Clear aligners are a terrific solution for mild to moderate alignment issues. Advanced, bio-compatible thermoplastics make clear aligners more discreet and comfortable than any other type of orthodontic appliance. Direct-to-patient platforms leverage technology to deliver expert treatment at a fraction of the cost of in-office alternatives. But clear aligners aren’t the silver bullet of orthodontics like some marketers would have you believe. The limitations of clear aligners include:
- Underlying bite issues
- Intrusion and extrusion
- Severe rotation
- Patient compliance
Underlying Bite Issues
Bite, or occlusion, is the relationship between the upper (maxillary) teeth and the lower (mandibular) teeth. When the lower jaw sits too far back relative to the upper it is called an overbite/overjet. When the lower jaw sits too far forward relative to the upper it is called an underbite. A person may not experience any ill-effects from an underlying bite issue, but severe instances will distort the face shape and can cause one or more of the following symptoms:
- Advanced tooth wear
- Poor bite function
- Joint pain
- Speech issues
- Sleep apnea
- Severe tooth crowding
While aligners can improve mild underbites or overbites, they cannot alter the way the lower jaw relates to the upper jaw. Severe cases will require more advanced treatments such as traditional braces or surgery.
Intrusion and Extrusion
Small intrusion and extrusion movements can be accomplished with aligners but the success of these movements can be unpredictable with aligners alone. When a treatment plan includes mild intrusion or extrusion it is critical that the patient use aligner seators to give the tooth the best chance to comply. Aligners alone will not be effective in producing significant intrusion and extrusion movements.
Teeth can rotate out of alignment for a variety of reasons. The move common reason is overcrowding. While aligners are very effective at de-rotating teeth, there is a limit how much de-rotation can be predictably accomplished with aligners alone.
All orthodontic treatment modalities require some amount of patient compliance. Because aligners can be removed by the patient, patient compliance is particularly important when it comes to clear aligner therapy. If the patient does not wear the aligners for the prescribed amount of time the teeth may not progress as expected. Once teeth stop tracking with the treatment, it is unlikely that they will catch up.
Ultimately, when considering orthodontic treatment options, patients should first clearly define their treatment objectives and then work with their doctor to select a treatment approach. Traditional wire braces are still the best option to correct a variety of more severe conditions.