Many people who want straight teeth never go through with treatment because they just don’t like the way braces look. In 1998, Align Technology introduced Invisalign tooth positioning aligners. Up until that time, the only cosmetic alternatives to silver braces on the teeth were clear (ceramic) or lingual (inside) braces. Why do orthodontists still use braces when Invisalign seems so much better?
Align Technology’s introduction of Invisalign changed orthodontics forever. First, for appropriate cases, Invisalign does provide the esthetic alternative to braces that many patients are seeking. Second, because Align bypassed professional providers and marketed directly to the public (think Little Purple Pill and Viagra), they created a demand for their product and an expectation that teeth can now be straightened without wires and brackets glued to the teeth. Third, because the Invisalign system seems so much easier to use than conventional braces, more than 300,000 non-specialist dentists are now also offering orthodontic services in their practices. Although these changes have encouraged more patients to seek treatment, Invisalign is not a replacement for braces in all cases.
First, although clear aligners are appropriate for many orthodontic problems, they are still biomechanically inferior to conventional braces in many situations. Because it is more difficult for plastic shells to create some of the forces required for complex tooth movements most orthodontists still prefer to use brackets and wires for moderate to severe cases.
Second, by taking Invisalign directly to the public without explaining its limitations, Align makes orthodontists give disappointing news to overly optimistic prospective patients. In my practice only a small percentage of patients who come in hoping for Invisalign actually have problems that qualify for aligner therapy. The others would be treated to a better result with braces.
Third, because Invisalign appears easier to use than braces, dentists with little or no orthodontic training are now also offering orthodontic services to their patients. Since most of us trust the advice of our family dentist, rarely do we question when he recommends a new service. The results obtained by any doctor however are determined by his skills and experience. Eliminating brackets and wires does not eliminate the need for accurate diagnosis, treatment planning, and case management. Invisalign is simply a tool. Just because I can buy the same golf clubs as Tiger Woods does not mean that I can shoot the same scores as he does!
I use Invisalign in my orthodontic office. It is effective for mild to moderate crowding and alignment cases. It is especially good for patients who have had previous orthodontic treatment but did not wear their retainers and have experienced some relapse. I like the fact that my patients can take out their aligners to eat and brush. Patients like it because it looks better than braces. And sometimes the benefits of being able to selectively move only certain teeth while maintaining the positions of others makes Invisalign the treatment of choice.
If Invisalign isn’t appropriate for your particular problem, what other options do you have? The most tried and true, esthetic, economical alternative is clear braces. They have been around a long time and are now better than ever! Modern manufacturing techniques have created clear brackets that are stronger, smaller and stain-resistant. They can be used for the exact same complex movements as metal brackets and move the teeth just as efficiently. In my office I have exclusively used tooth-colored ceramic braces on the upper teeth for many years now because I want every patient to have the most esthetic treatment option possible.
Invisalign might be perfect for you if your problems are only mild to moderate. If you want the ultimate invisible treatment, you could consider lingual braces, which go on the backside of the teeth, but can be more irritating to your tongue and tend to cost significantly more than traditional "frontside" braces. If you want the most cost-effective esthetic alternative to “railroad tracks” that can actually move your teeth like metal braces however, ask your orthodontist to show you today’s clear braces.
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