Esthetic Orthodontics 103: Invisalign
“Invisalign” is a brand name of the biggest and best manufacture of clear “aligners” that can be used to move teeth. The idea of moving teeth with clear trays is not a new one. Orthodontists have moved teeth with clear trays for more than 50 years! In the past, an orthodontist would make a physical model of a patient’s teeth and then move one or two teeth a small amount and make a clear tray to fit the teeth in the new position. When worn by the patient, the tray would put pressure on the teeth that had been moved on the model and the patient’s teeth would adapt to the new position. It worked great, but it was extremely limited because we could not move “all” the teeth and for every tray we made, it would require a new impression and new model. So moving teeth very far was not really practical.
The genius of Invisalign is that they applied a computer design and manufacturing process to this idea of moving teeth with clear trays. This allows an orthodontist to model “all” the teeth moving and also allows tray after tray to be made in a series without the need for multiple impressions! Yeah! In fact today, we can do the whole process without a single impression by using a digital scan of the patient’s teeth (but the advantages of a digital scanner will have to be a blog for another day; stay tuned).
The Primary Advantage of Invisalign is Esthetics.
Of course, the reason that Invisalign has capture so much of the orthodontic market is because it allows patients to have the tooth movement that they need without the look of braces. The trays are clear and are changed every two weeks so they stay very clear and unnoticeable in social situations. Another huge factor in the “esthetics” arena is the fact that the aligners are removable. So if you have a particularly important speaking engagement or photographs to take, you can remove them for the special occasion.
Here is one of our patients, wearing her aligners. As you can see (or should I see can’t see), it is very unnoticeable.
The Seconday Advantages are Numerous.
Patient’s understand the esthetic advantages of the aligner process, but often underappreciate the other advantages of moving teeth in this way. At the risk of being too long-winded. Here is the top 10 reasons that aligners are cool (beyond the estethics).
1. Brushing and flossing are tons easier! The fact that the trays are removable can be a great benefit to the ability of a patient to clean their teeth. Instead of brushing and flossing ‘around’ the orthodontic appliances affixed to your teeth, you remove the trays and ‘have at it’.
2. Aligners are much more comfortable than braces. Braces take some getting used to in terms of the lips and cheeks or tongue adapting to the roughness of the braces. Aligners are very smooth and being removable, can be easily modified if there is part of the tray that is rubbing.
3. The forces are very controlled. Because each step along the path is calibrated to very precise degree, the forces that patients’ have on their teeth is much more controlled and limited. The ‘soreness’ that patients can have with braces is almost completely eliminated with aligners.
4. The tooth movement is pre-planned. With aligners we pre-program the system to achieve a desired end-result. This is very different than with traditional braces where our ‘target’ only exists in the mind of the orthodontist. If the teeth are being moved to facilitate some other dental work, the final result can be visualized before the treatment begins. This also allows us to be selective about which teeth to “NOT” move or stay in the pre-treatment position. Maintaining an exact pre-treatment position is often difficult with braces, but is simple when the movement is pre-planned.
5. Emergencies are almost entirely eliminated. With fixed braces, there can be discomfort associate when a wire or bracket becomes detached from the rest of the orthodontic appliances. This can lead to pokey wires and undesired tooth movement if the patient is not seen fairly shortly after the bracket or wire breaks. With aligners, there is almost nothing to ‘break’. If a tray is lost, we have the patient go to the next tray and continue on the sequence. This makes aligners particularly attractive to patients who come to see us from great distances. If getting to our office involves a plane trip, we want to minimize the risk of extra ‘emergency’ appointments.
6. Speech is largely unaffected. Most patients adapt to speaking with the aligners within a couple of days of wearing them. With some other orthodontic appliances, speech affects can be much more. . .eh-em. . . . ‘pronounced’.
7. Tooth wear from grinding is prevented. With the trays covering the teeth, if you grind your teeth, you simply wear the plastic. So if you are prone to grinding this is a great way to protect the teeth during your orthodontic care. With traditional braces, this is a challenge because a nightguard will stop fitting as the teeth are moved with braces. These following photos are of a patient who was specifically concerned with tooth wear from grinding. You can see the wear on the edges of the teeth in the first picture. Then the second picture is with the aligners on the teeth. Notice that there is plastic between the teeth protecting them as they move.
8. Tooth bleaching can be done with the aligners. As patients’ teeth straighten, many also desire show off their pearly whites with ‘more white’. The invisalign trays can actually be used as a bleaching tray to whiten the teeth as we go along.
9. Retainers are digitally stored and can be reordered. With traditional braces, the retainer is made on a plaster model that is destroyed in making of the retainer. If a patient loses or fails to wear the retainer and the teeth shift slightly, often the best option is just to make a new retainer in the shifted position to prevent further shifting. When aligners are used, the patient’s final tooth position is saved and the retainer can be made to the ‘digital model’. If a new retainer is needed, another can be ordered without the need to take another impression. If the teeth have shifted (a very small amount) the new retainer can move the teeth back to their final position. If the shifting is more pronounced, then the new retainer may not fit.
10. Patient’s love them. For the most part, our aligner patients really appreciate how easy this process is for them. Of course, there are some who struggle with remembering to wear the trays or find it inconvenient to take the trays out for meals, but for the most part, patients really like the Invisalign process. This is especially true for patients who have worn braces in the past.