If considering orthodontic treatment using Invisalign clear aligners, there are ten important facts that will assist you when making a treatment decision. These facts fall into three categories; (1) the orthodontist’s role in successful Invisalign aligner treatment, (2) your or your child’s role in successful Invisalign aligner treatment, and (3) the alternative “invisible” appliance to Invisalign aligners, including its advantages and limitations.
1. Invisalign is a powerful and effective tool for orthodontists, not a technological orthodontic treatment.
What does this mean and why is it so important?
Invisalign’s technological aspect is found in the dashboard available to orthodontists (specialists who have completed post-doctoral orthodontic degrees and residencies) that allows them to create comprehensive, custom treatment plans for their patients using their own directions and inputs through that dashboard. It is from these custom treatment plans that the clear aligners are produced. What are clear aligners? Aligners are transparent, plastic trays that completely cover the upper and lower teeth, moving them in incremental steps toward the final bite (occlusion).
2. Invisalign software does not replace or replicate the comprehensive treatment plan of an orthodontist.
An orthodontist plans the Invisalign treatment from the first to the last movement while considering a multitude of factors not “recognized” by Invisalign photographic scanning. These include, but are not limited to:
- facial structure, including relative positions of the upper and lower jaws (maxilla and mandible)
- relationship of the facial bones and soft tissue and the effect of treatment on facial appearance
- relative size of teeth to bones
- current position of the teeth in the bones
- inherited facial form and the corresponding changes likely with aging, whether for a growing child or an adult
- periodontal (gum and bone) health and the likely safety and stability of tooth movements
- actions necessary, including involvement of other specialists, to bring the teeth together into a stable occlusion/bite while enhancing facial appearance.
After considering the above, an orthodontist specifies the sequencing of tooth movements; the location and timing of attachments, which are placed on the teeth and engaged by the plastic aligner to direct force; and the specific movements to be made to place the teeth in the correct position for intermediate work by another practitioner or for the final occlusion.
3. Invisalign/aligner treatment may require coordinated work with other specialists.
Orthodontists providing Invisalign will discern the need for other specialists and will coordinate treatment with them and your general dentist to effect a safe and healthy orthodontic journey and successful arrival at the most stable and attractive destination for your or your child’s smile and face.
4. Treatment plans using Invisalign aligners that do not address skeletal imbalances fail.
Skeletal imbalances are one of the principal causes of crowded or spaced teeth. An orthodontist is trained to both discern those imbalances and plan treatments to correct the imbalance through growth guidance for children or collaboration with an oral surgeon or periodontist for adults. If these options are ruled out, either physically or by your choice, the orthodontist will compensate for the skeletal imbalance with non-intuitive, complex adjustment to the dentition, which requires awareness of the most stable occlusion possible, given the imbalance, and the impact of treatment on facial aesthetics. The expertise acquired through the specialized schooling and experience of an orthodontist is required.
5. Invisalign aligners do not move the roots of teeth well, especially molars.
Root movements with Invisalign present complex challenges for the orthodontist that must be addressed through comprehensive planning, or the treatment will fail. General dentists offering Invisalign most often use Invisalign Go, which intentionally prevents the practitioner from attempting to move molars due to the potential for poor outcomes due to lack of knowledge and experience, which is wise. The ability to safely and effectively move roots is a requirement for successful treatment, however, and falls under an orthodontist’s purview.
6. Invisalign aligners require a high level of consistent wear.
Orthodontic tooth movement is a physiological response. Six hours of force are required to begin tooth movement, with only two hours of removal of that force resulting in regression. Interestingly and importantly, this regression does not mirror the original movement but leaves teeth in a new position, causing the current aligner to no longer fit or work properly.
Also, Invisalign aligners must fit every tooth throughout treatment very intimately to avoid failure of tooth movement sequencing.
To both prevent regression and keep aligners married to the teeth, aligners must be worn at all times except during meals when they are removed for eating. After eating, the teeth are cleaned before the aligner is reinserted. This becomes routine for most, with the side benefit of weight loss for those who consequently cut down on between-meal snacks. 😊
For some patients, the daily care and use of aligners such as Invisalign is an inconvenience. If you think that might be true for you or your child, alternative, advanced orthodontic treatment tools, such as the invisible Brava appliance, which is attached to the back of the teeth, or braces with clear or tooth-color, custom-fit brackets, might be better options, particularly given their advantages in treatment efficiency and root movement.
Note that “clear braces” are not clear aligners. Clear braces are clear brackets applied to the front of the teeth that are engaged by an archwire running through those brackets. The composition and tension of the wire exert a constant force that moves the teeth in a sweeping, rather than incremental, fashion. Clear braces are an example of a fixed appliance, which is not removed by the patient during treatment. Another fixed appliance is Brava, explored in fact #10, which is invisible to others.
7. During aligner treatment, regular monitoring and periodic intervention by the orthodontist are required for success.
Because teeth movement is a physiological process, all orthodontic methods require monitoring for potential adjustment due to the organic, non-linear nature of treatment. If the orthodontist uses remote dental monitoring, as in my practice, you will simply be asked to submit periodic photographic scans of your teeth using your phone and will be prompted for an office visit when necessary. Remote monitoring can significantly reduce the number of onsite appointments you must attend. If your practitioner does not offer remote monitoring or if you are inconsistent in its use, you will need to schedule and keep regular in-office appointments. Skipping self-scanning or scheduled appointments will lengthen treatment time and compromise your treatment result. To have the result you desire, aligners must be worn, and monitoring of some type must occur regularly.
8. Each Invisalign aligner has only a small range of motion.
Because of the small range of motion initiated by each aligner, significant movements take more time than when using fixed appliances, such as braces or the lingual (tongue-side) Brava, which generate more force and have larger, sweeping ranges of motion and correction. Invisalign aligners do work, however! Unless contraindicated, treatment with Invisalign will be effective given thorough treatment planning by the orthodontist and consistent wear on your or your child’s part.
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9. Combination-appliance treatment can hasten and improve outcomes.
Due to the limitations of aligners in tooth movement, many orthodontic cases would finish more quickly and ideally if Invisalign aligners were used in conjunction with other orthodontic tools, such as limited braces on a few teeth for a short time, or if another appliance were used throughout. As noted above, fixed appliances such as precision braces using LightForce brackets or the lingual Brava appliance can exert more force over a longer range of movement than incremental, plastic aligners, allowing the orthodontist to move teeth more efficiently when needed or when desired by the patient.
10. Invisalign is not the only “invisible” orthodontic appliance available: Invisalign versus Brava.
Invisalign is a powerful tool in the hands of an experienced orthodontist, who can treat you or your child discretely using clear aligners and tooth-colored attachments that are engaged by the aligners to exert force in specific directions. Treatment is well tolerated by patients and is a welcome alternative to traditional, wire-and-bracket braces for those who don’t want their orthodontics to be readily noticed. In my practice, the majority of patients seek Invisalign, and I complete hundreds of cases per year using this innovative tool.
There are, however, other options for invisible orthodontic treatment, such as the Brava fixed appliance, a fully discrete tool that is attached to the back of the teeth, completely unseen by onlookers. Like braces and Invisalign, the orthodontist directs all tooth movements when using the Brava appliance.
Advantages of the Brava appliance:
- Convenience: Some patients find the need to handle and clean aligners at every meal more a “hassle” than convenience. A fixed appliance, such as Brava (or braces), eliminates these extra steps, requiring only a moderate addition to typical oral hygiene practices. Moreover, since the Brava appliance has individual arms attached to each tooth, flossing between teeth requires no threading; flossing is fully accessible with the appliance in place.
- Attachment-Free Smile: The Brava appliance functions completely from behind the teeth. Unlike Invisalign or braces, there are no attachments on the front of the teeth.
- Plastic Free: The Brava appliance itself is plastic free with only a final, finishing plastic aligner used for detailing at the end of treatment.
- Speed: The Brava fixed appliance, like braces, is able to move teeth in a sweeping, continuous motion that shortens treatment length compared to aligners. In addition, the Brava appliance, unlike braces or aligners such as Invisalign, moves each tooth independently, making it the fastest orthodontic treatment appliance to date.
Brava’s Disadvantage:
It takes a varying amount of time for the patient to become accustomed to the Brava appliance behind the teeth. The tongue will be irritated after treatment begins but for a relatively brief time. The irritation fades over a one-to-three-week period. Tolerance to the appliance is high and results are fast.
Conclusion
Not a technology-driven treatment, Invisalign is a tool requiring the specialized knowledge and training of an orthodontic specialist for proper use and a successful treatment for anything other than the simplest alignments in an already-stable and balanced bite.
Successful aligner/Invisalign treatment also requires the ongoing participation of the patient in aligner wear, hygiene, and monitoring, whether remote or on site.
Alternatives to Invisalign, such as treatment with the invisible Brava appliance or traditional braces, may be recommended or preferred for convenience or speed.
Your orthodontist will thoroughly examine your or your child’s face, teeth, and bone structure before recommending treatment modalities for your consideration.
If you should have further questions about Invisalign, Brava, or braces, or wish to schedule a complimentary examination in my Seattle office, please feel free to use the buttons below.