Invisalign® - Disadvantages and treatment issues.

Removable braces, like Invisalign®, don't always make the best choice for straightening your teeth.

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

This doesn't necessarily mean that Invisalign® (or the similar system ClearCorrect®) 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 shortcomings, as well as possible treatment alternatives, so your can make an informed decision about the treatment you receive.

Situations and conditions that may not favor having Invisalign® treatment.

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

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

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

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 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 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.]

You may have to wear more than just clear aligners.

As a way of overcoming some inherent treatment difficulties, 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 case types that Invisalign® can be used to treat. As a disadvantage, 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.

More about the issue of closing large tooth spacings.

The difficulty of closing large tooth spacings with Invisalign® may be an issue for your case even though your teeth are severely crowded.

That's because your treatment plan may involve the strategic 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.)

Tooth and dental issues that may interfere with having Invisalign® treatment.

With removable braces it's the fit of the plastic aligners that generate and direct the forces that straighten your teeth. This means that any condition that interferes with allowing 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.

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

Any new or replacement dental restorations that are required while you're having your Invisalign® treatment will have the potential to alter with the fit of your aligners. That means any planned dental work should be placed either before or after, but not during, your treatment process.

Even having just one tooth fixed could mess things up.

Remember, the entire series of Invisalign® aligners that you will 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 having a new set of records taken and a new set of aligners made.

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

The Invisalign® system sometimes makes use of "attachments" and "buttons" (we discussed them previously on this page). 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.

Wearing Invisalign® may increase your risk for cavities.

Having your teeth straightened using removable braces can place them at increased risk for the formation of tooth decay. As a disadvantage of choosing this technique, however, this level of risk may not be much different than with traditional braces.

What's the cause of this increased risk?

When you wear your aligners, your teeth are essentially encased in plastic. And this makes the environment immediately surrounding them separate and isolated from the rest of your mouth.

Under certain conditions (like when you don't keep your teeth and aligners clean, or follow directions about consuming foods and beverages) this situation can place you at risk for tooth decay. Use this link for more details.

Of course, this doesn't have to be the case. If you follow the rules, you shouldn't have any problems. And, in fact, having removable braces will make it easier for you to keep your teeth clean than traditional braces. 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 be the best choice for them.

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

One of the main features that makes Invisalign® so attractive to patients is also one of this system's treatment weaknesses. That is, being able to take your aligners out.

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.

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.

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, you'll need to start all over so a new set of aligners can be made. This will be an added expense for you.

Traditional treatment approaches may cost less.

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

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

In some instances, choosing Invisalign® probably does cost too much.

If you're seeking treatment for a minor orthodontic problem, thinking that Invisalign® (including Express®), or the competing system ClearCorrect®, are your only removable-braces options may be wrong. There are other choices available; some are even "invisible" too. As a benefit, you may find that there is a price advantage in choosing one of them.

Hawley appliances. / Simpi 5®.

Your dentist may be able to treat simple cases with either a standard removable Hawley-type appliance (thick plastic and wire construction) or an Invisalign®-like product such as Simpli 5®. (These are the ways dentist treated minor cases before Invisalign® came along.)

As an advantage, your dentist's cost for a Hawley-type appliance or Simpli 5® are likely to be less than what Invisalign®, or even Invisalign Express®, costs them. Because of this, the fee they charge can be expected to be correspondingly less too.

Other issues 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 that 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.
  • Another issue of concern, although primarily just for your dentist, is that once your treatment has been begun the Invisalign® system does not offer any flexibility in altering the original treatment plan, without having a new set of aligners made.
  • Historically, there were age limitations associated with having standard Invisalign® treatment. This difficulty has since been remedied, however, with the introduction of Invisalign Teen®.

It's your dentist's obligation to discuss all of these issues and disadvantages 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 offer this type of 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 loosing the patient's case (as in, the patient is referred to an orthodontist's office). This can affect their financial bottom line and might be motivation for them to treat cases with removable braces rather than a technique that might produce a better outcome.

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