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Invisalign and Clear Aligner Alternatives: Fact and Fiction

by Keith B. Wong, DDS, MS

Advertisements for orthodontic aligners, including Invisalign and its alternatives, are confusing in several respects.  One important source of confusion is the distinction that aligner companies, such as Aligntech, the maker of Invisalign aligners, and others, attempt to draw between their “product” and the aligner of another company.  

To resolve this confusion, there is one critical fact to know and understand:  While aligners and aligner companies differ in their utility as an orthodontic tool, no aligner company, whether Aligntech (maker of Invisalign) or the maker of any Invisalign aligner competitor, offers anything approaching orthodontic treatment.  Aligners are not a product but a tool for use by an orthodontist, which is a dental specialist solely focused on the complex task of teeth movement and alignment.

What are Clear Aligners?

Orthodontic aligners are clear plastic trays that fit closely over the teeth.  The aligners themselves, whether Invisalign or an Invisalign alternative, are orthodontic appliances, like braces, that are tools in the hands of orthodontists, not a stand-alone treatment.  

The important factors in choosing orthodontic treatment are the skill and experience of the orthodontist (a specialist in orthodontics), who creates and executes your treatment plan, and the interface and dashboard of the aligner company’s software through which that specialist exercises control over the treatment design and outcome.

Invisalign Aligners versus Competitors:  What to Know

An Invisalign aligner, as is true for all clear aligners, acts as an orthodontic appliance for use by an orthodontist.  The differences across aligner brands are limited to variations in the aligner material and the sophistication of the company’s dashboard used by the orthodontist to specify the treatment that he or she has planned for the patient and the consequent ability of that company’s software to translate those instructions into the aligners to be worn by the patient. 

As stated above, what is important is not the aligner brand, per se, but the skill and experience of the orthodontist who controls your treatment plan and outcome and the sophistication of the aligner company’s orthodontist dashboard.  However, there is a reason that Invisalign is used by the vast majority of orthodontists.

What is Invisalign:  Is it the Best Aligner Option?

Invisalign, the most heavily marketed and well-known aligner brand, is not an orthodontic treatment; it is a clear aligner by Aligntech, the company that introduced the aligner-style orthodontic appliance to the market and has developed a sophisticated dashboard that enables the orthodontist to manipulate the creation of aligners and add vital attachments and modifications to craft very detailed treatment plans that result in the fabrication of corresponding and properly sequenced aligner forms.  

The sophistication of the Aligntec/Invisalign orthodontist dashboard for customization makes Invisalign brand aligners an extremely useful and effective tool for the orthodontic specialist and explains why Invisalign aligners continue to be used as a treatment appliance by a vast majority of orthodontists.  However, it is no longer the only aligner option for orthodontists.

Invisalign Competitors: Clearing up Confusion.

Aligntech’s Invisalign patent has expired, leading other companies to enter the aligner market as Invisalign alternatives while also falsely claiming to be or implying that they offer stand-alone treatments.

Pro Tip: Invisalign, while a great tool for use by orthodontists, allowing full customization, has created the impression of a stand-alone treatment through its marketing, leading consumers, and even advertising companies, to believe that the practitioner is unimportant and an orthodontic specialist is not necessary, both of which are false.

As a consequence of the Aligntec/Invisalign direct marketing efforts, other aligner companies have attempted to piggyback on the resulting misperceptions, for example, Smile Direct, through misleading claims and promises. 

It is the orthodontist’s skill in using the supplier’s aligners, whether Invisalign or any other, to design and execute treatments that is critical when choosing a practitioner.  Invisalign remains the leading aligner tool for orthodontists because its dashboard (online control panel) is the most sophisticated, facilitating the most efficient and effective customization of treatment plans and outcomes.

Limitations of Invisalign and other Clear Aligners:  Not a Treatment but a Tool

While clear aligners such as the Invisalign appliance are a great tool, they have several limitations.

  1. The software employed by Aligntech for use with Invisalign aligners, as well as the software of any other clear aligner company, cannot discern differences in facial structure, predict likely facial changes, nor determine the correct sequencing of or risks associated with tooth movements.

  2. Invisalign software is limited to rudimentary treatment planning that is not biologically sufficient except in a very limited number of cases that require unusually minimal movement.

  3. Unfortunately, determining which cases truly fall into the category of minimal, simple movement is not a capability of software, nor is it evident to the untrained eye, including that of general dentists.

  4. An orthodontist must use the aligner company’s dashboard to input the correct treatment plan from the first to last aligner, and he or she must do so more than once; first, when initiating the process after a thorough examination of the patient and, second, after receiving the returned aligner plan from the company (called a ClinCheck by Invisalign) when the orthodontist must make further refinements.  A third round may also be employed to create final, detailing aligners.

  5. Additional limitations of clear aligners, whether Invisalign or another, include the types of movements for which they are suited and the incremental nature of aligner tooth movement.
     
  6. Aligners are not mechanically suited for certain types of movements and may require supplementation with additional treatment appliances.

Pro tip: Simple-looking cases are not, by and large, simple in execution and must be evaluated by a trained and experienced orthodontist for accurate diagnosis, skillful treatment planning, and effective execution.

As noted above, the orthodontist interface of the Invisalign system is currently the most sophisticated of the aligner brands, allowing the orthodontist to customize the treatment plan for each patient’s idiosyncratic presentation—facial bones and the relative positions of those bones; tooth and root shape; soft tissues of the face; gum health; likely facial changes over time; the specific tooth and hard tissue movements that must be made—to arrive at the most effective treatment and outcome for health and appearance.

The appropriateness of orthodontic treatment with aligners of any type will be assessed by the orthodontist during an initial examination at which will be presented a case diagnosis and the recommended treatment methods.  An orthodontist will have extensive knowledge of the necessary tools to use for the patient’s particular case and will be capable of addressing a wide range of presentations.

Can Invisalign or its Alternative Clear Aligners Replace an Orthodontist?

The short answer is an emphatic no

Aligner company software programs, including that of Aligntech for Invisalign, are unable to diagnose, treatment plan, or execute comprehensive, orthodontically stable treatments.  Intimations otherwise are myths perpetuated by those companies to gain unwitting “customers” for their falsely advertised “product.” 

The Invisalign appliance, or any clear aligner alternative, is not a product to be purchased off of the internet.  It is a tool in the hands of a skilled orthodontist. 

The Invisalign brand of aligner currently gives the orthodontic specialist the greatest ability to customize and optimize treatment, as noted above, through its well-developed dashboard.

What is an Orthodontist?  Are Orthodontists Best for Invisalign Treatment?

An orthodontist is a dental specialist who exclusively focuses upon the movement of teeth within the bone. 

He or she must first complete four years of dental school followed by two to three years of post-doctoral education and residency in orthodontics to practice in the specialty. 

Only a doctor who has completed this additional, comprehensive training and residency may legally be called “orthodontist.”  Just as a cardiac surgeon must complete a rigorous residency to practice in his or her specialty, so must an orthodontist.  Each is acting invasively on the human body with all its attendant biological complexity and idiosyncrasy. 

To qualify for post-doctorate education and residency in orthodontics, a student must first graduate near the very top of his or her dental school class and compete with other such students for placement in a limited number of post-doctoral orthodontic programs.

How do Orthodontists differ from General Dentists for Invisalign?

An orthodontist differs from a general/aesthetic dentist in several respects that are crucial to the planning and execution of an Invisalign treatment.

  1. The field of orthodontics requires spatial and mechanical reasoning that is applied within a dynamic biological system of continual growth and change throughout life, which is distinct from the skill set employed by general dentists.

  2. General dentists are trained to diagnose and treat diseases of and damage to static teeth and gums, which, although very important, is neither the correct nor applicable set of skills or knowledge for the practice of orthodontics.

  3. The specialized skills and knowledge of an orthodontist are attained, not in dental school, but in orthodontic post-doctorate residencies and their accompanying post-doctorate Master’s degree programs, and these skills are honed through continual experience in specialized practice.

What Orthodontists Understand and Do that General Dentists Do Not

  1. Orthodontists understand dynamic tooth movement and the likely consequences of that movement for the stability of the bite and teeth, as well as facial appearance, throughout the remainder of the patient’s life.

  2. Orthodontists are versed in proper orthodontic diagnosis and treatment pathways for a vast array of presentations and idiosyncratic conditions and considerations, including the size, shape, health of, and relationship between the teeth, gums, facial bones, and soft tissue for each individual.

  3. Orthodontists understand when teeth can and should not be moved and anticipate the impact of that movement on facial growth and aging patterns, as well as the resulting change in the soft tissue and appearance of the face.

  4. Orthodontists are able to execute complex movements and, when advisable, coordinate treatment with other specialists, including oral surgeons, periodontists, and prosthodontists.

  5. Orthodontists have acquired, through a comprehensive and rigorous two-to-three-year post-doctoral (after dental school) education and subsequent experience, the vast amount of specialized knowledge and skill that is required to successfully treat patients.

  6. The required two to three-year post-doctorate (beyond dental school) orthodontic training of an orthodontist is comprehensive and rigorous because of the extent of knowledge and skill required to successfully treat patients.

  7. An experienced and highly skilled orthodontist addresses cases across the spectrum of complexity in a manner that results in a healthy, stable smile that is complementary to the face, both now and over time.

  8. When Invisalign aligners are the desired appliance, an orthodontist can and will discern how and when they should be used, understand what sequence of movements must be made to achieve the correct occlusion for health and appearance, and will also know how to plan the treatment with proper sequencing, specify attachments to modify force, and make in-house modifications of the aligners to achieve a stable and pleasing result for both the face and the teeth.

  9. An orthodontist has access to a wide variety of tools to compensate for the limitations of aligners and may have appliance options that are not only better suited for the patient’s treatment goals but may also be preferred by the patient.

Conclusion:  Invisalign versus Clear Aligners:  Fact and Fiction

Invisalign is an aligner brand developed and marketed to the public by Aligntech, which formerly held a patent on the only aligner-type orthodontic appliance.  Since the expiration of that patent, several companies have emerged as competitors to Invisalign aligners.  What is crucial to understand as a potential orthodontic patient, however, is that all aligners, including Invisalign aligners, are orthodontic appliances or intraoral tools for use by orthodontic specialists, not stand-alone products to be used at home or by a non-specialist (general dentist).  No aligner company possesses software that can diagnose, correctly treatment plan, or execute comprehensive orthodontic treatment except in exceptionally minimal applications that are not discernable by any software and are not apparent to the untrained eye, including that of general dentists.  What appears simple is often deceptively complicated.  That is why orthodontists must spend two to three years in post-doctoral studies (after graduation from dental school) and residency to train in the specialty and are the only persons who may legally use the term orthodontist.

Clear aligner companies that have emerged as competitors to Invisalign have ridden the coattails of Invisalign’s multiyear direct marketing effort that effectively but erroneously led the public to believe that aligners are a treatment rather than a tool.  No claims of this nature are accurate.

What is important when considering orthodontic treatment with clear aligners, whether Invisalign or another, is the skill and experience of the orthodontist who will create and execute your personal treatment plan.   Invisalign continues to be the tool of choice amongst clear aligners for orthodontists because of the detailed and controlled treatment that the orthodontist can design through its well-developed dashboard interface that allows full customization.

Orthodontists are distinct from general dentists, both in training and in skill set.  Orthodontists are specialists who are trained to properly diagnose and treat malocclusion, crooked teeth, misaligned jaws, and facial imbalances involving the teeth and their positions within the bones and resulting effects upon surrounding soft tissues of the face, all while considering the growth and change of the face over time, including throughout adulthood.

Orthodontic treatment is an invasive procedure that requires years of additional residency and education beyond the dental school requirements of a general/aesthetic dentist due to its complexity and the importance of its proper execution to the long-term stability of the teeth and appearance of the face.

Orthodontists can accurately determine if Invisalign or any clear aligner treatment is appropriate for your case and will know what should and should not be done, including what alternative appliances may be more effective and efficient for your treatment.

Orthodontists create highly customized treatment plans to be executed using clear aligners/Invisalign.  The resulting aligners are produced according to their exact specifications for the most stable and pleasing result.

Would you like to Explore Aligner/Invisalign Treatment?

Orthodontic examinations are typically free of charge.  I encourage you to seek more than one examination from among the orthodontists in your area before committing to treatment.  You should expect a thorough examination of your teeth, bite, and face, and a preliminary diagnosis with recommendations for treatment.  Seeking multiple opinions from orthodontists will aid you in discerning the most appropriate practitioner for you or your child.  Note that ongoing orthodontic appointments are now scheduled up to sixteen weeks apart, making proximity to the orthodontist’s office less important than in the past.

If you reside in the Seattle area and would like to schedule an examination with me, use the buttons below to contact my practice or access its online scheduler.  I would be happy to conduct a comprehensive examination on your behalf.

Author:

Keith B. Wong, DDS, MS, is a VIP Diamond Plus level Invisalign Seattle orthodontist who treats adults and children with Invisalign aligners, digital precision braces, and Brava lingual independent tooth-movers.  Dr. Wong also offers remote care for his Seattle-area-based and worldwide patients.
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