Realignment
Clear aligners, such as those used in Invisalign therapy, can yield amazing results in creating better smiles. But not all aligner companies are created equal.
A game-changing event happened last month in the world of aligner therapy…
So I felt compelled to get the data out to my readers due to who I am, what I do, and what I feel is right and accurate.
More about this game-changing event in a minute; but first, a little backdrop…
I have been involved with Invisalign® since 2008. After several years of unpredictable results, I left Invisalign in 2014. Then, they changed leadership, 3-D printing truly came into its own, and the world of polymers transformed almost every facet of our lives… as it has replaced countless materials in the fabrication of anything from shoes to cars.
Due to Invisalign’s intense research involving every aspect of orthodontics — from bone remodeling to tooth movement — I returned to using aligners, especially for metal-sensitive patients.
The team at Pfister Orthodontics has seen incredible improvements in aligner therapy over the years, especially with providers such as Invisalign.
As cases finished quicker and cleaner than conventional braces, my Invisalign practice blossomed into more and more adults and adolescents looking for an alternative to metal braces.
3-D printing truly changed the orthodontic world with the production of predictable tooth-moving aligners. The old style of injection molded polymers (which sagged and fatigued in all the wrong places at all the wrong times) were replaced by aligners that can do almost everything that metal braces can do… and do it more cosmetically!
However, not all aligners are created equal.
And various companies sprang up to capture this lucrative new market, but many of these fly-by-night companies had little biological backgrounds and a distinctive malalignment of their aligners. These companies produced a product with very little attention given to basic biological facts, and their attempts at tooth correction ignored the last 100 years of basic orthodontic procedures and protocol. You wouldn’t believe how many individuals have come in for an exam and when I recommended Invisalign, they would say, “Oh those aligner things don’t work in my mouth!”
And when I would ask why not, they would respond that either a friend, family member, or even they themselves tried them and they didn’t work. (They were using one of these fly-by-night companies previously mentioned, rather than Invisalign.)
These companies have given aligner therapy a bad name and have dragged down this uniquely designed tooth-moving system to their subterranean level! The most devious of these companies became a billion-dollar corporation within three years of its inception in 2014.
Which leads me back to that game-changing event I was talking about…
This past month (October 2023), truth would prevail, and the SmileDirectClub filed for bankruptcy!
In a televised interview, its founder was hopeful of finding a 20-million-dollar investor to bail it out. Hopefully not.
Let’s take a closer look at how companies today can spring up with little R and D but, with tremendous social media presence, become billion dollar corporations.
The SmileDirectClub used the oldest trick in the marketing book — make its product appear very user-friendly with minimal interference to the buyer’s lifestyle. Make the process as DIY as possible and present it at a rock bottom price with all kinds of financing options.
Their pitch — we’ll send the aligners to your home, you wear them only at night, and call us if you have a problem!
According to several patients that I have interviewed, the fit wasn’t bad, but several of the teeth of concern never moved after a couple of trays; and calling SmileDirectClub ended in lengthy hold times and frustration.
3-D imaging is another game-changer in determining the best approach to aligner therapy. Orthodontist-led treatment plans often yield better results than DIY aligner programs.
The problem with DIY aligner therapy (i.e. SmileDirectClub) is that not everything can be predicted or answered on YouTube…
Before a quality orthodontist delivers a quality aligner program, much diagnosis is necessary to literally design the entire system of aligners from start to retainers, taking into consideration each patient’s bones and gum condition and how it relates to proper tooth position.
Computers will analyze tight contacts that need to be removed in the beginning and, as treatment continues, to allow the teeth to slide past each other as they are being corrected with the minimal pressure that aligners exhibit. The most important difference is the fact that a smooth aligner against a tooth’s smooth surface has nothing to grab to help move the tooth into a corrected position.
Back in my early days of Invisalign, we only had four or five acrylic buttons (attachments) in each arch. Today, we have nearly double that number and are approaching a different shape and size for each tooth in the mouth. Addressing each tooth individually is where I have found Invisalign to truly excel in predictability and final outcome.
The biggest biological mistake made by SmileDirectClub was just having the trays worn at night.
Basic bone biology has shown that, in wearing any orthodontic appliance less than 18-hours-a-day, the body can reverse the activity that it was subjected to and return the tooth or teeth back to square one. This was also the downfall of headgear, the concept of pushing molars back to produce space to retract upper front teeth, thereby correcting the overbite. The concept was correct on paper, but needed cooperation in excess of just nighttime wear! (And how many people still wore their headgear during the day?!)
Even Invisalign admits that the prediction video that is produced by the attending orthodontist and Invisalign technicians is only 80% accurate due to our inability to predict how bone, gum, and tissue respond to treatment, not to mention the unpredictability of patient cooperation!
Let me end with a few statements on how aligner therapy differs from conventional orthodontic treatment.
The first statement of truth is that aligners do some things amazingly well, but even companies such as Invisalign will admit there are situations where conventional band and brackets (braces) are mechanically better and faster.
Yes, in some situations, I can complete a case quicker in braces than with Invisalign! Nothing, in my mind, rounds out upper and lower anterior teeth so cosmetically-well as Invisalign. But to upright molars or move them forward more than a few millimeters (or bring an impacted canine off the palate), it would take so many aligner trays that the patient would burn out before finishing.
And that leads me to the biggest surprise of a two-year research study presented this past Spring by one of the leading aligner users and developers, Dr. Moshiri, co-founder of the Aligner Intensive Fellowship. (I also mention Dr. Moshiri’s findings in my previous blog, Profile of a Successful Invisalign® Patient.)
Dr. Moshiri found patients will go two to three times longer in braces, with some complaining, but they continue.
Aligner therapy, however, requires so much patient participation (taking trays in and out for meals, smoking, coffee, etc.) that most adults begin emotionally shutting down at 18 – 22 months… and some don’t make it that long!
I have compared aligner therapy to exercising. We all know it is good for us and that the end definitely justifies the means. But why is it so difficult to stay on any type of routine exercise program, I ask you?
I have found with my Invisalign patients, especially the adults, that (like exercise) the initial starting steps to begin a program are the most difficult.
We are going to start publishing videos on our website this coming year with the personal comments and feelings of our Invisalign patients to help those considering treatment hear from users who are knee-deep into it… or finishing. My patients have been right up-front with their comments, especially the ones that are in the “It’s not for everyone, but I am so glad I stuck it out” population.
I also want to publish those comments and insights from those who really struggled. To date, I have had no patient quit. We have had a few that we reduced our treatment objectives to a more reasonable and realistic endpoint.
Adults make up a significant portion of Invisalign patients. And most are loving the results.
And that leads me to my final comment as to why I chose Invisalign as my professional aligner company for my patients…
I will make this brief and not a paid advertisement for Invisalign.
I tried several other brands ten years ago and, as I said earlier, I left Invisalign (after several years) due to quality and outcomes.
But once Invisalign got their research and polymer act together and developed a very user- and patient-friendly format, I was a convert.
What do I mean by patient-friendly? You aren’t nickeled and dimed with every change or paying for the initial retainers. If within the first set of say, 25 aligners, we are on aligner 12 or 14 (pick a number) and the tooth or teeth aren’t responding, I’m going to re-scan you and we will start from that point with a new set of aligners. And your treatment can go for three years with an unlimited number of aligners until you like your bite and smile. That is what I call patient-friendly!
And with Invisalign’s optimum movement attachments on most teeth and the newest (2022) G8 polymer, the teeth move incredibly well and, within three to five trays, patients can really begin to see and feel the difference.
In closing, I hope the demise of the SmileDirectClub will be a harbinger of a realignment in patients wanting to get their smile and bite corrected (but have stayed away from aligners due to the “bad press” of bad aligner companies).
There are, in fact, good aligner companies out there. And after years in observing developments in the industry, Invisalign remains my choice for patients willing to dive in.
If they can stick with the program, they’ll experience a more comfortable bite, quicker and easier flossing time, and a killer smile that truly builds the confidence necessary to help them be the best they can be.
This, my patients and readers, is what truly makes Orthodontics a life-changing decision!
Cheers to better smiles,
Dr. Charles Pfister
P.S. If you found this article informative, check out the first in this 2-part series right here: Profile of a Successful Invisalign Patient
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!