What are the advantages of Invisalign over traditional braces?
Jennifer Salzar, DDS: The new trend in orthodontics is invisible aligners. They're very nice because you can't see them. They just fit over the teeth and you wear a series of these aligners and they slowly straighten your teeth. The advantage is they're removable, so you can clean your teeth. You could floss and brush, whereas with braces, it's more difficult to have proper oral hygiene.
David E. Paquette, DDS: Invisalign is the latest technology. It's really a paradigm shift in how things are done. I was a complete skeptic before I took the course and learned how effective Invisalign can be. With traditional braces, the orthodontist has immediate control over every single frame that happens. If a patient doesn't cooperate or the teeth don't move as expected, you can make small adjustments along the way. More or less like driving your car, you hit a bump in the road, you turn the wheel and you keep going where you're supposed to go.
With Invisalign, all that's done on a computer before we ever start, so you can actually see the treatment from beginning to end. What that means for the orthodontist is they have to get used to looking at a virtual patient on the computer in anticipating all those little problems that they've seen throughout their career and experience and plan for those ahead of time.
So, to the orthodontist, it's a complete paradigm shift, because they're basically treating the patient on a computer, and then carrying that treatment to the patient, as opposed to planning the treatment ahead of time, and following along with the patient to make all those little adjustments.
Jennifer Salzar, DDS: Invisalign has been available since 1999. It's definitely an accepted method of treatment. I would say most orthodontists have been trained in this method and can opt to use it if they like. It's a very well-known idea. It's actually not a new concept; it's an old concept that now has been married with the technology.
David E. Paquette, DDS: Invisalign uses a process called Stereolithography, which takes a computerized image and creates a three-dimensional object that exactly matches what was on the computer. They have a bath of plastic that is activated by light. So a laser recreates what's on the computer, and you actually watch these three-dimensional molds of a patient's teeth and merge out of the plastic, it's almost like Terminator II type of science fiction.
It happens so quickly that it's just amazing. They use that technology more than any one else in the world. If I'm not mistaken, I think, the entire Stereolithography process was either started or refined at NASA, and then got carried through. Now, Invisalign uses it more than anyone else. But it's really fascinating to watch.
Jennifer Salzar, DDS: You take them out whenever you eat and whenever you brush your teeth.
David E. Paquette, DDS: So, generally speaking, it's a lot easier to maintain, nice, healthy gums and everything than it is with braces.
Jennifer Salzar, DDS: You really can't see them, you really can't; they're almost invisible. If you're more than a foot away from a person, you can't tell if they're wearing them.
David E. Paquette, DDS: The biggest advantage is oral hygiene. Being able to completely remove the appliances from your teeth and brush and floss after meals and before you go to bed and in the morning, that is a tremendous advantage. We encourage all our patients with regular braces to do the same thing, but I don't know if you ever wore braces, taking a floss threader and getting in and around every single tooth is a significant time commitment, every single day, several times.
With Invisalign, it's no different than if you weren't being treated at all. So, there is a big advantage to that, and with our adult patients particularly, we see many adults that their oral health actually improves during Invisalign treatment, because they become flossing phonetics. They take them out; they have an urge to floss. So, it's kind of fun, because with kids, we're constantly having to remind them and their parents that they need to do a good job, cleaning and everything else. With Invisalign, we just don't seem to have that issue.
Does Invisalign take longer than traditional braces?
David E. Paquette, DDS: The misconception that some people have is that, it only treats simple problems and that's simply not true. In my practice we treat anyone with Invisalign that would like to have Invisalign as their treatment modality. The treatment plan doesn't change; it's just what appliances we use to get there. So, if a patient had a complicated problem, and it would take a significant amount of time to treat them, meaning two to two-and-a-half years.
The teeth don't know it's moving them. So, whether we use traditional braces or Invisalign, it's still going to take two to two-and-a-half years. The difference is that we can treat some fairly simple problems in a few months that the patient probably wouldn't want to go through to bother of wearing braces. So, many people have this idea that if you're using Invisalign, the treatment always goes faster.
That's true sometimes, but it's not true all the time, because we're treating a full range of problems now. So, there are things that Invisalign does better than traditional braces. There are situations that it takes a little bit longer than traditional braces. So the timeframe is really patient-dependent, and you can't say overall that is faster or slower, it's really the individual patient. But by and large, it takes the same amount of time as it does with regular braces.
Jennifer Salzar, DDS: Spacing, if you have spaces between your teeth, crowding, especially lower crowding that comes after you've already worn braces and you don't wear your retainer, those are typical cases that Invisalign can treat.
David E. Paquette, DDS: At this point, there is virtually nothing that we can't treat. I have to qualify that because as an orthodontist, we have a lot of little tools in our bag of tricks. With traditional braces, we have to have rubber bands and different things and springs and whatnot along the way to get to where we want to go, and with Invisalign, it's no different.
Five years ago, when things were started, we only treated very simple problems. As the technology has improved, and our understanding of how the process worked has developed, then at this point, there is no patient that comes into the office that is not a candidate to treat with Invisalign, provided they understand that once in a while, we have to use other little, what we call, auxiliary devices along the way, to do individual tooth movements when necessary, or to correct bite problems or whatever. But I can't remember the last time that I told the patient that Invisalign just won't work for you. This just doesn't happen.
How does the cost of Invisalign compare to traditional braces?
David E. Paquette, DDS: In our practice, their cost is only slightly more than regular braces, it's not a significant amount, again, depending on the complexity of the problem. For a patient that's got a really complex problem that with traditional braces, it would actually take longer than it would to do with Invisalign; the fee is probably about the same.
For a patient that's got a simpler problem that wouldn't even consider wearing braces, sometimes the fee can seem like it's a little higher than they thought it would. But by and large, it's just the same as it would be with braces, because once again, the teeth don't know it was moving them. Like most other businesses, the biggest expense is the time it takes to treat the patient.
If you were to see, say, an attorney and you had a complicated problem that need to be worked out, and you need to spend a lot of time, your attorney's fee would be a little higher than if it was just to go in and ask a simple real estate question. So, in the same way, our fees really are dependent on how much time it takes to treat the patient in the office. So the fees are about the same, because it takes about the same amount of time.
Jennifer Salzar, DDS: The cost factor is actually similar to braces. It depends on the amount of treatment again, but usually, it's around the same range.
Why is Invisalign recommended for people 14 or older?
David E. Paquette, DDS: That's when the 12-year molars are all the way erupted. When Invisalign was approved by the FDA, it was approved when all the permanent teeth are erupted and visible in the mouth. So, the question is often asked, would it be effective on children that are younger than that and I actually believe, it would be. But, when it was first developed, the idea, of course, was that adults would be the one that would want to do it. So when the FDA approved it, they approved it for anyone that has their 12-year molars all the way erupted.
Although they start coming in at 12, they're usually not all the way until around 14. Obviously, like anything else in life, there are some children that have their 12-year molars all the way in at 11. So the real criteria is that all the permanent teeth are in, not any particular age.
Jennifer Salzar, DDS: The patient has to have a fully grown in set of permanent or adult teeth in order to use these appliances. So patient has to be done growing and have their full set of teeth, and then they're a candidate for Invisalign. So usually that happens around age 14.
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