Clear aligners are trays used to push teeth into an ideal position, in place of braces. Each tray deforms as it moves the teeth, then is replaced with a new tray.
A clear aligner pushes teeth, either by directly putting pressure on the tooth or by your dentist adding attachments. An attachment is a small piece of composite (white filling material) that is bonded to the teeth, aiding movement by providing a flat surface for the aligner to push against.
The roots of the teeth are covered in ligaments that attach to the surrounding bone. When you push on the tooth, the ligaments are crushed on one side, and stretched on the other. Over time, the bone on the crushed side will resorb (dissolve away), and the bone on the stretched side will increase so the ligaments are no longer stretched. This allows the teeth to move safely and remain in a new position.
Aligners work for most crowded teeth situations. The teeth can be shifted or tipped out to widen the arch. In some cases, an inter-proximal reduction is needed (IPR). This is when the dentist shaves off a small amount of enamel between the teeth to make room.
In more complex cases, traditional braces will get a better result than clear aligners; sometimes, other types of surgeries are needed to get an ideal outcome.
A clear aligner can work to close spaces between teeth, depending on many factors, such as the size of the space if the teeth are rotated.
Braces or other types of surgery might be better options for very large spaces.
Clear aligners can work well for crossbite if the problem is due to tooth positioning and not the jaw's position. If your jaw shape is causing the crossbite, you may need additional surgeries to correct your crossbite.
An open bite is when the front teeth do not touch, but the back teeth do. This can be caused by angled front teeth, or the jaw’s position. If the open bite is from teeth being tipped out, then clear aligners can be a great option to move them back into an ideal position. If the problem is not with the teeth, the position of the actual jaw bone could need to be corrected.
A deep bite is when teeth overlap more than they should in the front. Typically, this means the lower teeth are positioned too far behind the upper teeth, so they rest on the gums rather than the upper teeth. Clear aligners are usually a great solution to allow the lower teeth to sit correctly on the back of the upper teeth.
Clear aligners can rotate teeth back into position, but in some cases, braces are much better than clear aligners. In particular, rotating the canines or the premolar is much more difficult than rotating the central and lateral incisors (the four flat teeth in front).
Clear aligners can be a good option depending on the amount of rotation needed and the patient's treatment goals.
Clear aligners can take 6-24 months; most of the cases I do in my office take about 10-14 months. The length of time depends on the amount of movement needed and the patient's compliance with the retainer. In some cases, the teeth do not move exactly as expected and a refinement might be done. This is when new photos and impressions are taken, and the case is redesigned based on the current positions of the teeth.
Invisalign first created the patents to straighten teeth with clear aligners. Many patents related to designing clear aligners to move teeth expired in 2018, which allowed other companies to use the same method and technology to design their own cases.
Other dental labs now provide a similar method of straightening teeth, but at a much lower cost because they have access to expired patent information. These companies have made further advancements over the years and patented their own methods and technologies to help give patients better results.
Because Invisalign was the first to make a successful clear aligner product, they did a considerable amount of marketing, which is why it is such a well-known brand. However, they are no longer the only company that designs and creates clear aligners for tooth straightening.
Going to a mail-in clear aligner company is usually a cheaper option than seeing a general dentist or orthodontist for treatment, but this lower price comes with some additional risks.
I have seen a patient who used a mail-in aligner company. Her lower front teeth were pushed out of the bone. If I had been treating the patient in my office, I would have stopped the treatment and resigned from the case to prevent such a drastic outcome.
Many of these clear aligner companies advertise that patients can take their impression at home. Most patients have never taken a dental impression before, and, likely, they will not get an ideal impression because of their lack of experience. A defective impression could lead to designing an aligner case that is not ideal.
At We Care Dental Care, we take all digital impressions so that it is more comfortable for the patients. Dr. Burkitt has looked at thousands of impressions, so he can quickly identify any error that needs to be corrected.
Some clear aligner companies brag about not needing to add attachments, or design cases that do not require an interproximal reduction (IPR). Interproximal reduction is when the dentist removes a small amount of enamel between teeth to allow for more space. In the example from above, the patient did not have enough room in her arch for her teeth. The aligner company attempted to correct this problem by widening her arch and pushing the tooth out of the bone. If IPR had been done, space could have been created for this tooth.
Attachments are small pieces of composite that are bonded to the tooth. These allow the retainer a flat surface to push against. Some teeth, such as the premolar, look like a circle if you look straight down at them. This round shape makes them very hard to rotate. You can get some movement without an attachment, but it can be very difficult to get the tooth where you want it to go.
Designing a clear aligner case without using IPR or attachment is like trying to build a house and only using a hammer. The hammer might work well most of the time, but sometimes, a screwdriver or a saw is a better tool for the job.
People don't just want straight teeth; they want a smile they are happy with.
Many times patients are unhappy with their teeth for a reason not only related to straightening their teeth. A mail-in clear aligner company effectively has only one tool in its toolbox. But a dentist can look comprehensively at the patient's wants and needs, and then create a treatment that helps the patient reach those goals.
Most patients seek to straighten their teeth for cosmetic reasons. They want to look better and feel more confident, but there are other benefits to having straight teeth.
Straight teeth are easier to clean.
Overlapped or crooked teeth are hard to clean. Food can be trapped in tight spaces, leading to cavities or bone loss. By aligning your teeth, you will be better able to clean your teeth and prevent future problems.
Evening out your bite.
When teeth are tipped, crooked, or rotated, the bite is usually uneven, so pressure is unevenly distributed. This causes extra, unnecessary wear and tear on specific teeth. For many patients, when the teeth are better aligned, the pressure will be evenly distributed.
If are unable to wear your clear aligner for a day but you are able to put them back in the next day, this should not affect the progress of your cases too much. You should communicate this with your dentist; you might need to stay in an aligner for a little more time.
If you do not wear your aligner for a long period of time, you should speak with your dentist in Roanoke, VA. Your teeth may have shifted, and your case may need to be redesigned.
Please contact your dentist if you break or lose the clear aligner you are actively using. Your dentist may need to order the missing aligner from their lab. If you are near the end of the time needed for your current aligner, you MIGHT be able to move on to your next aligner. But before trying the new aligner, contact your dentist to ensure the success of your case is maintained.
Healthy gum and bone around the teeth are very important before starting clear aligner treatment. If you have active periodontal disease as the teeth are pushed, you can have severe bone loss and not achieve the desired movement. Having a dental cleaning and exam to make sure your teeth and surrounding bone are healthy is very important to achieving an ideal outcome with your clear aligner case.