Case Selection: When to Refer Instead of Treating with Aligners

Clear aligners can treat a wide range of malocclusions, but good outcomes start with good case selection. For general dentists building an aligner practice, knowing which cases to treat, which to treat with support and which to refer protects both patients and your reputation.

• Mild to moderate crowding or spacing
• Relapse after previous orthodontic treatment
• Mild dental crossbites
• Mild deep bite or overjet with good skeletal relationships
• Pre-restorative alignment with limited movements

• Moderate Class II or Class III dental relationships needing distalization or elastics
• Anterior open bite with a dental rather than skeletal cause
• Significant rotations of canines or premolars
• Patients with stable, treated periodontal disease
• Cases requiring substantial extrusion or root movement

For yellow cases, request a pre-submission consultation, plan for refinements and set expectations with the patient about duration.

• Significant skeletal discrepancies where facial appearance is a concern or surgery may be indicated
• Impacted canines or other teeth requiring surgical exposure
• Extraction cases requiring large bodily movements for space closure
• Severe vertical problems such as skeletal open bite
• Active, uncontrolled periodontal disease
• Significant untreated TMD symptoms
• Growing children with complex skeletal problems

A technically suitable case can still fail if the patient can't commit to 20 to 22 hours of daily wear, attend check-ins or wear elastics. Discuss compliance honestly and document it.

• Full clinical exam including periodontal charting
• Radiographs appropriate to the case
• Digital scan and bite registration
• Extraoral and intraoral photographs

Referring a complex case isn't a failure — it's a decision patients remember positively. Building relationships with local orthodontists and oral surgeons also creates referral paths in both directions.

Infinity Aligner certified providers can request a case review from our clinical planning team before committing to treatment.