth shape can be divided into three types: S — square, O – oval and T-triangular.
Tooth categorization depends on the form: square teeth have a square shape and a relatively large contact surface, closer to the gingival edge. Triangular teeth are triangular in shape and characterized by a smaller contact area near the cutting edge. Oval teeth are oval in shape and possess intermediate characteristics.
The table below provides average anatomical dimensions in the context of IPR:
| Tooth |
Mesio-distal crown diameter | Anterior wall thickness | Mesio-distal width | Distal wall thickness |
| Upper arch | ||||
| Central incisor | 9.0 mm | 2.0 mm | 5.0 mm | 2.0 mm |
| Lateral incisor | 6.4 mm | 1.4 mm | 3.6 mm | 1.4 mm |
| Canine | 9.5 mm | 3.0 mm | 4.0 mm | 2.5 mm |
| 1st pre-molar | 7.0 mm | 2.0 mm | 3.0 mm | 2.0 mm |
| 2nd pre-molar | 6.8 mm | 1.8 mm | 3.2 mm | 1.8 mm |
| 1st molar | 10.3 mm | 2.5 mm | 5.3 mm | 2.5 mm |
| 2nd molar | 9.2 mm | 2.2 mm | 5.0 mm | 2.0 mm |
| Lower arch | ||||
| Central incisor | 5.4 mm | 1.2 mm | 3.0 mm | 1.2 mm |
| Lateral incisor | 5.9 mm | 1.3 mm | 3.4 mm | 1.2 mm |
| Canine | 6.9 mm | 1.5 mm | 3.9 mm | 1.5 mm |
| 1st pre-molar | 7.0 mm | 1.5 mm | 3.9 mm | 1.5 mm |
| 2nd pre-molar | 7.3 mm | 1.8 mm | 3.7 mm | 1.8 mm |
| 1st molar | 11.2 mm | 3.0 mm | 5.5 mm | 2.7 mm |
| 2nd molar | 10.7 mm | 2.8 mm | 5.3 mm | 2.6 mm |
Attachment types
Power Ridges
Power ridges are added to the anterior teeth as another way to improve inclination or “in and out” tipping. On the aligner, they appear at the gum line on the outside. Power ridges are used on an “as needed” basis in the aligners plan and do not require any special instructions provided by the treating clinician.
3. In-office aligners Fabrication
Model Printing
Shortly after the approval of the 3D plan, eXceed will make available, via FTP, print files, covering all treatment stages for the upper and lower arch. The said files have to be printed using a 3D printer to create the working models for the respective aligners. Since each aligner is worn for 2 weeks. We recommend printing 4 sets (8 arches) in every cycle.
With Supports
Without Supports
| Add the print files to the 3D printer (in this guide, the Form2 from Form Labs). It is possible to print up to 8 exceed arches at a 100-micron resolution | |
| Use standard black resin 1L (GPBK02). | |
| Printing cycle takes approx. 9 hours. | |
| Working model is ready. |
Aligners manufacturing
Once models have printed, the next step is to produce the corresponding
aligners.
| Use lab cutters to remove the support structure from the working model | |
| Working model after all support structure has been removed | |
| Heat up the prescribed foil in the vacuum forming unit and place the model on the pad. When the temperature is right, swing the heater on top of the model to begin vacuum forming | |
| Open the unit to remove the vacuum formed model | |
| Separate the aligner from the working model | |
| Trim the gingival side using a trimmer and remove excess material. | |
| If the wisdom teeth are present, please trim as shown | |
| Following trimming, use a polisher to ensure all gingival surfaces are smooth as possible. This is critical for patient comfort. | |
| To improve support and fit, it is sometimes recommended to leave more gingival margin | |
| Examples of good and bad trimming are shown | |
| Thoroughly rinse and clean the aligner in warm water mixed with antiseptic liquid, using a toothbrush. | |
| Seat the aligner back on the working model and ensure fit. The aligner is now ready to be placed intra-orally (note anterior section attachments) |
Placing attachments
As indicated previously, some treatment stages may require the use of attachments on the aligners, fabricated from any light-curing adhesive. Use the matrix (aligner # 0) as a guide for placing the attachments
Apply a generous amount of composite material to the attachment.
The amount applied should be slightly above what’s necessary to fill the attachment void, to exclude incomplete contact with the tooth. The tooth surface should be prepared according to instructions for the filling material.
Recommended materials for attachments:
1. Adhesive system Adper Single Bond 2 (3M).
2. Dental composite Filtek 250 or z550
5. Case Refinement
5.1 Submitting refinements
If the treatment is not progressing in line with the approved plan, a refinement order may be submitted.
In “My eXceed”, go to the existing “eXceed Aligners” order:
Upload a new set of images (4 photos minimum) prior to removing the attachments; A new panoramic X-ray at this point is not mandatory:
After removing the attachments upload new STL files for both arches or send iTero/Trios new scan ID;
Still within the current order, submit a “Refinement” order and describe the objective of the refinement.
If the order which requires the refinement prescribes a significantly different number of upper and lower aligners (for example 5 lower and 15 upper aligners) we recommend wearing the last upper aligner until the treatment for the lower is refined and only after the clinician submitted the refinement order.
ATTENTION!!! Relapses are not covered by the refinement protocol.
