Teeth straightening at home (Direct-to-consumer / DIY orthodontic kits and systems) – Does using this kind of approach make a good idea?
Using home teeth aligners is big business … but does using this kind of DIY approach make a reasonable choice?
The possibility of making arrangements for straightening your teeth at-home, on-your-own has exploded into a myriad of options.
As proof, just do a quick web search for the keywords “home teeth aligners.” When you do, you’ll turn up a multitude of brand names (Smile Direct Club, SmileLove, Candid, SnapCorrect, AlignerCo, Byte aligners, etc…), with each company offering to guide you through the process of obtaining the perfect smile, on your own, at-home, seamlessly.
Even though you do have a number of, evidently quite popular, options, the question then arises: Just because you can buy an at-home kit, does it make a good idea?
In an attempt to help you answer this question for yourself, we’ve looked through professional dental publications to create a list of arguments and talking points that are usually mentioned about direct-to-consumer aligner systems (admittedly, typically as negatives for choosing this method).
So, if asked …
Here’s what dentists tend to say about choosing at-home teeth straightening.
A comparison of invisible vs. conventional dental braces.
1) Where’s the experienced oversight?
a) Who’s at the company end of your case?
As the buyer of an at-home system, you may take comfort in the fact that at least someone at your aligner company has looked at your case and passed judgment on it. But what qualifications (technician vs. dentist) and motivations (case rejection means no sale for the company) do they have?
b) Is an orthodontist involved with your case? To what extent?
As a selling point, some do-it-yourself aligner companies proudly state that an orthodontist does play a role in case acceptance, planning, monitoring and/or support. The term that’s frequently used to indicate this service is “orthodontist directed.”
We see this feature implemented at varying levels with the Candid, SmileLove, Smile Direct Club, SnapCorrect and Byte systems. It’s typically mentioned in conjunction with case acceptance/approval. Beyond that, the level of direct involvement with a patient’s case seems to vary.
FYI: The orthodontist approving your case doesn’t really have complete information.
While participating in the training program where any orthodontist has earned their credentials, they would have been required to do a complete patient workup before planning and treating anyone’s case.
Yet with DIY at-home aligner systems, the same standard isn’t met. The orthodontist doesn’t have this same level of information that they were trained to require. Instead, they frequently just have some self-made (patient-made) photos and dental impressions (of varying quality), and from that make a diagnosis and treatment plan.
What’s really needed.
- A patient’s pre-orthodontic treatment evaluation needs to include an oral examination (by both their general dentist and orthodontist), radiographic (x-ray) examination (with different types of x-rays needed by their general dentist vs. orthodontist), photographic documentation of their current status and taking high-quality study models or scans of their mouth.
- The professionals performing these examinations need to evaluate for conditions such as active tooth decay, the adequacy of the patient’s existing restorations, their periodontal (gum tissue) health, along with other dental conditions or pathology that may exist.
2) How much responsibility does your aligner company take for treatment outcomes?
You might be surprised …
It’s easy enough to find evidence that direct-to-consumer aligner companies realize that there are inherent flaws with the way their services are provided and therefore have taken steps to protect themselves from the unfavorable patient outcomes that inevitably can occur.
In short, the adage “buyer beware” seems to be especially applicable to the world of at-home teeth straightening. Here are some points to consider.
a) You’ll be asked to self-certify.
When signing up, you’ll probably be asked to approve consent documents that transfer the burden of performing a proper workup for your case onto you. This includes things like stating that you’ve had an appropriate examination performed by your general dentist recently.
Of course, even if a patient actually did have a pre-treatment examination performed, unless they specifically mentioned to their dentist their plans for undergoing orthodontic treatment, important considerations simply might not be discussed.
b) The liability two-step.
Direct-to-consumer aligner companies often take the stance that they do not actually provide dental services (like a dentist does) but instead only fabricate dental appliances. This side-step is a way of avoiding liability issues associated with the issue of “practicing dentistry.”
In the situation where the orthodontist involved with your case (the person who therefore is the one practicing dentistry and therefore liable for case problems) was technically an “independent contractor” rather than a company employee, your level for recourse related to treatment complications might be significantly more limited than you imagined.
c) Stifling patient complaints.
Check your system out with the FDA.
You can check to see the type and number of “Adverse Event Reports” that have been filed with the FDA (US Food and Drug Administration) regarding complications associated with the home teeth straightening system you are considering. Here’s a link to the FDA database.
Of all the brands mentioned above (Smile Direct Club, SmileLove, Candid, SnapCorrect, AlignerCo, Byte Aligners), our search of the database found the largest number of reports associated with Smile Direct Club.
We’re hesitant to suggest that that indicates there is something superior about the other systems. Instead, it seems more likely to us that SmileDirect is most mentioned because its system is used to treat a much larger number of cases than the other systems.
3) Are the impressions used to make your aligners really adequate?
It seems routine that home teeth aligner systems offer an option where a DIY impression kit is sent to the prospective patient and they then take the needed impressions of their teeth on their own. We see this feature as a part of the Smile Direct Club, SmileLove, Candid, SnapCorrect and Byte Aligners systems.
Nothing is more important than the accuracy of the patient’s pre-treatment dental impressions.
While reading through a copy of the “Invisalign Clinical Monitoring Guide,” which among other things helps a dentist using that system troubleshoot problems they encounter with their patients’ cases, we couldn’t help but notice how many treatment problems track back to deficiencies with the original impressions taken of the patient’s teeth.
Problems include the fit of aligners and how well they seat on the patient’s teeth. And these issues can result in complications where a patient’s teeth don’t move as planned, or subsequently drift position during later stages of the treatment process.
How can you expect to predictably do better?
Our point here is simply this, if dental professionals sometimes fail in creating an adequate impression of their patients’ teeth, what percentage of impressions taken by complete novices can really be expected to be optimal for their treatment?
4) Clear aligner orthodontics isn’t as turn-key as you may think.
You might be surprised to learn that even though you wear your aligners as directed that there’s no guarantee that your case will come out perfectly.
As an example …
- A study was devised by Chisari (2014) where clear aligners were designed to move a single front tooth for (thirty) patients over the course of 8 weeks.
- It was found that despite the simplicity of this task, only 57% of cases met the intended goal.
Our point here is this.
Dentist’s struggle with keeping their patients’ clear aligner treatment on track. And when teeth don’t move as planned, this error can be amplified as successive aligners are worn. At worst, the dentist may realize that completion of the case is not possible without restarting it (taking new impressions).
With DIY teeth straightening …
The question then becomes: What professional is monitoring the patient’s case so closely as to be able to identify treatment deficiencies early on and instruct them about the remedy that’s needed? (Like wearing aligners for extra days/weeks, re-wearing previous sets of aligners, or taking new impressions and restarting the case.)
5) No professional organization endorses do-it-yourself teeth straightening.
For all of the reasons mentioned on this page, it probably comes at no surprise that the major professional dental organizations pertinent to this subject (American Dental Association, American Association of Orthodontists) do not endorse direct-to-consumer aligner systems. And, in fact, have published strongly stated position papers on the subject.
▲ Section references – Feizi
Page references sources:
Appleby J. and Knight V. In-Home Teeth-Straightening Business Is Booming ― But Better Brace Yourself. January 23, 2020. KHN.org
Chisari JR, et al. Variables affecting orthodontic tooth movement with clear aligners. Am. J. Orthod. Dentofacial Orthop. Vol. 145, No. 4. 2014
Feizi A, et al. What every dentist needs to know about clear aligners. Gen Dent. Vol. 68, No. 4. July – August 2020.