Introduction
Embarking on the journey to a straighter, more beautiful smile with Invisalign aligners is an exciting step toward improved oral health and self-confidence; however, achieving the best possible outcome requires more than simply slipping on those aligners.
This comprehensive guide will explore the key factors that can make or break the success of treatment with Invisalign. From understanding the physiological processes of tooth movement to the importance of precision and real-time monitoring, this article will equip you with the knowledge needed to ensure you receive the most out of your aligner treatment.
Orthodontic Tooth Movement is a Physiologic Process
To fully appreciate the art and science of orthodontic treatment with Invisalign aligners and your role in the process, it’s necessary to keep in mind that tooth movement is a physiological process. Teeth can be gently nudged into new positions over time; however, doing so requires sustained, specifically oriented, light force, directed to bring about a complex of precise movements for each tooth (e.g., crown tipping, rotation, root torque).
Movement is initiated by a biochemical response occurring when and where the tooth root is compressed against the supporting bone. This initial biochemical process takes approximately six hours to reach the stage of physical tooth movement.
If the force is reduced for as little as two hours by, for example, the removal of an aligner, the six-hour process will revert.
Unfortunately, this reversion does not mirror the original movement. If reversion is allowed to occur, the aligner will no longer “seat” properly on the teeth, which is necessary to bring about the required tooth movements. When aligners are replaced, the orthodontic progress will no longer continue in the needed trajectory.
Pro Tip: To prevent teeth reversion and the resulting ill-fitting, ineffective aligners, our patients are advised to wear their aligners at all times except when eating, after which the aligners are to be reinserted. This is necessary to keep tooth movement on track.
How Invisalign Works and Your Role
Invisalign Aligners Induce Physiologic Tooth Movement via Forces Produced by Stretched Aligners
Invisalign aligners deliver specific forces to teeth by creating strain in the aligner resulting from the difference in position between the active aligner and the teeth. Patients feel tightness when fully seating the active aligners onto the teeth. This tightness arises from precisely prescribed directions of force on specific points of particular teeth or attachments (small tooth-colored shapes bonded to teeth).
Invisalign Aligners Must Fit the Tooth Extremely Well
For Invisalign to work effectively, the aligners must fit snugly around your teeth. The clear, removable aligners transmit precise directional forces to your body. If they do not fit properly, these forces are ineffective, resulting in a less successful treatment outcome.
Aligner fit is of paramount importance. As you progress through the aligner sequence, the teeth must remain seated in the aligner to allow the necessary physiological process of bone remodeling to take place.
The number of days a set of aligners will be worn will vary depending upon several factors, including which tooth is being moved (small front teeth versus large-rooted back teeth), what type of movement is being induced (crown versus root movements), and how many hours a day the aligners are worn.
Consistent wear of twenty-two hours per day is needed to maintain proper aligner fit and function.
Clear Aligners that Do Not Fit Properly Will Extend Treatment Length and May Result in an Unhealthy Bite
Suppose that an aligner is changed to the next in the sequence before all teeth have successfully moved to the positions anticipated for that next aligner. In that case, the new aligner will progressively lose grip on the slowest-moving teeth, necessitating the cessation of treatment, rescanning of the teeth, and a new treatment plan in order to recapture the teeth so that effective tooth movement can resume. This will delay treatment for one or more months and add to treatment costs.
Most importantly, if tooth movements are not completed according to the prescribed treatment plan, occlusion/bite or TMJ problems may develop in the future.
Invisalign Aligner Auxillaries Can Improve Clear Aligner Fit
Many orthodontists offer auxiliaries designed to help patients seat the aligners onto their teeth more fully (often at no cost).
One common type is the “chewie,” which is shaped like a cotton roll but is more rubbery in texture. Patients insert their aligners and then bite on the “chewies” to get the aligners fully onto the teeth to increase the stretch of the aligner plastic and, thus, increase the activation of orthodontic forces.
Another extremely effective option is the Vpro appliance. This device is motorized and vibrates while biting down on the inserted aligners for five minutes. The vibratory motion seats the aligners exceptionally well, allowing aligners to be changed at an accelerated rate (aligners changes can be routinely reduced from every seven days to every 3-4 days). Another positive effect of Vpro use is that orthodontic soreness is virtually eliminated. However, there is a financial cost associated with the Vpro, which varies from office to office.
Related The Ten Most Important Facts about Invisalign: What to know before seeking treatment.
Monitoring the Fit of Your Clear Aligners in Real-Time: The Difference Between Failure and Success
Real-time monitoring is essential to ensure your aligners maintain their optimum fit throughout your treatment.
Your teeth continually shift, but they must assume specific spatial positions within the aligners to ensure the treatment stays on track. Regular check-ins with your orthodontist will help ensure that your aligners remain in sync with your body’s ability to respond.
Many orthodontists offer remote virtual check-ins to maximize treatment effectiveness and increase patient convenience. My own practice offers complementary remote monitoring through a digital remote platform that utilizes pixel-level, photographic inspection of aligner fit, allowing us to review and monitor your progress. You are alerted if in-office visits are warranted and can move through treatment with confidence in your aligner efficacy. Additionally, you are able to directly message the practice through the application regarding questions, feedback, or updates specific to your situation.
For those who are diligent in aligner wear, treatment can often be accomplished even if overseas, with a minimum of in-person visits. (The advisability of this approach will depend upon the details of treatment and the need for intervention by other specialists, such as periodontists, prosthodontists, and oral surgeons, or the use of appliances in addition to Invisalign aligners for efficiency and efficacy.)
The Importance of Choosing an Orthodontist for Invisalign Aligner Treatment
Comprehensive Understanding of the Biomechanics of Tooth Movement: Not Just a Path Between Initial and Final Positions
One of the fundamental principles of successful treatment with Invisalign aligners is that the prescribed tooth movement must reflect a thorough understanding of the biomechanics of teeth within the bone. This goes beyond simply plotting a path from initial tooth positions to your ideal outcome. Understanding the intricate mechanics involved in tooth movement allows orthodontists to create treatment plans that work with your body’s natural processes to accomplish complex, non-intuitive movements that are difficult to achieve from a biological viewpoint.
With respect to Invisalign, complex tooth movements (e.g., an upper front tooth is to move downward and to the right with a thirty-degree rotation, with the root moving 2 mm more than the crown) will greatly increase the probability of losing grip with the aligner because 1) the movement requires multiple force vectors that create multiple ways that the aligner must stretch over that tooth and its attachments, and 2) the compound movements are more difficult for the body to accomplish (more bone remodeling is required on more surfaces of the root).
An experienced orthodontist overrides the initial default plan of a software program, which is predictably fraught with undesired tooth movements and sequencing, to break down movements into sequenced components that reliably and safely lead to the desired change and a successful and healthy result.
Consideration of Physiological Limitations when Planning for Future Dental Health
Successful treatment with Invisalign aligners isn’t just achieving a beautiful smile; it includes the long-term stability and functionality of your bite.
A well-thought-out orthodontic treatment plan must consider the limitations of your body’s physiology, the most stable position given that physiology, and how treatment will affect your future oral health. This holistic approach ensures that you achieve the desired aesthetics and maintain healthy teeth and gums.
Invisalign’s scanning software does not account for the status, volume, type, or health of a patient’s gum tissue or supporting bone. Nor does it register relative relationships of bones in the face or to the surrounding soft tissue. Because of this deficit, baseline treatment plans routinely result in final tooth positions that would cause short- and long-term damage to these tissues if they were to be carried out on a patient.
To protect the patient’s oral health, a specialist in orthodontics must specify the course of treatment and the final occlusion/bite. This is one of the most compelling reasons to seek clear aligner treatment with an experienced orthodontist. Incidentally, according to Invisalign’s parent company, Aligntech, 93% of treatments by general dentists are attempted using unmodified initial treatment plans.
When seeking Invisalign treatment, selecting the right healthcare provider is crucial. While general dentists may offer Invisalign, it is advisable to consult with an orthodontist who specializes in the science of tooth movement. Orthodontists are trained to understand the complex mechanics of tooth alignment and can provide the expertise needed for a successful outcome.
Employment of Real-Time Monitoring and Individualized Modifications
To ensure the highest probability of success, choose an orthodontist who offers resources for real-time progress monitoring. This includes regular virtual check-ups and the flexibility to modify your treatment plan as needed. Your orthodontist should be attentive to your unique needs and adapt the treatment accordingly.
Specification of Comprehensive, Individualized Orthodontic Treatment Plans
A key differentiator between successful and unsuccessful treatment with Invisalign aligners is the quality of the treatment plan. Your treatment plan must be customized to your specific needs given your facial structure, tooth shape, periodontal health, and anticipated changes through growth or aging. Default plans generated by software do not account for the intricacies involved in your tooth movement or the nuances of your physiology.
Orthodontists create a personalized plan that addresses critical aspects and complex movements that are necessary to prevent lengthy and failed treatments. In many cases, the result of “failed” aligner treatments is not limited to incomplete alignment of teeth but includes tooth pain, tooth damage, root canal, bone loss, tooth loss, and TMJ issues.
Finally, A Healthy, Functional, Aesthetically Pleasing Result
Ultimately, the goal of Invisalign treatment is to finish with a smile that is aesthetically pleasing but also healthy and functional. Your orthodontist’s expertise in understanding tooth movement mechanics, monitoring progress, and making real-time adjustments will contribute to a successful outcome that exceeds your expectations of tooth straightening.
Conclusion
Treatment with Invisalign aligners can be a transformative journey toward a better smile. Still, its success hinges on a thorough understanding of the physiological processes involved in tooth movement and the importance of precise biomechanical treatment design.
Pro Tip: To maximize the probability of achieving the desired outcome for yourself or your child, I recommend consulting an orthodontist who offers real-time monitoring and individualized, comprehensive treatment plans. Most orthodontists offer complimentary initial examinations; therefore, it’s advisable to seek a consultation with one or more recommended specialists in your area before embarking on treatment. With the right guidance and care, you can confidently look forward to a healthier, more beautiful smile.
If you would like to learn more about treatment with Invisalign aligners, see my blog posts, The Ten Most Important Facts about Invisalign: What to Know Before Seeking Treatment, and The Updated Seattle Insider’s Guide to Invisalign Treatment.
If you’re ready to explore treatment, I would be happy to work with you. Contact my Seattle office, Dr. Keith B. Wong, DDS, MS, Specialist in Orthodontics, or use the buttons below to schedule a complimentary examination or begin a virtual consultation.