Is it just rainbows along the way?
Tupperware. Hoover. Milo. Maggi.
These are just brand names which have become household names.
More accurate terms are containers, vacuum cleaners, chocolate drink and instant noodles, respectively.
Invisalign is a brand name, which is so commonly associated to clear aligners, which are medical grade dental appliances used to straighten teeth. With the advancement in this digital age, the dental industry is also maximising the advancement of 3D scanning and artificial intelligence to boost the development of clear aligners. Dental companies are jumping into the wagon of clear aligners space to be a part of this exciting advancement. Brands like Angel aligner, OneSmile, Reshap, Clear Correct, to name a few brands available in Malaysia, in the clear aligner scene.
In this article, we shall just call these appliances CLEAR ALIGNERS.
Why? Because I am not endorsing any clear aligner brand, and would like to give my honest unbiased opinion based on evidence-based research and clinical experience. (Unless any company pays me to endorse them)
The fundamental of clear aligners are similar. They are clear removable appliances which hugs snugly around each tooth. Users will then have to change a series of aligners in a specified amount of time, where each aligners pushes the teeth a little, until the desired teeth position.
Patients and clinicians will be able to see their planned tooth movement in a video simulation. This planned simulation is such a useful communication tool between patient and dentist. Patients are able to see the end result of their teeth alignment. Many companies even incorporate fancy superimposition of your new teeth alignment onto your face on smiling.
Impressive! I will be so convinced that I will sign up the plan with the dentist straight away. Take my money and go! I will start ASAP!!!
Now this is where things might go wrong. Nothing about being human is straight forward. Humans are complex beings, both physically, mentally and psychologically. Let’s break down what MAY go wrong.
Firstly, are you up for the challenge? Clear appliance requires high level of compliance. The appliance only works if it’s worn in the mouth. The benefit of clear aligners, being removable, may well be its worse feature. If you are someone who eats and snacks 10 times a day, then taking the aligners out the most parts of the day, you may not be the best candidate for clear aligners. We are aiming for 22 hours of aligner wear per day, for best efficiency.
Secondly, biology. Remember the visual simulation of your teeth alignment. The keyword is “simulation”. In the generated simulation, your teeth can be positioned to whichever location the you desire. But is it realistic? This is where your orthodontist jumps in to evaluate the feasibility of the tooth movement. A good orthodontist will foresee the challenges in certain tooth movement and position, and tell you what’s possible or impossible.
In addition to feasibility, humans are variable organisms. It may work well on you, but not someone else. We do not expect tooth movement on a 13-year-old boy to be exactly the same as a 50 -year-old lady. Variability is taken into consideration during orthodontic treatment. So how do we overcome this variability? Regular follow up during clear aligner treatment is essential. Your orthodontist will check if the teeth movement is acceptable, and if any modification has to be incorporated, whether a change of aligner interval, or even addition of any accessories, to aid it tooth movement in a specific vector.
Therefore, if your dentist tells you: “Take all 50 aligners and I will see you in a year! No need to see you in between. Bye!”. You should be weary of your dentist. If you are the perfect human being, and your teeth moves exactly like how it is planned, then perfect! But most if the time, this isn’t the case. Research has shown that modifications of the aligners are required most of the time to achieve a good result in clear aligner treatment.
Thirdly, biomechanics. “Are clear aligners as good as braces? It’s just plastic.” This statement is true to some extent. Clear aligners are removable, whereas braces are glued onto your teeth. We can quite surely conclude that braces definitely have more 3-dimensional control on tooth movement. However, we live in an era of unparalleled technology and material advancement. Clear aligner mechanics and control over tooth movement has improved tremendously. But has its biomechanical properties in tooth movement surpassed braces? In my honest opinion, definitely not yet. Will there be a day when clear aligners are better? Maybe, and I shall look forward to that day as well.
This article may sound discouraging those of you who is looking forward to getting clear aligner treatment, but these disadvantages have to be explained, as part of informed consent.
In the next article, we will look into the positives of clear aligner treatment, which may just change your view on clear aligners and go: Yeah! This is for me!