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Should you Choose Fixed Braces or Invisalign in St. Louis?

Choosing Invisalign or Braces

As an orthodontist, I am frequently asked whether I recommend Invisalign, which uses removable, clear plastic trays or traditional braces, which use wires, brackets and rubber bands to straighten teeth. From experience, I think that the best approach to this type of important decision is to compare the features of both options and determine which of the two is the best one for you. So, I decided to write this article about the different considerations when choosing between these two similar and popular treatment options that can both be used to correct the vast majority of orthodontic problems.

I. Overview of Both Types of Orthodontic Treatment Options

For both treatment options, my office will first use a digital scanner to create a highly detailed three dimensional impression of the contours of your teeth and mouth in minutes. This allows me to see your accurate digital dental impression right away, which results in improved orthodontic care. One of the advantages of the Invisalign treatment system is that based upon these digital impressions, I can explain the proposed treatment plan to you by showing you a computer based preview of your anticipated results and the difference between the current positions of your teeth and the final desired positions of those teeth. If this type of preview is important to you, it is also available with some other forms of braces, such as Insignia Braces.

Then, if you choose to treat with Invisalign, a series of clear aligners are created out of an FDA approved medical grade thermoplastic material (containing no BPA) and are customized for your individualized teeth and mouth. These aligners are removable orthodontic trays that are specifically designed for your particular teeth and mouth and as they are custom made for you and only you, they will fit over your teeth at each stage of the treatment process. The way the process works is that the aligners not only control the small but continuous force that is being applied to your teeth, but also control the timing of the application of this force which means that during each stage of the process only certain teeth are selected to be moved. Thus, as you incrementally replace each set of aligners with the next in the series, your teeth will be moved efficiently, gradually and gently until they have shifted to their final straightened positions and you have achieved your desired smile.

In contrast, all types of braces are traditional forms of orthodontic technology which has focused on using wires, brackets and rubber bands to generate gentle, yet precise forces on teeth to move them into the proper alignment. Even so, there are different types of braces that have some of the advantages of Invisalign. For example, Insignia Braces are also specifically customized to fit comfortably for your particular teeth and mouth and are precisely designed to affect your tooth movement in the most optimal way. This results in a reduction in the amount of office visits during treatment and the amount of time you would normally have to wear braces. For another example, both lingual braces which are placed on the inside surfaces of teeth and ceramic, tooth colored braces are relatively inconspicuous, which is one of the primary advantages of the clear aligners provided by Invisalign. Finally, regardless of the materials used for braces which may include different types of metal and ceramics, recent advances have caused braces to be more comfortable and attractive than their prior versions.

II. Treatment Process

Length of treatment

The length of orthodontic treatment varies greatly depending upon the severity and complexity of the problems being treated, but the average treatment times usually ranges between 9 and 15 months. That being said, braces and Invisalign typically require similar amounts of time to correct similar issues. Recently however, we began to offer a new option at my office for patients considering Invisalign in St. Louis called Accelerated Invisalign which halves the total orthodontic treatment time.

Frequency of office visits

There are usually less office visits with Invisalign because when using this treatment option we need to see you every 6 to 12 weeks to ensure that your treatment is progressing properly and to provide you with new sets of aligners. In between visits, you will change to a new set of aligners every two weeks, which means that most patients will typically use between 18 to 30 sets of aligners for the entire treatment process. On the other hand, with braces we will need to see you approximately every 6 weeks to check your progress and to adjust your orthodontic wires.

Avoiding treatment delays

In order to be effective, Invisalign trays must be worn approximately 20 to 22 hours a day and if this is not done regularly throughout the treatment process, the length of your treatment will be extended. Practically speaking, this means that you must wear the aligners while you are awake and while you sleep, although in my experience, most patients become accustomed to sleeping with the aligners very quickly. In addition, since you can remove your trays you must guard against losing them, because your treatment time will also be extended while replacement trays are being produced and delivered to you. On the other hand, neither of these issues presents a problem with fixed braces because they are bonded onto your teeth and as such they are worn 24 hours a day and they cannot be lost.

Post treatment

Regardless of whether you choose Invisalign or braces, it is likely that you will have to wear a retainer after completing your orthodontic treatment. This is done to prevent your teeth from slowly moving back to their initial positions. In many cases, you will only have to wear your retainer at night to ensure that you maintain your desired smile. Another new option that is offered at my office is to bond a very small wire on the inside surfaces of the front teeth for both the top and bottom teeth which reduces or eliminates the need for a removable retainer.

III. Lifestyle Considerations

Appearance and inconspicuousness

Invisalign aligners are removable, virtually undetectable plastic trays and thus they are designed to be largely unnoticeable. As a result, this treatment option is very popular with teenagers or anyone else with a professional or other reason to be discrete about orthodontic treatment. Even so, there are a variety of options for braces that are also almost undetectable, such as tooth-colored braces and lingual braces that are placed on the inside surfaces of teeth.

General comfort levels

Metal braces use wires and brackets that can poke at the cheeks and gums and cause them to get irritated. Even so, most patients’ cheeks and gums adjust and become accustomed to the metal braces over time so this type of problem becomes less of an issue. In contrast, the Invisalign aligners have smooth edges and do not cause these types of problems. In addition, both types of treatments can cause some discomfort when wires are tightened for braces or when a new set of Invisalign aligners is first put on. However, as the aligners apply less force than braces, they usually cause less discomfort than braces. It is important to note that for both treatment options, the discomfort that patients experience is usually mild, temporary and can be alleviated quickly with over the counter medications.

Restrictions on eating and other activities

Patients that have braces should avoid eating hard or sticky foods as these tend to damage brackets and/or wires. Similarly, patients using this treatment option should avoid biting anything else that is hard, such as pencils or fingernails. As Invisalign aligners can be removed, these problems should not present an issue for this treatment option. Even so, there are two general types of problematic activities that should be avoided when wearing the aligners: engaging in activities that will damage them and consuming food and liquids which will get trapped in them. So, for example, you should not chew gum or smoke while wearing the aligners as this will most likely damage the aligners. For another example, you should avoid consuming alcohol or soda while wearing the aligners because these liquids will become trapped in the aligners and can cause tooth decay.

Maintaining oral hygiene

Traditional braces use brackets that naturally catch and retain different types of food, making them difficult to clean. For this reason, it is very important to thoroughly clean brackets to prevent the buildup of tartar and plaque that often occurs around the brackets, which if untreated will often lead to tooth decay and swollen gums. On the other hand, teeth are easier to clean with Invisalign aligners because they are removable and should be removed before eating any food. In addition, the aligners should be cleaned before they are re-inserted into the mouth. In order to do so, Invisalign offers its own cleaning system for aligners which uses special cleaning tablets but you can also brush and rinse the aligners in lukewarm water.

IV. Invisalign vs. Braces: When Each Treatment Option Should Be Used

The earliest ages for using the different treatment options

In order to explain the earliest age at which it is appropriate to use the different treatment options, it is necessary to describe the conditions that first require orthodontic treatment in children. In the small percentage of children that require early treatment, the first phase of this treatment usually begins between the ages of 7 thru 10 and lasts an average of 12 to 18 months. This phase is necessary to direct the growth of the upper and lower jaws in a manner that will provide enough room for the adult teeth to naturally erupt. Then, there is a resting period during which a child’s remaining adult teeth actually do erupt, which usually takes 1 to 2 years. During this period, I will evaluate a child’s current condition about every six months for indications that it is appropriate to begin the second phase of treatment. The second phase most often uses braces in order to move all adult teeth into the exact locations that allows for the harmonious functioning of the jaws and teeth and achieves the desired smile. Under certain circumstances, after a teen’s second molars have erupted, a product called Invisalign Teen can also be used for the second phase of orthodontic treatment. This treatment option is very similar to the adult version and as such teens may prefer this option because the aligners are almost invisible. The teen version also contains special features aimed at this specific age group which include an indicator which tracks whether the aligners have been worn consistently and the ability to adjust the aligners for erupting molars.

Types of problems that can be addressed with each treatment method

I have found that in order to provide the best St. Louis Invisalign care, this treatment option is most effective at correcting moderate spacing, alignment and bite problems, but traditional braces are generally more effective for managing complex cases. That is, although Invisalign can be used in the vast majority of cases, it has been found to be less than completely effective at addressing the following complex orthodontic situations:

  • Moving any tooth up or down as opposed to sideways.
  • Moving certain types of back teeth that are more round because it is hard for the Invisalign trays to grasp them.
  • Creating rotational movement in certain types of teeth.
  • Moving a tooth that was tilted forward or backward and making it upright.
  • Moving teeth that are severely overcrowded.

Whether a situation is complex or not or should be treated with one type of option or another can only be determined after I perform a free orthodontic consultation for you.

Faster solutions for minor problems

There are often minor orthodontic issues that do not require full orthodontic treatment such as small rotation, crowding, misalignment, or spacing problems. Thus a new product called Invisalign Express only uses one to ten sets of aligners to complete treatment in less than six months in many situations. Even so, there are often solutions to these types of issues that use braces and are considerably more cost effective.

V. Cost of Treatment and Insurance Coverage

Cost of treatment

The cost of both treatment options vary based upon the length of treatment and the severity of the orthodontic problems involved. Even so, Align Technology, the manufacturer of Invisalign, reports that the national average for the cost of its treatment option is $5000, which is comparable to the cost of many types of treatment with braces. Similarly, at my office in St. Louis Invisalign and other forms of braces typically have similar costs for treating similar types of orthodontic problems. In any case, my office offers a number of financing plans for a variety of budgets in order to make treatment affordable.

Insurance coverage

Many dental insurance plans cover orthodontic treatment, but coverage varies greatly among plans as to the reimbursement rate for and the maximum lifetime payment for treatment. For example, suppose your plan covers half of the cost of orthodontic treatment with a maximum lifetime payment of $1800 and the treatment your orthodontist recommends will cost $5000. This means that your plan will cover half of the cost of your treatment up to $1800 and so you will have to pay the remainder of the cost, which is $3200. That being said, if a dental insurance plan covers orthodontic treatment it will usually cover both Invisalign and braces because they are similar. Consequently, such plans usually do not distinguish between both types of treatment for the purpose of the lifetime maximum reimbursement.

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