The most important decision in any aligner case is made before the first scan: is this a case you should treat?

Clear aligners can handle a wide range of problems, but not every case suits every clinician or every system. Choosing well protects your patients, your schedule and your reputation. Choosing poorly leads to refinements, delays and frustration.

This guide gives general dentists a simple way to sort cases into three groups, a checklist to run before you start, and clear signs that a case should be referred.

Case selection depends on three things

No list of treatable cases replaces your own judgment. Every decision combines:

1. The case itself: the type and size of the problem, and whether it is dental or skeletal.
2. Your experience: what you have treated successfully and how comfortable you are with complex movements.
3. The patient: oral health, expectations and willingness to wear aligners as directed.

The guide below is a general starting point. Always follow your training, your aligner system’s guidance and your local rules.

The three-group guide

Green: good cases to start with

These are usually the most predictable cases, and they are a good place to build experience:

• Mild to moderate crowding
• Mild spacing, including closing a small gap between teeth
• Minor relapse after previous orthodontic treatment
• Minor rotations and tipping
• Alignment before restorative work, such as veneers or crowns

Yellow: possible, with experience and a careful plan

These cases often work well but need more planning, tighter monitoring and sometimes extra steps:

• Deep bite or increased overbite that needs correction
• Mild open bite
• Mild to moderate Class II or Class III relationships treated with elastics or other aids
• Posterior crossbite that is dental
• Larger rotations, especially of canines and premolars
• Cases with planned extractions
• Cases needing significant IPR or attachments in difficult positions

For yellow cases, consider asking for a second review of the setup before you approve it. Our guide to aligner QC service explains what that review covers.

Red: refer or co-manage with an orthodontist

These cases usually go beyond a general practice workflow:

• Significant skeletal discrepancies
• Cases that may need orthognathic surgery
• Severe crowding or severe spacing
• Impacted teeth that need surgical exposure and guidance
• Active periodontal disease or unstable gums
• Significant TMJ problems
• Complex mixed dentition cases
• Cases where you are unsure of the diagnosis

Referral is not a failure. It is part of good care, and many dentists co-manage these cases with a specialist.

A quick decision table

Question	If yes	If no
Is the problem mainly dental, not skeletal?	Continue	Consider referral
Is the case mild to moderate in size?	Continue	Refer or seek specialist advice
Is the periodontal and caries status healthy and stable?	Continue	Treat first, then reassess
Have I treated a similar case before?	Start planning	Take extra care, or ask for a plan review
Does the patient understand the wear time and visits needed?	Continue	Discuss expectations before you begin
Does the patient accept the likely result and timeline?	Proceed	Pause and talk again

Your pre-treatment checklist

Before you agree to treat any case, make sure you have:

1. Full records: photographs, radiographs and a clean intraoral scan or impressions.
2. A clear diagnosis: dental and skeletal relationships, space analysis and risk areas.
3. Healthy tissues: gums and teeth treated and stable before movement starts.
4. Realistic goals: written treatment goals agreed with the patient.
5. Consent: a clear explanation of what aligners can and cannot do, including possible refinements.
6. A retention plan: discussed from the beginning, not at the end.

Mistakes that cause problems

• Taking a complex case too early because the first few were easy.
• Skipping the diagnosis and relying on the software to show what is possible.
• Overpromising results or timelines to win the case.
• Ignoring patient habits such as poor wear time, grinding or nail biting.
• Starting with unstable gum health and hoping it will settle during treatment.
• Approving a setup without a careful review. Our checklist of 7 signs a case needs a second look helps you check before you approve.

How planning support can help

You stay in charge of diagnosis and the decision to treat. A planning partner can help with the digital side, such as building the setup, reviewing staging and checking attachments and IPR. If you are deciding whether to plan cases yourself or send them out, read our guide on outsourcing clear aligner design.

To see how we describe the types of cases we support, visit our Treatable Cases page. Add your own details here about whether you offer a case feasibility review, so readers know what is available.

Frequently asked questions

Can general dentists treat aligner cases? Many do, especially mild to moderate cases, when they have training and use a sound diagnosis. Complex cases are often best shared with or referred to an orthodontist.

What is the easiest case to start with? Mild crowding or spacing with healthy gums and a motivated patient is a common starting point.

Can aligners fix a deep bite or open bite? Often in mild to moderate cases, with careful planning. These need more experience and close monitoring.

When should I refer a case? Refer when the problem is skeletal, severe, surgical, outside your training or when you are unsure of the diagnosis.

Can I ask for help before I start? Yes. A second opinion on the case or the setup before you commit saves time and avoids problems later.

Start your next case with confidence

Have a case you are unsure about? Visit our Treatable Cases page, explore our services, or contact OrthoAlign Solution to talk it through.