Clear aligners have been around for some time, but have only recently been manufactured and marketed in a way that some find more appealing. The concept of clear aligner treatment is identical to traditional braces in that a force is placed on a tooth in a controlled manner, and the body then reacts by initiating tooth movement. The difference lies in how the force is applied to the tooth i.e. through a clear tray versus with braces.
The process of Invisalign treatment begins the same way as any other orthodontic treatment: with a proper examination and diagnosis. Although it is not very apparent in the advertisements, there are sometimes limitations to what can be accomplished with aligners. Therefore, examination by the orthodontist will provide information about the feasibility of clear aligners for treatment, and determine whether limitations exist.
Conditions such as bite problems, severe crowding, or significant jaw problems may result in too many compromises to achieve a favorable result. While there are orthodontists that have treated patients such as these using clear aligners, the general consensus among many practicing orthodontists is that traditional braces will still provide the most effective and best result in patients with these types of problems.
If a patient has been determined to be a candidate for Invisalign or clear aligner treatment, the process begins with a comprehensive examination and orthodontic records. The records needed are the same as for traditional braces, since the same principals of diagnosis and treatment planning still apply. Besides the usual impressions taken of the teeth to make the plaster models, a set of highly accurate impressions are also taken. The accurate impressions are needed to allow a precise fit of the clear aligners. Impressions can be taken the usual way with a highly accurate physical material, or new digital scanning methods can be used to take an impression. The new digital scanning methods have been shown to be more accurate in many cases, so this will likely become the preferred method for most orthodontists.
The orthodontist will then submit the patient case, sometimes including the records, x-rays, photos, and the accurate impressions to Invisalign. Once they have received the information, the impressions of the teeth are reproduced digitally (unless they were submitted digitally). The orthodontist then has the ability to treatment plan the movements of the teeth digitally, which then is used to generate physical, clear aligning trays. The trays are fabricated so that the movements occur incrementally. That is, each tray will move the teeth slightly towards their final aligned destination prescribed by the orthodontist.
After the case has been submitted and the trays have been fabricated, the orthodontist will usually see the patient on a regular appointment schedule to check the progress and provide the patient with the next set of aligners. The aligners are usually worn for about 2 weeks, and then the next set is worn to continue the tooth movement process.
Just as cooperation is critical to traditional braces treatment, compliance with proper wear and care of the clear aligners is also essential for a good outcome. If the aligners are not worn, the teeth will not move. In fact, if they are not worn while in the midst of treatment, relapse can occur, and the teeth may shift to a point where the aligners will no longer fit. This is a serious problem that may necessitate re-impression and starting the treatment again from that point.
Many orthodontists will discuss the possibility of using braces following the clear aligners. In some situations, the most ideal alignment of some teeth and the bite are inadequate with the aligners alone. Traditional braces may be an option towards the end of treatment to finalize the outcome. If the braces are not desired, a compromised result will need to be accepted.
While Invisalign and clear aligners may have some limitations, there are many patients that may be served very well by this form of treatment. Usually, it is the adult patient that has a mild to moderate amount of crowding, and a negligible bite problem. Recent advances in the Invisalign technology has also allowed increased use by teen patients as well. Patients that otherwise would never have considered braces in the past now have another potential option for treatment. However, it is important that the patient fully understand the limitations and potential compromises of treatment before beginning.