Frequently Asked Questions – Invisalign
How often should one change the Invisalign aligners?
Usually, each aligner is replaced every 4-7 days. It has now been scientifically proven that changes made at longer intervals (e.g., every two weeks) unnecessarily extend the duration of the intervention. In general, the frequency of aligner changes remains a responsibility of the orthodontist, since he is the one who is planning the treatment. Therefore, the rate of dental movement per aligner depends on the orthodontist, but it could also be influenced by other factors (such as the increased duration of each aligner in people with periodontal disease predisposition).
Are visits at the doctor's office as frequent as with traditional braces?
There is a great difference between Invisalign orthodontic treatment and fixed braces, and that is the reduced number of visits. Unlike braces where visits are required on a monthly basis, treatment with Invisalign aligners requires visits every 2-3 months. At each visit, the smooth progress of the intervention is followed-up, checking if the digital planning defined from the beginning is still followed. In addition, oral adjustments are minimal or even non-existent. In this way, it is possible to have a treatment with visits every 3 months or after using 12-20 aligners. It is also possible to have a remote, virtual follow-up of the therapeutic progress and the placement of each aligner, through the use of selfie-type photos sent after each change to the orthodontist or using a video conferencing platform such as Zoom or Teams. With this "remote monitoring" the treatment becomes essentially independent of visits to the doctor's office; this has definitely a positive impact on the cost, among other things.
What are the uses of the buttons / attachments that are often seen on people who wear Invisalign aligners?
Quite often, in addition to the placement of clear aligners, additional actions may be required. So, in some cases, resin attachments (buttons) are placed directly teeth. In this way, the force exerted on the teeth is "directed" in a better way, or the best fitting of the aligner on the dentition is possible. Of course, attachments are visible to others, and therefore they somewhat take away the advantage of absolutely "invisible" orthodontics. However, with their use, dental movements are better controlled.
Is there a case where the patient needs to use elastics connecting the upper and lower jaw, beyond using clear aligners?
Elastics (or rubber bands) that connect the upper and lower jaw are an important part of orthodontic treatment. In fact, in some cases, they are the most crucial element in achieving the desired result. Consequently, there is a possibility that a patient would need to put on intermaxillary elastics, with the Invisalign technique too. The elastics enable certain movements, which could not be carried out under other circumstances, but also for cases with teeth occlusion issues. It is worth noting that the full cooperation of the patient is required, in the same way as it is required with the aligners. This practically means that the patient should be conforming and closely following the instructions given to them. Otherwise, there is a risk of prolonging the duration of the treatment and not achieving a perfect result.
What happens with smoking, eating, and drinking?
When the aligners are inside the mouth, the consumption of both food and sugar-containing beverages is strictly prohibited. Consumption of sugar can lead to the development of decalcification or caries. This is because sugar is trapped between the tooth surface and the aligners, and, at the same time saliva cannot act protectively due to the aligners. The only beverages that can be consumed without causing any problem are water, plain, no-sugar coffee (but only with a straw to avoid staining on the surface of the aligners) and white alcoholic beverages that do not contain any sugar. It is worth noting, however, that there are no other general restrictions on a person's diet. The patient, therefore, can consume every type food, even nuts or popcorn, which are prohibitive in an orthodontic treatment with traditional braces. Of course, this is only if the person removes the aligners before any meal.
On the other hand, smoking does not require the removal of aligners. Smoking, however, does have a negative effect on the colour of aligners, which will gradually turn yellow and consequently loose their characteristic of being discreet. The solution in such cases is the construction of double the required aligners from the very beginning. This way they can be replaced more often (every 3 days).
How many hours a day should a patient wear Invisalign aligners?
Invisalign aligners are different as compared to traditional acrylic plates. So, it is not enough for the patient to wear the aligners only for a few hours a day (for example at home or during sleep). On the contrary, in order for the treatment to be effective and the transition between the aligners to happen smoothly, the patient should wear them for at least 20 hours a day. Therefore, it becomes obvious, that in order to achieve a perfect result, the full cooperation of the patient is necessary, so they need to closely follow instructions by the orthodontist. This is the factor that would largely determine the success of the orthodontic treatment.
Is wearing Invisalign aligners painful? Is speech affected?
The intensity and duration of pain, and the duration of the necessary speech adjustment are both quite limited. Essentially, the pain is limited only to the first 2-3 days following the placement of each aligner. When it comes to speech, the adjustment period is only for the first 2-3 days of orthodontic treatment, as there is more salivation. In general, the term "splint" is often used to describe transparent aligners, but it may be very misleading since it implies something durable and rigid. Aligners, on the other hand, have the necessary elasticity for dental movement to occur. Specifically, Invisalign aligners are 0.5 mm thick and are made of SmartTrack material. This type of material is extremely elastic, it reduces the existing pressure on the teeth while exerting a mild force for a longer period compared to other materials used for the same purpose. Therefore, any pain and any speech adaptation should be transient.
Are all plastic clear aligners the same? Why choose Invisalign?
They are most certainly not! The SmartTrack material from which the Invisalign clear aligners are made has improved behaviour when it comes to gentle dental movement. Of course, not all plastic aligners are the same, and Invisalign aligners are very different from the rest. The SmartTrack material from which the Invisalign transparent aligners are made has a predictability of the teeth movements which is improved by 75%. Clear aligners are not just a piece of "plastic". This "plastic" is in your mouth for 20 hours a day, it is completely or may be incompletely in contact with your teeth, it bothers your gums and lingual frenulum, or not, and should move your teeth in a smooth, targeted, and predictable way throughout the duration of the treatment. Therefore, not all plastic clear aligners are the same. The choice is in your hands, or should we say, in your mouth, or that of your child.
After having an Invisalign orthodontic treatment, is a beautiful smile guaranteed?
The end result depends on several factors, as does the ideal smile. More specifically, these may be related to the colour, shape, and size of the teeth. The purpose of an orthodontic intervention is solely, the alignment of the teeth. Invisalign treatment, therefore, does not affect the morphology of the teeth. In case the desired, excellent result has not been achieved, one can proceed to aesthetic dental intervention to correct any possible defects. This method ensures a perfect smile! Since the colour, morphology, and shape of the teeth is already perfect, no aesthetic dental intervention is required.
Can the desired result be maintained over time?
Without the necessary retention, it is certain that at some point there will be a relapse of the result, meaning that the teeth will become crooked again, over time. Therefore, a retaining mechanism is necessary, in order to maintain the desired result. More specifically, a permanent titanium alloy wire is placed on the back side of the front teeth. This successfully treats the permanent tendency of relapse.
Why do non-specialists, general dentists also provide Invisalign treatments?
Quite often, we see general dentists providing Invisalign orthodontic treatments. Actually, many of these dentists have never undertaken a case where treatment with braces was needed. This is due to the fact that the Invisalign method offers great comfort to the doctor, since there is barely any adjustment required, and essentially, they are only responsible for monitoring the progress of each treatment. This way, the doctor spends less time, while at the same time there are no emergencies, as is often the case with braces. All of these factors have prompted dentists not specialized in orthodontics to undertake "Invisalign treatments" too.
Of course, this is not recommended, since, apart from monitoring your progress, the orthodontist also defines the final results and duration of the treatment, through the initial digital planning. If the patients interested in this method wish for the best aesthetic and functional result, they should choose a specialized orthodontist or dentists trained in orthodontics. In the exact same way that you would go to an orthodontist to have a treatment with labial or lingual fixed braces, you should also go to a specialist orthodontist for a treatment with Invisalign aligners. Similarly, as it happens in cases of root canals and fillings, it is not advisable to consult an orthodontist, but you should choose a dentist, then to have the Invisalign method applied, a patient should not consult a general dentist without university training in orthodontics.
What is interproximal reduction, or IPR, for the creation of the necessary interdental gaps for the arrangement of crowded teeth?
Interproximal Reduction (IPR) is a procedure to remove 0.2-0.5 mm of enamel from each point of contact at the front teeth (i.e., 0.1-0.25mm per surface) and it is usually performed in case of heavily crowding of the mandible (lower jaw). It applies in cases where both the extraction of teeth, for the elimination of the existing crowding via the application of orthodontics, and expansion of the dentition (by moving the roots to an area of minimal bone support) have clear contraindications. It is a completely safe procedure, and it is performed by the orthodontist quite easily. It is also scientifically proven that it does not increase the risk of the teeth against caries.
Is it possible to use an additional device, beyond clear aligners, in order to achieve the results of orthodontic intervention?
Clearly, there is such a possibility. In some individual cases, certain dental movements would not be possible or even predictable with the use of clear aligners alone. Moreover, this is necessary in cases where the total number of aligners is over 100. The use of various additional auxillaries such as sectional wires (see video), TAD's (temporary anchorage devices), or partial bracket bond up, ensures a more targeted intervention without the use of an excessive number of clear aligners. Besides, after a certain time, clear aligners inevitably lead to fatigue, which can greatly affect the prognosis of achieving the desired therapeutic outcome.