A comprehensive guide to clear aligners

Article reviewed by:
Dr Soh Shean Han • Orthodontist

Orthodontic technology has evolved over the years, with clear aligners as the face of orthodontics. A comfortable and aesthetic alternative to traditional metal braces, clear aligners are a series of custom–made thin, transparent and removable aligners trays to move your teeth into the ideal positions. Today, many brands of clear aligners are available on the market – Invisalign being one of the more prominent brands.

In this post, we will be covering the top 10 questions on clear aligners:

• How do I know if I need clear aligner treatment?
• Why is it essential to consult an orthodontist before starting aligner treatment?
• What age is suitable for wearing clear aligners?
• Are clear aligners suitable for me?
• How will clear aligners affect my daily life?
• Can I continue with other dental procedures like teeth whitening, scaling and polishing when wearing clear aligners?
• Which is the best type of clear aligners? How about Invisalign?
• Can I get a quick fix to achieve my desired smile?
• Are there any complications that come with clear aligner treatment?
• What can be done if I am unhappy with my clear aligner treatment results?

How do I know if I need clear aligner treatment?

Why is it essential to consult an orthodontist before starting aligner treatment?

Having undergone intensive training in a 3-year postgraduate programme and spent significant clinical time performing specialised orthodontic procedures, orthodontists can manage complex cases effectively and confidently.

An orthodontist can provide you with the most appropriate diagnosis and treatment plan for your needs through a comprehensive examination. They also have the expertise to monitor your progress at every stage of your treatment and make adjustments promptly. Upon completion of your aligner treatment, a retention plan will be tailored to your needs for optimal stability. Following through with the plan discussed pre- and post-treatment is vital for achieving the best results.

Undergoing alignment of teeth or jaws without a proper diagnosis and treatment plan may result in prolonged treatment duration, teeth not moving as planned, an unaesthetic or poor functional outcome, and undesired irreversible consequences such as bone loss and gum recession (shrinkage).

What age is suitable for wearing clear aligners?

Clear aligners can be worn at most ages, from children with baby teeth to older adults. In young children, as early as age 7, clear aligners can be used to develop the arches to create space for emergence of the adult teeth. It can also be used to straighten teeth, close unsightly spaces, or improve the bite. When correctly indicated, early treatment can arrest developing problems and simplify orthodontic treatment at a later age.

In teenagers, young adults or the elderly, clear aligners provide for a more aesthetic and comfortable option, and better facilitates the cleaning of teeth when compared to traditional braces.

Every patient has a unique set of teeth and needs and your orthodontist will recommend the most suitable appliance for your condition.

Are clear aligners suitable for me?

Clear aligners are the way to go if you want a more aesthetically pleasing and comfortable way to straighten your teeth. It can manage a variety cases, including those with and without teeth removal. Some dental conditions may look deceptively simple but require a hybrid of aligners and braces or adjunctive treatment for jaw growth. Every patient has a unique set of teeth and varying preferences. Based on your dental and lifestyle needs, your orthodontist will share the most suitable treatment method for you.

While wearing aligners, you need to be ready for other behavioural adaptations. Answers will be covered in the next question.

How will clear aligners affect my daily life?

As with all types of treatment, there will inevitably be some (albeit minimal) impact on your daily life. Initially, you may feel discomfort from the aligners because of the push and pull on the affected teeth. Though the aligners are smooth and fitted against your teeth, there may be occasional abrasion of your lips or tongue against the trays’ edges, but this is very rare. During the early phase, some patients may also experience tooth sensitivity to certain temperatures or foods. However, this is usually transient.

As aligners are removable, patient compliance in taking care of the aligners and wearing them of adequate duration is critical in aligners treatment. Depending on the complexity of the case, it is advisable that patients commit to wearing the aligners for twenty hours per day. Inadequate discipline in aligners wear can result in longer treatment duration and unsuccessful treatment outcomes.

While wearing your aligners, it is important not to eat or drink with the exception of water. This will minimize staining of your teeth and distortion of your aligners, which can set your treatment back. After meals, it is advisable to clean your teeth (or at least rinse your mouth) before re-wearing the aligners to reduce plaque build-up. Good aligners hygiene by cleaning your aligners with a brush and lukewarm water is imperative too.

Most patients get used to wearing aligners within a few days or at most after a week or two. If the side effects are overbearing, have a chat with your orthodontist to seek help in improving comfort for you.

Can I continue with other dental procedures like teeth whitening, scaling and polishing when wearing clear aligners?

Yes, in fact, we recommend regular dental visits and cleaning with your dentist during clear aligners treatment. This will help to maintain the health of your gums and teeth, and ensure an aesthetic and functional outcome after your treatment is completed.

Teeth whitening can also be performed, but do note that some patients have composite resin attachments made of tooth-coloured filling material glued onto their teeth. While these attachments facilitate tooth movement with the aligners, they cannot be whitened with the regular tooth whitening gel, and replacements will be required to match the new shade of your teeth.

Which is the best type of clear aligners? How about Invisalign?

Many clear aligner brands are available in the market, including in-clinic systems and direct-to-consumer aligners. Likewise with many other things, each type and brand of clear aligners has its pros and cons. Choosing which is best suited for you involves numerous consideration factors, such as budget, personal schedule and preference.

In-clinic or in-office aligners

In-clinic or in-office aligners systems are administered in person by licensed dentists or orthodontists. During your pre-treatment consultation, a thorough assessment of your problem list is performed via a physical examination and x-rays of your teeth. A detailed examination performed by a trained professional with adequate expertise will ensure that the correct diagnosis and treatment plan is developed, and this is critical in achieving a good treatment outcome. An orthodontist is well-positioned to track and monitor your treatment progress and make necessary adjustments when needed. This provides good treatment results and an easily accessible point of contact for any enquiries and emergencies that you may have.

Direct-to-consumer aligners

Another system involves direct-to-consumer aligners, where the process of purchase to treatment progression occurs online and treatment planning is done remotely by a team of dentists. Pre-treatment impressions are typically performed by the consumer with a do-it-yourself kit at home. Despite the convenience, it may affect accuracy resulting in aligners fitting poorly. Physical appointments at a clinic are available upon request, but additional fees may be required. 

Despite the surge of clear aligner brands, Invisalign remains as one of the more prominent brands of clear aligner treatment. Having data points from more than 9 million smiles globally over 20 years, they are known for their treatment planning algorithm across multiple ages. The patented aligner material reportedly uses sophisticated technology to provide more comfort with gentle yet powerful movement. A doctor supervises the entire Invisalign treatment journey, and every step is precisely calculated, allowing outcomes to be more predictable.

Can I get a quick fix to achieve my desired smile?

Every set of teeth grows and moves differently, as with how our body works. The duration of your treatment depends on the complexity of your case. Simple front teeth straightening may require less time, but correcting the bite at the back for good function and stability is also essential. In some instances where jaw bones are smaller, jaw widening or extractions may be required to create space for the teeth to shift and straighten. Although this may increase the overall duration of treatment, it will provide you with a better overall outcome.

Are there any complications that come with clear aligners treatment?

While clear aligners may be more aesthetically pleasing, it still involves movement of teeth and share similar potential complications with conventional braces. While the risk of these complications is very low, unmonitored tooth movement can have irreparable adverse consequences. Before commencing treatment, your orthodontist will advise if clear aligners suit your dental condition. Your orthodontist will also share any associated risks for you to make an informed decision.

Generally speaking, in the first few days, you may experience some tenderness and discomfort while adapting to the aligners. Once your mouth is accustomed to the trays, you should feel more comfortable throughout the treatment. Other rarer complications can include gum shrinkage, loss of tooth vitality, and root resorption.

Gum shrinkage (gingival recession)

This can occur in patients when inappropriate tooth movements, such as moving the teeth beyond the bony housing, are performed. Patients with thin gums are more prone to gum shrinkage.

Loss of tooth vitality

Although rare, there is a very small possibility of the nerve of the tooth becoming infected. This has a higher chance of occurring in patients with deep fillings and/or history of previous dental trauma. It can also occur if inappropriate levels of forces are used to move the teeth. Should it occur, root canal treatment may be needed.

Root resorption (shortening)

This is another rare complication, which requires close monitoring. Timely cessation or termination of treatment may be needed to prevent worsening of the root shortening process, which if excessive, can negatively impact the long-term prognosis of the teeth.

What can be done if I am unhappy with my clear aligners treatment results?

If you are nearing the end of treatment and are not pleased with the position of your teeth, do not fret! Express your concerns, and your orthodontist can discuss your treatment plan and outcomes with you. He/she can take new scans for additional aligners to further refine the tooth positions. This is usually included in your course of treatment.

Upon completion of treatment, following through with the after-care treatment, specifically retainers, is essential. Our teeth are most unstable in the period immediately after completion of treatment, especially in growing patients. Hence, wearing retainers diligently to keep your aligned teeth in place is especially important.

Ultimately, every set of teeth is different, and each appliance type works differently for every individual. Consult your orthodontist on your teeth to determine which orthodontic treatment method is most suitable and recommended for you.