Clear Aligner Therapy
I took this photo on Sept 8,2017 at Plitvice Lakes, Croatia. The thing with taking photos of waterfalls is that you can never capture the sound which is a major key to it’s serenity.
Orthodontist have historically been restless individuals. What I mean by this is, orthodontist seek continuous improvement. This characteristic draw has made our profession a very innovative one. There have been innovations in the way we diagnose, use imaging, improve patient comfort, improve the patient experience, improve the speed of treatment, the access to treatment and the list goes on. Of all of the areas of improvement, I would argue that esthetics and hygiene have been of the greatest interest to the consumer. Consumer, of course, meaning You, the patient. Clear aligner therapy has met both of these concerns head on! Let me tell you about clear aligner therapy and touch on some of the frequently asked questions that I field.
What is Clear Aligner Therapy?
Orthodontics is traditionally performed using braces and arch wires. These appliances impose a force on a tooth that moves the tooth in three planes of space. Moving teeth in three planes of space is in sum called orthodontics. What if we took the braces out of the equation and were still able to move teeth in three planes of space? Clear aligner therapy is just that! A clear aligner is a tray that is custom adapted to your teeth. Using CAD/CAM technology, we are able to create a series of trays where by each tray moves each of the teeth in small increments. Orthodontists have mastered the bone and tooth biology as well as the force systems needed to move teeth. With our foundation of knowledge in this area, the same principles of tooth movement can now be applied using a system other than braces and wires.
Clear Aligner Therapy has been around for over 20 years now, but it has widely gained popularity in just the past 5 years. This is greatly due to its vast technological improvements and the mastery of this tool by the orthodontic specialist. Clear Aligner Therapy is more commonly known by the companies that orthodontist use to fabricate these appliances. You may already be familiar with companies such as ClearCorrect, Simpli5, or MTM Clear Aligner. There are many orthodontic labs that make their own variations of these and there is even some trailblazing orthodontist that have purchased 3D printers and created their own clear aligner system. Still not sure what clear aligners are? Then perhaps you will understand me more clearly (pun?) when I mention Invisalign. Invisalign has become synonymous with Clear Aligner Therapy much in the way that Xerox has become with printers and Coke has become with soda. Invisalign is the most widely marketed, most widely known by the public, and most widely used amongst orthodontist. While Invisalign and many of these aligner companies can provide amazing results, it is important to remember that they are merely a tool used by the orthodontist to impose his knowledge of tooth movement with.
What are the benefits of Clear Aligner Therapy?
Digital Treatment Planning. I know, right?! This benefit is probably more exciting to other dental professionals and myself. I will still touch on it briefly as it has changed the way I am able to look at cases. With our iTero intraoral scanner, we are able to create 3-dimensional models of your teeth and arrange them in a way that replicates your bite on a computer monitor. Imagine being able see your bite with cheeks, tongue, and basically the rest of your body out of the way. Imagine all of the angles you could see! Imagine all of the extra information you might obtain! Now imagine if you could take your 3-dimensional bite and individually move the teeth and change your bite before even touching a single tooth! Guess what?! That’s exactly what we’re doing! I told you this might not be that exciting to you but I bet after reading all of those exclamation points I got your blood up at least a smidge. If I got you really fired up and you want to know more about this topic, please message me below.
Improved Hygiene. This is not the most exciting benefit of clear aligners but it is probably my favorite. If you have read my blog on white spot lesions you will gain a better understanding of my feelings on the matter. In summary, poor oral hygiene during treatment can lead to some serious damage to your teeth and it is counterintuitive to the creation of a healthy smile that you and your orthodontist are working towards. Clear aligners eliminate a lot of the hygienic obstacles that come with braces. Some that come to mind are as follows:
- Flossing is much easier. Flossing is an absolute must during orthodontic treatment and it is very commonly neglected. I can empathize that flossing around an orthodontic wire can be time consuming or challenging. Since we can remove the clear aligners, brushing and flossing are just as easy as if you had no orthodontics at all.
- Decrease of White Spot Lesions. As I mentioned above, there is easier access to cleaning your teeth when the aligners are removed. There is also not an accumulation of plaque around the braces that when not cared for, will leave White Spot Lesions. Disclaimer: White spot lesions can still form with aligners!
- We can supplement the trays with Fluoride. We provide a foaming gel to all of our patients that serves to both clean the aligners and deliver fluoride to your teeth. This makes your teeth “harder” and less susceptible to white spots or cavities.
Hygiene with clear aligners is still of great importance and there are different considerations that must be understood. For instance, the aligners are covering your teeth for at least 22 hours out of the day. This can make the teeth dry and to a degree eliminates the natural cleansing feature of our saliva. I want you to understand clearly that hygiene is NOT to be neglected when in clear aligners. For more information of how to care for your aligners, check out our page Caring for Aligners.
Esthetics are perhaps the most desirable quality for most of our patients that choose clear aligners. For years, more esthetic solutions to orthodontics has been a primary focus for improvement. They have come up with braces that are ceramic, braces that go on the backside of your teeth, and they have come out with clear aligners. As aligners have continued to improve on their treatment efficiency we have seen an upward trend of adults receiving orthodontic treatment over the past decade. Clear aligners has made it very acceptable to the vast population of people that would have never even considered wearing braces.
Faster Treatment Time?
There have been claims that Clear Aligner Therapy can decrease the overall treatment time of many cases. I believe that this is a tough statement to generalize since we know that no two of us are alike. Each mouth has its own unique problems and I would agree that there are some cases that can be treated faster with aligners but there are also some cases that can be treated faster with braces. I will agree that the amount of broken bracket repairs does prolong our treatment time. In clear aligners, we do not have any brackets that can break and therefore cut down on those treatments that would have otherwise been extended.
What are the limitations of Clear Aligner Therapy?
A question that we frequently receive is “Am I candidate for Clear Aligners?” or “Am I a candidate for Invisalign?”. As previously discussed, the innovations and greater understanding of clear aligners to straighten teeth have made the answer to those questions ‘Yes’, the majority of the time. I would be failing you however, if I did not discuss the short comings of aligners and why there still are some cases that are just better treated with braces.
One of the greatest features of clear aligners is also a demise. You can take it off but you can also take it off. The ability to take off your aligners for cleaning and eating is a great benefit of aligners. Taking your aligners off and not putting them back on makes the entire treatment fail. You must wear your aligners at all times except when you are eating or brushing. The responsibility is greatly in your own hands. If you do not wear them, they are not doing anything. I find it rare that this becomes an issue. If you think this is a concern for you, Lifetime Orthodontics does offer the opportunity to switch over to braces if its within the first 6 months of treatment.
I already discussed this above and have left you with some links to more information on oral hygiene and aligners. I brought it up again because I believe it to be very important. As healthcare providers, we treat the person as a whole and need to look beyond just straight teeth. Great oral hygiene must be maintained at all times regardless of braces, aligners, or nothing at all.
Describing this limitation requires a lot of depth and knowledge of orthodontics and general occlusion. I will not go into too much detail here but if you are interested please reach out to me in the comments below, by sending us an email at firstname.lastname@example.org, or shooting Dr Wesley a text at 313-451-2166. I will touch base on some of the things that I look for when determining the difficulty of the case in clear aligners.
- Tooth movements: There are some teeth that need to move an extreme amount and it can be difficult to really move a tooth in some directions without braces. We have to remember that there is a long root underneath the bone that must also move with the crown of the tooth. Movements that require the root of a tooth to move a great distance will be tough for aligners. There are also teeth that are very rotated. Those teeth rotated over 90 degrees would really be much better addressed with braces. At least until the rotation is fixed.
- Deep Bites. Some people have really strong biting muscles and it makes their bite very deep as well. This means the top teeth completely overlap the lower teeth. With orthodontic treatment, we often try to open these bites up and having aligners on can often lead to the bite becoming even deeper IF it is not addressed appropriately.
- Severe Spacing. Cases that require a lot of space closure can be difficult with aligners. This could be a case where a tooth is missing and we are trying to close spaces or it could be a case where the teeth are just greatly spread out (often due to a tongue posture habit).
- Impacted Teeth. These are teeth that have failed to erupt into the mouth. Another way to say it is they are stuck in the bone. In these cases, we need to move the tooth through the bone. With braces we can easily move the tooth down to the wire. With aligners, it becomes more challenging in some cases to move a tooth through the bone and into the mouth.
- Significant Skeletal Discrepancies. This is when someone has an upper jaw and a lower jaw that just does not line up with each other. One jaw may be too wide for the other. It could be that one jaw is more forward or back than the other. It could be a combination of several of these things. When significant corrections are needed, it is often a good idea to use braces.
Clear Aligner Therapy at Lifetime Orthodontics
Clear aligner therapy has become a huge part of what we do at Lifetime Orthodontics. Our team as well as our patients have enjoyed the experiences that have come along with our increased use of clear aligners. I have personally spent several hours a week dedicated to clear aligner study groups as well as spent many hours to reflect, review, and improve the way we do clear aligner therapy. I am passionate about this treatment modality in orthodontics and am anxious to share any discussion or thoughts on the topic. As a team, we have invested several hours dedicated to improvement of our office workflow that is designed to offer all of our patients a premium experience. Please, if you are interested in learning any more, reach out to us via our website or feel free to send Dr. Wesley a text or photo of your concern at 313-451-2166.
Later this evening is the Super Bowl and I want to share an incredible series I found on Facebook video about Tom Brady. Tom Vs Time. Even though he has been doing this for over 20 years, he has a burning desire for improvement. I think that says a lot about him and can be very inspiring to us all. On that I will leave you with this quote:
“You can’t go out and practice average on Wednesday, average on Thursday, okay on Friday and then expect to play well on Sunday.” -Tom Brady (G.O.A.T.)