The Claim That Aligners Work Faster Than Braces
In the last blog, I introduced the subject of fast and easy orthodontics, and the issues I have encountered with them. In this diatribe, my vituperation is focused on clear aligners and their ilk because of the magnitude of their media promotion and the unabashed, flagrant advertisement to the public and to the dental community, propagandizing that their product is better than braces, in every way. But do they do a better job? And are they actually faster than braces?
I thought I would go over some of the pros and cons of aligner therapy versus straight wire and let you judge for yourself what is best. These are my anecdotal takes on this subject. There are so many biases that I won’t even try to defend mine.
In my experience, dentists should always be aware of three common issues that patients hold in highest regard when considering any treatment that we recommend. When discussing a treatment plan with a patient, these concerns must be addressed in our discussions before the patient can process our proposals. These concerns, these fears, if you will, are time, money, and pain. And these are the visceral, gut fears the aligner ads target in our patients.
Time, Money and Pain
The ads to the public are filled with references about these three concerns. They claim that clear aligners are faster, cost less and hurt less than braces. But is it so? Again, this is not a referenced article. It’s a Blog. My audacious, unapologetic opinion. So, keep that in mind, just to be fair.
Time in treatment: The TV commercials say that aligners are faster than braces…so, are they?
It is important to note that when invisible aligners advertise about time, they always stipulate that the patient must wear the trays 22 hours per day. Less compliance will result in longer treatment time. Invisible aligners websites admit cases that are severely involved, such as severe crowding, rotations, deep bites, open bites, etc. will take longer than braces. One such site showed a crowding case, corrected with aligners, that required 2 ½ years. They seemed pleased with that treatment time. Not my idea of a brief experience. The same website suggested that many cases with mild crowding or just one or two teeth out of alignment, may take as little as five or ten weeks. I have never had an aligner case finish in five weeks, nor have I ever had an aligner anterior crossbite case finish in 2 ½ months. And, those cases usually require interproximal reduction (IPR) per the manufacturer’s strategy. Furthermore, most of my aligner patients cannot change the trays every week as manufacturers advise but prefer to move up every two weeks, rendering possibly twice the treatment time advertised.
I have also read on websites that praise invisible aligners the claim that anterior crossbites are always corrected faster and more easily with aligners than braces. The ads claim that the difference is that aligners keep the arches apart as they work so the teeth move smoothly out of crossbite. In my hands, crossbites can be treated with aligners, quickly, only if significant IPR or stripping is performed because the crossbite teeth are usually blocked out of the arch and crowded. These same sites suggest that it is essential that braces must prop open the bite while moving a tooth out of crossbite. But those dentists and orthodontists who are adept at using fixed appliances, especially those of us who are familiar with broader arch form Straight Wire techniques, can correct anterior crowding and crossbites in as little as six to eight weeks, consistently without sanding, grinding or cutting between the teeth, that is, IPR. In my experience, using the Straight Wire approach treatment time is always faster than aligners, seldom requires propping open the bite and allows me to avoid IPR (bite opening pads are used to eliminate bracket interferences, not to allow the tooth to pass over the opposing teeth; patient’s teeth are naturally apart most of the time). Although IPR is an option, using braces, we can expand the arch, making the room to get a crowded tooth out of crossbite. And the cases are treated completely and comprehensively.
In Straight Wire, most class I cases take 14–16 months and class II cases 18–24 months. And these cases are corrected completely, including the posterior occlusion. Dealing with the posterior occlusion is something that aligner proponents constantly keep in the forefront of their sales pitch to dentists, “We don’t fix the bite in the back; we just fix up the front”, “That is why we don’t have to obtain records and cephalometric radiographs and analyses”, “We really aren’t affecting the patient’s bite”. This is, by definition, a masking tactic, a camouflage. Certainly, Straight Wire can be used in such an approach, for example, the Six Month Smiles fixed appliance method. So, it really depends on the goals and objectives of treatment in order to rightly compare the duration of appliance therapy.
Specifically, regarding time in treatment, in the average case, the two modalities require very similar time. Taking everything into account, to compare typical aligner therapy with comprehensive Straight Wire treatment is “apples and oranges”. They are, most of the time, two completely different things. Overall, aligner therapy is almost always camouflage and mediocre camouflage at that; while braces, Straight Wire orthodontic therapy, is comprehensive treatment, ideal treatment, and even when it is used for camouflage, it is an excellent limited procedure with crisp finishes and superlative results. In the end, comparing true calendar time, that is, weeks patients can expect to spend in appliances, there is no treatment time advantage in aligners over braces and the results of aligners are consistently inferior.
So, I will conclude my tirade on comparing treatment time this way; the aligner’s advertised claim: “Faster than conventional braces”. My bottom line: I have been doing braces in my practice for 37 years. I have offered aligner therapy as an option for the last 15 years. During that time, I have rarely had an aligner case that finished in under a year and, without exception, there were compromises. Additional refinement trays, excessive IPR, placement of rescue brackets, veneers, bonding, or a change in patient expectation—all are compromises that occur to reduce aligner treatment time. Smile Direct Club runs a TV ad that promises the public “up to three times faster than braces”. I have never seen any aligner that can deliver on that promise.
In Part Three of this blog I will continue to look at clear aligners and their advertised claims of superiority over braces, this time relating to reduced cost and pain.