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Many pages could be written on the differences between braces and Invisalign. Patients initially intrigued by Invisalign, having resisted conventional appliances for so long, often ask if braces would be more effective. There is no simple answer to this, and any orthodontist who gives a stock answer is unfamiliar with Invisalign.
First, understand that both braces and the Invisalign aligners are tools that permit similar alignment of teeth. With braces, the force required to move a tooth is delivered via tension provided by elastics or metal wires, to a point of force located in the center of each brace. Aligners provide force as each subsequent tray is fabricated with the tooth positions slightly straighter than the prior aligner, the force being placed over the entire surface of each tooth.
It is a bit simplistic to say that braces work better in more severe cases. However, as a general rule, cases of crowding sufficient enough to warrant tooth removal indeed are treated more effectively with braces. This is because removal of teeth involves the shifting of certain teeth over relatively long distances, where as cases treated without tooth removal (the vast majority of all cases) involve more tipping or rotating teeth along their own axes. Recently, Invisalign has included extraction cases into their criteria of treatable conditions, but in many instances the goal is to use Invisalign for only a portion of the treatment, lessening the time braces ultimately need to be worn.
The majority of cases can be treated with either braces or Invisalign. Invisalign has the obvious benefit of being essentially invisible when worn, and easily removable for eating, tooth brushing, and occasional special events. The flipside of this advantage of removabliltiy is that great discipline is required to avoid going too long without wearing the aligners; they only work when in the mouth. Each aligner is worn for two weeks, and pressure is felt only for the first few days, yet full-time cooperation is required every day for treatment to progress in the most effective manner. Some patients who are in the midst of treatment have hit rough patches where due to travel, illness, pregnancy, or laziness, they cannot wear the aligners on a full time basis. All is not lost , however, as these patients can wear aligners only at night to capture the progress gained, and then resume full-time wear at some point in the future. Cases only half way completed with Invisalign look 50% better! Similarly, some patients who have had a bad week of wearing the aligners full-time simply wear the aligners for more than two weeks prior to switching to the next aligner. While most Invisalign patients accept the added responsibility of monitoring their own compliance carefully, most remain happy to have avoided braces. However, there have been some Invisalign patients who seem to tire of the daily grind of aligner wear and removal, petering out as the months go by. Without ideal cooperation in wearing aligners 20-22 hours each day, ideal results cannot be achieved.
Though braces cannot be removed, all patients, after a more unrelenting adjustment period, become completely used to the braces, and usually forget about them. Clear braces, which are bonded to the teeth, look surprisingly good compared to the braces you might have imagined from childhood. Many patients decide to swith to braces at the end of Invisalign treatment, for a very short time, to achieve the most perfect detailing, and often they comment that braces were not that bad at all!!
In terms of the final outcome, final detailing with Invisalign can be time consuming and not as precise as with conventional braces. Orthodontists are by nature perfectionists, and getting that tooth just right is easier with braces.
What's very surprising is that most Invisalign cases range in duration from 10-15 months, which is less time than most adolescents wear conventional braces. Also, Invisalign is actually the appliance of choice in our office for certain types of malocclusions, including cases with spacing between the front teeth, as well as narrow upper arches.
Dr. Goodman is a Certified Invisalign® Provider