What should you bear in mind when having aligner therapy?

Definition: What is an aligner?

The name "aligner" describes this correctional device's role perfectly: It is a transparent, plastic splint or tray designed for correcting and aligning teeth. Essentially, it functions as an invisible brace that can be easily removed from the mouth whenever necessary. Much like fixed and traditional removable braces, an aligner exerts pressure on the teeth, gradually encouraging them to rotate into the desired position.

The transparent splints, as we know them today, were developed and patented in the USA during the late 1990s. Following the expiration of the patent in 2017, the concept has also made significant inroads into the European market. 

What is the difference between aligners and Invisalign?

"Aligner" serves as the general term for all invisible plastic splints or trays designed for correcting and straightening teeth. Invisalign, on the other hand, is a well-known aligner brand. The relationship between the two terms is similar to that between "Hoover" and vacuum cleaner or "Chapstick" and lip balm.

Who can use aligners?

Aligners are suited for addressing mild to moderate tooth misalignments in both adults and young people. Aligner therapy is only recommended when the transition from primary (milk) teeth to permanent teeth is nearly complete. Aligners are not suitable for younger children.

Aligner therapy is a viable option for approximately 80 percent of misaligned teeth or malocclusions that require correction.

This includes, for instance:

• Crossbite
• Overbite
• Overcrowding
• Excessive spacing
• Deep bite/Head bite
• Underbite
• Open bite

In cases of severe malocclusions, fixed braces may be the preferable choice. Your orthodontist will determine the most suitable form of therapy for your specific needs.

Treatment: How do aligners work? 

Simply order online, insert and off you go? Unfortunately, aligner therapy is not quite that simple. At the beginning, a dentist or orthodontist will conduct an initial assessment to determine if aligner treatment is a viable option for addressing your teeth misalignment. If aligner treatment is deemed suitable, the dentist or orthodontist will scan your teeth and can then prepare a detailed treatment plan using state-of-the-art 3D computer technology. Typically, this process includes before-and-after simulations, allowing you to visualise the expected outcome before commencing therapy.

If you give a green light to the treatment plan and want to initiate therapy, a set of 14 to 50 transparent aligners will be custom-made for you, depending on the extent of the misalignment. The aligner treatment process typically involves wearing an aligner for a period of one to two weeks, after which you switch to the next aligner in the series. This gradual process applies continuous pressure to your teeth, steadily "aligning" them over time. The orthodontist may also affix attachments to your teeth to secure the aligners in place, if necessary. These clear plastic "little handles" are intended to enhance the transmission of force for better results. This treatment method is mainly used for more severe teeth misalignments.

To achieve the best possible result, it is advisable to wear your aligners for approximately 22 hours a day – both during the day and at night. You can take the aligners out for eating, drinking and brushing your teeth. A follow-up appointment with your orthodontist is typically arranged after six to twelve weeks of starting the treatment. The specialist will then assess the progress and can identify and address any issues, if needed.

Following the aligner therapy, you will receive a retainer to help prevent your teeth from shifting back to their original positions. Here you can choose between a fixed retainer – a type of metal wire affixed to the inner surface of the teeth spanning from canine to canine – and a removable retainer that you only wear at night. 

Duration of aligner therapy

How long you have to wear the aligners varies from case to case and depends mainly on the extent of teeth misalignment, as well as on how diligently the aligners are worn. Mild misalignments are often corrected within a few months, while more severe ones may necessitate treatment lasting up to three years.

Costs: How much does aligner therapy typically cost?

The costs for treatment can vary significantly depending on the severity of the misalignment or the number of aligners required. Commercial providers, particularly in Germany and Austria, frequently promote affordable prices below EUR 2,000, which can be settled through manageable monthly instalments over an extended period. However, for prolonged treatment, expenses of up to EUR 6,500 are not uncommon. In Switzerland, for example, costs range from CHF 2,490 to CHF 9,500.

In Germany, statutory health insurance companies do not usually cover the expenses for adults; and for young people, coverage is provided only if the treatment is deemed medically necessary and there are no suitable alternative options available. Patients with supplementary dental insurance or private health insurance may be eligible for partial or complete coverage of the costs, depending on their specific insurance policy.

Providers: Who offers aligner therapy?

The first point of contact for straightening and correcting teeth is typically an orthodontist. In an orthodontic practice, you will receive treatment from an expert who has undergone additional training in aligners and is well-versed in the complete range of orthodontic treatment approaches. Throughout the treatment, the orthodontist will provide ongoing care and oversee your progress.

 Meanwhile, there are also numerous commercial providers collaborating with dentists who offer aligner treatment. Instead of continuous monitoring, however, there is usually only one consultation appointment for the 3D scan at the dentist's. The aligners will be sent directly to your home if you give the go-ahead of course. Monitoring takes place via a mobile app. Commercial providers have multiple partner practices in major cities across Switzerland, Austria and Germany, including Zurich, Vienna, Munich, Berlin, Düsseldorf, Hamburg, Cologne and Stuttgart. But you can also find partner practices in smaller towns. 

Criticism of commercial providers

Commercial aligner providers often advertise affordable prices, make bold claims and showcase impressive before-and-after images that supposedly illustrate customer experiences. However, negative experiences with aligners are rarely discussed. Consumer organisations in North-Rhine Westphalia and Rhineland-Palatinate conducted a test comparison and concluded that the promises were "misleading" and took legal action – successfully.

Another problem with private providers is the absence of routine check-ups. Customers have no point of contact in case of problems, and it is unclear who is responsible if the treatment does not proceed as planned, the aligners do not fit properly or patients experience sudden pain.

The European Federation of Orthodontic Specialists Association (EFOSA), an association comprising orthodontic organisations from across Europe, views this as a significant violation of dental standards and recommends aligner treatment only in a dental practice with regular check-ups. The German Federal Dental Association warns that in the absence of regular check-ups, the worst-case scenario could even involve tooth loss.

Advantages and disadvantages: How effective are aligners?

To assist you in determining whether using aligners is a wise choice for you, we have summarised the advantages and disadvantages below.

Advantages

Adults, in particular, frequently choose aligner therapy due to the inconspicuous nature of the transparent removable braces, which interfere minimally with their daily work and leisure activities. Individuals undergoing aligner therapy typically do not feel less attractive while wearing aligners, which can sometimes be a concern with fixed braces, for example.

As aligners are removed before meals and placed back on freshly brushed teeth, there is minimal risk of food debris getting trapped in them, assuming proper oral hygiene is maintained. Caring for aligners and teeth is also easy and hygienic: Both the aligners and the teeth can be thoroughly cleaned separately. In fact, it is enough to simply clean the aligners with toothpaste and a toothbrush. As long as no attachments ("little handles" for better transmission of force in the case of more severe malocclusions) are attached to the teeth, there are no restrictions on dental care.

The transmission of force can be meticulously controlled using aligners, as each individual splint is designed to reposition specific teeth only. Furthermore, the treatment is predominantly painless. However, when changing the aligners and at the beginning of the treatment, you may experience significant pressure or discomfort lasting a few days.

Advantages at a glance:

• Transparent braces
• High level of comfort
• No psychological stress
• No restriction in food choice
• Easy care
• Targeted transmission of force

Disadvantages and risks

In addition to the criticism voiced by medical professionals regarding aligners from commercial providers, clear aligners may have inherent disadvantages even when administered by an orthodontist. However, it must be acknowledged that all treatments aimed at straightening and correcting teeth come with certain limitations.

In contrast to traditional fixed braces, the effectiveness of aligner treatment depends on strict adherence to the treatment plan. If you do not wear the aligners day and night, there will not be enough pressure on your teeth, ultimately impacting the outcome of treatment. Numerous individuals undergoing aligner therapy share their initial experiences in online forums. They often experience initial discomfort and speech issues, notably a lisp. This effect will, however, fade as soon as they become accustomed to wearing aligners.

Moreover, wearing aligners requires a high level of discipline in oral hygiene: After every meal, you must brush your teeth, including the spaces between the teeth, to prevent issues such as bad breath, teeth discolouration and dental decay. Inserting aligners with food stuck between your teeth creates an ideal breeding ground for bacteria. This environment allows them to thrive and potentially harm your teeth, as they are well protected from the flow of saliva. The same holds true when consuming sugary or acidic beverages while wearing aligners. You should, therefore, only drink water when aligners are inserted in your mouth.

Another important issue is demineralisation: Certain foods and beverages can stimulate the production of acids by oral bacteria, leading to the extraction of minerals like calcium and phosphate from the tooth enamel. Saliva usually replenishes the missing minerals to safeguard the enamel. However, since the aligners fully cover the teeth, direct contact with saliva is significantly restricted, making it challenging for the teeth to receive the essential minerals they need. This can lead to the formation of white spots. However, these spots can also occur when wearing fixed braces.

Disadvantages at a glance:

• Increased demineralisation
• Only successful when worn consistently
• Insufficient monitoring with private providers
• Heightened risk of dental decay
• Lisp at the beginning of treatment
• Chance of white spots

Care: What do you need to be mindful of when wearing aligners?

You might be curious about the day-to-day experience of wearing aligners and the challenges you will encounter if you opt for aligner therapy. Here are some tips and information about wearing and caring for aligners:

Inserting and removing aligners

To insert an aligner, start by gently positioning it over the front teeth and then exert slight pressure on the molars. To ensure a snug fit of the aligners, you can use what are known as "chewies". Chewies are small, soft plastic bite rolls that you chew on, much like gum, until the aligner is in the right position.

To remove an aligner, start by gently loosening it from the molars and then slowly slide it off the remaining teeth. 

Cleaning aligners 

Maintaining thorough oral hygiene is crucial during aligner therapy to prevent the buildup of bacteria and plaque on the aligners. Hence, individuals wearing aligners should clean their clear braces on the inside using a soft toothbrush (e.g., the CS 5460 from Curaprox) and a gentle toothpaste (such as products from the Enzycal range from Curaprox) and rinse them thoroughly with water before each insertion. The outside of the aligners is best cleaned while they are still in your mouth, meaning cleaning should ideally be done before removal.

It is recommended to use special cleaning tablets or solutions designed for aligners once a week. Cleaning tablets for dentures or mouthwashes are not suitable for aligners.

Dental care when wearing aligners

As already mentioned, maintaining thorough oral hygiene is of paramount importance. This is especially true if you wear aligners during pregnancy. During this time, the gums tend to be softer and more susceptible to inflammation.

Find an overview of the most important tips below:

• Each time before inserting an aligner, make sure to thoroughly clean your teeth and interdental spaces using a soft toothbrush and interdental brushes.
• Keep the aligners in your mouth only when consuming water (cold or room temperature). When eating or drinking anything else, remove them, and be sure to brush your teeth before reinserting them.
• If you are out and about without a toothbrush and toothpaste, rinse your mouth thoroughly after eating or drinking and also rinse the aligners under running water. And make sure to brush your teeth and aligners thoroughly at the next opportunity.
• In addition to the regular check-ups, it is important to schedule professional dental cleaning sessions with your dentist.
• To prevent the development of dental decay and white spots, pay particular attention to cleaning the edges of attachments thoroughly. The Single Brush or the CS 5640 from Curaprox are particularly suitable for this purpose.

The correct technique

While brushing teeth is a fundamental part of our daily routine, many individuals inadvertently make mistakes in this process. In the following instructions, we provide a step-by-step guide to the optimal approach and the scientifically proven best technique for brushing your teeth:

Instructions: Brushing teeth correctly

Instructions: Cleaning interdental spaces correctly  

Instructions: Brushing teeth correctly with an electric toothbrush 

Instructions: Using a tongue scraper correctly