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Bellevue Orthodontics Guide to Invisalign
and Clear Aligners

What are Clear Aligners and how are they different than Invisalign?

Clear Aligners are a series of clear thermoformed clear “plastic” retainers to move teeth custom made for each patient.  Like “Kleenex” there are many type of tissue but many people call all tissues “Kleenex”.  Invisalign is by far the best known Clear Aligner system, but today it is nor necessary the best appliance choice for an individual patient.  Invisalign is the best branded Clear aligner system but there are many systems that are better clinical choices in many aspects.  There are literally hundreds of different Clear Aligner systems of varying quality worldwide.  A few of the common systems you can find in North America are listed below:

ClearCorrect
Movement Aligners
Invisalign
Suresmile
Clarity Aligners
SDC (Smile Direct Club)
Candid Co
BYTE
SmileLove
SnapCorrect

Do Clear Aligners like Invisalign work?

Yes, but the answer is complicated.  Clear aligner systems like Invisalign are not appropriate for all types of orthodontic problems.  All custom appliances like Clear Aligners (of which Invisalign is one type) are products that are innovative and technically sophisticated with the ability to provide relatively aesthetic orthodontic treatment.  This innovative technology is not unlike the iphone in the sense that “Invisalign” the first popular Clear Aligner system changed the way orthodontists practice orthodontics and improved treatment options for millions of patient worldwide. In reality, Clear Aligners are technically advanced orthodontic appliances that are dependent upon the experience and judgment of the orthodontist.  Unfortunately, many Clear aligner system, including Invisalign are marketed directly to the public and some system employ the “direct to patient care” model where aligners are sold to patient without the supervision of an orthodontist or even a dentist.  These direct to patient clear aligner systems have great potential for harm if applied with the wrong plan or to the wrong patient.   All Clear Aligner system are fabricated using a “Treatment Setup” which digitally reposition the teeth.  This “Setup” model of the patient repositioned teeth (straight teeth) is then used to fabricated the Clear aligner system by “staging” the tooth movements from the original crooked tooth model to the straight tooth model in small increments.  At each small change in tooth position a new model the the patient teeth is 3D printed and a thermoform retainer is fabricated.  This process results in the creation of a series of Clear Aligners where each new aligner is sequentially straighter than the aligner before it. The Setup model that the series of Clear Aligner are design to move the teeth in the real world considers only position of the dentition without reference to bone and soft tissue status, factors which greatly impact treatment planning and the sequencing of tooth movement. In addition, the mechanics of the Invisalign system, i.e. the capacity for, and application of force, are different than traditional braces. Therefore, to effectively utilize Invisalign, the practitioner, whether orthodontist or general/aesthetic dentist, must make a significant educational investment in the use of this powerful orthodontic tool. 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.  The fact that the question remains, “Does Invisalign work?” points to the problem that many practitioners have using these appliances and the fact that they are frequently abused by companies trying to sell them directly to patients.

Does Invisalign only work in all orthodontic cases?

Invisalign aligners are one of several tools that an orthodontist may use to move teeth, as are traditional braces and braces behind the teeth, with each of these tools have an 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 place either on the front of the teeth or even placed behind the teeth if the patient wants an aesthetic solution.  By integrating modalities, experienced orthodontists are able to treat a wide variety of cases with Invisalign and achieve ideal results.

Why use Clear Aligners like Invisalign?

Invisalign aligners are very thin, clear, removable, and intimately approximated to the teeth; they are relatively “aesthetic” compared to traditional braces on the outside of the teeth.  The most aesthetic orthodontic appliance is certainly lingual braces (braces placed behind the teeth).  Clear aligners can be less costly, than lingual braces (braces on the inner aspect of the teeth) and can be taken off for eating.

Are there advantages associated with Clear Aligners like Invisalign?

Obviously aesthetics is a big reason orthodontists and patient choose to use Clear Aligners like Invisalign.  But appliances like Invisalign are not the moth aesthetic orthodontic appliance, Braces placed behind the teeth are absolutely invisible unlike Clear Aligner systems like Invisalign.  Clear Aligner Like Invisalign presents many clinical advantages, such as 1) when enhanced control of teeth is required— all custom orthodontic appliances like Clear Aligners (Invisalign being on type of Clear Aligner) are quite effective in creating space of exact size, e.g. where precise widths are needed for post-orthodontic restorative work with your dentist; 2) Patient with many restored teeth, sometime it is harder to keep traditional braces on the teeth (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: Clear Aligners might be able to accomplish these movement with less stress on the teeth.

Does Invisalign cost more than braces?

Fees vary across the country. In some regions, such as our own, Invisalign is priced similarly to braces placed on the outside of the teeth.  Insurance coverage for Clear Aligner systems like Invisalign is exactly the same as traditional braces in the State of Washington.

Does Invisalign treatment take longer than braces?

No, if the doctor is experienced in treating orthodontic patient using Clear Aligners the treatment time should be similar.  Some Clear Aligner treatment can be 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 braces placed either on the front or the back of the teeth.

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. Periodontal health is evaluated and there is a discussion covering the patients goals for treatment. Invisalign patients will have diagnostic records taken including a digital intraoral scan. These records are sent to are processed and a “Treatment Setup” is created that represents your straightened teeth.  from this setup the individual tooth movements are “staged” out in small increments and the Aligner are fabricated.

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.

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. There is likely to be an initial period of low-level discomfort around the teeth when the teeth begin to move. Once the orthodontic process begins, however, this discomfort lessens.How many hours per day are the Invisalign aligners to be worn?The ideal amount is 21 to 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.

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….  If you cannot wear the Clear Aligner at least 20 hours per day you are much better off using braces.  These braces can be placed either in front or behind the teeth.