What are aligners?
Orthodontic aligners are transparent plastic braces which apply pressure on teeth to straighten them. They act as a consecutive series, with each aligner having small changes to incrementally move teeth, typically by approximately 0.2 mm per aligner.They are produced by computer simulations producing a series of 3D printed dental models which then have an aligner formed on each one.
Pros & cons of aligners
Aligners are a popular form of brace treatment because they are discreet and can be removed for meals and hygiene purposes. However, an incorrect assumption that aligners provide an ‘easy’ low effort treatment may lead to disappointment, since teeth will not move properly if each aligner is not worn over 20 hours per day and correctly fitted every time. Sometimes patients find that there’s actually less to ‘juggle’ with a bonded brace instead.
Aligners are good at performing simple tooth movements (Figure 1), but research studies have repeatedly shown that complex 3D movements and many bite/jaw corrections are not readily achieved, no matter how impressive some computer simulations (and advertising literature) suggest. Therefore case selection is crucial to avoid prolonged treatment times and patient disappointment at the outcome.
Retention (the long term prevention of slippage of tooth corrections) must be a integral part of every aligner plan, rather than an afterthought. Quite simply, why pay for treatment and then watch it unravel afterwards! Unfortunately, the quicker the treatment, the greater the relapse risks, since the bone and gum tissues have had no time to adapt. In my experience, aligner treatment often requires a bonded retainer (a thin wire discreetly bonded on the rear surfaces of front teeth, shown in Figure 2) in addition to a removable (aligner-like) retainer worn at night.
Available options
InvisalignTM was the original and most commonly known aligner system, but there are now alternatives available, especially through orthodontic specialists. In particular, the latest 3D orthodontic softwares enable the specialist to personally simulate the tooth movements (Figure 3), rather than a remote technician following standardised algorithms, leading to more customised tooth movements and realistic results. In my experience, this also makes aligner treatment much more cost-effective, with patient fees a quarter to a third lower (compared to typical big brand quotations).
How can I get aligner treatment?
Aligner treatments may be provided by general dentists who have typically been accredited via an aligner company’s one-day course. Notably, there are no qualifications in aligner provision, and commercial titles of ‘gold’ or other provider status only indicate the number of brand cases treated by a dentist and are not a quality indicator. An orthodontist has undertaken at least three years of full-time specialist training and is qualified to diagnose all forms of dental and jaw anomalies. Therefore they are well placed to judge each individual’s aligner suitability and provide accurate advice on alternatives.
Free aligner ‘consultations’ are often advertised, but unfortunately, these risk becoming sales appointments rather than a full clinical assessment and balanced discussion. Therefore it’s advisable that patients consider several providers before signing up to treatment. Finally, there are even internet providers of aligner treatment, but these are not professionally supervised and not recommended by the General Dental Council.
Richard Cousley is a consultant orthodontist at the Priestgate Clinic in Peterborough. For further advice please contact via the website or ring the clinic 01733 865000.
Read last month’s article by The Priestgate Clinic
