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Invisalign is the brand name used by a US company which produces invisible braces or teeth aligners. They are an alternative to the well-known metal braces which are used to correct malocclusions like overbite and crooked teeth and, similarly to these traditional braces, gently manoeuvre the teeth into their correct place in the mouth.
You would be forgiven for thinking that Invisalign were the forerunners of this product. In fact, the first teeth aligner or ‘tooth positioner’ was invented by Harold D Kesling, an American orthodontist in 1945. These aligners were custom-designed, made of rubber and functioned rather like a mouthguard. When worn together with the traditional metal braces the process of re-aligning the teeth was much quicker. Throughout the 20th century there were various tweaks to the concept by different people, but it wasn’t until the 1990s that teeth aligners took off in a big way.
A Stanford University student, Zia Chishti, became disenchanted with the level of discomfort he had to endure with standard metal tooth braces. In 1997, together with a friend, Kelsey Worth, he invented the world’s first complete clear teeth aligner system. Together, they formed a company – Align Technology, which produced these teeth aligners under the brand name of Invisalign. So, for the first time, adults could straighten their teeth with discreet almost-invisible appliances. No more mouths full of metal brackets, wires and the such like. The concept was simple: a person was given a series of aligners, each one minimally different to the previous one, so that little by little teeth were moved into their correct position. Invisalign uses current technology to replicate a series of computer-aided models taken from one impression of the teeth. The product launched in 1999, and for a long time had no discernible competition.
The Invisalign process is fairly straightforward and hi-tech. Your dentist or orthodontist scans your teeth, and, with the help of a computer program, the full treatment programme is created. This will include representations of what your teeth will look like after the treatment, so any amendments and alterations can be made at this stage. When everything has been decided, the system will go on to create your personal teeth aligners.
As with metal braces your dentist/orthodontist may have work to do on your teeth before the first Invisalign aligners arrive. This may include filing some of the teeth to make sure that there is enough room in your mouth for the teeth to move. The average wait for your first trays is about four weeks, although it can take longer. Each of the aligners is custom-made to fit your teeth and to apply pressure in particular places in order to manoeuvre them into alignment. Usually, a new tray has to be used every 2 weeks, although your orthodontist will tell you the best timespan for each tray for your personal treatment plan. Typically your teeth will move about 1/10mm with each tray. After tray one, tray two will have a very slightly different shape so that it will move the necessary teeth another 1/10mm and so on. Your dentist/orthodontist will probably want to check on your progress about once every four to six weeks. At each consultation he will give you the next set of tray. The duration of the treatment depends on what correction is needed and how much the teeth have to be moved. Minimum treatment length is nine months but it can take up to 18 months or even longer. Sometimes extra attachments are fixed to the aligner to assist with the movement of the teeth.
Here are some frequently asked questions about Invisalign:
Does Invisalign work for crowded teeth?
Yes - often it can, however more severe and complex problems may require alternative treatment.
Does Invisalign work for overbite?
Yes - in most cases
Does Invisalign work for crooked teeth?
Yes - usually
Does Invisalign work for open bite?
Yes - research has shown its effectiveness in treating some open bite conditions
Does Invisalign work faster than braces?
In most cases, yes it does
Does Invisalign work for everyone?
Invisalign has its limitations. It can’t: -Rotate teeth much more than about 20º -Tilt teeth more than 45º -Close more than a total of 6mm of space between teeth Dental bridges, veneers and crowns can also create problems for Invisalign
It is estimated that the latest Invisalign products are suitable for around 90% of teeth re-alignments.
There are five Invisalign types – designed for different circumstances and lifestyles. Essentially, all the types work in the same way – the main differences are in the duration of the treatment, which obviously affects the cost. The exception to this is the Invisalign Teen braces which specifically target the teenager market. Below is a brief description of each of the types, however your orthodontist/dentist is the best person to advise you which would be the most appropriate for you.
Invisalign Full is the most commonly used of all the Invisalign types. They can be used to treat about 90% of problems. The treatment takes up to 18 months, sometimes longer. It is the most expensive of the different types because it includes full trays to cover all teeth on both the upper and lower jaw (if this is required).
Invisalign i7 is most often used for minor alterations to the teeth, chiefly for aesthetic reasons. The i7 treatment plan only applies to the front six teeth on the top and/or bottom jaw. It includes just seven sets of trays, so treatment is very short – around three months. It is therefore only suitable for very minor alterations to the teeth.
Invisalign Lite sits somewhere between the i7 program and the Full programme, but like i7 concentrates mainly on the front six teeth. For all three programmes the aligner trays are exactly the same, however the Invisalign Lite programme is completed within 6-8 months. So, although it can correct slightly more complicated problems than the Invisalign i7 programme, it is still limited to certain fairly minor teeth alterations. These include crooked teeth, small gaps between teeth and mild overcrowding. Both Invisalign i7 and Invisalign Lite can sometimes be used when there is a slight relapse after previous orthodontic treatment.
As the name suggests, Invisalign Teen is aimed primarily at the teenage market. The teen years are, of course, the best time to re-align teeth and in many cases Invisalign could be a suitable product. Invisalign Teen works in exactly the same way as the Full product except that it includes certain extras which could be helpful to this age group. Probably the biggest issue with teenagers is ensuring that they are disciplined enough to wear their trays for 22 hours a day, so Invisalign Teen braces have a blue indicator to show whether the tray has been worn for the recommended time period. The trays are also specially designed to allow for any new teeth which may be pushing through. The other useful feature is the replacement of up to six trays, should the original ones become lost or damaged.
Invisalign Express treatment is again only suitable for minor adjustments to the front six teeth. Invisalign Express 5 – allows for up to 5 trays and takes about three months for the complete treatment. Invisalign Express 10 – allows for up to ten trays so the typical treatment time is six months.
Are braces or Invisalign better? Unfortunately this is not the easiest question to answer. Dentists’ opinions are split over which is the most effective. It will depend on the type of condition which needs to be rectified, how severe the condition is, the patient’s lifestyle and preferences. A recent article, published in the BMC Oral Health Journal by Yunyan Ke, Yanfei Zhu and Min Zhu concluded that: ‘Both clear aligners and braces were effective in treating malocclusion. Clear aligners had advantage in segmented movement of teeth and shortened treatment duration, but were not as effective as braces in producing adequate occlusal contacts, controlling teeth torque, and retention.’ Likewise a review article in the Journal of Advanced Medical and Dental Sciences Research came to a similar conclusion. Only your orthodontist can make an accurate assessment of condition of your teeth, establish what corrections, if any, are appropriate and what the best treatment would be. The following table, however, will give you the main facts for the braces vs Invisalign pros and cons.
Traditional Metal Braces
Can be up to 2 years or more
In theory, a shortened treatment time, but this relies on the patient adhering strictly to the instructions and wearing them a minimum of 20-22 hours a day
Put more pressure on the root of the tooth so movement of teeth is usually at root level.
The force of clear aligners is not normally strong enough to move the tooth at root level.
Conditions to be treated
Metal braces can be used for all types of conditions
Invisalign can be used for up to 90% of conditions
There are no limitations
Bridges, crowns, veneers and dental implants may pose a problem
With the use of retainers, metal brace corrections should last a lifetime.
In the past there has been some research done that indicates that the long-term effectiveness of Invisalign is not as permanent as braces. However, since these research papers have been published Invisalign have upgraded their system several times. No recent research papers list this as a problem
Opportunities for increased bacteria and dental decay
Brushing and cleaning teeth with braces in is more difficult and the braces create additional nooks and crannies for bacteria and plaque to multiply.
If the patient only drinks water with the trays in and thoroughly cleans the tray and mouth before re-insertion, then clear aligners win over metal braces. However, if patients eat and drink (particularly sugary drinks) this can become trapped between the trays and the teeth, therefore not allowing saliva to perform its natural cleaning process.
Metal braces are immediately conspicuous whenever somebody opens their mouth. Ceramic braces may be less visible but they can still be seen
Invisalign is virtually invisible, although if clear additions are used, these may be seen.
Visits are required 4-6 weeks
Once every six weeks
Available free on the UK NHS for under-18s. Adults usually have to pay.
Costs are often higher than traditional braces
Frequent visits to the orthodontist mean that he/she is generally in complete control of the process
The removable nature of Invisalign and the swapping of trays every two weeks gives the patient more control over the process. This may be a good or bad thing - depending on how disciplined and/or organised the patient is.
Wires and brackets may cause some discomfort in the mouth in addition to the slight pain from the teeth moving.
The trays are smooth, so except for the initial discomfort of something strange in the mouth and slight pain from the movement of the teeth, we can say that Invisalign are more comfortable than braces.
Braces are fixed and can only be removed by your orthodontist
nvisalign can be taken out for eating, for that special photograph or any other time when you feel that you would rather be seen without the trays. However remember that the 20-22 hour a day rule must be adhered to.
It is sometimes possible to see the results of Invisalign treatment within 10-12 weeks. Usually the most crooked or out-of-place teeth are the last to be moved, so the most dramatic results may take some time. The Invisalign results time will depend on the type of Invisalign used i.e. Full, Lite, i7, or Express as well as the corrections being made. When patients are not happy with Invisalign results, this is often associated with the fact that they have not been worn for the minimum time each day. There may be a final ‘refinement’ period at the end of the treatment to rectify any teeth which are still not correct. As with standard braces, once the treatment is complete, the patient will have to wear a retainer to ensure that the teeth do not return to their old positions.
As with everything in life Invisalign has its pros and cons. The patient must assess the best treatment option for their condition and lifestyle. Firstly let’s look at Invisalign advantages:
So, what are the disadvantages:
Probably the biggest of the Invisalign benefits is their near-invisibility, and many people are prepared to live with the disadvantages for the end result of a great smile. After all, traditional braces also have their disadvantages!
The length of the Invisalign treatment depends on what is being treated, how severe it is and how good the wearer is at wearing the trays for 22 hours a day. Below is the expected length of time for each of the Invisalign plans:
How long do you wear Invisalign?
These are the average times that Invisalign trays may have to be worn. Orthodontists predict that about 80-90% of the intended changes will have taken place by the end of the Invisalign treatment. In order to correct the last 10-20% of changes, refinements are required. These are essentially more trays which could add up to another 3 months onto the end of your treatment. So, in answer to the question – how long does Invisalign take to work – we often need to add a few more months onto the above lengths of time. In addition, once you and your orthodontist are happy that the treatment has achieved what was required, retainers will need to be worn. This will probably need to be worn every night for the rest of your life. Your orthodontist will renew your retainer about every 9-12 months.
If your teeth are crooked or misaligned, are there any alternatives to Invisalign. The answer is – Yes.
Braces work in a very similar way to Invisalign by gently manoeuvring your teeth into another position, however this is done with brackets attached to the teeth with a series of wires and ligatures to gently pull/push the teeth. Ceramic or tooth-coloured braces are available, however they are still visible. Lingual braces are also available – these fit at the back of the teeth, rather than the front, so they are virtually invisible. However, they do make teeth cleaning very difficult. In terms of effectiveness, braces are just as effective as Invisalign and in some cases more effective.
Veneers work in a totally different way. A very thin layer of porcelain is bonded to a tooth or teeth in order to improve the shape and colour of each tooth. They will not fundamentally alter the position of the teeth but can help to close gaps. So. minor cosmetic alterations can sometimes be better rectified with veneers. Once in place there is no ongoing maintenance, like retainers, however you should expect to have to replace the veneers about every ten years.
Where teeth are simply misshapen or too long, cosmetic contouring is a further option. This is a relatively quick and simple procedure, where the dentist will sculpt the tooth by using a drill or laser. When the desired shape has been achieved the tooth is polished.
Only minor re-alignments are possible with veneers and cosmetic contouring.
Align Technology were the first modern-day producers to market clear aligners and therefore their Invisalign brand is probably the best known on the market. However, there are now several other brands of aligners which are currently available. Below are some of the main Invisalign competitors:
The Smile Direct Club has just over 20 Smile Shops in the UK, based in many of the major cities. A 30 minute consultation will assess your eligibility to the programme and for a one-off fee of £1499 or a monthly payment of £120 you can leave with a set of 22-hour aligners for six months or night aligners (min 10 hour wear) for 10 months. The price also includes teeth whitening. It can also all be done remotely – they can send you a special kit to take an impression of your teeth. Progress is monitored remotely. Although there is an element of custom-made treatment, this is verging on ‘a treatment in a box’. Great for minor realignments, but probably not suitable for more complex situations.
Clear Correct are similar to Invisalign. Their aligners are slightly thinner – and some people feel this is more comfortable in the mouth. The downside of this is that the aligners can be more easily damaged. On balance Clear Correct are slightly cheaper and they offer a few different payment plans. They also include whitening treatment.
Smile Love is a mail-order based company which will send aligners to your home address. Currently they have the thinnest of all the clear aligners available and some of the cheapest prices. There is little input from a qualified dentist/orthodontist.
Clear Smile aligner is designed to straighten just the front 6-8 teeth. They are very similar to Invisalign, and like them, are only available through a dentist or orthodontist. Payments are usually made for the first consultation – about £25 – and then a payment for each visit to the dental clinic – £250. Total cost is about £1500.
The business model for Candid Co is very similar to Smile Direct except they only work together with qualified orthodontists. As a US company they are currently looking for business partners in the UK.
Uniform Teeth is a relatively new start-up company based in California US. They work closely with orthodontists and market themselves as a cheaper and faster alternative. Faster – because they use 3D x-rays rather than 3D scans.
Snap Correct market their aligners as the ‘clearest in the industry’.Again they are based in the USA and operate a mail order service. Initial cost is for an impression kit which after the impressions are taken is sent back. If Snap Correct consequently decide their treatment plan is not for you, they will refund the cost of the kit. Similar to Smile Direct and Smile Love, aligners are ordered through by mail.
The above is just a small selection of the companies who produce and market aligners. Remember that like Invisalign most of them can only offer treatment for mild to moderate malocclusions. Mainly, they fall into two categories, those which work with orthodontists/dentists and those which operate a home kit/mail order business model.The latter is obviously cheaper but may not be the best choice for everybody.
Can you eat with Invisalign? The answer is Yes… and No!:
1) NO – You should not eat or drink anything except water when you are actually wearing the Invisalign braces.If you do food particles will get trapped between the aligner and your teeth, creating a breeding ground for bacteria and subsequent tooth decay.
2) YES – Invisalign is designed to be removed when you are eat, so once the trays are no longer in your mouth you can eat and drink as normal, with no restrictions.
It is also worth bearing the following in mind:
As with any procedure designed to move and reposition teeth there will always be some pain. Invisalign pain, in this respect, should be no worse than with any other teeth braces. The worst pain will probably be at the beginning and each time the trays are swapped, as each aligner applies more pressure to the teeth. However the pain should be quite mild, and if it is a problem, any over-the-counter painkiller will ease the problem. Generally the pain will last a few days after each tray swap. Should the pain last as long as a week it may be worth returning to your orthodontist so that he/she can take a look.
In an article ‘Motivation, acceptance and problems of invisalign patients’, it was reported that 35% of patients felt no pain and 54% of patients mild pain when they were using Invisalign.
With traditional metal braces some pain may be felt as the metal wires catch against the inside of the cheek and tongue, with Invisalign braces this is not a problem as the polyurethane material they are made of is smooth and flexible. There have been some reports of the aligners rubbing against the gums, however this can be easily overcome – your orthodontist can apply some dental wax and this should solve the problem.
Not looking after and/or cleaning your Invisalign aligners means they may become discoloured, start to smell and become a breeding ground for harmful bacteria. The following actions are advised to maintain both your trays and your mouth in tip top condition:
1) Clean both the trays and your teeth regularly every morning when you get up. Bacteria and plaque can start to build up overnight.
2) Always rinse the trays whenever they are taken out of the mouth.
3) Use a soft toothbrush to gently clean the trays inside and out. There is a lot of contradictory information about the use of toothpaste and or denture cleaners – the main problem being that they can dull the trays. Be guided by the information from your orthodontist. Invisalign produce their own cleaning crystals or alternatively clear anti-bacterial soap can also be used.
4) The trays must be soaked daily.
5) Your teeth should also be brushed and flossed before re-insertion of the tray.
6) Clean both the trays and your teeth every night before going to bed.
Remember to be careful where you leave the trays when you take them out of your mouth – leaving them on dirty surfaces or even in the ‘open’ is not a good idea. Hygiene is paramount with aligners.
At the end of the Invisalign treatment, it is essential that the patient continues to wear an Invisalign retainer after braces on a regular basis, otherwise the teeth will simply move back to their original position. Sometimes the last Invisalign tray can be used as a retainer for a while.
Invisalign recommends using Vivera retainers, which like the `Invisalign trays are made of clear plastic. The orthodontist will suggest what the best times for wearing the retainer will be in each case. However, usually, retainers are worn for 15-22 hours a day for about six months, then every night for about six months. Finally, the retainer will need to be worn on a regular basis at night 3 or 4 times a week for ever. Interestingly, many people who request Invisalign treatment, do so because, in the past, they have had treatment with braces, but have not regularly worn their retainer – so their teeth have gradually slipped back to their original position. An expensive mistake!
How much does an Invisalign retainer cost – the recommended Vivera retainer costs about from £100 for a set (top and bottom) if bought as a multi-buy. One set will last between six months and a year.
Essix retainers – similar to the Vivera retainers also cost from around £100 for a set and should last between one and three years.
The old style Hawley retainers with wires are the most economical. Although their cost is £250-300 their life expectancy is up to 10 years.
Fixed retainers are also available which are wired non-removable appliances attached to the back of the teeth.
It is worth investigating the cost of retainers at the beginning of the treatment. Some dental surgeries/clinics will include the cost of some retainers in their package price. If this is not the case then don’t forget to add the cost of the retainers into the overall cost of the procedure.
As with any procedure with braces and aligners, an important element of the treatment is the frequent visits required to the orthodontist in order to check that the treatment is working as required. This means that a certain percentage of the total cost will be to pay for the various appointments at the dental surgery/clinic. For this reason, the cost of Invisalign can vary greatly between different orthodontists. It, therefore, can pay to shop around, but bear in mind that when time and travel expenses are factored in, a cheaper orthodontist 20 miles away may in fact ultimately cost more than the ‘more expensive’ orthodontist a mile from your home/work.
Usually an orthodontist will not give a confirmed quote until he has taken scans/x-rays of the teeth and decided on the work required and the extent of the treatment. Once this quote is received it is very important to establish exactly what is included. Is the cost for all foreseen appointments included? Is any dental work required prior to the Invisalign treatment and, if so, is that included in the quote? What about retainers? Are these included in the costs, and, if so, what type of retainer are they? What will be the cost if refinements are needed?
Due to the different complexities of the Invisalign treatment it is difficult to give a precise cost for Invisalign treatment. Invisalign itself gives a guide price for its Invisalign Full treatment of between £2500 and £5500 for a course of aligners. However it is possible to find Invisalign Express advertised for a mere £1295, Invisalign i7 from £1200 to £3000 and Invisalign Lite £1800 to £3500. Your orthodontist will be able to tell you if any of the cheaper versions are suitable for the dental work you require
Many dental surgeries and clinics offer easy payment plans.
Unfortunately Invisalign treatment is never covered by the NHS. Often the cost of braces for under-18s is free of charge on the NHS, but this only covers treatment with traditional train track metal braces. Likewise, on the rare occasions when the NHS does offer treatment to an adult for a health-threatening malocclusion, this is also only for the traditional metal braces. There are no circumstances in which you can have Invisalign NHS funded.
It is highly unlikely that dental insurance plans would cover orthodontia, however if you do have a policy it is always worth checking.
Generally many dental treatments can be obtained at a cheaper rate abroad, even when flights and possible hotel accommodation are factored into the budget. This is not due to inferior materials or workmanship, but purely because of lower labour costs i.e. the dentist’s/orthodontist’s time costs much less.
The same can be said of the Invisalign cost abroad. The products will be genuine Invisalign products, the orthodontists trained to the same high standard but savings may be found in the cost of the dentist’s/orthodontist’s time.
The downside of obtaining Invisalign treatment abroad, is the fact that several return visits may need to be made to the orthodontist during the treatment and that will obviously increase the overall cost of the treatment package. It is therefore important that you live fairly close to an airport which has frequent flights to your country of choice – flight schedules permitting, day return flights will suffice for Invisalign appointments.
As with any dental treatment overseas it is worth paying a visit to your dentist/orthodontist in your home country in order to find out which Invisalign type is appropriate for your dental problem and to obtain a quote for the course of treatment – always remembering to check exactly what the quote includes. This will help when comparing prices, as, although the overseas dentist/orthodontist will want to re-confirm what he/she considers is the best treatment type, it does mean that you will be able to compare like with like.Remember to check with the overseas clinic how many times you will have to return for appointments and factor the flight tickets into your overall budget.
Dental treatment in Poland is becoming ever more popular. Well-appointed clinics, widely-spoken English and frequent budget flights from many European cities have all helped it to become the country of choice for dental treatments for many people. The Invisalign cost in Poland is generally cheaper than UK prices. Costs start at around £1000 with top prices of around £4000. Always check with the clinic how many times they will expect you to attend check-up appointments. With its frequent flight schedule from many UK (and other European city) airports, it may be that some people will find it cost-effective to use the wide range of dental clinics located in some of the major cities, like Warsaw, Krakow, Wroclaw and Gdansk.
Turkey is another country which is growing in popularity for dental tourism. In addition to well-equipped clinics, its coastal resorts also have the added advantage of being very popular holiday destinations. Flights from many airports in Europe, though, are probably less frequent than to Poland. The Invisalign cost in Turkey, however, compares very favourably with UK prices. Costs start at around £1000 with top prices under £3500. As with Poland it is wise to check how many return visits you will be expected to make and to check out the availability and costs of flights from your nearest airport to Turkey. For some treatment types, even with travel costs, it may still be cheaper than costs in the home country.
The five different Invisalign treatment packages are generally suitable for mild to moderate re-alignments of the teeth which represents about 90% of its requests for treatment. Invisalign’s advantages are its near invisibility, comfort when wearing and the fact that the trays can be taken out to eat. Its main disadvantage is the self-discipline required to ensure that the trays are worn for the optimum length of time. Cost could also a potential obstacle, although shorter treatment courses like Lite and Express, monthly payment plans offered by orthodontists and the possibility of cheaper treatment packages abroad can all help to alleviate the financial burden. There are now other similar products available on the market which are sold with or without the expertise of a specialist. Rather like braces this treatment plan is not a quick fix. It can take up to 18 months or even longer and even with the much shorter treatment plans, it is likely that retainers will need to be worn for the rest of your life.
Align Technology UK Invisalign website:
Yunyan Ke, Yanfei Zhu and Min Zhu – A Comparison of Treatment Effectiveness between Clear Aligner and Fixed Appliance Therapies published in BMC Oral Health Journal Jan 2019
Kumar Kislaya, Garg Vishal – Review Article Invisalign: A Transparent Braces published in the Journal of Advanced Medical and Dental Sciences Research 2017
Nedwed V, Miethke RR – Motivation, Acceptance and Problems of Invisalign Patients
Kau Chung H, Terpsithea Christou – Effectiveness of Clear Aligners in Treating Patients with Anterior Open Bite: A Retrospective Analysis published in Journal of Clinical Orthodontics 2017
American Association of Orthodontics Blog 2018
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