by John Graham, DDS, MD
The ease, convenience and aesthetics of clear aligner systems, like Invisalign and others, make them attractive options for patients—especially adults—who are looking to improve their smile but prefer to avoid the look and perceived trouble of metal braces. The problem is that, despite marketing messages that promise spectacular results, there are a good number of patients for whom clear aligners simply are not a viable option.
Certainly there are pros and cons to both braces and clear aligners. That’s why it’s important that you visit an orthodontist for a professional consultation. Only an orthodontist specializes in the full spectrum of teeth movement. Where a general dentist may be able to offer clear aligners, an orthodontist can offer a trained eye to make sure your smile doesn’t just look good, but that it functions properly too, with teeth that fit together for a healthy—and beautiful—smile.
If you seek consultation(s) from an orthodontist and you are not a candidate for aligners, but a general dentist says you are, beware. You may be disappointed with the results. And, it’s best to keep an open mind about treatment options when visiting an orthodontist. While you may come in with your heart set on clear aligners, be prepared that the orthodontist may take a look at your situation and determine that you’re not a good candidate.
Having been treated in both braces and clear aligners as an adult, I am in a unique position to share my first-hand experience with my patients. Understanding the pros and cons of both clear aligners and fixed appliances before you visit the doctor can help you make the best decision to get the results you’re hoping for.
Benefits of Clear Aligners
Determining whether you are a viable candidate for clear aligners is a matter of the professional opinion, experience and individual evaluation on the part of your orthodontist. Clear aligners are very well-suited for patients with mild misalignment requiring minor adjustments. Adult patients who have previously worn braces and have since experienced mild tooth movement are one example.
For those patients who are well-suited for clear aligners, there are some significant benefits:
They are removable, and in fact must be removed for eating and drinking, which allows the patient to enjoy foods and beverages without worry. However, the removability can also be a disadvantage—which we will address in a moment.
Hygiene is far better with clear aligners than fixed appliances. By removing the aligners, you can easily access all tooth surfaces to thoroughly brush and floss and you can even use over-the-counter tooth whitening products to keep your smile glistening, even while undergoing treatment.
Clear aligners are virtually undetectable if they fit well, enabling you to improve your smile without feeling self-conscious about it. However, a good fit is critical to avoiding discomfort and awkward speech.
Aligners make it easier to deal with a missing tooth or teeth throughout treatment. The trays can even be designed with an artificial tooth built right in, which might be replaced with a dental implant once treatment is done.
Aligners Aren’t for Everyone
While the advantages to clear aligners may be very tempting, there are some who simply are not good candidates. Sometimes determining your candidacy might require a frank conversation with the orthodontist about the drawbacks to clear aligners and the benefits of fixed braces:
Aligners don’t work for all cases. If dramatic tooth movement is needed, clear aligners are not the best choice. Only fixed appliances can deliver significant movement.
In cases where smaller teeth need to be adjusted, clear aligners may not be able to do the trick. There’s simply too little surface area for the trays to properly grip the tooth and move it as required.
Moving molars is often a challenge with clear trays, as is any treatment that requires repositioning the jaw (as with a significant overbite or underbite). Because of their very strong roots, molars can take a very long time to move with trays—if they can be at all—which may mean a longer treatment time with clear trays than with braces.
Treatment with clear aligners can sometimes take longer than braces. Tooth movement with clear aligners is much more subtle, which simply takes more time. In addition, every clear aligner tray for your treatment is fabricated before the treatment begins. This means that if something comes up unexpectedly along the way, it can be very difficult to correct. In many cases, it requires a complete “reboot” or a mid-course correction, which basically involves starting over with new impressions and new trays from that point. With braces, these adjustments are an easy fix: your orthodontist can simply reposition the brackets, make a bend in a wire, etc. and it’s done in two minutes—as opposed to possibly two weeks with a reboot on the clear trays.
Actually wearing the trays can sometimes be a problem with clear aligners, which also impacts treatment time. Since they can be removed, the trays are easy to conveniently “forget.” When they’re not worn regularly, the trays begin to fit poorly and cause discomfort. When this happens, you have to regress back to the previous tray, which delays treatment.
The removable aspect of clear aligners also makes them easy to lose. No doubt thousands of aligners have been thrown out on lunch trays and I’ve heard many stories of trashcan diving to retrieve them. When this happens, it can take 7-10 days to get a new tray—another delay in treatment.
Making the Right Choice is a Team Effort
When it comes to choosing the right treatment option, it’s important to talk openly and honestly with your orthodontist about what you’re hoping to achieve. Keep an open mind and try not to be committed to one particular type of treatment before you even make the visit.
Contemporary braces have come a long way in the past decade alone. We are now able to treat severe problems with high-tech tools and techniques that eliminate the need for extractions in the majority of cases, and that are much more comfortable for the patient. In addition, newer styles of clear brackets can give you the aesthetics of discrete treatment similar to clear aligners, but with the more advanced adjustments and shorter treatment time braces can provide.
Approaching your treatment as a team with your doctor is the most important factor in making the best choice given your unique situation. Find an orthodontist you trust and consider his or her experienced and knowledgeable recommendation with an open mind. Most providers offer a free initial consultation to evaluate your case, and I encourage you to see more than one to find the doctor and the technology that best suits your needs.
Dr. John Graham is a practicing orthodontist in Litchfield Park, Ariz. and a renowned innovator and educator in the field, lecturing worldwide to both doctors and staff on the most advanced orthodontic treatment philosophies available. He is also a physician. He is the co-author of several orthodontic textbook chapters, and has written many professional journal articles. He is a member of the American Dental Association, American Medical Association, American Association of Orthodontists, Arizona Dental Association, Pacific Coast Society of Orthodontists and the Progressive Orthodontic Study Club.
Dr. Graham is a contributing editor for both the Journal of Clinical Orthodontics andOrthotown, and is a reviewer for the journal ORTHODONTICS: The art and practice of dentofacial enhancement. He is on faculty at both the University of the Pacific, Arthur A. Dugoni School of Dentistry, and the University of Rochester, Eastman Institute for Oral Health and he is a past president of the Arizona Orthodontic Association.
You can visit Dr. Graham's website at: http://litchfieldparkortho.com/