Clear Aligners

Treatment  /  Orthodontics  /  Clear Aligners

Clear aligners (invisible braces) are a discreet, modern way to straighten your teeth. Clear aligners work upon the same basic principles as traditional metal braces; they are designed to gently and gradually adjust the positions of your teeth to give you a straighter, more beautiful smile. However, they are not suitable for every case and fixed metal braces are still used for more complex cases.

 Straightening your teeth has an obvious impact on the appearance of your smile, but did you know that it can also improve your oral health? Straighter teeth are generally at a lower risk for tooth decay, gum disease and other dental problems.

Clear aligners have several benefits. First, they are nearly invisible. This allows you to maintain your normal appearance while undergoing orthodontic treatment. Gone are the days of having a “mouthful of metal” to gain a straighter smile! Whether you are a teenager who is conscious of your image at school or an adult who would prefer to maintain your professional appearance at work, clear braces are a great option. Patients also often find clear aligners to be more comfortable than metal braces.

What are Clear Aligners?

• Clear aligners are thin, transparent, plastic trays that are custom-made to fit snugly over your teeth and have been carefully programmed to apply small but deliberate pressure on your teeth in order to move them towards the correct position.

You will be issued with a series of clear aligners that are worn in sequence to gradually move your teeth towards the intended position, improving both your bite and their appearance.

The clear aligners must be worn for at least 22 hours each day throughout treatment in order to be effective.

What are Fixed Braces?

• Fixed braces are made up of small brackets attached to each of your teeth and joined by a wire.

•Fixed braces are a more traditional method of moving teeth and are still widely utilised where more complex tooth movements are required.

What are the benefits of clear aligners compared to fixed braces?

• Being more discrete and virtually invisible when they are in use

• Being more comfortable and kinder to the oral soft tissues

• Being removable, they can be taken out to eat, drink, brush and floss the teeth without any impediment

• For many patients, clear aligners are a fantastic alternative to traditional braces, however, they are not suitable for every case.

How does it work?

Your dentist will gather detailed information about your treatment goals, expectations, clinical circumstances, dental and general health. This will take the form of a detailed dental assessment, photographs and often x-rays.

This data will be submitted to an orthodontic clear aligner company (various companies offer this service) who will help to design and plan your case.

Your orthodontic recommendations will be presented to you alongside other options, including that of no treatment at all, so you are in complete control of your treatment journey.

• If you want to go ahead with treatment, your dentist will communicate this with the clear aligner company and trigger the manufacture of your custom-made clear aligners, which will then be fitted by your dentist.

• Your dentist is responsible for managing and delivering your care, often with support from the clear aligner company.

Risks and Inconveniences

Orthodontic and cosmetic dental treatment can be a positive, life-changing experience for patients who are looking to upgrade their smile and achieve lasting results. That is not to say that treatment is not associated with certain limitations and risks. It is important to remind ourselves that the best results from orthodontics, and any other dental treatment, are achieved when patients are engaged and cooperative throughout the journey.

There are some risks or inconveniences that might be encountered as a result of teeth straightening which you must be aware of before proceeding with treatment. These include but are not limited to:

Case Suitability.  Aligner treatments have a limited scope of applications. For complex cases, a dentist may be required to extract teeth or use alternative appliances where aligners are not suited.

Compliance.  Failure in compliance with the instructions provided by your dentist may increase the treatment duration and affect the ability to achieve the desired outcome.

Soreness.  Soreness of the teeth and gums may be encountered, especially after switching to the next aligner in the series, or due to scratching or irritation of gums through aligner use.

Undesirable Effects.  The aligners may produce undesirable effects in the beginning such as speech impediment, dry mouth or excess saliva production. These effects are temporary and should subside within a few weeks of consistent use.

During Treatment.  There is a higher risk of tooth decay, gum disease or marking/staining of teeth as a result of poor oral hygiene or excessive sugars in the diet during treatment.

Relapse & Retention.  Relapse of tooth movements back to original positions after treatment has ended is a risk. Compliance with a recommended retention protocol (retainers) will reduce this tendency and should be continued for as long as you wish to maintain the new position of the teeth, this might be lifelong.

Aligner Loss/Damage.  Aligner breakages can sometimes occur. Replacement aligners can be manufactured, so you must inform your dentist of any loss or damage. There may be an additional cost associated with replacement.

Medical Contraindications.  Certain medications taken and medical conditions can affect orthodontic treatment and may make a patient unsuitable to go ahead with treatment.

Allergies.  Aligners are made of plastic and in rare cases, patients may be sensitive or allergic to this material. If patients are concerned they are experiencing an allergic reaction, they must stop wearing the aligners and contact their dentist.

Occlusion.  The way that your teeth meet (occlusion) may be altered over the course of treatment. Changes to the occlusion can result in disturbance of the bite, tooth wear or temporomandibular disorder that can cause pain and discomfort to the jaw as well as headaches.If altered bite issues persist after treatment has been completed, it is sometimes necessary to see a dentist to have some adjustments made to the teeth to change your bite and improve the stability of your top and bottom teeth.

Tooth Shape/Position.  Atypically-shaped, short teeth, partially erupted or missing teeth may affect the ability of the aligners to achieve the desired results.

Existing Restorations.  Aligners will not be able to move dental implants and they will sometimes dislodge existing restorations, such as fillings, crowns and veneers in the process of moving teeth. Occasionally, at the end of treatment these restorations will no longer be satisfactory from an aesthetic perspective and will need to be replaced at additional cost to you.

Gum Recession.  Where teeth have been overlapped for a long time, there may be pre-existing loss of gum attachment near the neck of the teeth, once aligned this can become more apparent resulting in the appearance of a 'black triangle' near to the gum. This is a particular risk for individuals with past history of gum recession or who fail to maintain impeccable oral hygiene throughout treatment.

Compromised Teeth. All teeth, but in particular those that have been previously traumatised or heavily filled, can be compromised by orthodontic tooth movements resulting in the need for further dental treatment and, occasionally, the premature loss of a tooth or teeth.

Root resorption.  Root resorption (shortening of root lengths) may result from orthodontic movements which can threaten the life-span of teeth, especially when gum disease is present or develops later in life.

Devitalisation.  There is a small risk of devitalisation (death of the nerve in the tooth) and discolouration of teeth as a result of orthodontic tooth movement. This is especially true where teeth need to be moved a long way or if teeth have been previously compromised, resulting in the need for root canal treatment and tooth whitening (in some cases).

Ankylosed Teeth.  Aligners will not be able to move teeth that have become ankylosed or locked in their position within the bone. If you feel that any teeth are not moving while the rest are moving around them, please seek advice from your dentist.

Treatment Failure. Sometimes teeth do not move as anticipated, so treatment does not progress in line with the plan proposed at the start. If the teeth fail to 'track' and your aligners no longer fit then you might need to be issued with new aligners to wear or even referred to a specialist to finish your treatment with traditional orthodontic approaches (wires, brackets and removable appliances) which will increase the duration of your treatment.

What are attachments?

Attachments are small, tooth-coloured bumps (or buttons) made of a composite material that is bonded to your teeth temporarily during treatment. They are removed at the end of treatment.

• They provide extra stability and small forces to help move your teeth into their desired positions more efficiently.

They also provide additional grip for your aligners, ensuring they fit correctly and stay in place.

Attachments come in different sizes and shapes, depending on where they are placed in your mouth.

• Without attachments, treatment time may be extended or the desired results may not be possible, as there would be nothing guiding your teeth into the ideal position.

• In summary, attachments play an important role in treatment by ensuring that each tooth can move into its desired position with precision and accuracy—which means better results for you!

What is IPR?

Interproximal Reduction (IPR) is the selective removal of some of the outer tooth surface between the teeth.

Reducing the width of selected teeth can create the space needed to allow you teeth to move into the ideal position.

• If your teeth are moderately crowded , IPR often works well. If your teeth are more severely crowded, then tooth extraction(s) may be needed.

It is possible to reduce the width of certain teeth by up to 0.5mm

• This procedure is also sometimes called enamel reduction, slenderising or tooth stripping.

IPR only takes a few minutes and is normally done in a single visit or spread over several visits, depending on how space is required.

IPR does not hurt, as as only a very thin layer of enamel is removed, and no anaesthetic is required. You may feel a strange pushing/pulling pressure during the procedure

Your dentist will advise if you need IPR when discussing your options with you.

• Without IPR, treatment time may be extended or the desired results may not be possible, as there is not enough space to move your teeth into the ideal position.

• In summary, IPR plays an important role in treatment by ensuring there is enough space for each tooth to move into its desired position.

Which companies fabricate the clear aligners?

Your dentist will be in charge of your treatment, using an external company to fabricate your aligners.

• There are many clear aligner providers out there, including: Invisalign, Six Month Smiles, Quick Straight Teeth, Smilelign, ClearCorrect and 32co to name a few.

I've heard of Chewies... what are they?

To get best results from your clear aligner treatment, your teeth must fit perfectly in each aligner. By biting down on Chewies each time you put your aligners in, you'll help ensure a snug fit for your teeth; especially useful when you first have new aligner trays.

How do I use them? Biting down on these firm foam cylinders helps to seat your aligners, improving the accuracy of fit over your teeth and speeding up your treatment. With proper care, two Aligner Chewies can last for a long time. They can be cleaned with soap and water, or diluted mouthwash.

Struggling to remove your aligners?

For aligners to work they need to have a snug fit to your teeth, which can sometimes present a problem when they need to be removed for eating and cleaning.

Some patients struggle to remove their appliance, which can be frustrating and lead to sore and broken fingernails.

An aligner removal tool makes it easy to position and remove aligners safely and hygienically.

What are retainers?

• As the name suggests, they 'retain' your teeth in their new position.

There are 2 main types of retainers:

• Removable - which are very similar in look and feel to your aligners

• Fixed - a thin metal wire is bonded to the back of your teeth

What happens if I don't wear my removable retainer?

If you neglect to wear your retainer, your teeth may move back into their original position.

How often should I wear my removable retainer?

Your dentist will able to advise you specific to your case, but general guidance is:

Full-time (up to 22 hours a day) for the first 4 months

• Daily (overnight) for the following 12 months

• Every 2-3 days (overnight) for life.  [In some cases, it may be possible to reduce your retainer wear to once a week but this is case dependent]

• If your retainers ever begin to feel 'tight', it may be a sign your teeth are beginning to move due to your retainer is not fitting as well, or you are not wearing it often enough. If this happens, consult your dentist ASAP.

• Simply put, wear your retainer for as long as you want to have straight teeth

Changes in the position of your teeth can continue throughout life as part of the normal ageing process. The only way to counteract this is to wear your retainers.

I've damaged/lost my aligner, what should I do?

See your dentist ASAP to have a new one fabricated

Go back to wearing your previous aligner, to prevent your teeth moving in the interim, whilst you are waiting for your new aligner to be fabricated

How do I clean my aligners/retainers?

A toothbrush and cold water works most of the time.

Do NOT use hot water or toothpaste, as these can damage the retainer.

• If you have stubborn stains a dedicated retainer cleaner may help

What about DIY Orthodontics?

You may have heard aligners that can be sent direct to your home and you don't need to see a dentist. This has also been called 'direct to consumer' or DIY orthodontics.

The dental profession has concerns about this treatment, and the General Dental Council has released guidance for patients:

Treatment outcomes also tend to be limited because attachments and IPR is not used.

If you are considering this type of treatment, please ensure you do thorough research including:

Who is there to fix any problems you may encounter?

What do you do if things go wrong?

What sort of guarantee do you have?

• What negative experiences have other consumers had?

The most well known company that offered this type of treatment was Smile Direct Club, which filed for bankruptcy in 2023

Further Reading