Orthodontic Treatment for Children and Teens: Are Invisalign Aligners the Best Choice for my Child?

Factors to consider when choosing orthodontic treatment for children’s dental health.

The most appropriate and effective orthodontic treatment for children and teens, whether executed using aligners such as Invisalign, precision braces, or the Brava lingual appliance, is dependent upon the following:

• your child’s dental age, i.e., the present development of his or her dentition (how many permanent teeth have erupted)
• skeletal relationships of the upper and lower jaws as they are now and their implications for future development of the facial bones, occlusion (bite), and facial appearance
• the potential need for early, interceptive treatment for those with mixed dentition (both “baby” and permanent teeth) to avoid current or later problems with tooth alignment, stability, and gum health
• the current status of your child’s bite, tooth alignment, and skeletal, smile, and facial balance. 

Pro Tip: If treatment is indicated, the most appropriate appliance for the orthodontist to use when executing your child’s treatment plan will be determined by the required tooth movements and your child’s willingness to participate in his or her treatment. 

The following will help you understand the factors involved, the purpose of early examination by an orthodontist, and the suitability of Invisalign aligners for children, which is a common question.  

Your Child’s Age and Type of Dentition: 

There are two distinct groups of children to consider when discussing orthodontic treatment and the appropriate use of various orthodontic appliances, such as clear aligners (e.g. Invisalign); clear or metal precision braces; or, for older children, the invisible, lingual appliance called Brava. 

Younger children (often 7-10 years old, depending upon their “dental age”) have distinct developmental needs that are addressed by what is called interceptive treatment. 

Older children and teens with no or few primary teeth are much like adults and are treated similarly except that their facial bones are actively growing and growing at different rates. Active bone growth assists in tooth movement but also must be considered by the orthodontist during the planning of treatment. 

An effective orthodontist observes the current skeletal relationships and considers likely growth patterns given available data, including familial facial forms.  Without such consideration, the treatment plan may be incorrect and the resulting tooth positions may not benefit the face as the child ages.

Orthodontic Treatment for Younger Children with Mixed Dentitions:

The following will assist you in understanding when and why an orthodontic specialist should evaluate your 7 to 10-year-old child.

• Children with mixed dentition may benefit from interceptive orthodontic treatment, often referred to as “Phase I” 
• Interceptive treatment focuses on correcting issues today that, if left alone, would result in unwelcome development of the teeth, gums, jaws, and facial appearance
• Interceptive, Phase I treatment is primarily concerned with improving present and future dental health rather than short-term cosmetic appearance; however, interceptive treatment also addresses current and future aesthetic imbalances by reducing those imbalances through growth guidance, orthodontic alignment, and bite correction. 
• Dental health, which determines the maintenance of teeth throughout the lifespan, is greatly impacted by the bite. Poor bites result in irreparable tooth damage, periodontal (gum) loss, and tooth loss.
• Orthodontists are trained to safely move teeth into what is called “Class I” occlusion—which is the most stable, healthy position for tooth and gum health—and doing so while considering the effect of their treatment plans on the entire face. Class I occlusion is not the only goal.
• Not all children require interceptive treatment; an evaluation by a skilled orthodontist can determine if your child would benefit from early intervention.  The need for interceptive treatment is not always obvious to the naked eye nor to general dentists. 
• Examination for interceptive treatment is best conducted at the age of seven for girls, eight for boys.  However, if your child is older yet retains primary teeth, interceptive treatment may still be indicated.  Your orthodontist will advise you if interceptive treatment is beneficial or if treatment may be delayed until all permanent teeth have erupted.
• When interceptive, Phase I treatment is indicated, treatment time is typically shorter than that of Phase II, permanent dentition treatment.
• Not all children who receive interceptive treatment will require secondary, Phase II treatment.  Interceptive treatment may be sufficient.
• For those children who would benefit from two phases of treatment, Phase I will prepare the dentition for Phase II, reducing the difficulty and length of treatment of the permanent teeth. 

Invisalign Aligners versus Braces for Children with Mixed Dentitions: 

• Aligners can be effective tools for interceptive treatment of mixed dentition and are often preferred to traditional braces by the orthodontist during this period.
• Aligners can overcome structural challenges presented when working with primary teeth by providing stability as teeth loosen or gaps are created during tooth eruption.  Braces lose rigidity and control in these areas.  In addition, enamel of primary teeth is less able to adhere to brackets, further contributing to loss of control and effectiveness.
• The acceptance of parental involvement and supervision regarding the consistency of aligner wear is generally high among patients of this age.  This is a very important factor in the success of Phase I aligner treatments, making aligner use an appropriate choice.
• The supporting gums and bone of children with mixed dentitions are very adaptable to tooth movement, allowing aligners to effectively execute movements that might otherwise benefit from the sweeping motion of a fixed appliance such as braces. 
• At the conclusion of interceptive treatment, patients can use modified Invisalign retainers for home-only use while the mixed dentition transitions into a permanent dentition.  Often, because of the experience of consistent aligner wear, these patients do well with Invisalign aligners during this period and for Phase II treatment should it be required.

How Old Do You Need to Be for Invisalign Aligners

• How old your child needs to be for Invisalign aligners depends upon his or her level of jaw and tooth development.  For girls, the minimum age for Invisalign aligners would likely be seven.  For boys, the youngest age for Invisalign would likely be eight.  In either case, the use of Invisalign at a young age is appropriate if interceptive treatment, see above, is warranted. 

Orthodontic Treatment for Children/Teens with Permanent Dentitions:

The following includes information about treatment considerations and appliance options for older children, including Invisalign aligners, precision braces, and the invisible Brava appliance.

• At this dental age, the body and head are continuing to grow, which is a factor in favor of comprehensive or Phase II orthodontic treatment.  During active growth, the teeth naturally move to compensate for skeletal changes, which allows the teeth to be moved orthodontically more readily than is the case for adults.
• Due to permanent dentitions, teens have options in addition to Invisalign aligners. These include precision braces with custom 3-D printed, metal, or clear brackets, and the speedy, invisible-to-onlookers Brava appliance that sits behind the teeth. 
• In some cases, a particular appliance (precision braces, Brava, or clear aligners such as Invisalign) will be recommended by the orthodontist due to the movements that must be executed during the course of treatment.  Each appliance excels at executing particular movements but not others; consequently, an appliance may or may not be suited for your child’s dentition.  In addition, given the task of aligner wear and related hygiene requirements. one of the fixed-appliance alternatives may be preferred by your child or more suitable given his or her personality and habits.

Related: Orthodontic Tooth Movement and Treatment Methods:  Exploring Invisalign, Precision Braces, and Brava

Invisalign Aligners versus Braces or Brava for Teens:

• Orthodontic tooth movement is a physiological process that demands the continuous application of light but specific forces on the teeth.  This continuity of force results in the remodeling of the supporting bone that allows the teeth to change position. 
• If the force applied to teeth is intermittent, the movements are geometrically SLOWER, or may not happen.  Consequently, Invisalign aligners must be worn 22 hours per day to be effective. 
• Fixed appliances, such as precision braces and the Brava lingual appliance, apply continual force and are independent of the wearer.
• Due to the continuing growth process, teenagers’ teeth respond more readily to Invisalign aligners than do those of adults. 
• Aligners create less force than fixed appliances such as braces or Brava, making them unsuited for some movements.
• Invisalign aligners may, depending upon the movements required, produce results more slowly than braces or the Brava appliance. 
• The Brava appliance, unlike braces or aligners, allows the orthodontist to move each tooth independently, which, in most cases, results in the shortest treatment time.
• The decision to pursue Invisalign aligners for children or teens with permanent dentitions hinges on the likelihood of the patient consistently wearing the aligners. 
• Aligner wear is critical to the success of orthodontic treatment if choosing Invisalign aligners for teens. At this age, acceptance of continuous parental supervision is generally much lower.  Depending upon your child’s tendencies, resistance and conflict associated with aligner wear may result. 
• Our practice employs digital remote monitoring of aligner treatments to help teen and adult patients maintain consistent progress.  Parents may be connected via a cellular phone application to share oversight.  Ultimately, however, the key to success with orthodontics using removable aligners lies with the patient.
• Your child’s typical internal motivation toward personal habits (e.g. tooth brushing, bed making) may indicate how he or she will do with removable clear aligners versus a fixed appliance.
• If aligners are an appropriate choice, successful orthodontic treatment with Invisalign aligners can be an empowering experience for patients of this age.  Children and teens often gain confidence and agency through their efforts to bring about a significant transformation in their lives. 
• For more information about treatment options for older children and teens, see my blog posts How Long do Braces Take and  Orthodontic Tooth Movement and Treatment Methods:  Exploring Invisalign, Precision Braces, and Brava
• For more information about successful Invisalign treatment, see my blog posts How to Guarantee the Best Invisalign Treatment Result: A Comprehensive Guide and The Ten Most Important Facts about Invisalign:  What to Know Before Seeking Treatment

Conclusion

Aligners such as Invisalign can be an effective tool for children given proper treatment planning by the orthodontist and consistent wear by the patient, regardless of the patient’s age.  Your orthodontist will determine if aligners can execute the movements that he or she deems necessary for your child’s dental health and development. 

If aligners are appropriate and desired, you and your child must agree to a pattern of consistent wear, which requires the removal of the aligners when eating or drinking anything other than plain, non-heated water, followed by tooth brushing and reinsertion of the aligners.  This becomes routine for most patients but is not for everyone. 

Related: How to Guarantee the Best Invisalign Treatment Result: A Comprehensive Guide

From children to adults, patients in our office often choose fixed appliances to avoid the handling of aligners, even when Invisalign aligners are appropriate for their treatments.  Fortunately, other appliances, such as precision braces (LightForce) and the invisible Brava device, are regularly used in our office to successfully execute both simple and highly complex treatment plans. 

Pro Tip: In some cases, an orthodontist is able to execute a treatment plan more quickly and effectively with a fixed appliance due to the ability of the fixed appliance to move teeth in long, sweeping motions and generate force in directions for which aligners are not suited.  The Brava appliance can further reduce treatment time by allowing the orthodontist to move each tooth independently.

A comprehensive examination by a skilled orthodontist will inform you of your child’s dental health requirements and the available orthodontic options for him or her.  Orthodontic examinations are performed without charge; consequently, I encourage you to seek more than one opinion from an orthodontic specialist when seeking the best practitioner for your child.

If you reside in the Seattle area and would like to explore treatment options, I would be happy to perform a comprehensive, complimentary examination for your child during which I will communicate my findings and recommendations.  Call my office, 206-812-4494, or visit our contact page to schedule an initial examination.