Transparent Aligners

Without any embarrassment, beauty issues, or any inconveniences while eating your favorite meal, I can say Orthodontic treatment is possible!

Today we will talk about a topic that I have always been asked about, whether in my clinic or on social media, the transparent aligner, or what we call the ((invisible aligners)).

Let's go back in time to the beginning of the twentieth century.
When metal braces "brackets" used to be welded onto a sheet of metal completely surrounding the teeth like a ring. These sheets were called "Bands". 


With the development of materials and fillings used in dentistry, it became possible to adhere orthodontic brackets directly on the teeth surface, and it was time to dispense with metal bands.


However, despite this development, the metal braces kept suffering from two main defects:
1- Its unpleasant color and shape, which affect the beauty and shape of the smile. Metal braces are easily noticed on the teeth. And there are some jobs that require not wearing anything on the teeth (like braces) as a prerequisite, such as the job of flight attendant.

2- Difficulty cleaning teeth. Braces usually accumulate food remnants around them, and sometimes it becomes completely difficult for the patient to clean his teeth well, especially for kids. Over time, this might result with the accumulation of plaque and calculus, which leads to tooth decay and pigmentation, in addition to gum infections.

To solve the aesthetic problem, ceramic braces appeared, where the stainless steel material -from which the metal braces are made- was replaced with white porcelain, and transparent crystals were somewhat used too. 

However, despite the quantum leap ceramic brackets have made, the problem of difficulty of teeth cleaning remained, in addition to the fact that this device couldn't completely hide the braces. Metal and even aesthetic wires were still losing their white coating to become visible when smiling.

A new orthodontic device was on the way too, the lingual brackets, yes, lingual! where the braces are installed behind the teeth, to be completely hidden and invisible.


To be frank, this type of braces was able to solve the aesthetic problem of orthodontics, but unfortunately, it was not able -like its predecessors- to maintain good oral health. It had many other defects too, such as the severe scratching it applies to the tongue, its clear effect on the pronunciation, and its high prices compared to the metal braces. All these factors led to the less common use of this type of braces in dental clinics.
However, from the end of the twentieth century until the beginning of the new millennium, a new type of orthodontic device was developed, which was called invisible aligners, commonly known between people as Invisalign 


The transparent aligner is a cover or a thin layer made of transparent or semi-transparent, bio-acceptable plastic materials. The aligner completely surrounds the teeth (from the side of the cheek, the tongue, and from above), and the patient can take it off from the teeth and wear it himself without the need for the orthodontist's help to remove it or install the aligner. 

Orthodontic treatment with transparent aligners depends on moving the teeth gradually to reach the natural occlusion, where the movement of the teeth (or the target tooth) is divided into small stages, and each stage represents one aligner that must be worn for a sufficient period of time to accomplish the required dental movement before we move to the next aligner to continue moving the teeth.


The transparent aligners were able to solve the previously mentioned problems of the fixed orthodontics. The patient can clean his teeth comfortably without facing any problems, get rid of the lips and tongue irritation caused by the braces, and finally, the best part is that it is difficult to notice the aligners on the teeth even from close distances!


These aligners have even conquered the market! since the beginning of their spread in 1999, about 22 years ago, and till the moment, invisible aligners was able to dominate at least 59% of the cosmetic orthodontics market (in all its types, lingual and ceramic), which in turn represents 11% of the global market for dental products (whether orthodontic or non-orthodontic products). Invisalign has announced on June 30, 2019 that 7 million orthodontic cases so far were treated using its orthodontic device (the Invisalign).
Even though transparent aligners and traditional fixed braces share the same biological effect on the teeth (moving the teeth), and the difference between them lies in the mechanical method of moving the teeth.

And now, after reading all this information, the question comes, are invisible aligners safe?
 Most of the transparent aligners currently available consist of one of the two compounds: polyethylene terephthalate glycol (PET-G) or polyurethanes. Both materials are safe for use inside the mouth and are not carcinogenic, as dozens of laboratory experiments have been conducted on them before allowing their use.
The thickness of the aligners ranges between 0.5 mm to 1 mm, and in some types, it exceeds 1 mm.


Now after all previous information if you want to have an orthodontic treatment using transparent aligners, what are the steps awaiting you from the moment you enter the clinic until you receive the first transparent aligner?
In fact, despite the diversity of transparent aligners manufacturers, the majority of them share almost the same steps whether inside the clinic or during the aligners manufacturing process. 
For me, I have been using Invisalign™ aligners in my clinic since 2013, despite their higher prices in comparison to other companies. And this choice is not surprising, since Invisalign is the company that established this type of treatment, and it has nearly a quarter of a century’s experience in this field. In addition to its constant quest to develop the techniques and materials that it uses in manufacturing the aligners. For all these reasons I consider it one of the best companies, and I trust it to make aligners for my clinic’s clients
Briefly, I will mention the steps that every client will need to go through from the moment he enters the clinic to the moment he receives his 1st aligner:
1- The first and most important step from my point of view is to check whether this aligner is suitable for the patient
Yes, as you are thinking right now, the transparent aligner is not suitable for all people!  Why? …. for several reasons:
• If the patient is not able to wear the aligner on his teeth for at least 20 hours - which is the daily needed time required to ensure the success of the treatment process-,  transparent aligners might not be useful in this case, and would be is better to use fixed braces.

• Some severe and difficult cases require moving the teeth for large distances, and from my personal experience with my patients, my observations, and my connection with my colleagues in the dental field, i found that transparent aligners may not be the best option for these cases, - although companies emphasize the transparent aligner effectiveness for the various types of cases. 
2- Taking x-rays of the teeth, to make sure that there are no problems in teeth that might obstruct the orthodontic treatment. In addition to taking photographs of the face to analyze the smile, as well as taking intraoral pictures of the teeth.

3- Making a model for the patient's teeth:
 - The digital model is the best option, through intraoral scanners. The taken model is delivered directly to the manufacturer within seconds.

 - The dental model can also be made in the traditional method, by using special molds and paste, placing them inside the mouth to take dental impressions, and then sending these molds by mail to the manufacturer. This process may take several days, in addition to the fact that most patients do not prefer placing molds inside their mouth because it causes them annoyance and a feeling of nausea.

4- In this step I start developing the appropriate treatment plan for the patient's case, I make a virtual model for the treatment and move the teeth on the computer to reach their correct position and perfect alignment.
After that, I usually welcome my patients to come and see their treatment model and see how their teeth will look at the end of the treatment. In this step, I listen to their notes and make any necessary and possible adjustments to the model, before we come to an agreement about the desired final result of the treatment. And then we ask the company to start manufacturing the transparent aligners.
5- Let's say that point (A) represents the patient's teeth in their current form, while point (Z) represents his teeth at the end of the treatment. Now, the treatment is divided between these two points into several stages (the tooth is usually moved to no more than 0.25mm in each stage), and a model of the teeth is made by means of 3D printers for each stage. After that, transparent aligners for each stage are manufactured, based on the shape of the teeth in each printed model.

6- Finally, the aligners are sent to the orthodontist, and the treatment phase begins.