Wheeler Orthodontics' Blog: Esthetic Orthodontic Appliances: What To Do When Invisalign Is Not An Option

Many people who want straight teeth never go through with treatment because they just do not like the way braces look. In 1998, Align Technology introduced Invisalign tooth positioning aligners. Up until that time, the only cosmetic alternatives to traditional metal braces on the teeth were clear (ceramic) or lingual (inside) braces. Why do orthodontists still use clear braces when Invisalign seems so much better?

Align Technology’s introduction of Invisalign changed the field of orthodontics forever. First, for appropriate cases, Invisalign does provide the esthetic alternative to metal braces that many patients are seeking. Second, because Align bypassed professional providers and marketed directly to the public (think Nexium—“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 general 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.

Here's why...

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 like turning round teeth, making teeth longer, and paralleling roots in extraction cases, most orthodontists still prefer to use brackets and wires for moderate to severe cases—where underlying skeletal discrepancies may exist in addition to dental issues.

Second, by taking Invisalign directly to the public without explaining its limitations, Align forces orthodontists to be “the bad guys” who more often than not have to give disappointing news to overly optimistic prospective patients. My practice statistics indicated that only one out of eight patients who come in hoping for Invisalign actually have problems that qualify for aligner therapy. The other seven 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 or she 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 and some 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 so much better than braces. So in many cases, Invisalign is actually my treatment tool of choice.

If Invisalign isn’t appropriate for your particular problem, what other options do you have? The most tried and true, economical alternative is clear braces. They have been around a long time and are now better than ever! Modern manufacturing techniques have overcome practically all of the long-standing weaknesses that have plagued previous generations of clear brackets. Today’s appliances are stronger, smaller, and do not stain like previous models. They can be used for the exact same complex movements as metal brackets and move the teeth just as efficiently. The only drawback is they still cost your orthodontist more to purchase (which he must pass on to you).

So if you are dead set against metal braces, you now have three options. Invisalign might be perfect for you if your problems are only mild. If you want the ultimate invisible treatment, you should consider lingual braces—which we use the Incognito system. If you want the most cost-effective esthetic alternative to “railroad tracks” that can actually move your teeth like metal however, ask your orthodontist to show you today’s clear braces. I think you’ll be impressed!