Introduction to removable / invisible braces systems (Invisalign®, ClearCorrect®, OrthoClear®, eCligner®, ClearPath®, and Simpli 5®). -

What do "invisible" tooth aligners look like? | What are the advantages of using a removable system vs. conventional braces? | How do the different aligner systems available compare?

What are removable / invisible dental braces?

Plastic tooth aligner systems, like Invisalign® or one of its many competitors, are a relatively new treatment option for orthodontic patients.

Unlike conventional dental braces made up of brackets, wires and elastic bands ...

... these systems, sometimes referred to as "clear aligner therapy" (CAT), straighten your teeth by way of your wearing a series of removable plastic tooth aligners.

Advantages over regular braces.

Two of the biggest advantages of having your orthodontic treatment performed using a CAT system vs. traditional braces are:

  • The clear nature of the aligners makes the whole process of having your teeth straightened relatively unnoticeable to others.
  • And being able to take your appliances out whenever you need to offers a significant convenience factor.

What do removable tooth aligners look like?

Invisalign® brand.

Invisalign® aligners are clear, thin, vacuum-molded plastic appliances formed to fit snugly over your teeth.

Sideshow explaining what Invisalign® tooth aligners look like.

Slideshow explaining what Invisalign® tooth aligners look like. (Common tip-offs that you're wearing Invisalign®.)

  1. They look a lot like bleaching trays.

    However, orthodontic aligners are made out of a thinner, stiffer plastic (medical-grade polyurethane) that's also more optically clear. This makes wearing them less obvious than whitening trays.

  2. They are also very similar, almost precisely so, to clear plastic, vacuum-molded orthodontic retainers (Essix/Vivera®-style appliances).

    Although, the plastic used to make tooth aligners is just a little bit thinner, and trimmed in a more scalloped fashion (an Invisalign® aligner's edge generally follows the shape of the teeth and does not extend over gum tissue).

  3. In case you're wondering about the potential for release of bishenol A from Invisalign® aligners, laboratory studies simulating the aging process have not identified any cytotoxicity or oestrogenicity concerns. (Malik 2013) [page references]

How about the aligners used with ClearCorrect®, eCligner®, ClearPath®, and Simpli 5®? | How do they compare?

For all practical purposes, the aligners worn with competing CAT systems look essentially the same as Invisalign®'s.

  • With some brands, the aligners cover over the patient's gums just slightly more so than Invisalign®'s design. (This tends to aid aligner retention.)
  • And also, with some systems each step of tooth movement is accomplished by way of the patient wearing multiple sets of aligners, each one having a slightly greater thickness. (Said to help to minimize patient tooth-movement discomfort.)

But despite these differences (which we discuss individually for each brand below), for the most part what you the patient experiences, and what other people are able to discern about your having treatment, is all very similar no matter which brand/system is used.

 
Slideshow explaining advantages of Invisalign® vs. metal braces.

Slideshow outlining advantages of Invisalign® vs. conventional braces.

Advantages of Invisalign® (and similar systems) vs. conventional braces.

Removable aligner systems have some obvious advantages over regular wire-and-brackets braces. They include:

They're less irritating to soft tissues.

A major complaint heard from patients who wear traditional braces is the way their brackets and wires scrape against and irritate their lips, cheeks and tongue.

In comparison, since the contours of removable tooth aligners are typically smooth and rounded, for the most part these same types of issues don't exist.

  • From time to time a sharp edge may be discovered but these are usually easily trimmed down.
  • It's possible that when the Invisalign® system is used to treat relatively more difficult cases, the use of "buttons," "anchors," and/or elastics may be required (details and pictures).

    Admittedly these can be an annoyance, or even moderately irritating. But usually not nearly to the same degree as the brackets used with conventional braces.

Eating food is a lot easier.

With conventional braces, meal time is typically a messy, possibly embarrassing, ordeal. With Invisalign® aligners, you simply take your appliances out when you eat.

Cleaning your teeth.

People who wear fixed appliances know that few things make it more difficult for a person to brush and floss their teeth than having braces. And for patients who fail at this task, they place themselves at greater risk (possibly significantly so) for complications with gum disease and tooth decay.

Due to the removable nature of plastic tooth aligners, the challenge of performing oral home care becomes a non-issue. Of course, you still need to be motivated enough to do it.

Other advantages of having Invisalign® / clear aligner treatment.

Besides those issues that are normally obvious to the patient, there are other, sometimes more technical, advantages that using a removable braces system (Invisalign®, ClearCorrect®, eCligner®, ClearPath® and Simpli 5®, etc...) can offer.

  • Virtual treatment planning. - Case planning for the Invisalign® and other advanced CAT systems involves digitizing the patient's information, and then via the use of software, creating a on-screen, animated visual representation of it. (Simpli 5® doesn't offer this feature.)

    This presentation can then be viewed and tweaked by the dentist, thus aiding with both treatment planning and the evaluation of case progress.

    It also allows an opportunity for the patient to see detailed information about their treatment and its expected outcome, even before committing to it.

    Traditional braces offers nothing like this.

  • Overcoming difficulties associated with existing dental work. - When traditional braces are placed, brackets must be bonded to the patient's teeth. And in the case where they have existing porcelain or metal restorations (veneers or crowns), creating or maintaining this bond may be difficult. (Damaging the surface of the restorations is a possibility too.)

    When a removable aligner system is used, this difficulty doesn't exist.

  • Treatment time. - It's been suggested that the treatment time required for removable aligner cases is less than with conventional braces. At this point in time however this should be considered more conjecture than hard fact.
  • Bruxism (tooth grinding) cases. - The treatment for patients who brux (grind their teeth) typically involves their wearing a plastic dental appliance (nightguard, occlusal splint). Unfortunately, wearing this type of appliance typically isn't feasible for patients who have braces bonded to their teeth.

    The nature of plastic tooth aligners, specifically the way they fully cover over the chewing surface of both the patient's upper and lower teeth, makes it so they can act as a passable substitute for these types of appliances during their orthodontic treatment.

  • Treatment can serve as an alternative to cosmetic dentistry procedures. - Elective dental work, porcelain veneers in particular, are frequently placed just to improve the apparent alignment of the patient's teeth.

    In all cases, if simply straightening the person's teeth would give the same general outcome, doing so would make the more ideal treatment choice. And for some, the comparatively simple experience of wearing removable aligners as opposed to traditional braces might make this choice acceptable to them.

(Boyd 2008)

Note.

As positive as all of the advantages mentioned above are, treating patients with Invisalign® or an equivalent system can have some disadvantages that must not be overlooked. In fact, there's enough to know about this topic that we've given it its own page.


Invisalign® alternatives and near equivalents (competing systems).

Invisalign® isn't the only brand of invisible/removable braces available. There are other clear aligner products that your dentist can choose from for use with your case. They include:

a) Systems very similar to Invisalign® ...

While Invisalign® is generally considered to be the most comprehensive clear aligner system on the market, several competing brands can also be used to treat complex orthodontic cases. They include:

ClearCorrect®

ClearCorrect, Inc. was founded in 2006 and first introduced its invisible braces product in 2009.

Differences.

The primary difference between ClearCorrect® and Invisalign® is that the aligners used with this system cover over the patient's gum tissue just slightly, whereas with Invisalign® they generally do not.

The company claims that this extra coverage gives their aligners greater retention, and therefore better control over tooth movements. However, while clearly this could offer an advantage for a patient's case, in terms of what the person experiences during their treatment, having either system used would be essentially identical.

Advantages.

Seemingly related to the issue of greater aligner retention, the ClearCorrect® system tends to place less emphasis on the use of "engagers" in a patient's treatment. (The Invisalign® system uses the terms "attachments" and "buttons" for these bumps of white filling material placed on selected teeth so an aligner can better engage and therefore move them. See link above.)

Since engagers, buttons and/or attachments are often considered a nuisance or source of irritation by patient's, ClearCorrect® may offer an advantage in this regard.

ClearPath®

This system has been available in the USA since 2008. The design of ClearPath®'s aligners seems to be similar to ClearCorrect®'s in the fact that their edge laps over the patient's gum tissue just marginally. And as mentioned above, this difference should be a minor detail in regard to how it affects what the patient experiences during their treatment as compared to wearing Invisalign®.

eCligner®

This company claims to be the first in the world to develop a "transparent orthodontic device" (in 1998). And after decades of providing their CAT system to dentists throughout the world, the company obtained FDA clearance in 2015 thus allowing their system to be available in the USA.

  • In similar fashion to other Invisalign® alternatives, eCligner® aligners have a design that slightly covers over the patient's gum tissue (said to improve aligner retention).
  • In contrast to other systems, with this one a set of three aligners, each having a different thickness (stiffness), is used at each stage of tooth movement.

    The idea is that wearing the appliances in succession (the thinnest one is worn first) gradually ramps up the amount of pressure applied to the teeth, thus helping to minimize patient tooth-movement discomfort.

OrthoClear, Inc.

For a time, OrthoClear, Inc. (founded in 2005) offered an invisible braces product that directly competed with the Invisalign® system. As of 2006, this product is no longer available.

In response to litigation, Align Technology, Inc. (the makers of Invisalign®) and OrthoClear, Inc. reached a settlement. As a part of this settlement, OrthoClear, Inc. agreed to stop accepting new cases.

b) Comparatively less robust systems ...

Some clear aligner therapy systems are just designed for minor tooth movement cases. They include:

Simpli 5® - AOA Orthodontic Laboratory, Inc.

AOA Orthodontic Laboratories offers three invisible braces systems (Simpli 5® / Red White & Blue® / RW II®). And in terms of what the patient experiences, are each essentially identical to being treated with Invisalign®.

They are not however directly comparable in the way the aligners are fabricated, or the types of cases they are intended to treat. These systems are primarily purposed for treating relatively simple cases that just involve the realignment of anterior (front) teeth.

For information in greater detail, use this link to our page: Simpli 5® / Red White & Blue® / RW II®.

c) Invisalign® variations.

Align Technology, Inc. has developed offshoots of their basic full-featured Invisalign® system named Express and Teen.

  • Express is intended for use with relatively less involved, more quickly resolved cases (a fewer number of aligners are worn), with a cost-savings benefit for the patient.
  • Teen targets those patients at an age too young for standard Invisalign® treatment.

Both of the links above provide greater detail about these programs, and offer a comparison to the standard Invisalign® system.

All of these systems, while each being very similar, may be quite different to your dentist.

Due to their similarity in regard to what you the patient experiences, on our pages we consider each of the above discussed clear removable aligner systems/products to be equivalent and therefore make no distinction between them.

However in terms of treatment capabilities, there can be subtle yet significant differences between them that are important points to your dentist and therefore limit their choices in deciding which of these systems makes a suitable selection for treating your case. If so, your dentist will have to fill you in on their reasoning.


Details about the Invisalign® system.

Who makes Invisalign®?

Align Technology, Inc. invented and manufactures the Invisalign® orthodontic system. It was first made available in 1998.

Popularity and use.

It's easy enough to say that Invisalign® is the most popular/frequently used clear aligner therapy (CAT) system in the USA. It's also offered in over 100 countries worldwide.

Align Technology corporate reporting states that it has nearly 60,000 actively participating dentists, and manufactures over 200,000 aligners each day, with roughly 60% of cases involving treatment for patients in the US. (Align Technology, 2017)

How does a dentist get "certified" to use Invisalign®?

Dentists are required to take some basic coursework.

Align Technology, Inc. requires that all dentists who want to offer the Invisalign® system to their patients must complete a certification course. Initially when the system was first introduced, this certification training was only offered to orthodontists. Nowadays, enrollment is open to general dentists too.

This training may not be quite as rigorous as you'd expect.

While additional coursework, workshops and seminars are available for those who are interested, the minimum amount of training required before a dentist can participate in the Invisalign® program has historically been a single one-day course.

Your dentist's level of training and experience plays an important role in creating treatment success.

In your quest to become an informed consumer, you should take note of the following fact. For the vast majority of general dentists, having a removable braces system to offer patients means that they can now treat a much, much more complex level of malocclusions than ever before. It's important to point out however that this isn't necessarily a positive thing.

A certain level of practitioner expertise is needed.

In their role as "medical device manufacturers," the makers of removable aligner systems (Invisalign® and all others) defer to the judgment of the treating dentist during case planning.

To this point, we couldn't help but to notice the following disclaimer on the ClearCorrect® website.

  • "Treatment decisions and case diagnosis are entirely the responsibility of the prescribing doctor."

We'd have to assume that this same type of statement is buried in all other manufacturers' websites and required agreements too.

Of course, this is precisely the way it should be. Your dentist is your treatment provider. But this statement also brings to light that a case's successful outcome depends on that dentist's ability to make a proper diagnosis and develop an appropriate treatment plan.

The level of expertise needed to make these decisions could easily lie beyond that of many general dentists (we're assuming circumstances would be that most would not even be aware of their limitations). Of course, the patient too would be oblivious about the level of difficulty their case presented.

Consider consulting with an orthodontist.

With our comments above, we're simply suggesting that during that phase where you're learning about your case and shopping for a treatment provider, consulting with an orthodontist might make a prudent choice.

The primary advantage being of course a higher level of clinical knowledge about providing orthodontic treatment in general. And more specifically, having a firm idea about whether a removable aligner system makes a good, or at least an appropriate, choice or not.

A CAT system doesn't make the best choice for all situations (related page: Case selection considerations.). Make sure that the treatment provider you have chosen has enough clinical knowledge and experience to know when and where it does, and is not just offering you a treatment approach simply because that's the only one they have to offer.


What's the history of removable braces?

The concept on which Invisalign® is based has been around since the 1940's. In 1945 Dr. H.D. Kessling suggested that a series of "positioners" could be used to produce the tooth movements needed to straighten a patient's teeth.

After that point, removable appliances of varying sorts were used by dentists but the laboratory steps needed to craft them were prohibitively labor intense. And it was this difficulty that historically always dampened the widespread adoption of Dr. Kessling's idea by the dental community as a whole.

Now, as a result of the pioneering efforts of Align Technology, Inc., and their accomplishment in melding computer technology with custom manufacturing, the picture has changed. Removable braces technique has now become a practical treatment alternative.


What else do you want to know about Invisalign®?

If you're seriously considering having your teeth straightened using the Invisalign®, ClearCorrect® or Simpli 5® systems, we have lots of information to share. Here's an outline of our other pages:

a) Basic information about removable/invisible systems.
b) Details about treatment and the treatment process.
c) Information about wearing your appliances.
 

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