Dental Aligners: Types, Benefits, Costs and Side Effects

Dental aligners, also known as invisible braces, clear braces, clear aligners, etc., are transparent removable braces that help tooth alignment and position on the dental arch. As they are transparent, they are very aesthetically pleasing and perfect for patients who want a perfect smile without any of the aesthetic baggage associated with metal brackets and wires.

They consist of a customized set of removable dental trays that progressively alter the dental occlusion. Since they are removable, they rely heavily on patient compliance, as the patient is responsible for wearing them for the required amount of time. Each tray in the set is custom fabricated as per the treatment stage, and any carelessness of the patient can completely derail the patient’s treatment progress.

Some common differences between at-home aligners and in-office aligners are described below:

You can self-examine when you need dental aligners or some other orthodontic treatment by performing the following self-assessment tests:

• Assess your smile in the mirror: Stand in front of a mirror and smile widely. Look for signs of imperfections such as gaps/spaces between the teeth, overcrowded teeth, or teeth out of alignment in the dental arch. If you have any teeth positioning or alignment problems, you should consider getting treatment.
• Examine your bite: Bite down so that your teeth are comfortably resting on each other. Use your tongue to examine your bite and check for signs of asymmetry.
• Check for oral hygiene issues: If you have oral hygiene issues like getting food stuck between the teeth, difficulty properly brushing and cleaning your teeth, bad breath (halitosis), etc., then you may need dental aligners for teeth alignment correction.
• Health problems due to dental misalignment: You can also have oral health problems like lisping, frequent tooth decay, jaw pain, clicking sound during jaw movement, etc., due to malocclusion. Consult your dentist for aligner treatment to relieve such problems.

Some common instructions that every patient getting aligner treatment should follow are:

• Wear your aligners for at least 20-22 hours a day: Wearing your aligners for any less will not affect your dental alignment and render the treatment ineffective. Eventually, your upcoming aligner trays will stop fitting your teeth. You should only take out your aligners while eating, brushing, or drinking something other than water.
• Keep your aligners clean: Use a soft-bristled toothbrush to clean your aligners, and then rinse them in warm water to prevent plaque and bacteria accumulation.
• Maintain oral hygiene: Brush and floss your teeth properly before wearing your aligners. Wearing aligners on unbrushed teeth increases the chances of cavity formation and other dental problems.
• Limit your consumption of snacks and coffee: You must take off your aligners to eat or drink something and brush them before wearing them again. Habitual snacking can make the treatment very cumbersome, so you should alter your habits if you begin the treatment.
• Store your aligners in their case: even if you remove them for a few minutes only. This protects them from damage, infection, and getting lost.
• Follow the aligner change schedule consistently: The wear-time for each aligner tray is different and customized according to the patient’s needs. You need to follow your aligner schedule strictly to ensure treatment success. If you have to travel, carry the next set of trays with you in advance.
• Consult a dentist regularly: While your treatment is ongoing, you should consult a dentist regularly to ensure you have maintained proper dental hygiene. Get teeth cleaning or filling done as needed, and do not postpone tooth care.
• Keep smiling confidently: Clear aligners are barely noticeable, so you do not need to worry about any aesthetic repercussions of the treatment. You can smile, perform on stage and confidently carry on with your life.

Some common instructions that should not be followed if you are going for dental aligner treatment:

• Don’t delay wearing your aligners: Once you’ve started your treatment, you have to commit to wearing the aligners. If you dawdle or delay wearing your aligners, they will not be as effective in moving your teeth and can even fail in some cases.
• Don’t expose aligners to air or heat: Aligners are generally made of a special type of plastic, and heat can warp their shape and disturb their fitting. Bacteria present in the air can infect the aligners and increase the risk of dental caries.
• Don’t eat or drink while wearing aligners: Aligners can’t withstand the occlusal pressure of chewing and can warp in shape and fitting if you consume something while wearing them.
• Avoid smoking while wearing aligners: Most orthodontists recommend not smoking while wearing aligners to avoid damage and discoloration of the trays. However, if you smoke, try limiting the number of your smoke breaks.
• Don’t eat sugary or sticky foods: Sugary and sticky foods are hard to clean completely from the tooth surfaces, so indulging in these promotes the chances of dental caries. Sugary chewing gums are the worst option, as they keep the aligners off for a long time.
• Don’t clean your aligners harshly: One of the biggest benefits of aligners is their invisibility, but aligners with scratches are easily visible to others, so don’t use strong cleansers or harsh products to clean them.
• Don’t delay dental appointments: Make sure you are getting regular dental check-ups to ensure your teeth are healthy and the treatment is progressing at the correct pace.

Dental aligners are usually fabricated using 3D scans of the patient's oral cavity. They act as moulds around the teeth while subtly applying gentle pressure on them to guide them to the proper position. Each patient has to wear at least 20-30 sets of aligner trays during their treatment, and each tray will direct the teeth a little toward the proper alignment.

Each set remains in the patient’s mouth for an average of 20-22 hours a day, for about 1-2 weeks for successful treatment outcomes. The patient has to make sure they wear the aligners for this duration, which is why motivation and persistence are key to aligner treatment success.

Clear aligners have proven to be effective, even for patients with moderate to severe malocclusion. Braces and clear aligners, both, are helpful in getting rid of malocclusion. Both have their advantages and disadvantages as clear dental aligners were found to be more effective in segmented movement of teeth and a reduced duration of treatment. On the other hand, braces are more effective in producing sufficient occlusal contacts, managing the torque in teeth and retention.

Clear aligners are more popular because they are less visible and can also be removed if any special occasion arrives. The effectiveness of clear aligners depends on the following factors:

• Duration for which the patient wears the aligners
• Complexity of the patient’s malocclusion
• Patient’s sex and age, etc.

• The results of dental aligners treatment are generally predictable as it is very comprehensive and follows a preset treatment plan.
• Each tray is customized to the patient’s dental alignment, so they are very comfortable to wear and do not cause any cuts or bleeding.
• It is very easy to maintain dental hygiene during aligner treatment, as the patient can remove them while eating, brushing teeth, etc.
• The patient does not need to follow that many dietary restrictions as the patient can remove the aligners while eating.

Clear aligners are excellent at treating a variety of bite issues like:

• Overbite or buck teeth: upper anterior teeth stick out vertically, covering the lower anterior teeth, common in children with thumb-sucking and tongue-thrusting oral habits.
• Overjet: the anterior teeth on the upper jaw are extended outward at an angle that they are unable to occlude with anterior teeth on the lower jaw horizontally, affecting the smile, chewing, speaking, biting, and other oral functions.
• Crossbite: the upper teeth fit inside the lower teeth due to oral habits, tooth growth delays, bone structure problems, genetics, etc. Anterior crossbite occurs in the incisors and canines, while posterior crossbite occurs in molars and premolars.
• Spacing: spacing or gaps between the teeth, usually hereditary in nature or caused due to tooth migration, early extraction, protrusive teeth, impacted teeth, abnormal tissue attachments to the gums, etc.
• Overcrowding: a lack of space on the dental arch due to which the teeth have to compete for space caused if the patient has a small jaw, relatively large teeth, supernumerary teeth, lingual oral habits, narrow palate, missing or broken teeth, rotated teeth, etc.
• Open bite: a space between the upper and lower teeth, even when the patient is trying to occlude them together. It can be caused due to teeth positioning, jaw positioning, or both, and is common in children with oral habits - thumb/pacifier sucking and tongue thrusting.
• Diastema: Diastema is the gap in the middle of the upper incisors. If the gap persists even after all teeth have erupted, then the patient needs to get orthodontic treatment for its correction.

Dental aligners are more aesthetic than braces, but generally, metallic braces are considered more effective than aligners, especially for complex malocclusion cases. But nowadays, aligners are being successfully used for even severe malocclusion cases. Some differences between braces and aligners are:

• Aligners are usually considered more effective for patients who want more precise and perfect smiles, as compared to braces.
• Aligners are less noticeable than braces, as they are clear and customized to teeth.
• Patients have to follow severe dietary restrictions during metal braces treatment to maintain oral hygiene, but there are very few dietary restrictions with dental aligners.
• It is easier to brush, floss, and maintain dental hygiene with aligners as compared to metal braces.
• Visit a dentist/orthodontist regularly to ensure the treatment is progressing smoothly.
• Aligners are more comfortable than braces. They also do not irritate or cut the oral tissues.

The cost of dental aligners lies between the range of Rs. 30,000 to Rs. 1,50,000. This cost range depends on a number of factors, like the severity of dental misalignment, the number of aligner sets required, the type of aligner treatment, the duration of the treatment, etc.

Normally, the cost of at-home aligners ranges from Rs. 30,000 to Rs. 80,000, while in-office aligners usually cost around Rs. 1,00,000-Rs. 1,50,000. Some other common factors that affect the cost of aligner treatment are:

• Material that dental aligners are formed from
• Diagnostic tests and supplemental treatments required
• Patient’s dedication to the treatment
• Complications during the treatment
• Consultation fees

If the patient fails to wear their aligners properly and their trays don’t fit them anymore, they may need re-fabrication of trays, which can increase the cost of the treatment drastically.

Some potential side effects and disadvantages of dental aligners are:

• The success of the treatment depends entirely on whether the patient wears their aligners. Kids often do not understand it and either remove them or refuse to wear them if they are uncomfortable. This is why the treatment is not preferred for kids.
• Since aligners alter the tongue-tooth relationship and movement, the patient may have a slight lisp at the beginning of the treatment. The lisp generally goes away as the treatment progresses.
• Some patients may feel shy or uncomfortable in social situations if they need to remove it for eating, drinking, or cleaning. Moreover, they need to keep track of their aligners whenever they go out to eat.
• Aligners alone may not be effective for complex malocclusion cases, so the dentist may need to combine them with other orthodontic appliances.
• If worn for a long time, aligners can affect the gum health and the roots of the teeth and result in issues like root resorption, gingivitis, and periodontitis
• Aligners are considerably more expensive than braces, which is why many patients can’t afford aligners, especially in-office aligners.

Aligner treatment usually lasts between 6-12 months, more for complex cases. The treatment plan is customized to every patient’s individual needs. The patient needs to wear the aligners for at least 20-22 hours every day till the completion of the treatment. Generally, the treatment takes longer in adults as compared to teenagers, as teenagers’ teeth are easier to move and more responsive to the overall treatment, while adults usually have more complex misalignment, and their jaws and teeth are less pliable.

Generally, the results of dental aligners do last for a long time if the patient follows their orthodontist’s instructions carefully, however, they are not permanent. Once the treatment is complete, the patient has to wear a set of retainers so that the teeth can retain their new positions for a long time. The retainers are fabricated similarly to the aligners and usually appear the same. If the patient does not wear the retainers, the teeth will eventually move back into their original positions.

Aligners are overall very effective in the correction of dental misalignment and are generally preferred over metallic braces by most people nowadays. If you have any dental misalignment, you should consider getting aligners, especially if you haven’t gotten the treatment yet due to aesthetic or budgetary concerns. At-home aligner treatment is perfect for you in all aspects, as it is aesthetic, cost-effective, and comfortable.