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Aligners: Are they for you?

Aligners: Are they for you?

Sounds like too good to be true…getting perfectly aligned teeth without braces, just wearing this plastic. Can eat what you like. No pain. Is it a reality or just some wishful thinking? What about claims that you no longer need the dentist to get this done. How far fetching can this be?

This article will dissect and show you the hard facts based on the author’s 25 years of dental and 15 years of orthodontic experience.

Background

Traditionally dentist have been moving teeth with metal attachment that is glued to the teeth. This time tried technology does provide predictable way of moving teeth to a pleasing position. However, this method comes with some severe drawbacks like difficulty in cleaning the teeth and makes the teeth more prone to decay and gum disease. There is a risk of injury to the lips, cheeks and tongue too due to the poking wires or dislodged metal pieces.

With the advent of Computer Aided Design and Computer Aided Technology (CAD CAM) we now can move the teeth digitally and make it a reality clinically. How its done? Firstly, a digital scan of the teeth is taken or a mould of the teeth is done and this mould is digitized to be seen in the computer screen.

A dedicated software with designing capabilities is utilised to view the dental condition in 3 dimensionally. Movements are made in this software bearing in mind the biological capabilities of the human teeth and surrounding structure. That’s why someone with dental training needs to be present at this stage so we would know the movements are possible and predictably done in the patient’s mouth. Each movement is calibrated so every month or twice monthly the teeth is moved to a new position and a study model is produced based on this movement.

Patient Dentition Scanned Into Computer

Patients scanned dentition in the designing 3D software.


Does it have to be metal?

The tool to apply force to move the teeth are no more ugly and unsightly metal but comes in the form of clear “plastic” BPE free type of material. The exact material is either PEG(poly ethelene glycol) or polyurethane.

Using aligner to move teeth is not a new phenomenon. In fact, the FDI approval for using aligner to move teeth was given more than 20 years ago and millions of patients have benefitted from this technology. If it doesn’t work or cause too much discomfort, I am sure it would not have stayed in the market this long. So, it works, but need a good dentist to utilize its full benefit.

Luckily the teeth do not care where the force is coming from as long as the force is consistent in a particular direction, the teeth will move. Nevertheless, space need to be planned for the movement. Frequently some additional accessories need to be attached to the teeth in the form of attachments. This are like door handle which make application of the force from the aligner more effective. A dental practitioner needs to fix this attachment which is fairly inconspicuous.


Treatment Process

As any orthodontic treatment, the whole process of treatment may extend over a period of time from 6 months to more than 2 years. This depends on the condition of the patient’s initial malocclusion and the objective or the treatment aims. During this period of time, it is important the movement of the patient teeth is closely monitored by the dentist. Biological tissues are so unpredictable that they might not move the way it is planned. The dentist role is to check every month, if the movement is as predicted and take the necessary steps to correct deviation from the planned movements before it is too late. The dentist also will check on the health and condition of the teeth and gums on this monthly visit. A healthy teeth and gum are so important for good tooth movements.

Each aligner is made to be work for one week or 10 days and changed to a new one after that. Each aligner moves the teeth in the predetermined distance which is biologically viable.

Right side view of the aligner in the mouth.

The Aligner in the mouth with the attachments which can be seen as “bumps” on the aligner

Left side view of the aligner in the mouth.


Conclusion

In conclusion, aligner treatment is effective in moving the teeth to a more favourable position but it must be under supervision with a trained dentist in providing this treatment. Its not wise to be penny wise and pound foolish!

Author

Dr Kathiravan Purmal


Orthodontist/Oral and Maxillofacial surgeon

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