|Bite opened up following Aligner treatment, patient cannot chew on back teeth.|
Dental protrusion after Invisalign treatment.
Recession following Aligner expansion of the lower arch for alignment with no thought to how the teeth would fit once expanded.
Ever wonder why the aligner commercials never talk about function of the teeth? And do you believe everything you hear on commercials and social media?
Also, ever wonder why you only hear about one company; Invisalign? That’s because Invisalign is a tech company, not a medical company. And we all know what tech companies do when there is competition ….
Deep down everyone knows Aligners are a short-cut to a partial correction of minor alignment only. No matter what companies are trying to tell you, common sense tells you that a weekend course to learn how to profit from selling aligners is no substitute for a 2 to 3 year residency. And removable plastic is no substitution for fixed/attached braces that work 24h a day using different force wires. Braces are difficult though which is why it takes additional years to become an orthodontist.
|Note the recession of gums as the teeth have been pushed out of the bone to correct rotations.|
Traditional braces allow more control in all three dimensions to prevent this and specialists are trained on what movements are good and which are detrimental. Forces have been controlled and can be modified to suit the movement with specific wires, segmented wires, and good knowledge of physics. Trays cannot control the force like wires, they have one thickness and all movement is based on distance or degree of rotation, not force. They do not take into account bone density, physiology, individual morphology or differential root sizes/resistance in the bone.
|Patient K.B. previously treated with Invisalign, fontal view.|
|Patient K.B. from the side showing protrusion of font teeth, pushed out by the aligners to correct rotations. This patient still has a fixed lower retainer revealing that this is how the dentist left this patient as "completed".|
|Patient K.B. being re-treated with traditional braces to re-align teeth while pulling front teeth back/upright over the bone to prevent recession; permanent teeth were removed to allow full correction.|
|Patient K.B. during braces from the side.|
All of these cases reveal bites that remain open with no contact on molars. This has been shown to be a common problem with Invisalign (see research below).
Relapse can be rampant in aligner cases due to expansion of the dental arches to gain space by increasing the length of the arch. For 100 years we have known not to expand the width of lower canines as they ALWAYS relapse but aligner providers just turn their eyes to this fact. This is why aligner providers now offer many years of trays in case of relapse. But is this good for the teeth? Constantly re-treating the teeth? Research continually shows increasing the time teeth are moved or are in treatment can lead to root resorption and loss of teeth.
In children we can expand the actual upper jaw bone (see my previous blog on expansion) however during our middle teens, these upper bones fuse and cannot be expanded without surgery. That also does not stop unscrupulous dentists from “expanding” the teeth to gain space for aligners; unfortunately for the patient this only pushes the teeth out of the bone which will lead to either recession or immediate relapse after treatment. If held indefinitely with a retainer, the patient may actually lose bone and eventually teeth from this procedure. There are many cases that have been “treated” with Aligners that are being held with permanent retainers where recession is inevitable and the patient is ignorant of the ticking time bomb in their mouths. Time will tell if the damage done on these patients is correctly attributed to previous poor treatment.
Just as in Patient K.B. shown previous, fixed bars are placed in these patients actually holding the teeth outward and over-expanded which is literally causing the recession right in front of the dentists' eyes.
In many adults with long-term crowding, the teeth have determined where the jaw bites down. This normally includes a shift to one side or the other, front or back or even vertically. Essentially, the jaw shifted around to a “best fit” and the patient learned to function there. If the shift is too great, we get excessive wear and chronic jaw problems such as TMD. Aligners cannot take this into consideration as the trays are made from the beginning. Even with a modification of trays later in treatment, the jaw can continue to shift throughout the entirety of tooth movements as different teeth begin to hit and others no longer hit.
As the jaw shifts, the relationship of every tooth changes but the aligners cannot accommodate this; you get upper teeth aligned (somewhat), lower teeth aligned the same, but then they do not fit together. As the jaw now has to shift again to find a best fit after treatment, you introduce wear and tear on the teeth and joints and can create TMD where there was a balance prior to aligners. Traditional braces are adjusted regularly and good Orthodontists look for these inevitable shifts throughout treatment. Even with traditional braces, corrections can be very difficult causing changes or refinement in treatment many times along the way.