Clear Aligners are the modern alternative to fixed braces. They are removable, transparent, customised, comfortable, with fewer dental visits. The ever-increasing popularity of clear aligners can be seen with today's well-informed patients. However, still some doubts persist in the minds of patients as well as general practitioners.

1. Dr. Harsimran Singh Kapoor

2. Influence of appearance in personal and
professional lives have led to a considerable
interest among the adult population seeking
orthodontic treatment in the last few years.
Invisalign or clear aligners are the new age
aesthetic orthodontic treatment methods
developed especially for adults who are very
self conscious of how they appear.

3.  Aligner is an orthodontic device that uses
incremental transparent trays to adjust teeth.
 It is used as an alternative to dental braces
 It offer patients an aesthetically agreeable
solution, using a computer-assisted technology
that produces a series of clear plastic overlays

4. Aesthetic Comfortable
Less chair
time
Customised Removable

6.  Aligners are worn for at least 20 hours a day
to reach the desired maximum effectiveness.
 Each aligner is worn for 2 to 3 weeks before
changing to the next one. The length of
treatment with aligners depends upon the
severity of each case.
 Each aligner is designed to move the teeth a
maximum of about 0.25 to 0.3 mm over a 2-
week period, and is worn in a specific
sequence.

7.  Clear aligner treatment falls into • ESSIX
RETAINER & INVISALIGN
 The first category consists of thermoformed
appliances sometimes known as ESSIX
RETAINERS.
 This are fabricated by making adjustments to
the tooth positions on models and fabricating
one or more aligners to correct a minor
malocclusion.

8.  The second category is Invisalign, which is a
proprietary orthodontic technique that uses a
series of computer generated custom plastic
aligners to gradually guide the teeth into proper
alignment. It is both a brand name and a
technique and is used synonymously.
 Invisalign is the computer aided design and
manufacturing (CAD – CAM) Precision aligner
product. The company and the technique was the
brainchild of two graduate students at Stanford
university – 1997,Kelsey Wirth and Zia Chishti.

9.  The appliance is currently recommended for
adults and for adolescents with fully erupted
permanent teeth who meet an acceptable
standard of compliance.
 Excellent compliance is mandatory since the
appliance has to be worn a minimum of 20 to
22 hours a day and each aligner should be
worn 400 hours to be effective.

10.  Mild crowding (1-5 mm)
 Mild spacing (1-5 mm)
 Deep overbite (Class II div 2 cases )
 Narrow arches that can be expanded without
tipping the teeth too much.
 Absolute intrusion (1 or 2 teeth) .
 Lower incisor extraction for severe crowding
cases.
 Tip molar distally.

11.  Moderate to severe crowding and spacing over 5
mm.
 Skeletal anterior-posterior discrepancies of more
than 2 mm
 Centric-relation and centric-occlusion
discrepancies.
 Severely rotated teeth (more than 20 degrees).
 Open bites (anterior and posterior)
 Extrusion of teeth.
 Severely tipped teeth (more than 45 degrees)
 Teeth with short clinical crowns.
 Arches with multiple missing teeth.

12.  Better esthetics as it is a clear material and no
metal show as seen in fixed appliances.
 Since these are removable appliances, they
are more comfortable and better maintenance
of oral hygiene can be achieved and lesser
white spot lesions during treatment.
 Less chair side time for the orthodontist.
 Technically it is more easier to fix/fabricate
than lingual appliances.
 Treatment duration is more predictable as it
can be calculated more precisely than braces.

13.  Since most clear aligner treatment involves
interproximal reduction, extraction of
premolars in minor to moderate crowding
cases can be avoided.
 Decreased occlusal abrasion from
parafunctional habits during treatment.
 Disarticulation of the teeth may be
advantageous for patients with TMJ problems.
 Better periodontal health and less risk of
enamel decalcification by avoiding brackets

14.  Since aligners are removable, they require
more patient motivation to achieve the
desired results.
 These devices must be worn 22 hours a day.
 Clear aligners must be removed during
meals, when drinking hot drinks that could
spot or cause deformation, sugary drinks and
during the oral hygiene.

15.  Treatment time may exceed due to patient
non-compliance to dentist’s instructions, not
wearing aligners the required number of
hours per day, missed appointments,
excessive bone growth, poor oral hygiene and
broken appliances which can also increase
the cost, and thus can affect the quality of
the end results.

16.  Data Acquisition
- Intra Oral Scans
- Radiographs
- Intra & Extra-oral
photographic records
 Digital Treatment
Planning & Clin-check
 Aligner fabrication

17.  Getting started:
• Orthodontist evaluates and discusses any
problems or goals for smile with patients.
• Once patient and dentist establish that
aligners are the right treatment option, digital
intra-oral scan, impressions, photographs, and
radiographs (OPG, Lateral Ceph.) are taken.

18.  CUSTOM TREATMENT PLAN
•Dentist sends patient’s records — Intra-oral
scan, photos, and radiographs to Aligner
manufacturing company with a prescription.
•Lab uses records to create exact 3D models
of Maxillary & Mandibular arches.
•They maps out a complete treatment plan of
gradual adjustments from start to finish.
•Once completed, Patient & Dentist will be able
to preview the projected results in "treatment
set-up” of before and after treatment.

19.  ALIGNERS ARE COMPUTER CRAFTED -
• When Patient & Dentist are satisfied with the
projected results shown in treatment set-up,
Clin-check, the manufacturing process begins.
• Using the digital thermoforming machines
such as ministar, custom aligners with
computer precision are manufactured.
• Aligners are delivered to Dentist for delivery
to the patient.

20.  PROGRESSIVE WEARING OF ALIGNERS
• To wear aligners all the time, except while
eating and drinking or during daily tooth care,
such as brushing and flossing.
•When using aligners, a series of slightly
different trays are custom made in order to fit
over the teeth.
Patient must wear each one for a period of 20
hours a day for 2-3 weeks before switching to
the next in the line.

21. •The aligners are barely noticeable, they won't
have an impact on patients day to day life.
• Aligner by aligner, patient will be able to see
the difference as teeth slowly adjust and align
to target smile.
• Patient has to visit dentist periodically for
checkups to see the progress.

22.  How do you eat with Aligners?
 What foods should you avoid?
 You cannot eat while wearing them. But you
can eat whatever you want only after
removing your trays and then wear them back
again.
 No food restrictions while you are under
aligners treatment.
 Remember! One need to remove aligners
before eating or drinking.

23.  Do you sleep with aligners?
Keep wearing the aligners
while you sleep.
It is completely safe to keep
your aligners on while
sleeping since it snugly fits to
your teeth, so no fear of it
getting dislodged.

24.  Why do one have to wear aligners for 2
weeks?
Because that is time period where most if the
teeth movement work starts, gums and bones
get adjusted and this time period ensures that
proper forces are getting applied to all the
teeth which requires alignment.

25.  Can one leave aligners out for a day?
Unfortunately no, because teeth are getting the
ample amount of pressure which is causing it
to move to desired position.
Leaving it for one day may haphazard the
pressure and teeth movement as a result the
process is delayed or you may have to repeat
the process from that point on.

26.  Can Invisalign push teeth back?
Yes, definitely. That’s what they are designed
for. They apply pressure onto the teeth that
brings about the change in alignment of teeth
and attachments are placed onto the teeth
which helps in quicker and proper movement
of teeth.

27.  Can attachments chip or damage Aligners?
No, attachments are actually smooth resin
buttons that are fixed onto teeth that requires
movement.
The aligner trays are made up of thermoplastic
BPA free material that is hard enough to bring
on the movements of the tooth and contains
attachment areas on which the resin
attachments sits and thus pressure gets
applied onto the teeth.

28.  How much does Aligners cost on average?
The normal cost of aligners in India is regularly
a lot higher than standard braces, yet at the
same time less expensive than abroad.

29.  Is the first aligner tray the worst?
It’s not worst but yes you will definitely have a
slight discomfort and lot of pressure that is
being applied onto your teeth by the aligners
tray which is working for the alignment of your
teeth.

30. How many hours a day should
one wear Aligners?
 20-22 hours daily is
recommended for optimum
results.
 Remove only while brushing,
eating and drinking.

31.  Can you eat with aligners?
- No, we cannot eat with
aligners.
- We need to remove aligners
while brushing, eating and
drinking any hard/soft cold
or hot drinks, since it will
damage or warp the aligners
material.
- We can drink normal water
while wearing aligners.

32.  Are braces or aligners better?
Both have the same effect in the alignment of
teeth.
- Braces are fixed and tend to cause more
discomfort and aesthetically unpleasing as
compared to Aligners.
- Also you can eat and drink as usual when
undergoing aligners treatment unlike braces
- So yes Aligners have more positive points than
Braces

33.  Aligners have opened up a new area of adult
orthodontics, serving patients who may not
want conventional fixed appliances
 Educating patients on the advantages and
disadvantages of clear aligner therapy.
 The results significantly depends on patient’s
expectations and compliance.

34.  One of the benefits of the aligner systems is
the opportunity to see the end result of
straight teeth and the progression of tooth
movement during the multitude of stages.
 It is essential to continuously motivate each
patient during treatment to properly wear
aligners to avail benefits of the treatment,
ensure patient compliance as well as patient
self discipline.