8 things you should know about Invisalign & clear aligners, according to a top dentist

For folks who are looking to straighten misaligned teeth, braces are but one of the choices you can opt for. You can also go for clear aligners, and what’s come to be synonymous with them — Invisalign clear aligners.

How do they work? Clear aligners are less visible and work by gradually straightening teeth, with the user changing to a new custom-made set every few weeks. And unlike braces, they can be easily removed to eat or brush your teeth.

We tap Dr. Hwang Yee Cheau, an orthodontist at TP Dental Surgeons and also an adjunct professor at the NUS Faculty of Dentistry to weigh in on the benefits of clear aligners as compared to traditional braces, the dangers of shopping for aligners online, and more.

1. How long have you worked with Invisalign aligners, and what do you like about them?

Dr. Hwang Yee Cheau (HYC): I have been working with Invisalign clear aligners for my patients for over 15 years and what I really like about it is that the system leaves no room for guesswork.

One of the biggest advantages of Invisalign treatment is that it starts with advanced 3D planning software comprising data from 10 million patients worldwide. This system allows me to visualise each stage of the treatment together with my patient right up to the desired results so there are no surprises for either of us.

2. How do clear or Invisalign aligners work?

HYC: After the initial iTero 3D (a digital system) scans of the patient’s teeth, we create a customised treatment plan that maps out the movements of the teeth towards the smile that they want. Patients will then wear a series of removable Invisalign clear aligners that gradually straighten the teeth over time, and change to a new set every few weeks as directed.

Invisalign-trained doctors like myself are with the patient every single step of the way and we schedule regular check-ups to monitor their progress and ensure the aligners fit correctly.

Apart from in-person consultations, we can also monitor progress via the MyInvisalign app where patients can share images with us. It also sends reminders of their dental appointments, and lets them record and keep track of their aligner wear-time. This is especially welcomed by patients with busy schedules or those looking to minimise outdoor trips amidst the pandemic.

3. What is the most important thing people need to consider before getting aligners?

HYC: As teeth straightening is a medical procedure, patients should consult and discuss with a dentist or orthodontist before any treatment. For a safe treatment and sustainable results, they should opt for a clear aligner brand that is doctor-directed — and many may not even be aware that not all brands are doctor-supervised.

Having a dentist by your side is critical and the Invisalign journey is one where the dentist or orthodontist walks together with the patient from start to end. In fact, as Invisalign doctors, we are in charge of more than just the clinical aspects of the treatment. We are also the ones motivating and guiding patients, in addition to monitoring for potential issues, reassuring them, or alleviating any discomfort.

4. What are the most common conditions that aligners can treat? Can they treat complex conditions as well?

HYC: While there are consumers who are only looking to straighten the front few teeth that are visible when they smile, Invisalign clear aligners can straighten the full set of teeth. They’re also suitable for adults, teens, and kids and can treat complex cases, such as overbite, crossbite, and severe crowding conditions that may require initial extractions.

Since 2011, over 1.9 million patients globally with complex malocclusions have been treated with Invisalign clear aligners.​ Most other clear aligner brands don’t have these options, but of course, Invisalign treatment is also dependent on doctor experience and patient compliance.

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Dentists must always consider the various factors that may be unique to a patient before recommending the most suitable procedure. For example, some tweens (aged 9-12) and teenagers may suffer from a misalignment of their upper and lower jaws, resulting in an overbite.

Individuals in this age group may not be keen on bulky appliances that can impact their appearance and lifestyle. Invisalign clear aligners with mandibular advancement can be an effective solution, and help move the lower jaw forward with precision wings, while straightening the teeth.

This is more comfortable and less disruptive. In addition, some patients who require corrective jaw surgery may also choose to have pre-surgery orthodontic treatment done with Invisalign clear aligners.

5. What is the most common misconception about aligners?

HYC: Some people may think that all clear aligners are the same because they look similar. However, there are important differences between the materials and technology used by each brand.

In my opinion, Invisalign treatment is in a category of its own as it uses SmartTrack material, a proprietary medical grade plastic, together with advanced software technology supported with the experience of treating more than 10 million patients worldwide.

Invisalign aligners can also straighten teeth with 75 per cent more predictability, and most importantly, it’s the only brand that requires doctor direction from start to end.

6. What are the dangers of getting clear aligners without proper supervision?

HYC: Teeth straightening is a medical procedure so ongoing supervision by a dentist is essential. It is not something that patients can do on their own; if not done correctly, there may be adverse side effects like tooth loosening, gum recession, or inferior outcomes.

Patients may not realise that something is wrong until it’s too late and cause long-term damage to their teeth and gums. In fact, I have come across patients who damaged their teeth after undergoing these procedures that were intended to improve their smiles.

For instance, the husband of one of my regular patients had to hold his teeth in place while brushing. What had happened was that he had undergone teeth straightening with a clear aligner brand that wasn’t doctor-directed and felt his teeth loosening. It was extremely worrying and clear that a doctor wasn’t involved as this issue would otherwise have been identified, addressed or even avoided much earlier.

Patients may also not be able to receive medical attention when needed. One patient came to me because she was in pain due to a serious abscess.

While she had reached out to the clear aligner brand’s hotline numerous times, she was told that the pain was normal. But her ulcer subsequently worsened and developed into an abscess. It was only then that the customer service officers advised her to get it treated by her own dentist.

As a dentist, my patients’ safety and wellbeing is my priority, so I want them to be aware of the risks and help them detect potential issues before it becomes a problem.

7. Are there any limitations to clear aligners? Are there people with teeth issues or lifestyle concerns who aren't suited for clear aligners?

HYC: Invisalign treatment is suitable for many different conditions from mild to complex, and various age groups, from adults and teens to kids. People who are interested in undergoing teeth straightening should first consult their dentist or orthodontist for a detailed assessment to understand the different options and outcomes.

To achieve desired results, a certain level of commitment is required, and patients must be sure to comply with the aligner treatment wear time to see progress. For Invisalign treatments, patients will need to wear their aligners for 20 to 22 hours a day to achieve the maximum results.

8. What are the benefits of getting aligners compared to braces, and vice versa?

HYC: Many of my Invisalign patients have worn traditional braces in the past and their teeth issues later relapsed. After experiencing both options, many are impressed by the convenience, comfort, and how seamless the entire treatment process is. A big benefit of clear aligners is that they are removable during eating or brushing teeth.

It also means that their lifestyles aren’t affected as they don’t need to compromise on dental hygiene or eating some of their favourite food — something that may be difficult to do so with metal braces.

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In fact, 65 per cent of dental hygienists agree that most Invisalign patients have a visible reduction in plaque during treatment. Of course, aligners must be worn diligently to get the desired results. Without the wires and brackets, clear aligners are also more comfortable and cause less irritation and ulcers.

Invisalign treatments require fewer dentist visits as compared to braces as well. Especially with the ongoing pandemic, many of my patients appreciate the flexibility and the option to minimise visits to the doctor.

Through digital tools like My Invisalign App and Invisalign Virtual Care, we can monitor patients virtually, offering them certainty and reassurance during these unprecedented times.

This article was first published in The Singapore Women's Weekly.