Invisalign vs Braces: Which Is Right for You?
Choosing between Invisalign vs braces before treatment starts comes down to case complexity, meaning how many tooth movements the case requires and how difficult each one is. Most patients expect to choose based on appearance.
Some movements suit a clear aligner system. Some still favor brackets bonded to the teeth.
Our team has completed more than 5,000 Invisalign cases, and in my experience the appliance has to match those movements. Appearance comes second.
Orthodontic Records We Review Before Any Appliance Recommendation
Patients usually open the conversation with questions about whether other people can see clear aligners. The aligners are close to invisible. Brackets are not.
I begin the evaluation with records. What I look for in a panoramic X-ray, an iTero digital scan and a full set of photographs is how far each tooth has to travel and in which direction.
Those distances and directions, taken together, are the case complexity. A simple case can be treated well with either appliance. A complex case narrows the choice to the appliance that can produce the required movements.
Consultations include a treatment simulation reviewed in person. A patient sees the planned movements before committing to either appliance.
Tooth Movements That Divide Clear Aligners and Bonded Brackets
Aligners can produce the movements most adult cases require. Crowding, spacing and relapse after earlier orthodontic work respond well to a carefully sequenced set of trays.
Most aligner cases also need attachments, small tooth-colored composite shapes bonded to the teeth. Without them the smooth aligner slides over the smooth tooth instead of gripping it.
Attachments also mean Invisalign is not fully invisible. For on-camera professionals at our West Hollywood office, we place attachments behind the six upper front teeth rather than on the visible surfaces.
An aligner only moves teeth while it is worn. I tell patients an excellent result takes at least 20 hours of wear a day. Patients who wear the aligners fewer than roughly 18 hours a day end up with aligners that no longer fit and results that fall short of the plan.
I also tell every patient starting aligners to assume at least one refinement. A refinement is a finishing set of aligners that corrects the difference between the planned result and the result in the mouth.
Brackets work continuously because the patient cannot remove them. When a case needs continuous force with no missed hours, I lean toward brackets.
In my experience brackets also remain the stronger choice when a case requires heavy root movement or the closure of spaces left by extractions. Those forces are easier to sustain from a fixed appliance.
Patients who need those movements can still use Invisalign for the rest of the case. We bond three or four brackets in the specific area for three to four months, a short stretch of sectional braces that completes the movement the aligners cannot sustain.
We place metal brackets, clear ceramic brackets and Invisalign clear aligners. When a patient tells me the trays would end up sitting in a drawer, I recommend brackets, whatever the scan shows.
The general rule that difficult movements favor brackets has an exception. An open bite is a gap where the front teeth fail to meet while the back teeth close. Patients assume a bite problem that severe requires brackets.
The opposite is true. Invisalign closes an open bite through posterior intrusion, a programmed vertical force on the back molars that lets the front teeth come together. Braces exert force in a direction that can worsen the same open bite.
In our practice an open bite case takes about 16 months to treat. We plan open bite cases with exaggerated movements in ClinCheck, Align Technology’s treatment planning software. A severe overbite is another bite patients expect to need surgery that aligners often correct.
The simulation looks strange. The finished bite does not.
Programming Work Inside a Customized Invisalign Treatment Plan
Align Technology’s software generates an automatic plan for every submitted case. Approved without modification, that plan achieves about 50 percent of the desired clinical result.
General dentists can buy and offer Invisalign. Many approve the automatic plan as written. Our practice re-treats a meaningful number of cases that started that way.
We program the direction, distance and rotation of every tooth movement. Tissue resists movement, so a tooth stops short of the position the software plans for it. To move a tooth 2mm, we program 2.5mm.
The outcome depends more on the plan than on the appliance. A carefully programmed aligner case produces a better clinical result than a routinely managed bracket case. The reverse is also true.
Three Questions to Bring to an Invisalign Consultation
Patients choosing between Invisalign and braces can bring three questions to the consultation. The three questions concern the complexity of the case, the specific movements it requires and the reason the orthodontist favors one appliance for those movements.
In our practice braces and Invisalign cost the same. Patients can set price aside and weigh the appliance choice on clinical grounds alone.
Patients who want to prepare can review the questions worth asking at an Invisalign consultation.
Patients already in brackets sometimes ask about changing appliances after treatment is underway. That is a separate decision, and I evaluate it separately.
