Invisalign is one of the most remarkable advances in orthodontics in the last 20 years. I use it. Invisalign offers patients an alternative to good old-fashioned wires and brackets. It is more attractive, allows more normal eating during treatment, and permits better hygiene…all positives! Because it doesn’t require learning how to place and adjust complicated brackets and wires, Invisalign has attracted the attention of general dentists in addition to orthodontists. Is Invisalign treatment the same no matter who provides it?
Teeth move in response to pressure. They don’t care where it comes from. Braces move teeth. Thumb sucking moves teeth. It is no surprise that plastic aligners can move teeth too. Invisalign is a series of clear aligners that deliver precise forces which sequentially move teeth into pre-determined positions. The manufacturing process is genius. The marketing campaign is even more impressive. The bottom line however is that Invisalign is just another tool that a doctor can use to straighten teeth. The keys to the outcome of your treatment are 1) an accurate diagnosis, treatment plan, and aligner design provided by your doctor, and 2) how well you wear your aligners.
Align Technology (the company that makes Invisalign) is a manufacturing company. They do not provide diagnosis or treatment plans. The Invisalign process begins when your orthodontist submits a set of very accurate digital scan to Align. From this scan, a digital model of your teeth is constructed. This 3D model, called a ClinCheck, is created by computer technicians in Costa Rica. They are neither dentists nor orthodontists—they are computer geeks! Once this first model is created, it is sent back to your doctor for the diagnosis, treatment plan, and appliance design. While anyone can order a set of aligners, not everyone knows how to diagnose and treatment plan an orthodontic case.
Once your doctor has the digital model on his computer, it is up to him to find all the problems that exist and decide how each will be addressed. How will crowding be eliminated (expansion or enamel reshaping)? How will the smile line be changed (upper teeth moved down or lower teeth moved up)? What is the best way to reduce the overbite (move the top teeth back or the bottom teeth forward)? These are all decisions that must be made by your doctor. The computer technician at Align is not a doctor.
After the desired goal has been determined, your doctor must prescribe how the aligners will deliver the forces needed to move your teeth. While a general dentist might be able to learn how to move teeth, orthodontic specialists have extra training and experience that helps them understand the biology and physics necessary to create results that are attractive, healthy, and stable. The education and experience gained from treating thousands of patients using braces carry over to aligner therapy. Your orthodontist knows how fast teeth can safely move. He knows which attachments (tooth-colored bumps bonded to the teeth) will be necessary to create the desired forces. He understands how much interproximal reduction should be done to help the alignment of your teeth without compromising the teeth or surrounding gums and bone.
I just played golf with some boy scouts this past weekend. It was hilarious to watch because none of us were very good. Just because I can order a new set of clubs online doesn’t mean that I will automatically become a good golfer. That will take years of instruction and practice. Just because any dentist can now order Invisalign does not mean that he or she will be able to straighten teeth any better than he could using standard brackets and wires. Invisalign is just a tool. It does not eliminate the need for diagnosis, treatment planning, and experience.
NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the Westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 25 years of specialty practice and nearly 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog is for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Please understand that because he has tens of thousands of readers each month, IT IS IMPOSSIBLE FOR HIM TO RESPOND TO EVERY QUESTION. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.