The New Patient Dilemma: Clear Aligners or Braces?!
At almost every new patient consultation, I will have a conversation with the patient and/or guardian about the differences between aligner therapy (Invisalign/Spark/in-house custom aligners) vs. traditional braces. Sometimes the patients are surprised about the advantages/disadvantages that each can offer, so I figured that it would be good to explain these in detail! Got 10 minutes to spare? Read on!
Traditional Braces advantages:
“Jesus, take the wheel” mentality: Do you misplace your car keys often? Do you think that 20-22 hours of wearing plastic just feels like too much of a commitment? With traditional braces, the wire is tied in and ‘voila’, teeth start to align! All you have to do is show up for your appointments, and let the doctor take control.
Colors, colors, everywhere: Not only popular with the tweens and teens, but adults also love to display their own personality through colors! With an almost unlimited color patterns of elastomeric ligatures (o-ties that hold wire in place) that they can choose from, this is a chance for patients to wear those braces with style!
Orthognathic surgery: Most oral and maxillofacial surgeons still prefer wires and hooks for more predictable control for their jaw surgeries. However, some surgeons are becoming more comfortable performing jaw surgeries for patients in aligner therapy.
Traditional Braces disadvantages:
Oral hygiene disruption: Let’s be honest, not every patient in braces is flossing daily. Let’s be even MORE honest, even without the difficulty of wires/braces, patients are struggling with everyday flossing. Braces can act like a food trap and a magnet for plaque collection. Some patients are amazing with their oral hygiene remedies and their tooth surfaces and gum tissue look amazing. Other times, we see moderate gingivitis and decalcification (enamel weakening in the form of the scary white spots!). Simply, it’s just harder with braces.
More appointments: Because the life span of an elastomeric ligature/chain lasts slightly longer than a month, we need to see our patients more frequently to “activate the wire”. We also need to transition from very light wires to heavier wires throughout treatment to keep correction going, so this calls for more appointments than aligner treatment.
Clear (Invisalign/Spark/In-house 3D printed) Aligner advantages:
Oral hygiene: You like to floss every day? Easy. Just pop out the trays and floss as normal! You also don’t have food particles and potential damaging sugars collecting around braces. So risk of gingivitis and decalcification are greatly reduced with aligner therapy.
Less appointments: Busy moms and dads, listen up! This is a BIG ONE. At High Tide, I give the patient 10-12 trays at a time (this number is totally up to doctor’s discretion). Wearing each tray for one full week, 10-12 trays allows for ~3 months between visits to our office. And, with the advent of A.I. monitoring (companies like Grin or Dental Monitoring) for monitoring progress, in the near future we may require even LESS appointments. So, more time spent getting Johnny and Ella to soccer practice, less time worrying about having to come see me every month.
We also experience very few comfort visits with Invisalign vs. traditional braces (think: pokey wires, broken/loose brackets, etc)
You are what you eat: Love your popcorn, the corn right off the cob, and/or chewing the meat off of a buffalo chicken wing? Don’t fret! Just remove the aligners and eat what you want. (Just remember that you need to wear the trays for 20-22 hours/day to get desired outcome, so keep mealtime and snack time within the 2-4 hours/day range)
“Invisible”: Besides the barely-visible attachments on the front of a few teeth, aligners tend to hide the fact to friends/family/enemies that you are correcting your alignment and bite!
Teeth Whitening: A lot patients think that they have to wait until after treatment to start whitening, but that is a myth! We have our patients use their aligners as bleaching trays, and the whitening occurs normally even with the attachments or “bumps” on the tooth surface
Complex cases*: Surprising to most patients, I am leaning more into aligner therapy vs. traditional braces for the more difficult cases. I have a lot of experience moving teeth predictably with plastic, and I have even more control with aligners over traditional braces
*In-house 3D printed aligners are currently only being used for mild/moderate cases at High Tide Orthodontics. Adults with dental crowding relapse are perfect candidates for High Tide in-house aligners as these are usually more affordable because we keep lab costs in-house!
FASTER?: I may sound crazy, but I am treating most of my cases faster with aligners (if patient is compliant with wearing the trays). The main reasons I can make this claim are:
We are able to start bite correction with elastics/rubber bands from DAY 1. With traditional braces, we sometimes will have to wait until we get to a larger wire to wear heavier rubber bands.
More control: a competent orthodontist using traditional braces will always attempt to predict and control future side effects of a wire. These side effects caused by wires can sometimes extend treatment, especially if we don’t want to change a bite that already looks great from the beginning. With aligners, I don’t have this problem!
Clear (Invisalign/Spark/In-house 3D printed) Aligner disadvantages:
COMPLIANCE: I am a total believer that aligners can offer the SAME beautiful finish as traditional braces (at least in my hands). But this style of treatment relies heavily on TEAMWORK. I set up the plan, the patient puts that plan into action. I’ve toyed with nighttime only with Invisalign, I’ve played with every-other-day, and I’ve experimented with switching to the next aligner too fast. The proof is in the pudding: wearing these plastic trays for 20-22 is absolutely necessary for optimal treatment.
For all you constant snackers out there… you need to change your routine or traditional braces it is!
Certain tooth movements: Sometimes I still struggle to complete some tooth movements (molar tipping, canine rotation, impacted canine exposures) faster than braces. These are a case-by-case basis, and I will always explain to the patient if and when braces are preferred over aligners!
Colors: we have experimented with colored attachments, but the teeth appeared like the patient just finished Fruity Pebbles and forgot to brush. Yikes!
Some practices offer fun stickers to place on the aligners for the youngins! We plan on offering those, as well!
Main takeaways
Almost every patient is a candidate for clear aligner therapy at High Tide Orthodontics.
While there may be advantages/disadvantages to both methodologies, I can usually finish in the same amount of time along with the same high quality result. In the rare event that one option is much more efficient or predictable, I will explain that to you during the initial consultation. Ultimately, you know yourself better than anyone. So the choice is up to you!
We don’t want price to influence your decision, we only care about quality treatment and providing an unmatched patient experience. So, whether you choose the braces or the Invisalign, they are the same price!
I won’t skirt around it: I love treating with clear aligners. I have been testing the limits of Invisalign for ~9 years at this point, and I still get surprised with how efficiently I can treat a case. This is especially true for even a difficult case, and I still can finish with a high quality, beautiful result. Plastic aligners (regardless of company) can provide amazing control while allowing the patient to live their best life. They can floss and brush like normal, they can eat all their favorite foods, and they can speed through treatment incognito. Clear aligners are not just for adults either! More teens are choosing clear aligner therapy over traditional braces in our office! That’s where things are trending!
Cheers,
Dr. Trev