Clear aligners: what the brand does and does not decide

"Clear aligners" is the category. Invisalign is one brand within it, alongside Spark, ClearCorrect, Angel Aligner and a growing list of direct-to-consumer products. If you have searched for clear aligners rather than Invisalign, you probably want to know whether the brand matters, and whether the cheaper mail-order options are safe. Both are fair questions.

Does the brand matter?

Less than the person planning your case. The major professional aligner systems all use similar thermoformed plastics, all require attachments for most movements, and all move teeth in staged increments. Differences exist in material stiffness, clarity, staining resistance and software, and an orthodontist may prefer one system for a specific type of movement. But two orthodontists using the same brand can produce very different results, and one orthodontist using two brands will usually produce similar ones. myORTHODONTIST uses Invisalign for most aligner cases because of the depth of its planning software and the volume of cases the team has planned on it, not because other systems are inferior.

Direct-to-consumer aligners

Mail-order aligner companies send an impression kit, have a remote dentist approve a plan, and ship aligners without an in-person examination. Several have gone out of business, leaving patients mid-treatment. The clinical concerns are straightforward:

• No x-ray means no view of the roots, bone or unerupted teeth. Moving teeth through thin bone or into a root can cause permanent damage.
• No bite assessment. Many of these products align the front teeth only, which can worsen a bite problem rather than fix it.
• No attachments, which limits the movements to tipping. Rotations and root movements are largely out of reach.
• No one to see when something goes wrong.

For a very simple relapse case in an adult with a healthy mouth, the risk is lower. For anything else, we would rather you had a limited-treatment quote from a specialist first; it is often closer in price than people expect, and it comes with an examination.

Who is a good candidate for clear aligners?

Most people with crowding, spacing, mild to moderate bite problems and healthy gums, who will commit to 20 to 22 hours of daily wear. Children from about age 7 in selected Phase 1 cases. Adults of any age. The main reasons the orthodontist would steer someone toward braces instead are severe rotations, large vertical movements, complex extraction cases and, most often, an honest doubt about wear time.

What treatment involves

Scan, plan, attachments, a series of aligners changed weekly, check-ins every 6 to 10 weeks, a refinement round, then retainers. Detail on the Invisalign page, which applies equally to other professional systems.

Cost comparison

Specialist clear aligner treatment in the Lower Mainland: roughly $5,000 to $9,000 for comprehensive cases, less for limited cases, including attachments, refinements and retainers at this clinic. Direct-to-consumer: typically $2,000 to $3,000, not including retainers, refinements or any in-person care. The gap narrows for limited cases and disappears entirely if a mail-order case has to be redone.

Questions to ask any aligner provider

• Will I have an x-ray and a bite assessment before treatment?
• Who is planning the tooth movements, and what are their credentials?
• Are attachments, refinements and retainers included?
• What happens if a tooth does not track?
• Who do I call if an aligner cracks on a Saturday?