Thinking about getting Invisalign, ClearCorrect, or other dentist-supervised invisible aligners? Before you decide on this type of orthodontic treatment, here are few things you should know. Please note that this article is NOT talking about mail-order clear aligners (such as Smile Direct Club, Candid Co, and SmileLove). For information about mail-order aligners, please see the article Mail Order Invisible Aligners: Worth The Risk?
What Is Invisible Aligner Treatment?
Invisible Aligner Treatment (brand names Invisalign, ClearCorrect, Inman, RedWhiteBlue) is an orthodontic method that uses a series of custom-made clear plastic forms, called “aligners,” to move teeth. (Some people also call them “trays,” “aligner trays,” or “liners.”) They completely cover all surfaces of your teeth and fit tightly. Most aligners are made out of a plastic material composed of multilayered thermoplastic polyurethane/copolyester. Each set of aligners shifts your teeth a small amount in very specific ways, and over time your teeth are straightened and your bite is fixed.
Before starting this treatment, you must go to a dentist or orthodontist to evaluate whether you are a candidate for invisible aligners. If you have gum disease, a severe problem with your bite, or if the roots of your teeth are not strong, you might not be a candidate for this type of treatment.
If you are deemed a candidate, the dentist or orthodontist will take photos, x-rays, impressions and (possibly) 3-D scans of your teeth and make a treatment plan. The treatment plan is then sent to the company that makes the invisible aligners, who make a computer model that moves the teeth in a step-by-step sequence.
The dentist or orthodontist logs in to their account at the aligner company and may make a few changes to fine-tune the movement sequence. When they are satisfied, a series of invisible aligner sets are fabricated and sent to them. This process usually takes anywhere from 3 to 6 weeks.
Most invisible aligner treatment lasts about a year and requires 20 to 30 sets of aligners. If your treatment is complicated, you might need as many as 50 sets of aligners. If your treatment only addresses minor issues, you will need less trays and could be done in as little as six months.
When your aligners come in, your dentist or orthodontist will give them to to you and have you insert them to ensure that they fit correctly. You wear each pair of aligners for two weeks, 20 to 22 hours per day (you don’t wear them while eating). Sometimes near the end of treatment, you might change your aligners more frequently.
Each pair of aligners is manufactured so that the teeth move slightly — about 1/10mm per aligner tray. With each set of aligners, your teeth continue to move according to the treatment plan set by your dentist or orthodontist.
Who Can Provide Invisible Aligner Treatment?
In general, it’s best to chose an orthodontist to do your treatment. Although many dentists are capable of doing simple tooth movement, orthodontists have received an extra 2 to 3 years of advanced training specifically in the bio-mechanics of tooth movement, and can do the best job for you (especially if your case is complicated).
Only licensed dentists and orthodontists who have completed a certain number of training hours are certified to perform invisible aligner treatment. This training is often not in orthodontics, but in how to use the invisible aligner company’s products and systems. It is assumed that the dentists who apply to become providers already understand how to accomplish proper tooth movement and jaw alignment.
For example, the company that makes Invisalign requires 7 hours of in-person training in their system (1 hour if done online). The company that makes ClearCorrect requires zero hours of training, although they recommend that the dentist watch a few “getting started” videos and read the “getting started” guide. Both companies provide ongoing education in using their systems.
Some dentists and orthodontists take extra training to keep informed about the latest methods and innovations in a clear aligner system. Some companies require a provider to submit a minimum number of cases per year, or complete ongoing clinical training classes to earn the designation such as “Preferred Provider.” Terms like “Elite Provider” or “Diamond Provider” usually refers to the number of cases that a dentist has submitted per year; if it’s a high number, they are designated as “Elite,” or so on. A status such as “Preferred” or “Elite” doesn’t reflect on the skill of the orthodontist or dentist, but it may reassure you that they are up-to-date and actively treating a lot of patients with invisible clear aligners.
Beginning Invisible Aligner Treatment
It usually takes a couple of weeks to get used to wearing Invisible Aligners. Once the novelty wears off, you might find yourself being annoyed that you can’t snack between meals as freely, that you’re having a little trouble speaking, and that you need to brush your teeth and clean your aligners so frequently. At first the aligners might feel tight, and you might have trouble taking them out of your mouth. But once you get over these humps and fall into a routine, things should start to go smoothly.
Your dentist or orthodontist usually gives you 2 or 3 sets of aligners at a time, and has you come back for a checkup every 4 to 6 weeks to ensure that your treatment is progressing correctly.
Yes, It Will Hurt A Little
Getting fitted for invisible clear aligners doesn’t hurt; it’s a totally painless process. The pain comes later. Each set of aligners is designed to move your teeth into new positions. They place force on your teeth, which loosens the periodontal ligaments, allowing your teeth to move. This will hurt to some degree. Most patients who get clear aligners say that a new set feels uncomfortable for the first few days, and then the pain subsides — until they put in the next new set of aligners. So, you might be in some amount of discomfort for a few days every two weeks (or every time you put in a new set of aligner trays). It’s not the type of pain that requires strong pain killers — usually a little Tylenol is all you need to get comfortable. (Ibuprofen is not recommended, as it could interfere with tooth movement).
As your treatment progresses, you will get used to the initial discomfort of each new set of aligners. It’s similar to the type of pain that patients feel when they get an adjustment done on traditional braces. If anyone has told you that wearing invisible aligners is totally painless, either they have a high pain threshold, or their treatment was so minor that there wasn’t as much force involved in moving their teeth. Everyone’s case is different, and everyone’s experience will be different. If you start invisible aligner treatment and don’t experience any pain, that’s great! Just realize that you might be in temporary discomfort at some point along the way.
You Might Need a Chewie or Two
Sometimes a new set of aligner trays is so different from the previous set that you can’t quite get it to seat completely onto your teeth. This is where the Aligner Chewie comes in. An Aligner Chewie is a small cylinder made of a soft spongy plastic-like material called Styrene Copolymer. It looks like a small roll of gauze or cotton. You use Aligner Chewies to help close any air gaps between your teeth and your aligners. Biting on the Chewie helps your trays to fit tighter on your teeth, which helps your treatment progress faster. Your dentist or orthodontist may give you some Aligner Chewies, or you can buy them online. In a pinch, some rolled-up gauze can also do the trick.
You Need To Keep Your Teeth and Aligners Clean
If you were lazy about brushing your teeth before getting clear aligners, you will need to change your habits. You always take your aligners out before eating (whether it’s a small snack or a full meal). Before you put them back in, you must brush your teeth and clean your aligners. As you can imagine, this gets to be a chore after a while, and you might find yourself deciding not to snack because it’s not worth the hassle. The only thing you can eat or drink without needing to take out your aligners is clear water. This is because other beverages may leave sugar, carbohydrate, or staining residue inside and on your aligners. It can stain and damage your aligners, and contribute to tooth decay and tooth stains. If you’re not a home, you’ll need to take a cleaning kit with you to ensure that your teeth and aligners are clean between meals.
You May Need To Reduce the Width Of Some Teeth
Sometimes a little enamel needs to be removed from the sides of a few teeth to create space for movement. This is called Interproximal Reduction (IPR). It is usually done with a small dental file or special handheld electronic drill. IPR doesn’t hurt, and it doesn’t effect the health of your teeth because only a small amount of enamel is stripped away from the sides of the teeth. If your teeth are not overly crowded, IPR can be a good alternative to tooth extraction if you need more room for your teeth to move into new positions.
You May Need Attachments
As your treatment progresses, you may need Attachments (also called Engagers) placed onto your teeth. These are little bumps of tooth-colored composite material that are bonded onto your teeth with a curing light. They act as knobs and help the aligners to grip your teeth and move them in specific ways. Sometimes an attachment called a Button (also called a Hook or a Bracket) is necessary to attach orthodontic elastics. Buttons are can be made out of plastic, composite material, or stainless steel. Your dentist or orthodontist decides how many Attachments or Buttons you need to accomplish your treatment goals.
Attachments and Buttons may feel uncomfortable at first — like you have something stuck to your tooth (because you do). You will feel them on the insides of your gums or behind your teeth. They may make it a little harder to insert and remove your aligners. After a week or two, you will get used to feeling them and dealing with them.
You May Need Refinements or Revisions
In the middle or near the end of treatment, your dentist or orthodontist might take new scans to evaluate how your treatment is progressing. If they are not happy with your progress, they might make revisions or refinements to your upcoming sets of aligners. Sometimes this process increases your treatment time by a few months. You may be eager to be finished and annoyed that your treatment will be prolonged. But remember: your dentist or orthodontists only wants to accomplish a great outcome for you! If you stop too soon, you may not get that great smile you were hoping for.
You Need to Wear Retainers Afterward
When you’re done, you’re not really done. No matter what type of braces you get, you need to wear retainers afterward to maintain your new smile. The retainers are custom-made for you and are usually clear plastic, just like your aligners — except that the retainer’s plastic is thicker and meant to last several years.
At first, you will need to wear your retainers 24/7 for the first few months. This helps to solidify the periodontal ligaments into their new positions. If you don’t wear your retainer as directed, your teeth could shift. Your teeth may seem static, but in fact they are dynamic; your jaws exert a more powerful force than you may realize! Be sure to wear your retainer exactly as your dentist or orthodontist recommends. Usually, after about 6 months, you can switch to wearing your retainer only at night.
You also need to be sure to keep your retainers clean. Just like your teeth, your retainers can get a buildup of bacteria and white plaque. They need to be cleaned daily with an antibacterial retainer cleaner such as Retainer Brite, Dentibrite, or Steraligner.