· 9 min
When you approve an Invisalign treatment, what you sign is a digital file called ClinCheck. The aligners come afterwards and are manufactured from it. That file holds every movement of every tooth, in order, decided before the first aligner exists. That is why the quality of the ClinCheck defines the quality of the treatment. I am Dr. Camila Sampaio, an Invisalign Diamond Provider continuously since 2021 and Clinical Assistant Professor at the Apa Esthetics Advanced Clinical Fellowship, NYU College of Dentistry, and I want to walk you through what is inside that plan and what you should look at before approving it.
ClinCheck is Align Technology's 3D planning platform, available only to certified Invisalign providers. It starts from the intraoral scan of your mouth, rebuilds a complete three-dimensional version of your current dentition and lets each tooth be moved in simulation, showing how the movement of one affects the others. The output is a sequence of intermediate positions, one per aligner, that carries the teeth from where they are today to the final position.
When you approve a ClinCheck you are approving three things at once. The final position of your teeth: how your smile and your bite will end up. The path to get there: what moves first, what moves later, how many stages there are. And the resources that path needs: attachments, interproximal reduction, elastics where indicated. The video you see on screen is the visible part. The decisions holding it up are the part that matters.
Everything begins with the scan. In our workflow we use iTero 5D, and the precision of that scan sets the precision of the model on which everything else is built. A scan with poorly captured areas, saliva or gum tissue distorted by pressure produces a model that already carries error before a single tooth is moved. If you want to understand how the capture works, we explain it in what an intraoral scanner is.
The iTero 5D adds two things I use in the same session: near-infrared transillumination for caries detection, relevant in patients with active caries or a tendency to demineralization, and comparison with earlier scans. That integration between scan and ClinCheck is what lets us submit the case for planning the same day as the diagnosis. The scan travels to Align together with photographs, radiographs and a clinical prescription: what I want to correct, which teeth I do not want to move, what relationship between the arches I am aiming for at the end.
With that prescription, Align returns a first draft of the plan. It is a starting point. The final plan comes after review. This is where a large part of the result is decided. When I review a ClinCheck I do it tooth by tooth, and I modify every plan personally before you see it. What I review, in this order:
This work takes between 45 and 90 minutes per case depending on complexity. It is invisible, but it is what defines the result. A rushed ClinCheck turns into later refinements.
It is one of the questions I hear most from patients who have already sought a second opinion. The short answer: the scan is the same, the decisions are not. A ClinCheck can be built in three ways. By the orthodontist personally, reviewing and modifying the proposal until it reflects their diagnosis, which is what I do in my practice. By an in-house clinic technician trained on the platform. Or by the Align Technology technician assigned to the case, with the orthodontist reviewing and approving but without building it stage by stage. For simple cases all three can work. For complex cases, with many movements that depend on each other, the judgment of the person who will see the patient at every visit is hard to replace.
Add to that differences in diagnosis. How to gain space: interproximal reduction, expansion, tipping the incisors forward or extractions. What to correct: only the alignment of the front, or the bite as well. How much risk to take: some plans promise more than the bone can give, others are deliberately conservative. A shorter plan or one with fewer attachments may simply be a plan that asks for less. The reasonable move is to ask each clinic why it made those decisions and how it intends to correct course if a tooth stops following the aligner.
Two ClinCheck resources tend to surprise patients when they appear on screen. Attachments are small tooth-colored composite bumps bonded to specific surfaces at the start of treatment. They create the grip points the aligner needs to produce movements that would otherwise be impossible, above all rotations, root translations and extrusions. Their shape and exact position are calculated in the plan before they are bonded in the mouth.
IPR, or interproximal reduction, appears in the ClinCheck as small marks between specific teeth, with an amount in tenths of a millimeter and an assigned stage. It creates space without pushing the teeth outward. The plan tells you exactly where, how much and when. If your orthodontist explains both resources on screen, you arrive at the first appointment knowing what to expect.
The ClinCheck is a projection, and it should be treated as one. What it does well: it orders the movements, anticipates interferences between teeth, shows the final relationship between the arches and sets a clear target against which progress is compared at every visit.
What it leaves out matters just as much. ClinCheck does not diagnose preexisting occlusal problems that require prior treatment. It does not replace clinical evaluation of the temporomandibular joint. It does not predict soft-tissue changes associated with aging, or how your lips will look. In growing patients it requires a separate skeletal evaluation. It is an orthodontic planning tool, and it is always preceded and accompanied by a traditional clinical diagnosis.
There is also a difference between what the software shows and what the bone does. The aligner pushes; the tooth responds according to its root, its bone, the hours a day you wear the aligner and your own biology. That is why the final result resembles the plan and is rarely identical to it. And that is why refinements exist.
In the consultation after the scan you should see your complete ClinCheck on screen: starting position, stage-by-stage transition, final position, planned attachments, IPR points and the expected occlusal result. In my consultation we go through the plan step by step. I show you which movements are critical, where my expectations are conservative and what I would do differently if the biology does not cooperate. Only then do we sign.
If something does not convince you, the plan is modified before the aligners are manufactured. That is the moment to ask for changes: I want to keep this tooth as it is, I want less expansion, I want to understand why there is reduction there. Once approved and sent to production, any change goes through a later refinement. And if your orthodontist does not show you the ClinCheck, or shows you only part of it, ask why. It is your face, and your mouth for decades to come. You deserve to see the complete plan.
The plan is approved and then watched. At every visit I compare what I see in the mouth with the stage you should be at according to the ClinCheck: whether the aligner seats well, whether any teeth are lagging behind, whether the attachments are still intact. When a tooth stops following the aligner we catch it there and adjust, with more days per aligner, a new attachment or a change in sequence.
At the end of the initial set we take a new scan and build a new ClinCheck to correct what fell short. Almost every case needs it, and it is a normal part of the system. In my practice most cases close with one, ideally zero refinements; some complex cases require two. More than two refinements in a row suggests an over-optimistic initial plan, a case beyond what the system can predict or a problem with aligner wear. I go into it in refinements in Invisalign. And when the plan ends, the phase that protects it begins: retention.
A well-built ClinCheck ensures the case starts with a rational plan, reviewed by the person who will treat you and discussed with you before the first aligner is manufactured. The final result is decided by biology, and that is what the check-ups and refinements are for. That is the difference between aligner orthodontics done with judgment and aligner orthodontics done by inertia.
If this article left you with questions, explore the related services or book an evaluation at AS Odontología Digital in Vitacura.
Book an evaluationIt is Align Technology's 3D planning platform, available only to certified Invisalign providers. From the intraoral scan it rebuilds your dentition in three dimensions and lets the orthodontist simulate every movement of every tooth before the aligners are manufactured. The final ClinCheck plan is what defines the treatment; the aligners are the physical tool that executes it.
Three things at once: the final position of your teeth, the path to get there (sequence and number of stages) and the resources that path needs, such as attachments, interproximal reduction or elastics. Before signing you should have seen the complete simulation on screen, from the starting position to the final one, with those resources marked.
Align delivers a first proposal based on the orthodontist's prescription. From there, it can be built by the orthodontist personally, by an in-house clinic technician or by the Align technician assigned to the case, with the orthodontist reviewing and approving. In my practice I review and modify every ClinCheck personally before the patient sees it. It is a question worth asking any provider before starting.
Because the scan is the same and the decisions are not. What changes is who builds the plan, how space is gained (reduction, expansion, tipping or extractions), whether only the alignment or also the bite is corrected, and how much biological risk is taken. A shorter plan or one with fewer attachments may simply be a plan that asks for less. Ask each clinic why it made each decision.
It resembles it, and it is rarely identical. The ClinCheck is a projection: the aligner pushes and the tooth responds according to its root, its bone, the daily hours of wear and your biology. That is why the plan is monitored at every visit and, at the end of the initial set, a new scan and a refinement are almost always done to correct what fell short. A good plan narrows that gap; none removes it entirely.
Yes, and the time to do it is before signing. In the review consultation we look at the plan on screen, you tell me what concerns you and we adjust as many times as needed before the aligners are manufactured. Once approved and sent to production, any change goes through a later refinement, with a new scan and a new ClinCheck.
Between 20 and 40 stages for a moderately complex case, which equals 20 to 40 sets of aligners. Each stage advances between 0.25 and 0.30 millimeters. Complex cases can reach 60 or 80 stages. The number depends on the magnitude and direction of the movements, and on the velocity the orthodontist decides for each tooth.
No. Almost every case requires at least one refinement at the end of the initial set, because the system predicts movements and biology carries them out at its own pace. What does point to a problem is needing more than two refinements in a row: that usually means an over-optimistic initial plan, a case beyond what the system can predict or a problem with aligner wear.
Between 45 and 90 minutes of orthodontist work per case, depending on complexity, and more in combined surgical cases or those with several critical movements. It is work the patient never sees, but it is the work that defines the result. A rushed ClinCheck turns into later refinements.
