Clarity Ceramic Braces vs Invisalign. What’s the difference?

Clarity Ceramic Brackets Invisalign AttachmentsThere are many people out there who would love to have straighter teeth, but are put off by the look of metal braces. Fortunately, there are treatment options that are much more esthetically pleasing for those who would rather not rock the “metal” look. When it comes to esthetic treatment, clear braces and Invisalign are the most popular choices, but is one better than the other? The answer: It depends.

Clear aligners have the advantages of being removable, and move teeth without braces and wires, which is great for many cases, and in certain situations our first choice of methods to move teeth. There are no braces to break, no wires to become “poky”, and no obstacles to regular brushing and flossing. However, there are some disadvantages that are definitely worth knowing.

First, clear aligners are removable. They only work when the patient actually wears their trays for the recommended 22 hours per day. Second, any type of clear aligner cannot transfer the same biomechanical forces to the teeth that a bracket bonded to a tooth with a wire doing the work. Third, clear aligners aren’t always more esthetic. The attachments needed to make the trays work well don’t always look better than clear braces (see above).  Fourth, clear aligners are just a tool to move teeth with, and although it may seem easier to do with a computer program doing the work, the doctor still has to know what to tell the computer in the first place to achieve the desired result. Fifth, they don’t move teeth any faster than any other system without changing the biology that makes it happen.

Invisalign and other clear aligner systems do work, and we use them extensively in our practice. However, our practice is committed to providing the best results possible. If one system can deliver a better result than another for a given case, we’ll do our best to explain the reasoning behind our recommendation, and compromises that must be accepted otherwise.

First, Invisalign is removable, which is simultaneously the greatest advantage and disadvantage. The system only moves teeth when the trays are worn for the required 22-23 hours per day. If they’re spending more time in the case than what’s needed to eat, brush and floss, chances are the teeth won’t move like they’re supposed to. This also means that the trays have to be worn with all of the attachments on the teeth and prescribed elastics to work.

Second, there are things that Invisalign doesn’t do well. Invisalign’s marketing has definitely raised awareness of esthetic orthodontic treatment options, and has empowered people to explore orthodontic treatment who may not have in a world of metal-only braces, but strategically don’t explain the limitations of the system to the public. This puts orthodontists in the less-than-ideal situation of delivering the disappointing news to prospective patients who may have their hearts set on having their teeth straightened with Invisalign. In fact, only one out of five patients that come into our office looking for Invisalign have problems that can be treated just as well as with clear braces. In the marketing world, everyone is a potential Invisalign candidate, but reality is very different. Certain treatments require some tooth movements that clear aligners can’t do very well. Achieving the best results requires extensive knowledge of biomechanics and limitations of the system to design movements that will actually work. Even with that knowledge, correcting rotations, making teeth longer, making roots parallel and closing extraction spaces are much more efficiently achieved with brackets and wires. Sometimes we use braces to achieve those movements, and then get back into Invisalign.

Third, attachments. Patients sometimes ask, “Do you need to put those bumps on my teeth?” To which we answer, “Yes, if you want your treatment to be successful.” Attachment placement and types are dictated by the type of movements the doctor asks the system to achieve. Without these attachments, movements like twisting and making teeth longer can’t happen, because smooth plastic on smooth teeth will just slide across each other without the transfer of force that makes teeth move. In certain cases, attachments with trays covering them are more noticeable than Clarity Advanced brackets and wires.

Fourth, any system used to move teeth requires an understanding in how teeth move to make it work. Since Invisalign uses a computer simulation to design the treatment plan, it appears easier to use than braces. As a result, dentists with little orthodontic training now offer to straighten their patients’ teeth. With any kind of treatment, the outcome depends more on the doctor’s training, skills and experience than the tools used to get there. Adding a computer simulation to the treatment process does not replace the need for understanding of biomechanics, diagnosis, treatment planning and management of complications. Clear aligners are just tools made of plastic. Anyone can go out and buy a custom shop guitar identical to Eric Clapton’s too. But without the artist to play it, it’s just a hunk of wood. A really cool hunk of wood, though!

Fifth, treatment time is dictate by speed and distance just like anything else. By designing efficient tooth movements, we can decrease the distance that teeth have to move to get the desired result. This is easier to do when you have computer simulations to help with the treatment planning process. However, tooth movement is a result of biological processes that just take time. The cellular turnover and biochemical pathways triggered by pressure on teeth are the same whether plastic, metal or ceramic is used to do the pushing. Accelerated orthodontics has a lot more to do with changing biology than the system used to move teeth.

We use Invisalign extensively in our office, because in certain cases it’s the best choice. For patients with mild to moderate crowding, live far away from the office (such as kids going off to college), or hygiene concerns, it works very well.

In other cases, clear braces are the better choice. Advances in materials and manufacturing processes have made clear braces work just as well as metal. Our Clarity Advanced brackets do not stain, look great with colored elastic ties (if you want to show some colors from time to time) and move teeth just as efficiently as metal braces- but they look a whole lot better!

NOTE: The author, Dr. Jared Gianquinto, is an orthodontist in the private practice of orthodontics in Bakersfield, CA. He was trained at Temple University and Naval Medical Center San Diego, completing orthodontic specialty training at Temple University. Dr. Gianquinto’s unique combination of extensive past general/cosmetic and current specialty orthodontic practice qualify him an expert in two-phase treatment, extraction and non-extraction treatment, clear aligners (Invisalign and ClearCorrect) and multiple bracket systems. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.