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Questions You Should Ask When Considering Aligners For Treatment

Questions You Should Ask When Considering Aligners For Treatment

Important Considerations to Keep In Mind

Thinking about using a removable tray aligner system such as Invisalign or ClearCorrect to straighten your teeth? Before committing to treatment, we encourage you to look at websites and social media comments from patients that have already gone through treatment. There will be positive comments, but you may be surprised by just how many negative comments there are about the experience. Treatment does not turn out as expected by many patients for a wide range of reasons, some legitimate, some not.

Invisalign is just one of at least a dozen or more companies that offer aligners. There is no question aligner systems from any chosen company can work well when properly selected. Orthodontists use the term “bite” or “occlusion” to refer to how well your upper and lower teeth physiologically come together when you close your mouth. From what we have seen professionally, aligners can improve your bite, but they are not as effective as braces for all cases. By our experience and estimation, aligners can improve occlusion by up to 75-90% of what braces or other fixed orthodontic appliances can do.

Many aligner companies will advertise questionnaires to determine if you are a good “candidate” for aligners. What this really means is that aligners have limitations and do not work well in all cases, and even for the cases that they may work for, braces are usually a much more effective choice for improving your bite. This means it becomes incredibly important to not only look up reviews from patients that have gone through treatment, but it is also important to know what questions to ask to ensure your aligner treatment is a success if you do choose aligners.

So, what questions should be asked when interviewing prospective orthodontists or dentists prior to committing to treatment with an aligner system?

A Few Questions To Ask

  • Can I expect my teeth to look and fit just like the projected final result shown by the aligner companies prior to authorizing the construction of the aligners? If not, why not?
  • How often do you find you need to retake impressions, or scans, to restart cases that get off track?
  • How often do you monitor the case and how many trays do you give out between office visits?
  • What financial responsibility do you, the orthodontist, have when the case goes off track and new scans or impressions must be taken? Is it always the patients’ fault and financial responsibility?
  • Does your practice have the in-office capability to create substitute trays to manage lost or broken aligners in a day, or must it be ordered from the company and shipped out days later?
  • Is lack of compliance in wearing these trays (required 20-22 hours a day) the reason patients are given for less than desirable results? Are poor results blamed on the aligner company for not treatment planning the case correctly?

Shifting Responsibility

Professionally, we have seen a dramatic shift in who assumes responsibility when treatment does not go as planned, especially when it comes to treatment with aligners. With braces, the responsibility of fixing the bite and straightening teeth has always been shared jointly by the patient and orthodontist. The orthodontist had the ability, skill, and mechanical means to align your upper and lower teeth in an ideal position as long as the patient was responsibly following the directions of their orthodontist. Some patients need to wear elastics to help move their bite into position, and in those cases, the patient bears some of the responsibility to ensure treatment stays on track.

With aligner systems, the responsibility for generating a nice bite has shifted to the patients and the aligner companies. This is partly why so many dentists will treat patients with aligners and less frequently with braces. Dentists are not orthodontists and do not have the same education or skills to move teeth in the way orthodontists do. Instead, dentists will opt for aligners since all that is necessary for treatment planning with aligners is a scan of your mouth. The aligner companies no longer require x-rays that can determine extra teeth, short roots, or other anomalies that can negatively impact the outcome of the treatment. They send this scan to the aligner company and then the aligner company treatment plans the individual tooth movements according to their evaluation of the scan. The aligner company then creates a tray-by-tray visual sequence of their proposed treatment for the doctor’s evaluation and final OK. This is the critical step where knowledge of how teeth move and how aligners work is essential.

Once the OK is given by the doctor, the company sends the trays to the doctor to put on the patient’s teeth. However, dentists and trained orthodontists have come to rely on the expertise of the aligner company technicians to treatment plan the cases that are sent to them instead of developing their own expertise in treatment planning. As a result, it has become easy to blame the patient and aligner companies for the shortcomings in treatment that occur to many patients.

How To Know You Are In Good Hands

Orthodontists should be taking the time and effort to properly evaluate the case within the parameters of what aligners can effectively and predictably accomplish. This means, just because a patient may prefer aligner trays, orthodontists should be honest to patients about whether or not aligners are the best solution for their bite. Orthodontists, or dentists that use aligners, should also be extremely comfortable and proactive in adjusting the programming and treatment planning that aligner companies propose. These companies do not see the patient in-person, but the dentist or orthodontist does see patients in-person. This puts the orthodontist in the best position to make real-life and real-time adjustments to manage the case most effectively.

Lastly, orthodontists should follow through with careful and frequent checks to make sure every aligner tray accomplishes its individual goal before proceeding to the next tray. It is not a “plug it in every two weeks and forget it until all the trays are done” approach. Far from it. In fact, you should be seen for monitoring more frequently with aligners than if you had braces. The reason for this is that if an aligner gets off track even slightly, then every successive tray will be off track even more and more until a new scan or impression is required to get a new set of trays that can re-start from where the trays originally started to no longer fit! This issue of trays not fitting properly becomes a much bigger problem to fix than with braces.

When patients ask us about aligners during consultations we always implore them to do their homework and learn as much as they possibly can about aligners. More importantly though, make sure to find out how the orthodontic office you choose deals with problems that occur with aligner treatments. Aligners absolutely have a place and we do use them. We just want to make sure it is the best option for you to have an optimal bite.

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