Clear Aligners: A Transparent Smile Solution

Andrew Bain
10th Feb 2024

Before I start this blog post, I wish to clarify that this post is not intended as an advertisement or endorsement for any specific product or brand. I am a dentist and I use clear aligners extensively in my daily practice and have been doing so for over 15 years. I, almost exclusively, use the Invisalign® system. Invisalign is what I have the most experience of and therefore I shall be talking about this system in this post. The opinions expressed are solely based on my personal experiences and research, and I am not receiving any financial gains, sponsorships, or incentives from Align Technology, the manufacturers of Invisalign®and iTero scanners. I encourage readers (dentists and patients) to conduct their research and make informed decisions based on their individual preferences and needs.

Internationally us Brits have quite a reputation for ‘wonky teeth’. In the US fixed braces are virtually a rite of passage for every teenager and a full set of military straight, white, teeth seems almost mandatory. Over here, however, we have historically seemed less worried about geometric precision in our mouths. In addition, the rationing of NHS funding for orthodontics means that many teenagers are told they don't need braces only to find their teeth crowding as they enter adulthood. However with the advent of social media and increased awareness and desire for the "perfect smile" this is changing. And filling this need are clear aligner systems with the most recognisable brand being Invisalign®.

Invisalign clear aligner versus Fixed Braces

Revolutionising the field of orthodontics, Invisalign® and other clear aligner systems have emerged as an alternative to traditional metal braces, appealing to a wide range of patients seeking a subtler route to a straighter smile. With custom-fitting aligners which are both removable and very discreet, Invisalign® promises an aesthetic and convenient approach to tooth correction. But like all medical procedures, it comes with its own set of advantages, limitations, and risks. This article aims to delve into the details of this orthodontic solution to help you make an informed decision.

My Experience

I have been using the Invisalign® system for around 15 years now and am rapidly approaching 1000 completed cases. When I did my initial training it was already an established brand with over a million cases having been completed worldwide. I found this particularly reassuring because at the time I had been using a rival clear aligner system that went bust right in the middle of a few of my patients' treatments!

I immediately enjoyed using the system and quickly became confident in the product. I knew that if I chose my cases carefully and planned properly AND the patient played ball by wearing the aligners as directed, we could achieve the results they and I were looking for. Here is one of my early cases:

Before and after invisalign for crowding

Throughout the last decade, clear aligners have become a large part of my everyday dental care. The range of situations I can confidently treat has increased as Invisalign® has refined the system by updates in the plastic, attachments, software and aligner design.

Who is suitable?

As Invisalign® has developed and invested extensively in Research and Development, the range of situations that can be treated has increased. It can successfully treat crowding, spacing, overjets, openbites, crossbites, and overbites.

However, very deep bites can be tricky to improve significantly. Heavily rotated teeth used to be a complete no-go area with clear aligners but now I routinely correct teeth that are significantly rotated.

Like any orthodontic system patients with multiple implants, bridges with uncontrolled decay or periodontal (gum) disease are unsuitable.

I also find that class 3 (underbites) and patients with large spaces are difficult to treat predictably. Similarly, patients with severe skeletal malalignment are unlikely to get a good result with Invisalign and I would generally recommend fixed appliances and possibly even surgery.

The most common scenarios I see are:

1: "I had braces when I was younger but never wore my retainer" or "I had braces when I was a teenager but my orthodontist told me I didn't need to wear my retainer after 6 months"

This is a common scenario, previously many orthodontists advised that patients did not need to wear them long-term. However, this advice has changed. They are a lifelong commitment if you want your teeth to stay put. The British Orthodontic Society's advice on retainers can be found here:

2: "My dentist said I didn't need braces but my wisdom teeth have pushed them and now they are crowded"

This is not true, wisdom teeth do not cause crowding. The erupting force of a tooth is not enough to move an entire row of teeth. The reasons for this "mesial drift" as it is called are relatively complex and numerous theories have been proposed for it over the years. Like most things in life, it is probably due to multiple factors but it seems to me that the most important factor is that as we grind our teeth there is a net forward movement which over time pushes teeth forward.

I now offer aligners to many of my patients for lots of reasons. Patients who want a complete aesthetic makeover who would normally end up with destructive veneers can now be treated by first moving the teeth into a good position so further enhancements can be far less destructive by using composite bonding or extra thin veneers which require little or no drilling of the teeth.

Another situation where Invisalign® can be excellent is in patients who have worn their anterior teeth. Aligners can be used to create space for protective restorations.

It is not just for crowded teeth here is an example of a great result achieved for a patient with large spaces:

Invisalign® used to close spaces

Pros of Invisalign

There are several advantages to choosing Invisalign and other clear aligner systems over fixed wire appliances:

  • Aesthetics: The aligners are nearly invisible, making them a popular choice for adults and teenagers who are self-conscious about the appearance of traditional braces.

  • Comfort: Clear aligners are smooth and generally considered more comfortable than the brackets and wires of braces, which can sometimes irritate the cheeks and gums.

  • Hygiene: Since the aligners are removable, it’s easier to maintain oral hygiene. Patients can brush and floss as normal, reducing the risk of plaque buildup and gum disease.

  • Convenience: With no dietary restrictions, patients can continue to enjoy their favourite foods by simply removing their aligners during meals.

  • Time-Effective: In certain cases, Invisalign can straighten teeth faster than traditional braces. Also, Invisalign often requires fewer dental visits for adjustments.

  • Software and Tech: Invisalign® uses advanced 3D computer-imaging technology called Clincheck to plan the case from the initial position to the final desired position. Recently Invisalign has also introduced image manipulation techniques to see how the result will look. The manipulation is not just a "Photoshop job" they have used AI to incorporate the clincheck results into the patient's photo.

Cons of Invisalign

Like any procedure, there are risks and downsides.

  • Discipline Required: For the treatment to be effective, aligners must be worn for 20–22 hours a day. This level of discipline may be challenging for some.

  • Cost: The cost varies depending on the complexity of the treatment and the number of aligners needed.

  • Potential for Loss: As aligners are removable, they can sometimes be lost or thrown away accidentally. This can increase the cost and length of the treatment.

  • Discomfort: Some patients may experience discomfort or pain as the teeth begin to shift, similar to traditional braces.

  • Attachments: Most cases require attachments. These are small custom-shaped white filling material bonded to several teeth. These can make the aligners more noticeable.

Risks of Invisalign

Likewise, it is essential to consider the potential risks of opting for Invisalign aligners:

  • Relapse: As with any orthodontic treatment, there’s a risk of teeth reverting to their original position. Retainers are necessary post-treatment (FOREVER) to mitigate this risk.

  • Root Resorption: A tiny percentage of patients may experience root resorption, where the root length of the teeth decreases. This is a risk with all orthodontic treatments.

  • Open Bites: There is a risk that teeth at the back may not be in full contact at the end of treatment

  • Allergic Reactions: Though rare, some patients might have an allergic reaction to the clear aligners.

  • Impact on Speech: Some people may notice a slight lisp when they first start wearing the aligners, though this usually diminishes over time.

  • Gum disease/Decay: If patients fail to maintain proper oral hygiene and consume sugary food or drinks while wearing aligners, there is an increased risk of cavities.

Understanding the pros, cons, limitations and risks of Invisalign® can guide you towards making a well-informed decision about whether it's the right choice for your orthodontic treatment. It's vital to consult with a certified orthodontist or dentist to discuss your specific needs and expectations.

Concluding Thoughts

Invisalign® and other aligner systems are a great option for many people over 10 million people worldwide have had it! However, like any dental or medical treatment diagnosis and case selection is vital to get the best result.

I love using it and have had some very happy patients over the years. It is a commitment as wearing it 22 hours a day can be harder than you think but it is worth it. Your oral hygiene must be immaculate during treatment as plaque will build up more readily with plastic in your mouth 22 hours a day. It is also vital to remember that the retainers afterwards are for life, otherwise you'll be back for more aligners!

If you want to book a consultation with me or have any questions about Invisalign try the chatbot on your right.

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