$900 Credit off Invisalign teen

$900 Credit toward Invisalign Teen:  Now through 9/30/2017

Invisalign Teen—orthodontic alignment with clear, removable “aligners,” enhanced for teenagers with five replacement aligners and a guarantee of transfer to fixed appliances if deemed necessary by patient, parent/guardian, or Dr. Wong—is now more convenient and reliable, thanks to remote monitoring, than has ever been the case.  As a leading Invisalign provider in the Seattle area, our practice has been authorized to extend $900.00 credit toward any Invisalign Teen case initiated prior to September 30, 2017.

We are pleased to have been asked to participate in this offer—applicable to Invisalign treatment of any patient under 20 years of age—and are grateful to be ranked as Yelp’s #1 “orthodontist,” “Invisalign orthodontist,” and “Invisalign teen orthodontist” in Seattle. It is our goal to live up to those rankings by continuing to provide excellent, forward-thinking orthodontic care for you and your children. 

More about Invisalign Teen

A few of the many reasons Invisalign Teen is becoming a favored orthodontic modality by patients, parents, and orthodontists alike: 

LESS OFFICE VISITS for busy teens and their families:  On average, office visits are reduced by 30-50% compared to traditional braces/fixed appliances.

MORE CLINICAL SUPERVISION with Virtual Invisalign Progress tracking:  Via a specialized phone application, treatment is digitally supervised and directed between office visits.

LESS DISCOMFORT:  Studies show—and our patients report—significantly less discomfort using the lighter forces of aligner therapy compared to those of traditional fixed appliances.  

ELIMINATION OF EMERGENCIES:  There are no broken brackets or “poking” wires necessitating urgent trips to the orthodontist.

SIGNIFICANTLY BETTER ORAL HYGIENE:  Aligner removal simplifies hygiene—making it more likely and more effective; no “white stains,” bleeding gums, or cavities due to inadequate hygiene prompted by fixed appliances.  

LESS INTERFERENCE WITH WOODWINDS AND HORNS:  Removable aligners are more harmonious with practice and performance than are traditional fixed appliances.

TOOTH PROTECTION:  For those involved in sports or physical activities that do not already require mouthguard wear, aligners offer real protection from dental impact.

LESS ROOT RESORPTION:  Studies suggest that root shortening due to orthodontic treatment is lessened in aligner therapy—possibly due to the intermittent nature of force in such therapy.

LAST BUT NOT LEAST—NO FOOD RESTRICTIONS:  Aligners, unlike fixed appliances, are removed to eat; therefore, no foods are forbidden for fear of breaking an appliance  (This is greatly appreciated by patients.)

If you believe that Invisalign Teen may be a good choice for you or your child, contact us for a complementary consultation via email, contact@drkeithbwongseattle.com, or telephone, (206) 812-4494.  We look forward to seeing you! 

Keith B. Wong, DDS, MS is a Seattle orthodontist specializing in Invisalign and traditional orthodontics, with extensive experience in the treatment of complex and simple cases alike.

Finding and Choosing an Orthodontist for Invisalign

Is there an official Invisalign Orthodontist?

There is a very meaningful difference between an orthodontist that has mastered the specific and unique way one needs to approach any case with Invisalign and an orthodontist that has not completed the associated “learning curve.”  There is an even greater (and more crucial) difference between an orthodontist that has expertise utilizing the Invisalign modality and a general dentist that promotes him or herself as a “certified Invisalign provider.”  Unfortunately, there is currently no official designation that can point to an ideal Invisalign practitioner with 100% accuracy, however, there are several steps one can take to locate an excellent provider; steps I will cover below.  First, some context is needed.

The educational/experiential difference between an orthodontist and a general dentist:

According to Aligntech, the parent company that makes Invisalign aligners, the typical general dentist who holds him or herself out as an “Invisalign doctor” has completed a weekend course limited to instruction in logging onto the Invisalign doctor site, submitting records for a prospective case, and accepting and paying for that case.  Furthermore, this type of practitioner starts, on average, only 3 cases per year.  (Several years ago, Aligntech, in response to a glut of unsatisfactory results produced by unskilled providers, attempted to institute minimum criteria to remain certified as an Invisalign doctor, but failed to stand firm in this when confronted with an eruption of discontent from a subset of general dentists.)

The difficulty for general dentists’ rests in the fact that Invisalign, although utilizing computer technology to produce a series of aligners, is in no way a comprehensive orthodontic treatment planning program, as commonly believed.  Well-meaning general dentists have had no fundamental training in comprehensive orthodontics (the average number of comprehensive orthodontic cases that a dental student in the US treats and finishes is ZERO).  Why?  Because dental students must become proficient in general dentistry, which includes numerous other subjects that are unrelated to the biomechanical process of moving teeth orthodontically.  Orthodontics is a dental specialty pursued through post-graduate education.  Orthodontists, like other dental specialists, have completed dental school and been accepted into highly competitive graduate programs and residencies that focus exclusively on the practice of that specialty.  To illustrate the different curricula of an undergraduate dental school and that of a graduate orthodontic specialty program, I have included links to examples of each:

The four-year curriculum of the University of Minnesota undergraduate dental school
Note that only 2 of the 106 classes are related to orthodontics; in addition, only half the class could be included in an orthodontic rotation to observe what orthodontists generally do.

The three-year curriculum of the post-graduate residency program in Orthodontics at the Arizona School of Dentistry & Oral Health
Note that all 33 classes focus on orthodontics.  These subjects include, the biological basis of orthodontic tooth movement, the biomechanical principals of orthodontic appliances, the clinical strategies of orthodontic treatment, and current orthodontic research.

The stark difference between the education of a general dentist versus that of an orthodontist helps one understand that this comparison is like that of a formula one race car driver to a formula one race car mechanic—they are both highly-trained, highly-skilled individuals who share an object of focus but have very different relationships of expertise to that object.  The driver would have a much higher probability of winning a race and the mechanic would have a much better chance of optimizing an engine for victory.  Like the driver and mechanic, the orthodontist and general dentist perform equally important, yet distinct, functions.

The educational/experiential difference between an expert Invisalign orthodontist and a non-expert:

The basis of difference between two orthodontists, one an expert Invisalign clinician and one less skilled in its use, is in the level of knowledge regarding clinical capabilities and limitations of Invisalign as a specific modality of treatment and the differences, which are many, between that modality and the use of braces/fixed appliances.  These differences are not trivial.  For example, because braces can push and pull whereas Invisalign can only push, the phasing of treatment when using Invisalign must often be quite different than when using conventional treatment.  This, and other distinctions, mean that treatment planning, which must be completed at treatment onset, is highly dependent upon a thorough understanding of Invisalign as a separate and unique appliance.

In addition, Invisalign tooth movement is distinctly intermittent in comparison to braces.  This implies that Invisalign treatment alone, in cases where a more sweeping, larger range of motion is required (e.g. alignment of a distant impacted tooth or correction of a significant rotation), is insufficient.  To make this determination and address the situation, a practitioner must not only be an orthodontist, who, unlike a general dentist, can combine treatment modalities, but one experienced in the use of Invisalign, familiar with its capabilities and limitations, and proficient in the proper combining of Invisalign with conventional treatment.

Further, there are numerous idiosyncratic aspects of excellent clinical Invisalign treatment that require the surrender of assumptions associated with fixed appliance treatment (braces).  These aspects are mastered by:  1) attending advanced Invisalign-specific courses; 2) collaborating at advanced Invisalign peer-to-peer symposia; 3) intently adapting ongoing treatments as indicated; 4) appropriately integrating new technologies to enhance the efficacy of the specific biomechanics of Invisalign (i.e. biologically enhancing the body’s response to the low-force mechanism of Invisalign via Propel micro-osteoperforation or Orthopulse photobiomodulation); and 5) creatively integrating known orthodontic modalities with Invisalign treatment to address all aspects of a given case by the most effective means available (i.e. combining treatment methods to offset biomechanical deficiencies of any given modality).

In Summary:  The learning curve for effective and efficient Invisalign use is significant.

Why aren’t all orthodontists expert Invisalign orthodontists?

First, it must be said that, just as in any field, not all orthodontists are expert, regardless of modality.

Second, in my experience, and that of my friends and colleagues, it takes time, intention, and energy to become “good” at Invisalign orthodontics and significantly more to become “expert.”  One must commit not only oneself, but the whole team to thinking and doing things differently.  Moreover, this intention needs to be ongoing and not everyone, nor every practice, can, or desires, to do this.

Third, orthodontic residency programs vary significantly in their approach to training Invisalign utilization.  A few programs, like Univ. of the Pacific, have an excellent Invisalign education but most are limited and some even ignore Invisalign altogether.  Some recent graduates are not only relative neophytes in traditional clinical orthodontics but absolute neophytes in Invisalign.

Fourth, some experienced orthodontists feel they do not have time to close their office to attend the necessary educational events, let alone make time for subsequent in-office training and systemic upheaval.  Other orthodontists still have the opinion that Invisalign really does not work well.  This opinion lingers from the early years of Invisalign (1999-2010) when it was not particularly effective and the majority of cases were attempted by unskilled to minimally-trained general dentists.  Thus, when unsatisfactory results emerged, the general conclusion was “Invisalign doesn’t work or doesn’t work very well,” as opposed to “Dr. Jones doesn’t know how to use Invisalign.”

When one considers that, as specialists, orthodontists are acutely aware that each of their patient’s results are scrutinized by the general dentist, the dental hygienist, other specialists, the patient, and the patient’s friends and family, it is easy to understand why many orthodontists did not want to utilize an unproven modality knowing they could deliver an excellent result with traditional orthodontics.  In recent years this has begun to change.  Emerging across the country are a number of orthodontists who are truly expert in Invisalign’s use.

The evolution of Invisalign into an excellent orthodontic treatment option:

At present, Invisalign aligners are a very efficacious and predictable orthodontic modality when used knowledgeably.  It is important to note that Aligntech has spent approximately one billion dollars in research & development since Invisalign’s inception in 1999.  In one of the most important moves in Invisalign’s history, Aligntech hired the preeminent research-orthodontist in the field of Biomechanics (the study of the mechanical laws relating to the movement or structure of living organisms, specifically teeth in this case), John Morton, away from the University of Connecticut.  Since then, he has led the way to numerous technical and biomechanical innovations.

Clearly, Invisalign has become a fundamentally improved, effective orthodontic modality.  But like all modalities, there are strengths and limitations.  Aligntech has recognized that, to move the technology forward, it is crucial to have experienced orthodontists who are committed to using and developing the best treatment practices with Invisalign.  To that end, Aligntech has created the Key Provider Program (KPP) that both assists specific practitioners in providing the most advanced treatment and, also, partners with them in development of the Invisalign as a treatment modality.  The list of those in the KPP is not public.  However, there are ways by which a patient or parent may assess an orthodontist’s skill.

How to choose an “Invisalign doctor:”

First, with respect, I would say that the initial step in reducing the field of prospective clinicians is to choose an orthodontist to do your orthodontics.  If you skipped over the links to the respective curricula of the dental student and the orthodontic resident (who had previously graduated from dental school), I recommend that you peruse them below.  These illustrate, most pointedly, the educational hurdle for the well-meaning dentist who would like to add orthodontics to his or her practice:

Dental School

Orthodontic Residency

Second, attempt to determine which orthodontists are excellent orthodontists, regardless of whether they are expert using Invisalign.  Online resources such as Yelp can give you a glimpse into comparative practices prior to contact.  By reading reviews one can get a sense of whether a doctor is a definite “no” or a “let’s see.”  You can search “Orthodontist,” “Invisalign,” or “Invisalign orthodontist” directly on Yelp, or other system.  Reviews such as these are not definitive, of course, and only a starting point.

Third, visit the Invisalign Doctor Locator.  Aligntech assigns classifications to practices (unfortunately, not individual practitioners) based upon number of historical and recent cases (e.g. Preferred/Premier/Elite/1%).

“Preferred” practices do at least 5 cases every six months (and historically have done 10 or more)

“Premier” practices do at least 25 cases every six months (historically have done 50 or more)

“Elite” practices do at least 50 cases every six months (historically have done 300 or more)

“1%” practices do at least 100 cases every six months (historically have done 800 or more)

Note:  Some caution should be used when interpreting this type of classification.  While it is true that one needs a certain mass of experience to become expert, it does not necessarily follow that a lot of case experience implies expertise.  For example, every expert golfer has golfed many, many times, but there are many more golfers who golf as frequently and are still self-proclaimed “hackers.”  Usually, these “hackers” have not invested time, effort, and energy into critical analysis and improvement (i.e. lessons and focused practice).  This is true in any endeavor or field.

In addition, as noted above, in a multi-practitioner office, these classifications reflect aggregate practice volume, not that of each doctor.  Thus, in a multi-doctor practice, a high-volume practice, or a clinic/corporate setting, the classification may be “Elite” or “1%” but the doctor you see may not be expert or especially experienced.  In addition, the high-volume classification may be associated with a practice culture that you would not otherwise choose, such as the sharing of patients across practitioners, or high-volume tactics designed for profit maximization.  As an example, an orthodontist who had been “Elite/1%,” and who perpetually offered Groupon Invisalign at significantly lower-than-market fees, made the news in 2017 by closing his doors without warning, leaving his patients without recourse.

Fourth, request personal or professional referrals from friends or your dentist/hygienist.  It is recommended, however, as with all sorting methods, that one confirm these recommendations with other sources.  There are several reasons for this:  1) your friend or dental professional may not appreciate the same attributes in an orthodontist as do you; 2) he or she may have a bias, pro or con, regarding Invisalign; and/or 3) his or her favored orthodontist may not be adept at Invisalign.

Finally, at your investigation’s conclusion, schedule and attend complimentary examinations with the practitioner or practitioners identified through the above.  Do not make assumptions.  An examination, its thoroughness, the professionalism of the doctor and his or her staff, and the recommendations made, will greatly inform you as to the most appropriate choice.  In an age of online shopping, it is second-nature to make choices based upon superficial impressions.  Health care is not the place for superficiality, however.  And make no mistake, orthodontics is healthcare.  The difference between proper and improper treatment is not only appearance, but the stability and longevity of teeth.  Improper alignment leads to tooth fractures, gum disease, and eventual tooth loss.  Proper alignment results in not only a beautiful smile, but a healthy one.  Orthodontists, just as with all professionals, are not interchangeable.  Your on-site assessment is the best means of determining if the practitioner is truly skilled and someone with whom you wish to begin such a relationship.  Fortunately, such examinations are given free of charge; so, take advantage of this in making your decision.  (Note:  Free of charge does not mean “can be cancelled”.  Orthodontists have limited time for examinations and must use that time effectively.  If an examination is missed, you may or may not be allowed to reschedule.  Office policies differ and the reason for cancellation is often considered; however, if you wish to be treated, examinations should be considered as commitments.)

In conclusion:  Consider all information noted above; seek complimentary examinations with likely practitioners; employ common sense—and smile; you’re half way there, already!

I hope this post has been of help to you in choosing an Invisalign provider.  Please see Seattle Insider’s Guide to Invisalign for additional information.

The Seattle Insider’s Guide to Invisalign

Does Invisalign work?

Yes, but the answer is complicated. Invisalign is a product that is innovative and technically sophisticated with a certain aesthetic elegance, not unlike an iphone; therefore, many assume that Invisalign is similar to an iphone in that where it is acquired is unimportant. In reality, Invisalign is of greater similarity to a surgical robot or a Boeing aircraft—technically advanced, yet dependent upon the experience and judgment of the operator. However, given that Invisalign is a commercial product, developed and marketed directly to the public, and that the chance of morbidity is non-existent, the threshold of qualification to become an Invisalign provider has been loosely regulated. This is a complicating factor in Invisalign performance due to several issues. Firstly, the Invisalign technology has been marketed to both orthodontists and general dentists under the mistaken belief that the computer-programed Invisalign baseline is sufficiently sophisticated to produce satisfactory results in non-complex cases without significant doctor modification. This has not proven to be true. The Invisalign baseline considers only position of the dentition without reference to bone and soft tissue status and relationship, factors which greatly impact treatment planning and the sequencing of tooth movement. Secondly, the mechanics of the Invisalign system, i.e. the capacity for, and application of, force, are quite distinct from the edgewise/bracket-and-wire system; therefore, to effectively utilize Invisalign, the practitioner, whether orthodontist or general/aesthetic dentist, must make a significant educational investment in the use of this tool. Thirdly, a further complication for the non-orthodontist is that the ability to determine the relative complexity of an orthodontic case, as well as treatment plan for those that are complex, is developed not through education as a general/aesthetic dentist but through two to three years of post-doctorate education in orthodontics. (Even so, there do exist general/aesthetic practitioners who are capable of utilizing Invisalign responsibly and who are quick to refer those cases that present with complicating factors to an orthodontic specialist.)

The fact that the question remains, “Does Invisalign work?” points to the issues discussed above and the resulting inconsistency in treatment outcome. A significant number of Invisalign cases have been and are attempted by those who do not have the adequate diagnostic skills, mechanical understanding, and/or experience to complete these treatments. However, when utilized by an orthodontic clinician who is both experienced in the specific biomechanics associated with Invisalign treatment and who has the diagnostic ability to recognize appropriate clinical indications, Invisalign is a very effective and reliable orthodontic modality.

Does Invisalign only work in certain cases?

Invisalign aligners are one of several tools that an orthodontist may use to move teeth, as are traditional braces, with each tool having both advantages and disadvantages. Certain tooth movements are not accomplished effectively by Invisalign aligners. In such cases, these difficult movements may be accomplished using limited braces (often, on a few teeth for a brief period), resulting in a case that can then be successfully completed with Invisalign. By integrating modalities, experienced orthodontists are able to treat a wide variety of cases with Invisalign and achieve ideal results. (What are these movements? Due to the specific mechanical properties of the Invisalign appliance, which differ substantially from that of a wire and bracket appliance, the aligners are a poor choice for translating large rooted teeth and do not rotate teeth efficiently.)

Why use Invisalign?

Invisalign aligners are very thin, clear, removable, and intimately approximated to the teeth; they are extremely “aesthetic” compared to traditional or even clear braces. They are less costly, sometimes significantly so, than lingual braces (braces on the inner aspect of the teeth) and avoid the associated issues of speech impediment and discomfort to the tongue.

Are the advantages of Invisalign only cosmetic?

No. In certain cases the use of Invisalign presents a clinical advantage, such as 1) when enhanced control of teeth is required—Invisalign is quite effective in creating space of exact size, e.g. where precise widths are needed for post-orthodontic restorations; 2) when braces would not remain on the teeth well (e.g. patients with numerous crowns or veneers, patients with abnormal tooth enamel); 3) when access for particular dental procedures is important; 4) when indications of root resorption necessitate the isolation of certain teeth: Invisalign is able to accomplish this whereas braces cannot do so; 5) when there exists an anterior open bite in which the patient cannot bite the front teeth together (i.e. to incise lettuce); and 6) when there exists a deep bite in which there is excessive vertical overlap of the upper and lower incisors.

Does Invisalign cost more than braces?

Fees structures vary across the country. In some regions, such as our own, Invisalign is priced similarly to fixed appliance/traditional treatment.

Does Invisalign treatment take longer than braces?

No, if the doctor is experienced in orthodontic treatment and Invisalign specifically, most Invisalign cases are somewhat shorter in duration than if they had been attempted with fixed appliances (braces). Cases that include movements difficult for Invisalign to accomplish, thus necessitating limited fixed appliances in a hybrid Invisalign/fixed appliance treatment, experience an overall duration similar to that of fixed appliance treatment. Certain types of cases, however, are best treated with fixed appliance alone.

What is involved in initiating Invisalign treatment? Each patient, regardless of treatment type, should receive a comprehensive examination of his or her facial structures (hard and soft tissue), teeth and dental alignment, jaw joint (temporomandibular joint), periodontal structures (hard and soft tissue), and a meaningful discussion covering his or her goals for treatment and other salient issues. Invisalign patients will have diagnostic records taken including a digital intraoral scan (which will later be used to create aligners). These records are sent to Aligntech (the parent company of Invisalign) with an initial prescription provided by the orthodontist. The Aligntech technicians use software to formulate a preliminary treatment plan involving a “path” toward the prescription of desired tooth alignment. This preliminary treatment plan will indicate intermediate alignments (stages), each slightly different (from misaligned to ideally aligned). The number of stages will vary depending upon the extent of tooth movement required. The software used for this preliminary treatment plan cannot, however, determine what is clinically realistic or advisable; therefore, it is imperative that this treatment plan be modified by an orthodontist who is experienced in both diagnostics and Invisalign biomechanics. (The preliminary treatment plan would commonly lead to case failure if implemented without modification: this is why I recommend that Invisalign treatment be sought from a qualified practitioner [see “Does Invisalign Work?” above].) Once the orthodontist has sufficiently modified the treatment plan for the case in question, he or she will approve the plan (known as a Clincheck) and the construction of aligners will commence. In our Seattle office, the aligners arrive two to three weeks after the taking of diagnostic records.

What happens when I receive the Invisalign aligners?

At the first appointment, the aligners will be checked to confirm fit and you will be instructed on their placement and removal. The rate of change from one aligner to the next will also be discussed. Two cases will be provided and you will be asked to store all of your used aligners in their individual packages in the case any should be needed in the future. You will also be shown how to clean the aligners and given tips to help you incorporate the aligners into your everyday life. This is an exciting and relatively short appointment.

What will I notice once I begin wearing the aligners?

First, you may be surprised at how difficult it is to see the aligners once on and how closely they fit to the teeth (the fit will become even closer as your teeth adjust to the aligners). You will probably note a mild increase in salivation because your mouth senses something new and assumes it is food; this phenomenon usually lasts one to two days. As you speak while wearing the aligners, we advise that attention be brought to any changes in your speech; if such changes occur, we recommend practicing those sounds that require adaptation. Speech adaptation usually takes one to two days, as well.

Is Invisalign treatment painful?

The perception of discomfort or pain varies widely among individuals, but, given that orthodontic tooth movement requires some amount of force to elicit a biological response, at least some initial discomfort will be experienced. Invisalign aligners, however, cannot generate the heavy force of the traditional braces of past generations. Patients who are seeking retreatment with Invisalign tend to report less discomfort as compared to earlier, traditional treatment. However, there is likely to be an initial period of low-level discomfort around the teeth when the dentition goes from unperturbed to orthodontically mobile. Once the Invisalign orthodontic process begins, however, this discomfort lessens.

How many hours per day are the Invisalign aligners to be worn?

The ideal amount is 22+ hours per day. Typically, patients remove the aligners to eat, clean their teeth, clean the aligners, and to speak or perform in special situations. They should be worn at all other times, including sleep. It is ideal to reduce the number of times the aligners are removed each day; we have strategies for those who like to snack or sip throughout the day.

Does Invisalign treatment involve anything that is attached to your teeth?

At some point in treatment, most patients are provided with small, tooth-colored attachments that have very specific shapes and are positioned precisely at certain spots on designated teeth. These attachments will correspond to similarly shaped forms in the aligners to allow specific force vectors to be delivered to each tooth to bring about precise patterns of orchestrated tooth movements through space and time. In addition, auxillaries such as bonded buttons or hooks may be used in concert with the aligners to allow the use of other force-generating units, such as elastics.

What if I have a nightguard/biteplate?

Your nightguard/biteplate will not fit your teeth as they begin to move. Therefore, you will be asked to wear the aligners at night. The aligners (which cover the chewing surfaces of the teeth) will serve as a new nightguard/biteplate. Because each set of aligners is typically worn for only two weeks, even vigorous tooth grinders will not wear through the material.

What if I have crowns, bonding, or veneers?

In general, Invisalign is better suited for those patients with significant dental work of this type because these restorations present a more difficult bonding surface than the natural tooth, whereas Invisalign aligners work equally well with restored and unrestored teeth.

What if I have bridges or implants?

If fixed teeth exist, such as implants or ankylosed teeth (teeth that have fused to the bone, usually after trauma), these teeth must be considered in the overall treatment plan whether that treatment involves Invisalign or braces. If, in the final result, these teeth can remain in the present position, they can be extremely helpful “anchors” from which to move other teeth. If these teeth would ideally be repositioned, the decision must be made whether or not to do so. In the case of bridges that need repositioning, the abutment teeth can be moved individually after the pontic(s) are removed. (Pontics are the false teeth that connect the abutment teeth.)

Should I have a dental check-up before Invisalign?

Yes. It is important that dental issues such as decay, gum disease, infection, tartar build-up or any procedure that would necessitate altering the shape of any tooth be completed before your aligners are fabricated. A very intimate fit of the aligners results in the most efficient and effective transfer of orthodontic forces and, therefore, the most ideal orthodontic result. In addition, the dental check-up allows your dentist and orthodontist to collaborate in planning your overall long-term treatment relative to aesthetics, function, and health.

Can I wear the aligners just at night for more weeks and get an ideal result?

No. The orthodontic process is a biologic reaction to the presence of force; therefore, when the stimulus of force is removed, aspects of the biologic (and orthodontic) process begin to reverse. To complicate matters, different teeth will move and revert at different rates. This means that each tooth will shift to a different stage in treatment and no single aligner will fit all of the teeth as well as it should. If this “non-tracking” is caught early on, extremely consistent wear of the best-fitting aligner can recapture the dentition. If the situation has gone too far, rescanning is necessary to create a new treatment plan and set of aligners; this lengthens treatment and, at some point, an additional fee will be charged by Aligntech and the orthodontic office. The best advice is to commit to the recommended level of aligner wear—22+ hours per day. (If this seems unlikely, a viable alternative is to consider the use of clear brackets and enamel-colored wire. The convenience of such a choice includes having no loose parts to misplace and ease of maintenance [the appliance itself is cleaned when brushing the teeth and is not removed and repositioned, necessitating brushing, upon eating]. Once the initial period of adjustment has occurred, this appliance protocol is typically found to be very satisfactory.)

Is Invisalign for adults only?

No. In fact, teenagers often make the best patients. The biologic facts that, compared with adults, teens have more active bone metabolism, more facial growth, and active tooth eruption means that their dentition is quite malleable. This makes the teenager an excellent candidate for Invisalign (except in such cases that Invisalign is not diagnostically recommended). In assessing the appropriateness of Invisalign for a teen, one must consider both the orthodontic situation and the patient’s level of dedication and commitment to achieving treatment goals. Many teens are highly motivated, responsible, and willing. For this type of teen, Invisalign is not only more aesthetic and convenient, it allows for better oral hygiene and less interference with daily activities (e.g. athletics, playing certain musical instruments, eating specific foods) and usually a shorter treatment length. For the peace of mind of parents, in our practice it is made clear to the teen that we are committed and obligated to the best orthodontic result possible. Therefore, if aligner wear is insufficient, the treatment will revert to traditional braces (at no extra cost to the parents). While this type of motivation is not needed for the adult patient, it can be very helpful in solidifying the teen’s commitment to consistent wear and hygiene.

How long does Invisalign treatment take, and am I, or is my child, a good candidate?

In our practice, Invisalign and traditional treatment with brackets and wires require similar treatment lengths; the total time being dependent upon case complexity.  The key to efficient and excellent treatment with Invisalign is the clinical understanding of Invisalign mechanics, which differ greatly from wire and bracket mechanics.  Most patients, adult and teen, can be effectively treated with Invisalign through the incorporation of advanced Invisalign techniques, the proper sequencing of tooth movement, and, when needed, the limited use of traditional orthodontic auxiliaries.  Many cases that would be difficult to treat with Invisalign alone are hampered by the position of one or two teeth and the corresponding corrective movements that are necessitated.  Often, by utilizing traditional techniques to align these teeth in preparation for Invisalign, an experienced orthodontist can transform the case into one that will allow successful and efficient Invisalign treatment.  Orthodontists skilled in both the use of Invisalign and traditional care can effectively integrate the use of auxiliaries and eliminate those failed Invisalign cases that have resulted in the erroneous impression that Invisalign is either ineffective or takes longer than traditional braces.

Certain cases, such as surgical orthodontic therapy with skeletal fixation, are most commonly treated with traditional braces.  However, Invisalign is a superior modality for non-surgical, high-angle, and/or anterior open bite cases.  And, for the majority of presentations, as noted above, traditional treatment or Invisalign may be effectively used.

Suitability of Invisalign for a child is highly dependent upon not only the orthodontic diagnosis but also the expected level of patient participation.  The necessity of consistent wear of the clear plastic aligners over the full length of treatment can make Invisalign inappropriate for some individuals, whether adult or child.  (Experience in orthodontic practices across the country indicates that the percentage of patients that present with insufficient aligner wear is similar in adult and teen populations.)  The likelihood of high compliance will be discussed with your orthodontist to determine if your child is a good candidate.  I often ask the younger patient if he or she is the type of person who always makes the bed, or habitually brushes his or her teeth without being reminded.  If the answer is no, accompanied by a chuckle and knowing glance between parent and child, I remind everyone that our ultimate goal is to have an ideal result, which will necessitate 22+ hours of aligner wear every single day of treatment.  If the desire for the benefits of Invisalign is not sufficient to instill the necessary dedication and commitment, I suggest that the family reconsider their options.  Patients that do not sustain the necessary level of aligner wear can still attain an ideal result, but usually only following a transition into braces.  Such cases take longer and may cost more than if they had been started with fixed appliances (braces).  Thus, even though many teens prove to be some of the best Invisalign patients, it is important to have a frank appraisal of the most likely level of patient participation before entering any treatment.

While the vast majority of adult patients seek out Invisalign over braces, some adults opt for traditional treatment, preferring not to remove and replace aligners.  This is particularly appropriate if the patient is both busy and unconcerned with visible brackets.  We offer crystal clear brackets and tooth-colored wires that greatly reduce the visual impact of traditional treatment.  Lingual braces are yet another option for the adult patient.  These options are available in most orthodontic practices and provide the adult with many acceptable alternatives to metal braces.

Regarding treatment length, there are now technologies (Acceledent, Propel, and Wilckodontics) that enhance the biological processes involved in tooth movement, reducing the time required to achieve an excellent orthodontic result by 25-40%, regardless of modality chosen.  Some of these technologies are easily incorporated, such as Acceledent, and can have the added benefit of reducing the discomfort of orthodontic tooth movement.

In all cases, I recommend that you seek an examination with one or more orthodontists and choose that practitioner who is willing and able to address your questions and concerns.  If Invisalign is your preference, you must use your own judgment regarding the practitioner’s expertise.  As an aid, you may wish to inquire about continuing education; Invisalign is a rapidly evolving modality with many opportunities for advanced training.  Some very competent and busy orthodontists have not yet been able to devote time to Invisalign education and, while excellent practitioners of traditional treatment, are not able to effectively and efficiently utilize the Invisalign system.  As Invisalign becomes more and more prevalent this situation will likely become rare.  For the time being, however, potential patients should educate themselves and be willing to ask questions to determine expertise.

Best wishes on your future treatment, and keep smiling!