Is a clear braces system the best choice?

Clear braces are not the best choice for correcting all types of malocclusions.

In comparison to traditional braces, the Invisalign ® system does not offer the dentist or orthodontist as much control over certain types of tooth movements. Because of this, as a technique, clear braces are typically considered to be most suited for treating those malocclusions that are only mild to moderate in complexity.

This is an important point to keep in mind. The competent dentist should take the attitude that invisible braces are simply one orthodontic technique that can be offered to their patients. Their goal should be to evaluate a patient's treatment needs and then discuss with them the advantages and disadvantages of all of the various orthodontic methodologies that are possible (traditional braces, invisible braces, other removable orthodontic appliances), whether they can offer this treatment or not. As opposed to attempting to treat any and all cases with only the Invisalign ® system.

Examples of malocclusions best treated with traditional braces.

Because of its diminished control over some types of tooth movements, your dentist may feel that the Invisalign ® system may not be the best choice for treating severely rotated teeth (teeth rotated from their normal position more than 20 degrees, especially premolars and lower canines), teeth that are severely tipped teeth (at an angle of more than 45 degrees), severe deep overbites, skeletally based malocclusions, open bites, or other cases where the extrusion of teeth is required.

Additionally, clear braces may not the best choice for cases where tooth spacing (greater than 6 mm per arch) is one of the issues being addressed. This is because removable orthodontic aligner technique has difficulty keeping teeth upright when they are being moved over relatively large distances. Crown tipping and associated poor root inclination is often the result in these types of cases.

While large spaces between a patient's teeth may exist naturally or be the result of previous tooth loss, even people with severely crowded teeth might fall into this category. This is because the extraction of strategically located teeth is often required as a part of a patient's treatment, so to create space into which the remaining crowded teeth can be realigned.

Clear braces treatment requires patient compliance.

One of the main characteristics that makes invisible braces so attractive to patients is also one that creates a significant potential weaknesses for this technique. Being able to remove the orthodontic aligners is an advantage for the dental patient, but not necessarily for the dentist providing the treatment. The Invisalign ® system might not be the best choice for an individual if there is some question about their ability or desire to comply with directions regarding how often their aligners should be worn (on the order of 22 hours per day). Since no treatment progress can be made unless the aligners are worn as prescribed, the dentist must rely on the patient's motivation and dependability for the success of the treatment.

A patient's noncompliance with wearing their orthodontic aligners can cause all sorts of problems. At a minimum, not wearing the aligners as directed will slow the progress of the treatment. Worse, it is possible that if a patient stops wearing their aligners for a period of time they will allow their accomplished progress to relapse, or even veer completely off-track.

Possibly the dentist can get the patient back on-track by having them go back and re-wear previous sets of aligners (aligners should never be discarded without your dentist's permission). But if not, a new set of records and impressions must be taken so a new set of aligners can be manufactured. Most likely incurring an added expense for the patient.

Other potential disadvantages associated with Invisalign ® invisible braces treatment.

As we have previously described, the Invisalign ® invisible braces system generates and directs the forces needed to produce tooth movement differently than tradition braces do. With traditional braces, brackets, bands, wires, springs, and elastics are physically attached to the patient's teeth as a means of generating these forces. In comparison, with clear braces the orthodontic forces are generated and directed by way of the fit of the aligners over the patient's teeth.

This means that any situation that might inhibit the ideal aligner-to-tooth relationship could hamper the effectiveness or predictability of Invisalign ® treatment. As a simple example, if the crowns of the patient's teeth (the portion of each tooth that would fit into the aligner) are especially short, Invisalign ® might not be the best method of treatment.

Along these same lines, any new dental restorations that are required during clear braces treatment have the potential to interfere with the fit of the aligners. The entire series of Invisalign ® aligners that the patient will wear are created before their treatment is begun. While small dental restorations might be easily accommodated, any new dental restoration that significantly changes the shape of a tooth so the tooth-to-aligner relationship is altered might create a situation that can only be resolved by taking a new set of records and having a new set of aligners made. New dental work must be planned for and typically placed either before or after, but not during, invisible braces treatment.

Another, somewhat different natured, complication associated with dental restorations has to do with the fact that the Invisalign ® system sometimes makes use of "buttons" (small dots of white filling material which are strategically bonded onto specific locations of certain teeth to help direct an aligner's forces). It can be difficult, or in some instances even impossible, to bond these buttons onto certain types of existing dental work (crowns, porcelain veneers).

The cost associated with invisible braces may be significantly out of line with more traditional treatment approaches.

With the simplest orthodontic cases, the thought that a decision must be made between choosing clear braces or traditional braces might not be a valid one. It could be that a simple case might be treated with just a standard removable orthodontic appliance (plastic and wire construction) instead of fixed braces.

If that were possible, then both treatments would involve the use of a removable appliance. While the traditional orthodontic appliance would not be "invisible," it could be removed when the patient eats, cleans their teeth or for special occasions. A dentist's cost for a traditional removable appliance would most likely be significantly less than the fee paid to Align Technology, Inc. for an Invisalign ® or even Invisalign ® Express cases. Because of this, the price they would need to charge the patient for their treatment would likely be correspondingly less.

Additional potential disadvantages associated with invisible braces technique.

There can be other issues associated with clear braces technique that can present problems. There is potential that invisible braces can affect a person's speech, although this is usually quickly and easily overcome. There have also been isolated cases of what seem to be an allergic reaction to the plastic from which the aligners are made. Another issue, probably of greater concern to the treating dentist than the patient, is that once a patient's treatment has begun the Invisalign ® system does not offer any flexibility as to altering or changing the original treatment plan, without having a new set of aligners made.