Invisalign-Part 1

Myths and Truths About Orthodontics: Invisalign; A Replacement for Braces?

“Invisalign, what a concept?” Ads everywhere, your family dentist, magazines, Internet touting that perfect smile WITHOUT those ugly braces. In fact, wearing those stupid looking braces is usually the primary reason that’s stopping many adults and older teens getting orthodontic treatment. “Hey, Invisalign is even removable, I can wear it only at night and no one will ever know I even have braces.

Great marketing BUT, is Invisalign just as good as Braces, that’s this issue’s installment of: Myths and Truths about Orthodontics: Invisalign; A Replacement for Braces?”

The Myth: Invisalign is a Complete Replacement for Braces To Straighten Your Teeth.

The Truth: Many times But Not Every time. In fact, it has been my experience, after being involved with many Invisalign patients, Invisalign does not give me the same results as consistently as what I have come to expect from those treated with traditional braces do. That does NOT mean I do not use Invisalign but rather I use it as a tool like everything else in orthodontics. The many, many tools which have been developed in orthodontics all work…just not on everyone and not every time. Invisalign’s marketing has made it seem like they have created an invisible replacement for braces, period. I believe that is an optimistic statement or implication. I will make it very clear to my patients who are contemplating Invisalign to expect some potential limitations with Invisalign treatment and possibly even needing a very short course of braces to “finish” the treatment if you want the results I expect for you.

“Why’s that?” is the obvious question. Invisalign “works” differently than braces and has some limitations that fixed braces do not have. The primary difference is the Invisalign “Aligners” are not actually attached to the teeth as braces are. The Aligners relies on “squeezing” your teeth into place and are made from a clear thermo-molded plastic which has been formed to the exact shapes of your teeth. Invisalign’s patented process progressively changes the location of where your teeth fit into the Aligner. As you wear each Aligner, it has been shaped with the teeth a little bit straighter each time. The teeth get “squeezed” closer and closer to their projected finished position. The problem is that the closer your teeth get to that theoretical location, the less and less “squeeze” Invisalign puts on the teeth. On many occasions that “squeeze” is just not strong enough to create the biological changes to move certain teeth that last little bit of their intended movement. Invisalign can be altered in ways to attempt increasing the pressure or direction of “the squeeze” or a new series of Aligners can be ordered from Invisalign to build in more “squeeze”. But it’s been my experience, that on many occasions, “if it doesn’t get it the first time, it never will.” On the other hand, braces are made to be progressively adjusted based on the changes since the last tightening. The braces are physically attached to each tooth. This allows the orthodontist complete control of the ongoing direction and amount of pressure applied to each tooth independently. If the orthodontist sees a particular tooth is resisting its intended direction or movement, the braces can be immediately and appropriately adjusted for that right away.

The two most common problems I have had with Invisalign are:

Not achieving perfectly straight teeth at the end of the course of Invisalign Aligners

The teeth have always improved but sometimes we just can not get them perfect with Invisalign. That is not good enough for me; consequently I have recommended a very short finish-up in braces after Invisalign. This is not to say Invisalign can not make your teeth straight, but if anyone guarantees perfect teeth with Invisalign only be aware that may be optimistic.

Limited control of the Bite and its Correction.

Invisalign uses independent Aligner for your upper and lower jaws which have been fabricated using a generic computer imaging model for your mouth which is anything but generic and the same as everyone else. Invisalign has worked very hard to modify their techniques for bite corrections within their system but simply put… no unique individuals bite corrects exactly the same way. It is optimistic to expect a system of Aligners which are all made in advance with no knowledge of your uniqueness will “work” every time.

One final consideration concerning orthodontic correction in general, I have found that sometimes in the process of straightening the teeth and correction of the bite does not always occur at the same time or as expected with either braces or Invisalign. The advantage braces have over Invisalign is we can constantly make course adjustments when we tighten the braces monthly. The orthodontist can see that happening and make changes to the braces on a “real time” basis as we need it. With Invisalign, the only way to dramatically change the course of Invisalign treatment once it has been started is to resubmit to remake all the Aligners.

The Bottom Line

Braces do not require your teeth to “act” like everyone else’s nearly as much as Invisalign does. There is certainly more customization and individuality that can be incorporated in fixed braces. But… if compliance and instruction are followed, getting your teeth fixed without wearing braces can be worth all the extra challenges if you are just know what to expect.