Some questions about treatment with Invisalign aligners are asked repeatedly by my patients. I have compiled and answered the most common here—without marketing spin, just what I tell patients in the chair. —Dr. Wong
1. What is Invisalign, exactly?
Invisalign aligners are clear, removable trays designed to move teeth. Invisalign in and of itself is not a product that works independently; it is a treatment tool. Each set of aligners is made from a prescription, and the quality of that prescription is what determines the outcome. Patients with similar starting tooth positions have very different results depending on the expertise of the practitioner creating the treatment plan.
Like braces, Invisalign aligners move teeth by utilizing pressure to influence biological processes such as bone remodeling and, in growing patients, jaw development. Because each patient’s biology responds uniquely, orthodontic treatment with aligners requires ongoing supervision and adjustments to the treatment plan as treatment progresses.
2. Do I need to see an orthodontist for treatment with Invisalign, or can my general dentist do it? (Orthodontist vs Dentist for Invisalign)
Yes, you should see an orthodontist for treatment with Invisalign aligners. Under antitrust laws, general dentists are not prevented from using Invisalign; however, orthodontists complete two to three years of additional, post-doctoral training focused exclusively on tooth movement, bite mechanics, and jaw and facial development. General dentists do not. In fact, virtually no general dentist has had the experience of starting and completing even one comprehensive orthodontic case during dental school. There is neither enough time in the curriculum nor the supply of willing orthodontic patients for this to occur.
And here is a fact that most patients don’t understand about Invisalign and the question of orthodontists vs. dentists: the company software that generates an initial Invisalign plan is automated and based on what is, in truth, limited information from photographs and scans. In the vast majority of cases (99%), that automated plan requires significant modification to produce a stable, healthy result. Knowing what to change, and why, is the job of someone trained specifically in tooth movement and facial development and aesthetics. (For this reason, it is unsurprising that Aligntech, the parent company of Invisalign, reports that general dentists typically accept the automated treatment plan without modification.)
The reason to choose an orthodontist for treatment with Invisalign aligners is the same reason you would choose a cardiac surgeon over your primary care doctor to perform a cardiac operation—both are qualified physicians, but only one has the specialized training for that specific purpose.
3. How long does treatment with aligners take?
Treatment duration with Invisalign aligners ranges from 6 to 24 months, with 12 to 18 months most common. Treatment length depends on the complexity of the required tooth movements and how consistently a patient wears the aligners.
Complexity of tooth movement:
Aligners are efficient at certain types of movement and slower at others—for example, rotating a tooth or closing a gap require different force vectors than tipping a tooth upright or moving a root through bone; the latter two, though not impossible, especially with in-house aligner modification, are more challenging for aligners, given their mechanical limitations. If tipping and root movement are required, additional time will be needed. Other factors include the relationship of the jaw bones, the patient’s bone health and growth cycle, and familial growth patterns, among others.
To evaluate treatment length during the examination/initial consultation, I observe the bite, facial structure, and dental anatomy to determine a realistic timeline based on all relevant factors, including the types of appliances to be used. Before that exam, it is impossible to say how much time a treatment will require.
Consistency of aligner wear:
When asked how long treatment using Invisalign takes, I stress that consistency of aligner wear is extremely important; the teeth must experience consistent pressure to initiate and maintain the ligament and bone alterations required for the teeth to move in the proper sequence and to land, not only in the correct position, but also in a stable one. See number 4 below for more!
4. Do I really have to wear aligners 22 hours a day?
Yes. That number isn’t arbitrary—it’s the wear time required for the aligner to apply sufficiently consistent pressure to move your teeth on schedule and in correct relationship. The force vectors applied by the aligners to the teeth alter the surrounding biochemistry, bringing about the physiological processes necessary for tooth movement. Aligners only work when they’re in the mouth. When they are removed, the biological response is to reverse what has just occurred during wear. Every minute skipped adds up, degrading the mandatory biochemical changes. Inconsistent wear is the most important factor contributing to treatment delays.
The practical approach to aligner wear:
Take aligners out when eating, when drinking anything other than cool/cold water, and when brushing your teeth. Otherwise, they should be in. Limit the period when aligners are out of the mouth to less than one hour at a time (half an hour is ideal), keeping the total to two hours or less per day.
5. Will insurance cover treatment with Invisalign aligners?
If your insurance policy includes orthodontic benefits, treatment performed by an orthodontist using Invisalign aligners is covered in the same way as braces. Aligners are tools used to execute a treatment plan, not a separate product, so they fall under the same orthodontic benefit as any other appliance.
6. How much does treatment with Invisalign aligners cost?
Treatments with Invisalign aligners and braces are priced comparably. What drives cost is the complexity and length of treatment. I will describe both during your consultation—you will leave that visit with a real number, not a range. We also offer payment plans with adjustable monthly amounts.
One avoidable cost of aligner treatment that is important to mention up front: If you do not wear aligners as prescribed, with teeth failing to move as required, you may need a new treatment plan and a second set of custom aligners partway through your initial treatment. That cost and the delay associated with starting over are avoidable with consistent wear—or by choosing braces, which some do!
7. Can Invisalign aligners fix anything braces can, or are there limits?
Aligners can be used to handle a wide range of cases as quickly as braces, but not all. Some tooth movements—particularly certain rotations and vertical movements—are mechanically difficult for an aligner to accomplish efficiently.
In my practice, I use in-house modifications (advanced aligner techniques) to extend the capabilities of aligners, enabling me to treat some cases with aligners that would otherwise require braces. However, there are situations in which braces are simply the better tool for the job. If that’s the case, I will tell you. It’s better to know than to force a fit, which can lead to poor results and too-slow treatment.
8. Is treatment with Invisalign aligners only for adults? May my child be treated with aligners?
Use of Invisalign aligners is not age dependent. Orthodontists treat children, teens, and adults with aligners. For growing patients, ongoing jaw and facial development are taken into account. These rapid changes over time impact the treatment plan differently than the ongoing, slow bone growth of an adult, which also influences treatment decisions (bones continue to change throughout the lifespan). However, age isn’t a barrier to treatment—it only affects the factors considered by the orthodontist when creating the treatment plan.
Of importance is the commitment to wearing the aligners (see number 4, above); children and teens are often quite conscientious. If aligners are an appropriate treatment tool for a child’s case, a parent can typically assess the likelihood of compliance with the treatment protocol based on their child’s habits.
9. How often do I need to go into the office during treatment with Invisalign aligners?
In-person appointments for patients treated with Invisalign aligners are typically spaced four to five months apart when an orthodontic practice uses weekly remote monitoring via images captured with your phone; this provides consistent care from an in-house clinician, who reviews the images, with patient convenience. With consistent wear and remote monitoring, patients treated with aligners typically have fewer in-person visits than those with braces.
I’ve treated patients living abroad with minimal in-office time when their cases allow. That said, some cases need closer supervision, regardless of the appliance. During the consultation, I’ll tell you what to expect.
10. What’s the best way to find out if I’m a candidate for aligners?
Attend an initial exam/consultation. During that consultation, I examine your teeth, bite, and facial structure, review imaging, and provide straightforward answers about whether Invisalign aligners are the right tool for your case—and, if they are, describe the treatment plan, timeline, and cost. Orthodontic exams are complimentary in most practices.
Do you have a question I didn’t cover? Reach out to me through our contact page or call 206-812-4494.