Clear Aligners – Fact or Fiction

Efficiency, effectiveness and treatment stability of clear aligners: A systematic review and meta‐analysis

Zheng M, et al.

Orthodontics and Craniofacial Research 2017

Background

Clear aligners, such as Invisalign or Spark, are plastic trays that fit closely to the surfaces of the teeth. By changing the aligners once or twice per fortnight, the teeth are slowly moved into the desired position to create a straight smile and functional bite. Clear aligners are one of the greatest innovations in orthodontics over the past 20 years and have encouraged millions of patients to have their teeth straightened without the need for metal braces. As exciting as this technology is, it is important to separate some common facts from fiction. A recent systematic review and meta-analysis sheds some light on the topic.

Fact or fiction

Clear aligners are faster than metal or ceramic braces.

FACT. The total treatment time for clear aligners can be anywhere from three to five months shorter than braces. However, most orthodontists treat their “easier”, non-extraction cases with clear aligners. More difficult cases involving the extraction of teeth usually require more time with clear aligners when compared to braces.

Clear aligners achieve a better final smile and bite.

FICTION. For mild to moderate malocclusions (crooked teeth and bite), there is little difference in the final result that can be achieved by either clear aligners or braces. More severe malocclusions, especially when removal of teeth is required, are harder to correct with clear aligners and, according to an American Grading System, do not correct malocclusions as well as braces.

Braces create a more stable final smile and bite.

FACT. Although this fact is based on a single study, it was found that patients treated by Invisalign relapsed (teeth moved back) more than those treated with traditional braces. However, the factors that contribute to relapse after orthodontic treatment are complex and it is important to remember that retention, with removable or fixed (bonded) wire retainers, is one of the most important factors in maintaining a long-term smile and bite.

Clear aligners have fewer appointments and emergencies than braces.

FACT. Most clear aligner appointments take half the time of a regular braces adjustment because there are no wires to change. Furthermore, clear aligner patients generally require fewer overall appointments. Those with good compliance (wearing aligners for 22 hours per day consistently with excellent oral hygiene) can be seen at 10—12-week intervals rather than the regular 8-week interval. Emergency visits are not as common with clear aligners as there are fewer parts that can break and no bands or brackets that can come loose. Clear aligners must be removed for eating, which negates the risk of breaking something whilst chewing.

Summary

The main advantages for clear aligners over braces are shorter treatment time, fewer emergencies and less office visits. However, this is only significant when mild-to-moderate malocclusions are treated. More severe malocclusions are usually treated more efficiently with braces. 

Dr Jensen

What do adolescents think of braces?

Brazilian adolescents’ perception of the orthodontic appliance: A qualitative study Barbosa de Almeida A, Leite I, Alves da Silva G AJODO April 2019

Background

Straightening teeth with braces changes the way teenagers feel about their smile and can improve their quality of life through their high school years. We see happiness with all of our teen patients, the day we take the braces off, they cannot stop smiling. Nowadays, walking through Unley Shopping Centre, most teenagers have braces on. It is a normal part of being an adolescent. But what do adolescents think about braces? What are the changes that they see in their smile and what are their concerns with braces? A paper from the American Journal of Orthodontics and Dentofacial Orthopaedics provides some information on the topic.

Research question

What is the perception of Brazilian adolescents regarding braces and the orthodontic treatment process? What did they do? The Brazilian research group performed a prospective study with teens aged 12-15yrs enrolled in both public and private schools. 142 adolescents (91 female and 51 male) from 8 schools (4 private and 4 public) were enrolled in the study.

Firstly, they used word association where the adolescents were invited to respond with 3 words when asked “What comes to your mind when you think of braces?” and “What comes to your mind when you imagine a friend of yours wearing braces?”

The most common words used from these teens were then used to develop related questions for small focus groups with students from the same schools. The focus groups were made up of 71 students (23 male and 48 female), equally divided between public and private schools.

Results of the study

The most common positive words for braces were “cool,” “beautiful,” and “colour” whereas the most common negative words were “expensive”, “pain” and “difficult to eat”.

The aesthetic benefit of orthodontic treatment was the most frequent category in all focus groups, followed by the colour of the braces and the social impact. The functional benefit of braces was low on the list of benefits.

The pain associated with orthodontic treatment was the most relevant negative aspect. Most of the time, the pain was reported as a momentary setback that was easily overcome. Difficulty eating, cost and length of treatment were also mentioned as negative outcomes of orthodontic treatment.

Summary

The conclusion of the study was that “orthodontic treatment has a positive aesthetic impact for Brazilian adolescents, with improvement of their self-image.” I thought that this study was a novel method for gaining understanding of the population which are most commonly in orthodontic care. It gives an insight into what are the most important factors for adolescents are when they are deciding to have braces. It is interesting to note that this population care more about the aesthetics of braces including the colours than the overall function or final bite.

As an orthodontist, my goals are to achieve a smile that every patient is happy with, but I also am concerned with developing the best bite. The occlusion, or the way the teeth bite together, is important for aesthetics of a smile, chewing and biting as well as stability of the teeth after treatment. Often when I am seeing teens, I am really focused on getting the bite right, but after reading this article, I’ll also make certain we have lots of different colours to choose from and provide adequate information about pain relief and tips on how to make the right food choices whilst going through braces treatment.

Dr Jensen