Profile of a Successful Invisalign® Patient
Dr. Pfister believes Invisalign therapy is a great way to move teeth in both adolescents and adults, but it’s not for everyone.
Recent studies have shown that 40-45% of dental patients today are not good candidates for Invisalign therapy.
Seeing as though I’m an orthodontist who offers Invisalign, you must be shocked that I’m relaying this fact to you. “Dr. Pfister, shouldn’t you be convincing me to try Invisalign therapy to create my best smile?”
My answer…
Invisalign is amazing. But it’s not for everyone.
Many individuals have entered into an Invisalign program with the thought that it’s just like braces, just not so shiny. Nothing could be further from the truth! Recent literature findings have pointed out that Invisalign providers, at initial exam visits, must spend twice as much time analyzing the space between the patient’s ears as the space between their lips!
In other words, no matter how excited the patient is to begin an aligner therapy program (and no matter how perfect they may be suited for aligners from a dental standpoint), certain questions and personality profiles should be assessed by the provider before initiating treatment.
So what makes a good Invisalign patient?
The summary sentence that I have heard so many times that defines a successful Invisalign patient is, “If it’s not in the heart, it won’t be in the mouth.”
I have to agree that the main difference between the two different modalities of tooth movement, braces versus Invisalign, is the amount of self-participation. Braces tend to be, except for rubber bands or headgear, a system on autopilot… with the orthodontist doing most of the work. Whereas, Invisalign involves a large amount of self-participation and involvement, due in part to the need to remove aligners when eating and drinking colored beverages, as well as multiple daily cleanings of each aligner. This constant in-and-out of aligners on sometimes an hourly basis seems, in my opinion, to be the chief point as to whether a patient will be successful or not!
The staff at Pfister Orthodontics assess an Invisalign case.
Many Invisalign patients start strong, but struggle to keep the pace…
In the beginning, say the first 6-10 aligners (approximately 4-6 months into treatment), patients seem to justify the orthodontic workload as they see the positive results of their “new” smile emerging in their front teeth. But as time goes on, 12-14 months into treatment, the aligners are working on opening the bite and setting the molars into proper alignment. This is the functional phase and isn’t as cosmetically visible as early treatment.
Like exercise, if we don’t keep seeing psychologically-motivating positive results for the time and hassle expended, we lose interest (and prematurely ending treatment is imminent).
This fact was recently driven home this past May (2023) when Dr. Maz Moshiri, co-founder of the Aligner Intensive Fellowship, presented his research from the last several years. He found that the average Invisalign patient will stay on task for 18-20 months and then quit after hitting a psychological wall.
This wall develops, in part, from the amount of self-participation involved in aligner therapy (with Invisalign being just one of nearly a dozen programs available today). The fact that SmileDirectClub went bankrupt last month was proof that if the system is not professionally developed and monitored by a qualified provider, the chances of success barely reach a double-digit value!
Thus, today’s successful Invisalign patient needs to be focused on achieving the final goal of a great smile with a long-lasting functional bite.
The end result does, in fact, justify the means to get there. But the desire for this end result has to be the patient’s desire, not the spouse’s or parent’s desire for the patient.
In my own observations, I have found athletes, coaches, CrossFit athletes, 5K / marathon runners, and first-born goal-focused individuals to be exceptional Invisalign candidates. We’re talking about individuals who know how to push themselves physically and emotionally, even when the going gets uncomfortable or boring. It takes mental fortitude. This may explain why we have more adults than adolescents this year in our Invisalign program.
The most interesting group to turn down aligner therapy, in my opinion (and we have now kept track since January 1st of this year), is the eighth-grade female! I have begged, dropped the price, given various incentive packages only to hear them remark, “No thank you, Dr. Pfister, I want braces. Invisalign takes too much work!” Maybe it’s a sign of the times… maybe it’s another post-Covid casualty… who knows?!
3-D imaging has taken aligner therapy to new heights.
So how are Invisalign (and Invisalign Providers, such as myself) working to reduce the trend of aligner therapy burnout?
Invisalign has doubled the number of attachments (buttons on the teeth that move the teeth as the aligner tray locks onto them) to ensure better and more efficient movement. The G8 3-D printed trays are the best polymers on the market today for efficiency and comfort.
Additionally, individuals (like myself) who are designated as Invisalign Premier Providers have been given the authority to re-scan the patient and pitch out the non-productive trays if we don’t think a tooth or set of teeth are moving efficiently and in a normal time allotment. This is like changing a wire in braces; we simply can’t always predict the tissue response to aligner pressures.
As Premier Providers, we have also been able to reduce the time in each tray, thereby going through the prescribed regimen at a faster pace. We use our 3-D digital x-ray equipment to help us assess when this is possible. Visualizing the entire tooth (and not just the crown) allows Invisalign to develop a more efficient system of aligners, as prescribed by the attending orthodontist. I have personally finished treatment on a patient with as few as 10 trays, while I’ve had other surgical adult cases require 80-90 trays. But no matter the amount of trays required for Invisalign therapy, the results can be magnificent.
After 3 decades of moving teeth around, I truly feel that, in most cases, Invisalign is a far superior option than conventional braces for these reasons:
Invisalign Advantage #1 - Better Dental Hygiene
One of the biggest benefits of Invisalign over braces is seen at the last treatment appointment when retainers are installed. Braces tend to produce various degrees of gingivitis, depending on how well the patient brushed and flossed their teeth during treatment.
In the case of Invisalign, the ability to remove aligners and properly brush and floss without metal interferences, brackets, and wires is a key advantage. This is not only a benefit in tissue and enamel preservation, but also in allowing the teeth to move quicker with less discomfort (by moving through healthier tissue).
Invisalign Advantage #2 - Less Patient Sensitivity to Materials
There is a percentage of individuals, usually females, who have a sensitivity to metal (especially nickel). Nickel makes the arch wires in braces more flexible, but I have to closely monitor the individual’s gingival response from the moment we place them. If there’s an issue, we’re usually changing them out within two visits.
In the case of Invisalign, the monomer used for aligner construction is hypo allergenic. As to date, over the past ten years, I’ve witnessed no gingival inflammation.
Invisalign Advantage #3 - Patient Comfort
Braces produce discomfort by moving upper and lower teeth up and over each other and causing traumatic interferences, though usually only for a short time. It continually happens throughout the mouth during treatment.
In the case of Invisalign, with its dual arch aligner coverage, no tooth comes into contact with an opposing tooth during movement, except during meals (but even then, a bolus of food is usually between the teeth). This separation of teeth-in-movement has been another way for Invisalign to move teeth faster and with less discomfort than braces in many cases!
Finally, in the case of braces, brackets are not only a food and plaque trap on each tooth, but also tend to be a cheek and lip irritant (as they rub 24/7). Thankfully, most individuals get used to it… unless they sleep on their face! I have had, thankfully, few of these individuals that cardiologists and pulmonologists say are shortening their lives by this position of sleep. The individual brackets of face sleepers actually imprint into their lips and cheeks, thereby making this tissue very sensitive to acidic foods and movements, such as talking.
Conversely, the dual arch aligners used in Invisalign actually protect these tissues as the teeth are moving by. They also serve as night guards to protect against clenching and grinding, which occurs as a collateral neurological response to tooth movement.
As you can see, the ability to move a single tooth or set of teeth is not that difficult. But how you do it varies greatly with the modality or system chosen (i.e. braces versus Invisalign).
My hope is that, after reading this blog, you’ll have a better idea of whether or not Invisalign therapy is right for you.
Invisalign is an amazing way to create that perfect smile. But it’s not for everyone. It requires a great deal of patient cooperation and determination. In contemplating braces versus Invisalign, be honest with yourself… and your orthodontist!
Cheers to better smiles,
Dr. Charles Pfister
P.S. If you found this article informative, check out the second in this 2-part series right here: Realignment
P.P.S. If you live in or around Medina, Ohio, please call my team here at Pfister Orthodontics if you’d like to schedule an appointment to see if Invisalign is right for you. I’d love to meet you in-person!