Let’s face it, the idea of getting straight teeth faster, cheaper, and without the need for an orthodontist is pretty appealing. Before you choose to give direct-to-consumer (DTC) aligners a try, however, here are five differences between the aligners you’ll get in the mail and those provided by a local orthodontist.
They May Not Be Designed by an Orthodontist
In our office, we design every aligner that we provide our patients. Aligner design requires an understanding of 1) the patient’s final goals, 2) the sequence and speed of tooth movements, 3) the overcorrections that must be built in the prescription to achieve the desired results, and 4) the additional features that are required for difficult tooth movements (see below). Most direct-to-consumer aligners as designed by computer algorithms and then approved by “dental professionals.” Although there may be a dentist’s name on the aligner packaging, he or she may have had nothing to do with designing your aligners.
They Won’t Have Attachments
Front teeth are kind of shaped like pyramids (tapered to a point) and back ones are round like cylinders. Some tooth movements may require that tooth-colored attachments made of dental composite be attached to your teeth by a local orthodontist. Patients can’t bond attachments to their own teeth. Although some movements can be achieved without them, making front teeth longer or shorter as well as turning back teeth may not occur as planned.
They May Not Feature Rubber Bands
Braces and aligners can both be effective at aligning the teeth in a single arch (the uppers or the lowers individually). When improvements are needed in the bite however, orthodontists usually prescribe something connected between the upper and lower teeth. For example, if you have a crossbite or “overbite,” you might be given rubber bands to wear that can improve your bite. To date (March 2021), direct-to-consumer companies are not providing rubber bands with their aligners. In fact, they require that customers sign a statement before they begin treatment acknowledging that DTC aligners will not improve their bite.
They Might Not Fit as They Should
To be effective and safe, clear aligners must fit properly. If they do not, they will not be able to provide the forces required for moving the teeth. Additionally, if they rub or impinge on the gums, they can cause pain, sores, or even permanent recession. It is possible that any aligner, whether from a mail-order company or an orthodontist, might not fit as planned. There can be errors made in the impressions or scan, the creation of the digital models, or in the manufacturing of the plastic shells themselves. If you are being treated by a local orthodontist, he or she can easily evaluate the fit for you. If you don’t have local doctor, you won’t have someone in-person to make sure your aligners fit right.
Your Teeth Might Not “Track” as They Should
Even if your aligners fit right on the first day, it is important that the teeth move as directed as your treatment progresses. This is a concept known as “tracking.” If the teeth do not follow the plastic, the desired movements won’t take place. Problems with tracking can be caused by poor aligner design (too fast or the wrong sequence of movements), the lack of appropriate attachments, or poor cooperation (not wearing them enough). A local orthodontist can easily evaluate tracking and determine what to do if there is a problem. If you get your aligners in the mail, you won’t have a local specialist to help you.
There is real value in getting your teeth straightened by a local orthodontist. He or she will be able to evaluate the health of your teeth, discuss your goals, present treatment options, design aligners or braces that will achieve your goals, provide in-person procedures not available with DTC aligners (attachments, interproximal reduction, rubber bands, etc.), make sure your aligners fit and the teeth are tracking, and provide you with long-term retention after you’ve achieved your goals. You only have one smile. Shouldn’t you trust is to a real, local orthodontist?
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, Suresmile, 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.