Since launching in 2000, over 8million people have been treated worldwide with Invisalign and each year it seems increasing number of patients are opting for removable aligners rather than traditional braces.
When I started with Invisalign in 2008, the decision of braces versus Invisalign was, in the main, determined by how severe any crowding was. I have some colleagues who will disagree with me, but back then Invisalign was primarily focused on getting a great smile - as soon as things became complex and required a lot of movements of the back teeth, often braces would give a quicker and/or better result. As a result I would routinely send around a third of my patients down the hall to my orthodontist colleague for braces.
Fast forward to 2021 and the technology has moved on at an astounding pace - I am now routinely successfully treating cases with Invisalign that I would never have dreamed of all those years ago when I started (although I do still regularly send some prospective clients off to my orthodontist colleague if I think they will get a better result).
So assuming you are suitable for either option how do you choose one over the other? Well there are a few considerations you need to think about....
Comfort and Appearance
Invisalign tends to appeal to those who prefer comfort and want things as discrete as possible. Aligners are thin, easily removed and discrete when worn compared to more bulky braces. With both braces and Invisalign you will feel some discomfort in the teeth as they move - however this tends to be significantly less with aligners as we are not putting as much pressure on the teeth at any one time.
One challenge that patients with braces face is irritation to the cheeks and lips from the brackets themselves - this can lead to ulcers and sore spots, particularly when starting out although placing wax over the brackets can help with this.
The flip side though is that although the aligners can be easily removed to eat and brush, this also represents the biggest challenge with Invisalign. For Invisalign to work you have to be committed to wearing the aligners 22hours a day on a consistent basis. If you can't consistently wear the aligners for the recommended time it can greatly extend your treatment time and sometimes can prevent you getting to the finish line at all.
It should also be mentioned that even with braces there are alternatives to the traditional metal "train tracks" you might have seen (or experienced) as a child. One alternative is to use clear braces where, instead of the brackets being made out of metal, they are made out of either ceramic or plastic. This can make the appliance a little more discreate. A second alternative is lingual braces where instead of placing the braces on the outer surface of the teeth we place them on the inner surface of the teeth. The most common brand of lingual braces world wide is Incognito. Lingual braces do have the advantage of being completely invisible. They are however harder to adapt to as the brace is occupying the same place as your tongue which can lead to more ulcers and speech issues.
Regardless of what you are wearing, the teeth still need to be effectively cleaned as you go through treatment otherwise there is a significant risk of both decay and gum issues. This is harder to achieve when wearing braces as the brackets are attached to the teeth and connected with a wire - this creates lots of areas where food can become trapped as well as areas that are difficult to get to when brushing. For this reason your orthodontist will recommend certain foods that you should avoid both to try and reduce the amount of food particles trapped around the teeth as welling as preventing damage to the brace itself.
Obviously cleaning is a lot more easily achieved with Invisalign as it can simply be removed when brushing and studies have shown that when, compared to braces, Invisalign patients experience significantly less plaque accumulation and bleeding of the gums.
Time in treatment and visits to the clinic
Ten years ago I would tell patients with moderate or severe crowding that wearing braces would reduce the time in treatment by about a third when compared to Invisalign. These days for all but the most severe of cases the amount of time in treatment I find is very similar - assuming the aligners are being worn consistently of course!
With braces the orthodontist will need to "tighten" the appliance approximately every 4weeks so it is important to choose an orthodontist that is reasonably close to your work, school or home. Invisalign requires fewer direct adjustments so generally appointments are every 6-8 weeks depending on where you are in treatment. The advent of Dental Monitoring (see the video below) has also been a game changer in that progress can be assessed remotely every week via a digital scan. This means we can better tailor your visits to the practice based on how treatment is progressing.
Finally there is always the question of cost. This is actually very challenging as there is a large variation in the fees that are charged for treatment - a lot depends on the experience of the clinician, how many cases they do a year, where they are specialist or not and, of course, the overall complexity of your case.
Another less obvious issue is what exactly is included with the fee quoted and whether their are any add-on fees. Some clinics will charge additional amounts for records, x-rays, emergency appointments, retainers and even additional aligners. It is important that you know not only the fee for treatment but also the likelihood of any additional fees as you go through treatment (if any).
Keep an eye out for an upcoming blog post where I go through this in detail!