Many people who want straight teeth never pursue treatment because they just don’t like the way braces look. In 1998, Align Technology introduced Invisalign tooth positioning aligners. Up until that time, the only cosmetic alternatives to silver braces on the teeth were clear (ceramic) or lingual (inside) braces. Why do orthodontists still use clear braces when Invisalign seems so much better?

Why is Invisalign so popular?
Align Technology’s introduction of Invisalign changed the field of orthodontics forever. First, for appropriate cases, Invisalign does provide the esthetic alternative to metal braces that many patients are seeking. Second, because Align bypassed professional providers and marketed directly to the public (think Little Purple Pill and Viagra), they created a demand for their product and an expectation that teeth can now be straightened without wires and brackets glued to the teeth. Third, because the Invisalign system seems so much easier to use than conventional braces, more than 300,000 non-specialist dentists are now also offering orthodontic services in their practices. Although these changes have encouraged more patients to seek treatment, Invisalign is not a replacement for braces in all cases.

Some complex tooth movements are difficult with aligners
First, although clear aligners are appropriate for many orthodontic problems, they are still biomechanically inferior to conventional braces in many situations. Because it is more difficult for plastic shells to create some of the forces required for complex tooth movements like turning round teeth, making teeth longer, and paralleling roots in extraction cases, most orthodontists still prefer to use brackets and wires for moderate to severe cases.

Advertising has created unrealistic expectations
Second, by taking Invisalign directly to the public without explaining its limitations, Align forces orthodontists to be “the bad guys” who more often than not have to give disappointing news to overly optimistic prospective patients. My practice statistics indicated that less than half patients who come in hoping for Invisalign actually have problems that qualify for aligner therapy. The other seven would be treated to a better result with braces.

Better results may be possible with real braces
Third, because Invisalign appears easier to use than braces, dentists with little or no orthodontic training are now also offering orthodontic services to their patients. Since most of us trust the advice of our family dentist, rarely do we question when he recommends a new service. The results obtained by any doctor however are determined by his skills and experience. Eliminating brackets and wires does not eliminate the need for accurate diagnosis, treatment planning, and case management. Invisalign is simply a tool. Just because I can buy the same golf clubs as Tiger Woods does not mean that I can shoot the same scores as he does!

Sometimes aligners are better than braces
I use Invisalign in my orthodontic office. It is effective for mild to moderate crowding and alignment cases. It is especially good for patients who have had previous orthodontic treatment but did not wear their retainers and have experienced some relapse. I like the fact that my patients can take out their aligners to eat and brush. Patients like it because it is less noticable than braces. So in many cases, Invisalign is actually my treatment of choice.

Cosmetic brackets are a great alternative to Invisalign
If Invisalign isn’t appropriate for your particular problem, what other options do you have? The most tried and true, economical alternative is clear braces. They have been around a long time and are now better than ever! Modern manufacturing techniques have overcome practically all of the long-standing weaknesses that have plagued previous generations of clear brackets. Today’s appliances are stronger, smaller, and do not stain like previous models. They can be used for the exact same complex movements as metal brackets, move the teeth just as efficiently, and are compatible with Suresmile CAD/CAM technology. The only two drawbacks that remain are that they are still more fragile than metal (for athletes in contact sports), and they still cost your orthodontist more to purchase (which he must pass on to you).

So if you are dead set against metal braces, you have options. Invisalign might be perfect for you if your problems are only mild to moderate. If you want the most cost-effective esthetic alternative to “railroad tracks” that can actually move your teeth like metal however, ask your orthodontist to show you today’s cosmetic brackets. I think you’ll be impressed!

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is 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 in the United States. Dr. Jorgensen’s 25 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, Suresmile, and lingual braces). This blog 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 can he select treatment plans for readers. Because he has over 25,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.