Ditching Braces: Use of Orthodontic Aligners Expanding

Clear aligners, such as the brand name Invisalign, offer the advantage of nearly imperceptible orthodontic treatment, unlike traditional braces

By Deborah Jeanne Sergeant

Clear orthodontic aligners have improved a lot since the late 1990s.

“It’s a world of difference from then until now,” said dentist Emile Rossouw, Ph.D., chairman of the orthodontics and dentofacial orthopedics department at Eastman Institute for Oral Health, part of the University of Rochester Medical Center.

“If I look at what I can do with them today and what I could do with them 20 years ago, that is very different. Our knowledge and expertise and the biomechanical principles help us use it much more efficiently today.”

The better materials and a greater variety of attachments used “allow clinicians more options for correcting malocclusions,” Rossouw said.

Clear aligners, such as the brand name Invisalign, offer the advantage of nearly imperceptible orthodontic treatment, unlike traditional braces. Once a patient at an orthodontic office completes an intake, exam and measurement protocol with the orthodontist’s team, a series of aligners is made specific to that patient and tailored to the treatment goals. As prescribed, the patient exchanges one aligner for the next in a series of incremental changes.

Since the devices are removable, patients can take them out for eating, which means they won’t face dietary restrictions like no sticky or hard foods. This also makes cleaning the teeth much easier — a big reason aligners are important for patients who are not as scrupulous with their at-home care. Patients must remove aligners only for eating and brushing. Otherwise, the devices must be worn, even overnight.

Aligners can correct most problems patients bring to their orthodontist’s office, but not all.

“If you want to extrude a canine that’s impacted, you may need something rigid, an anchor in the mouth, to pull down the tooth,” Rossouw said. “With clear aligners, it may be harder. One can do quite a bit with aligners, but there are limitations.”

Another example is the orthodontist’s ability to adjust the plan with the patient in the chair. Standard braces may be infinitely adjusted on the spot to suit the patient’s comfort level and how the oral plan unfolds. Teeth aren’t always compliant to the plan. Rossouw said it’s not uncommon to obtain additional aligners when this happens.

Orthodontists can also attach a type of resin to the teeth to promote and restrain certain movement among the teeth, which can make the process more efficient.

It’s not either/or. Some patients have an aligner on one arch and traditional metal braces on the other. They may begin with one appliance and end their treatment with the other.

Dentist Steven M. Kazley operates orthodontic offices in Brighton and Fairport. He said that at first, orthodontists selected more straightforward cases for suggesting aligners; however, as the technique and appliance both improved in recent years, their use expanded. He estimates that 80 to 85% of his adult patients are treated with aligners.

With increasing interest in aligners and orthodontics in general, a number of companies have begun selling FDA-approved appliances for a do-it-yourself approach to orthodontics at home. Clients buy a kit to create their dental impressions and purchase the resulting aligners which they use in succession until their plan is complete, all without visiting an orthodontic office one time. There’s no professional assessment or measurements, X-rays or radiographs.

The reason many go the DIY route is financial. Traditional braces and aligners can cost around $6,000. The “DIY” services like SmileDirectClub offer a series of aligners for $1,895. But the professionals warn buyers to beware.

“There’s no oversight,” Kazley warned. “It’s purely sold to an unknowing consumer. The promises seem to be very good but the way that they do things, they don’t have the kind of range of latitude to do what can be done under supervision of a doctor.”

For example, orthodontists can perform tooth reshaping to help oddly shaped teeth fit together better. They also use attachments that help them properly rotate a tooth into alignment, something that an aligner bought off the internet can’t do.

“If there’s nothing to grip on, it cannot happen,” Kazley said.

DIY-ers also have no professional monitoring the progress with x-rays and exams to ensure that the teeth are moving properly. Orthodontists focus on oral function and health, not just cosmetic appearance. Teeth that appear perfectly straight in the front may not align properly for chewing which can lead to temporomandibular joint (TMJ) damage, bone loss, and root problems.

The FDA approves only the appliances — not how they’re used.

Should a DIY-er run into problems, they don’t have a means to correct them except for going to an orthodontist, which incurs more expense than if they went there initially.

Rossouw said that the American Association of Orthodontists has noticed numerous complaints from people using DIY kits.

Short term braces represent another means of saving money compared with standard orthodontic treatments from an orthodontist. Companies such as Six Month Smiles train dentists at long weekend retreats on how to use their orthodontic appliances to help patients improve their smiles cosmetically. While at least patients receive professional oversight, training for a long weekend is much different than the master’s degree required to become an orthodontist.

“They likely cherry pick the easiest 10% to 15% of patients for treatment, but it’s really also a difficult thing to move teeth,” Kazley said.

Roussouw added that the six-month method isn’t really fixing the problem, since crooked teeth could be only one facet of a malocclusion. There’s also overbite, cross bite and a variety of other dental issues. In many cases, other teeth may need to be moved into position first.

“Uninformed patients choose a product because it may sound more affordable but it doesn’t correct the problem,” he said.

Orthodontist offices work with patients to set up payment plans that can help them better afford quality care that truly addresses their oral health needs.

The American Association of Orthodontists offers a Q&A at www.aaoinfo.org/_/online-orthodontic-companies to help consumers better evaluate the risks of alternative alignment programs.

Photo: Once the aligner is totally in place, it is very difficult to see unless one is looking for it. It’s like contact lenses for orthodontia. 

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