Invisalign® - Disadvantages and problem issues.

- Situations and cases where using removable aligners to straighten teeth may not work well.

Removable braces systems (like Invisalign®, ClearCorrect® and Simpli 5®) don't always make the best choice for straightening teeth.

As we outline on this page, this technique has some limitations and disadvantages (both real and potential) that may make it difficult, or even impossible, for your dentist to produce an ideal, or predictable, result.

Quiz your dentist about possible shortcomings.

This doesn't mean, however, that when problem issues exist that Invisalign® absolutely can't or shouldn't be used for your case.

It absolutely does mean, however, that it's your dentist's obligation to advise you about these disadvantages, as well as possible treatment alternatives, so you can make an informed decision about the treatment you receive.

Problem issues and disadvantages associated with the Invisalign® system.


1) Invisalign® doesn't make the best choice for correcting all types of malocclusions.

In comparison to conventional braces (wire and brackets), removable braces systems don't offer your dentist as much control in creating some types of tooth movements.

And due to this limitation, Invisalign® (and the similar product ClearCorrect®) is typically considered best suited for treating malocclusions that are only mild to moderate in complexity.

A case that would be difficult to treat with Invisalign®.

This case makes a poor, or at least very difficult, choice for Invisalign® treatment.

a) Examples of conditions that may be too involved for Invisalign® treatment.

Due to this diminished amount of control, Invisalign® usually isn't considered the best solution for treating cases that involve:

  • Severely rotated teeth - Teeth rotated from their normal position by more than 20 degrees (especially premolars and lower eyeteeth).
  • Teeth that are severely tipped - Teeth angled more than 45 degrees from normal.
  • Large tooth spacings - Cases where all tooth gaps (combined) total more than 6 mm per arch.
  • Other problem situations - Severe deep overbites, skeletally based malocclusions and open bites (or other cases where the extrusion of teeth is required).

[Here's a comparison table that contains details about the types of cases that standard Invisalign® (vs. Invisalign Expresss®) is typically considered best suited for treating.]

b) You may need to wear attachments and buttons too.

As a way of overcoming some of its inherent limitations, employment of the Invisalign® system often involves the use of "attachments," or "buttons" and elastics (use the link for more information and pictures).

On the upside, using them expands the range of cases that Invisalign® can be used to treat. As a disadvantage however, these items may be visible to others. That means, when they're required you do get the benefit of wearing a removable orthodontic system but not so much an "invisible" one.

c) More about the issue of closing large tooth spacings.

The limitation mentioned above about closing large spaces with Invisalign® may be an issue for your case even if your teeth are severely crowded.

That's because your treatment plan may involve the extraction of some teeth, as a way of creating space into which your remaining crowded teeth can be realigned. Here's an animation that shows how this technique is used. (Examples of how other basic orthodontic techniques are used with Invisalign® are illustrated too.)


2) Tooth issues that may interfere with having Invisalign® treatment.

With removable braces it's the fit of the plastic aligners that generates and directs the forces that straighten your teeth. And this means that any situation that interferes with creating an ideal aligner-to-tooth relationship may hamper the effectiveness, or predictability, of your treatment.

a) The shape of your teeth may impose limitations.

As an example, if the crowns of your teeth (the portion of each tooth that fits into the aligner) are especially short, Invisalign® probably isn't the best treatment choice for you.

Besides just short teeth, those that are pegged, round or severely tipped can be difficult for Invisalign® aligners to manipulate too.

b) Your teeth must be in good repair before your treatment is begun.

Any new or replacement dental restorations that must be placed while you're undergoing your Invisalign® treatment may alter the fit of your aligners. Because of this, any planned dental work should be placed either before or after, but not during, your treatment process.

Even having just one tooth fixed can mess things up.

Remember, the entire series of Invisalign® aligners that you'll wear is created before your treatment is begun.

And while a small dental restoration might easily be accommodated, a large one that significantly changes the shape of a tooth (and therefore interferes with the fit of your aligners) might cause a need for a "mid-course correction" (having a new set of records taken and new set of aligners made). There will probably be some expense involved with this.

c) Some types of existing dental work may interfere with Invisalign® treatment.

The Invisalign® system sometimes requires the use of "attachments" and "buttons" (discussed above). It can be difficult, or in some instances even impossible, to bond these items onto certain types of dental work (i.e. crowns, porcelain veneers).

As a separate issue, having dental bridges (a type of dental work that splints multiple teeth together as a unit) makes having Invisalign® treatment difficult, if not impossible.


3) Treatment with removable braces requires patient cooperation, and that can be a big disadvantage.

One of the main features that makes Invisalign® so attractive to patients is also one of its biggest weaknesses. That is, being able to take your aligners out.

a) With Invisalign® you're in control of the success of your treatment.

Being able to take your aligners out whenever you want is a great advantage for you, the patient, but it's a disadvantage for your dentist, the treatment provider.

Since no progress can be made unless your aligners are worn as prescribed (22 hours per day), your dentist must rely on your motivation and dependability for the success of your treatment.

That means the Invisalign® system is not the best choice for any individual where there's some question about their ability, or desire, to comply with their dentist's directions.

b) Noncompliance can cause big problems.

Patient noncompliance can cause all sorts of difficulties.

  • At a minimum, not wearing your aligners as directed will slow the progress of your treatment.
  • Worse, not wearing them for some period of time may allow your previous progress to relapse, or even allow your case to veer completely off-track.

c) Noncompliance can be expensive.

Once things have started to go wrong, your dentist may be able to get you back on-track by having you re-wear previous sets of aligners (aligners should never be discarded without your dentist's permission).

If this doesn't work however, your treatment will need some type of reset.

  • With Invisalign® this is termed a "mid-course correction."
  • Your dentist will need to repeat many of the initial steps of your treatment process so a new set of aligners can be made.
  • Some versions of the Invisalign® system include a free mid-course correction, if needed. But that is a courtesy and savings for your dentist, not you.

    If your dentist has to expend additional treatment time and materials (taking records and impressions), it's only logical that they should pass these expenses on to you. It may be several hundred dollars.


4) Conventional treatment approaches may cost less.

You'll probably find that your cost for Invisalign® is slightly more than for conventional braces (from the same provider). This isn't always the case, it may be the same. But it's unlikely that it will be less. Here's a page where we discuss treatment costs for different types of braces.

a) In some instances, choosing Invisalign® likely will cost you more.

If you're just seeking treatment for a minor orthodontic problem, thinking that Invisalign® (including Express®), or the competing system ClearCorrect®, are your only removable braces options may not be entirely accurate.

There are other choices available, some of which are "invisible" too. As a benefit of choosing one of them, you may find that it's cheaper.

Simple orthodontic cases might be treated with a Hawley appliance or Simpli 5®.

Minor corrections may be cheaper to correct using a traditional Hawley appliance or Simpli 5®.

b) Hawley appliances. / Simpli 5®.

Your dentist may be able to treat simple cases with either:

  • A standard removable Hawley-type appliance (plastic and wire construction).
  • An Invisalign®-like product such as Simpli 5®.

(These are the types of appliances dentists used for treating minor cases before Invisalign® came along.)

As an advantage, your dentist's overall cost when using either of these alternatives is likely to be less than what Invisalign®, or even Invisalign Express®, would cost them. As a result, they may be able to charge you less for treating your case.


5) Wearing Invisalign® can increase your risk for cavities.

One of the big advantages of removable tooth-aligner systems is that you can take them out to clean your teeth. But under certain circumstances, wearing them can place your teeth at increased risk for the formation of tooth decay.

What's the basis of this risk?

When you wear your aligners, your teeth are essentially encased in plastic. And this makes the environment immediately surrounding them separate and isolated (sealed off) from the rest of your mouth where normal biological anti-cavity events take place.

Under certain conditions (like when you don't keep your teeth and aligners clean, or follow directions regarding food and beverage consumption), conditions can form that place you at increased risk for tooth decay formation. (Use this link for details.)

Of course, this doesn't have to be the case. If you follow the rules you're given, you shouldn't have any problems. But for those who are lax in their habits, their risk for decay can be substantial. And this may be a good reason why Invisalign® might not make the best choice for them.


6) Other limitations and disadvantages associated with Invisalign®.

There can be other factors related to the use of removable braces that can present problems. They include:

  • The potential exists that your Invisalign® aligners will affect the way you speak (although this is usually quickly and easily overcome).
  • There have been isolated reports of what may be allergic reactions to the plastic that is used to make Invisalign® aligners.
  • Historically, there were age limitations associated with having standard Invisalign® treatment. This difficulty has since been remedied with the introduction of Invisalign Teen®.

It's your dentist's obligation to discuss all disadvantages and potential problems with you.

Your dentist is supposed to be your advisor.

Your dentist's role should be one where they simply evaluate your current status and then discuss with you the advantages and disadvantages of all of the various types of orthodontic approaches (traditional braces, lingual braces, Invisalign® and other types of removable orthodontic appliances) that are available to remedy it, whether they can personally provide this treatment or not.

Few general dentists can offer treatment alternatives.

As a consumer, you need to understand that for a lot of general dentists, Invisalign® is the only orthodontic technique that they have to offer for treating relatively involved cases. (Very few general dentists place traditional "wire and brackets" dental braces.)

That means that a general dentist usually can't offer treatment alternatives, without losing the patient's case (i.e. referral to an orthodontist). This can affect their financial bottom line, and might be motivation for them to go ahead and treat cases with removable braces when another technique might be expected to produce a superior outcome.

 

 

[Reference sources for this topic.]

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