Direct-to-consumer orthodontic aligners (also known as mail-order or do-it-yourself aligners) are everywhere these days. Companies selling these aligners imply you can get the same results as if you were treated by a local orthodontist, only faster, cheaper, and more convenient. If you are currently attempting to fix your smile yourself using these aligners but are not seeing the results you were hoping for, here are five possible reasons why:

Problems Were Too Difficult in the First Place
Plastic orthodontic aligners can be effective for aligning mildly crooked (turned) teeth, resolving minimal crowding (overlapping), and closing small spaces. There are other orthodontic problems, however, that are more difficult to fix with aligners. Examples include moderate to severe crowding and alignment issues, tipped or rotated teeth (especially those with round shapes like canines), overbites (top teeth stick out), crossbites (top teeth are inside of the bottom teeth), open bites (front teeth don't overlap), and deep bites (front teeth overlap too much). Although orthodontists can fix these problems with plastic aligners, these tooth movements are usually too difficult for direct-to-consumer products.

No Attachments or Tooth Reshaping Were Provided
Most tooth movements require "handles" on the teeth. With braces, silver or tooth-colored brackets perform this function. Plastic aligners need tooth-colored handles called “attachments” bonded to the teeth for movements such as the rotation of round or small teeth, extrusion (making teeth longer), intrusion (making teeth shorter), and tipping (changing the angle of a tooth). Additionally, some alignment problems are due to the size or shape of the teeth. Correcting these issues may require tooth reshaping, known as interproximal reduction. Bonding attachments and reshaping teeth must be performed by a local doctor and is not possible with current direct-to-consumer products.

Inappropriate Tooth Movement Speeds or Sequences Were Prescribed
Despite the claims made in advertisements, plastic aligners cannot move your teeth faster than braces. The speed of tooth movement is limited by your body’s ability to remodel bone. If the prescription in your aligners attempts to move the teeth too fast or too far in a single step, your teeth will not move as prescribed. Furthermore, orthodontic alignment requires space. A tooth must have somewhere to go before it can move. If your DTC aligners aren't working, it may be because the prescription tried to move your teeth too fast or did not create enough space before trying to correct the alignment.

Rubber Bands Were Not Provided
Although aligners alone (with or without attachments and tooth reshaping) may be able to align upper and lower arches separately, improving the relationship of the upper teeth to the lower ones may require the use of rubber bands (elastics). Aligners provided by local orthodontists can incorporate elastics that improve overbites, underbites, and mismatched midlines. Currently, most direct-to-consumer aligners systems do not include rubber bands.

In-Person Care Not Available
Tooth movement is a dynamic (constantly changing) process. As with most things involving the human body, progress rarely goes exactly as planned. When you work with a local orthodontist, you will have the advantage of an in-person doctor who can evaluate your x-rays, examine your teeth AND bite, discuss your goals and concerns, present all treatment options, provide the attachments, tooth reshaping and rubber bands needed for complex movements, make sure your aligners fit, monitor your progress, and change your treatment plan along the way if needed. There really is no substitute for a local orthodontist when it comes to getting your best smile.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa. Dr. Jorgensen's 28 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor select treatment plans for readers. The opinions expressed here are protected by copyright laws and can only be used with the author's written permission.