Thinking About Orthodontic Treatment: Invisalign may be a great option for you

As an orthodontist, I get many questions and concerns from patients and parents of patients, who are hesitant about getting braces but also curious if Invisalign is right for them. In this article I will be addressing some of the most commonly asked questions. The article should answer all of your questions about Invisalign. These clear aligners will change the way you think about teeth straightening.

Why Invisalign?

Each year many people find that they need or want to straighten their teeth, or correct their bite. Most adults and older teenagers dread the first thing that pops into their heads, a mouthful of metal braces. Although there is a tremendous desire to do something about their teeth, the thought of wearing metal braces for even 6-8 months seems daunting and horrible. They decide to live with the crooked teeth, poor bite, TMJ problems, or whatever concern they have about their teeth. But now, there is another alternative to braces, Invisalign, and it’s one that most patients love.

Since 1998, when Invisalign first came on to the orthodontic scene, there has been an increase in the number of adults and older teenagers getting orthodontic treatment.  One of the reasons for this is due to the fact that before 1991 most orthodontists recommended wearing a retainer after orthodontic treatment for only 1-2 years. After several longitudinal studies were done it was discovered that one’s teeth will shift and move your entire life. Whether you had perfect teeth naturally, or from braces, one’s teeth shifted over time. And it was these adults that had relapse from previous treatment that were many of the adult patients going into treatment, or re-treatment. In fact, the founder of Invisalign, the person who came up with the idea for Invisalign was a former orthodontic patient that had stopped wearing his retainer and let his teeth get crooked. Yet, as an adult, he was completely opposed to wearing braces for a second time.  Like they say, “necessity is the mother of all invention”.

In addition, to the adults getting re-treated, there has been a growing number of adults that want to improve their health and looks to help stave off, or slow the effects of aging. Many adults that never had orthodontic treatment are now looking to improve their smile and the function of their teeth. And they are turning to Invisalign. One of the biggest things that adults don’t like about traditional metal braces is that they are so obvious. Not only does everyone know that you have a problem with your teeth, but everyone knows your business and that you are undergoing treatment. But with Invisalign, the treatment essentially goes unnoticed because they have designed to be invisible.

In order to become an Invisalign patient, one needs to visit an orthodontist for a full orthodontic exam. Once the orthodontist determines that you are a good candidate for Invisalign, then a 3D scan is taken of your teeth. The scan is done on an iTero machine (see right).  It’s from these 3D scans of your teeth that the orthodontist designs a series of custom trays.  The orthodontist will program in all of the movements necessary to correct your bite and properly align all of your teeth. Programming in all of the correct movements is at the heart of Invisalign treatment, and it is important to go to an orthodontist that has years and many cases of experience programming Invisalign treatment for patients. Invisalign does not decide how the teeth move. It is solely up to your orthodontist. So you should choose wisely. 

The treatment uses these custom-made clear plastic aligners that fit right over the teeth. They are virtually invisible once inserted on to the teeth. One of the other major benefits to Invisalign treatment is that they are also removable. A patient can remove the aligner to eat, and brush and floss their teeth as they normally would without braces. The trays are worn approximately 1 week each until all of the trays in the series have been worn. Each tray moves the teeth about 0.25mm, and with each tray worn the teeth get closer to ideal.

Another reason that Invisalign appliances are so popular is because patients find them so much more comfortable than braces. With braces, patients usually find that the wires and brackets can sometimes irritate the inside of their cheeks or lips. But with Invisalign, there is a thin clear smooth plastic tray that covers the teeth and nothing else. There is no poking, no broken braces, no food getting caught in the braces, and the best part, no food restrictions. The Invisalign trays need to be worn 20-22 hours per day and should be taken out to eat and brush. However, if you are attending an important meeting or family function, or taking important pictures, you have the advantage of taking them out. With braces there are no such options. 

Does Invisalign Really Work?

The major misconception of Invisalign treatment is that many still consider Invisalign a product, like a stereo or a pair of shoes. It doesn’t matter where you buy the shoes. As long as they are the

shoes that you want, the store that you buy them at doesn’t matter (except for the return policy). But Invisalign is not a product, it is a tool, an appliance. One should think of Invisalign as one would a paint brush, a golf club, or even a computer. Knowing how to use these appliances/tools is one thing, but knowing how to use these instruments well is a different story. Know how to get the most out of the appliance/tool takes knowledge, skill, practice and experience. One of the common questions

I get asked by patients in my practice is “Does Invisalign really work?” Many patients have heard stories from friends, co-workers, or family that tell them Invisalign didn’t work for them, or that they were told by an orthodontist that they were not good candidates for Invisalign. While this may be true for some of these cases, this is not true for most of the patients that tell me this in my practice. The doctor telling them this is not “lying” to them, but what the doctor is telling them is that within their hands and expertise Invisalign would not work, or has not worked.

Here is a patient, 67 years old, that said her health was failing because of her poor diet. One of the main reasons why her diet was so bad was that she couldn’t chew very well. As the pictures show she could only bite on her two back teeth. The front teeth were essentially non -functional. She had gone to 6 other orthodontists that all told her she could only be treated with braces and jaw surgery. She was in tears and knew that jaw surgery meant she would have to go under general anesthesia. With her health failing she would be taking a great risk with surgery. It was out of the question. 

I told her that Invisalign is a great appliance for closing open bites like hers. Although I had never closed such a large open bite before with Invisalign I knew what the appliance was capable of and I knew we would at the very least be able to get her teeth to touch and improve her bite. She went forward with Invisalign treatment and after 22 months we were able to not get her teeth to touch, but were able to get an ideal, I repeat, IDEAL bite. She was thrilled. 12 months after treatment was finished she has lost 55 lbs and says she hasn’t felt this good in years. Her diet and health did a complete 180. 

In my opinion, there are 10-15 percent adult cases that I see that are not good candidates for Invisalign, and approximately another 5-10 percent that can be treated with Invisalign but would probably have a slightly better outcome with braces. Looking at this from the opposite perspective, of all of the adult and adolescent patients I see, about 75-80% are great candidates for Invisalign treatment. If you would like orthodontic treatment with Invisalign appliances and have been told you’re not a good candidate, get a second opinion from an orthodontist that has treated at least 1500-2000 cases with Invisalign. You may very well be a candidate.

How Much Does Invisalign Cost?

Patients who prefer the idea of Invisalign over traditional braces may find that the fee is slightly higher, not in all cases but in some. The higher price is reflective of the technology and the high cost to make the aligners. Yet, most patients find that the fee is balanced by the fact that they feel more confident and secure in their treatment decision when they are wearing the invisible trays. This is especially true for those that are in the workplace, or a junior or senior in high school. The small increase in cost is worth not drawing attention to their orthodontic treatment, and the convenience of being able to take it out whenever they want.

There are several ways that patients can go about paying for Invisalign treatment. Most dental insurances, if they cover orthodontic treatment, will offer the same coverage for Invisalign. The insurance company does not care what type of appliance your doctor is using. Even great dental insurance will only cover a portion of the costs for treatment. The remaining amount will come out of the patient’s pocket. In most offices this expense can be financed in office, usually at 0% interest.

The balance will usually be spread over the course of the treatment. Many people work for employers that offer a Flexible Spending Account (FSA) that allows them to put away pre-tax earnings into an account that they can use for dental and medical expenditures. Most FSA accounts allow one to usually put away more than enough to cover the out of pocket expenses associated with Invisalign treatment. There are many different financing options to help patients cover the cost of Invisalign treatment. With Invisalign now a treatment option for most patients and all of the different payment options available, the question now is “Is this something that you want to do?” “Is improving your bite and smile something that you are really interested in doing?” If improving your bite and smile, and looking your best is something that you value and desire then the answer should be very clear, almost “invisible”.

In summary: 

1. Invisalign can move teeth just as good as braces. Approximately 80% of all orthodontic patients can be treated with Invisalign, if the orthodontist is skilled at using Invisalign appliances.

2. Invisalign has improved dramatically over the last 20 years, and there are very few movements that are difficult with Invisalign. But it’s like any other tool: the better you are at using it, the more things you can do with it, and the better the results. 

3. The success of treatment depends on two main factors: the ability of your orthodontist to program in the correct movements, and the ability of the patient to wear the aligners at least 21-22 hours per day.