Pros and Cons of Invisalign for Adults

I go through the pros and cons of Invisalign for adults with patients at consultations almost every day. One feature produces the biggest advantage and the biggest drawback.

That feature is removability. Invisalign straightens teeth with a series of clear aligners, removable plastic trays that come out for meals and cleaning. Removability sits at the top of the pros column and at the top of the cons column, because clear aligners only move teeth into alignment while they are worn.

The Pros

Appearance

Whether other people will notice the aligners is the question adults ask about most. Clear aligners are less noticeable than the brackets and wires of metal braces.

That difference matters most to adults planning a wedding, a reunion or another occasion built around photographs. Treatment does not have to interrupt the pictures.

Flexibility

Clear aligners come out for meals, so adults avoid the food restrictions that come with brackets and wires. A business lunch needs no workaround beyond putting the aligners back in afterward.

Comfort

Clear aligners have no brackets to rub against the cheeks and no wire ends to poke the lips. Adults who wore metal braces as teenagers usually tell me the aligners are more comfortable than what they remember.

A new aligner still presses on the teeth, because pressure is how teeth move. That early soreness settles within a few days as the mouth adjusts.

Hygiene

The aligners come out for brushing and flossing, so patients clean their teeth the way they always have, with no wires in the path of the floss. The aligners need their own daily cleaning as well, and adults can read about keeping aligner trays clean through the day.

The Cons

Commitment

The commitment drawback is the daily obligation to keep the aligners in the mouth. Patients who have read up on the pros and cons of Invisalign for adults usually arrive knowing the pros. Whether a patient can keep that daily obligation settles the choice between aligners and braces more often than everything else on this list combined.

The wear requirement follows directly from removability, because every hour an aligner spends out of the mouth is an hour of no tooth movement.

The standard we hold patients to for an excellent result is 20 or more hours of wear per day. Align Technology, the company that manufactures Invisalign, recommends 22 or more. Below roughly 18 hours of daily wear, the aligners stop fitting correctly and the treatment results fall short.

Our team has completed more than 5,000 Invisalign cases, and the compliance records from those cases, the logs of how many hours patients actually wore their aligners, are the basis for these numbers. Adults who want the full picture can read what compliance data shows about wear time.

Compliance patterns show up in the first eight to 12 weeks of treatment. In my experience, patients who start well tend to finish well.

The adults who struggle most with wear hours are the ones whose days involve constant eating and drinking. Each snack and each slow drink is time with the aligners out. Those minutes add up to lost wear hours.

I have treated a patient who insisted on wearing the aligners roughly eight hours a day. Two years later the case was still in progress, because the tissue around each tooth pulls it back toward its old position every hour the aligners are out.

Poor compliance is by far the most common reason a case takes longer than planned. When wear hours stay low, I do not pretend the originally planned result is still reachable. We re-plan the case around the hours the patient actually wears the aligners.

Attachments

Most cases need attachments, small tooth-colored bumps bonded to the teeth so the aligner can grip them. Attachments are visible up close, an exception to the appearance benefit. In my experience, attachments draw little notice on a person who interacts naturally.

At our West Hollywood office, we place attachments behind the six upper front teeth for patients who work on camera.

Speech

A new aligner can give speech a slight lisp for the first three to seven days. The tongue adjusts to the top edge of the aligner, and most patients speak normally within the first week.

Patients preparing for a lecture or an on-camera day can remove the aligners for the event and resume wear afterward.

Refinements

A refinement is an additional set of aligners that dials in the result at the end of treatment. I tell every adult patient to expect at least one. Refinements are a standard part of aligner treatment, not a sign the case went wrong.

Bottom Line for Adults Weighing the Two Invisalign Columns

Every patient weighs the pros and cons of Invisalign for adults differently. What I look for at the consultation is whether the patient’s daily routine allows 20 or more hours of aligner wear. The way a workday is structured, including how often it pauses for food and drinks, tells me more about likely wear hours than anything a patient says about motivation.

In our practice, the sole reason a patient chooses ceramic brackets over clear aligners is that they do not trust themselves to wear a removable aligner 20 or more hours a day. Brackets are bonded in place and work around the clock, so the result does not depend on wear hours.

Our team programs the best result an aligner case can reach. The hours the patient actually wears the aligners determine how close the finished teeth come to that programmed result.

Adults still weighing these pros and cons can measure their own daily routine against the 20-hour wear standard. Treatment typically takes between six and 18 months, so the routine has to hold for that long. We plan Invisalign treatment for adult patients around that measurement.

After treatment ends, the adults I treat tend to say they wish they had started sooner.