Invisalign: Know Before You Go

Invisalign is likely the greatest advancement in dentistry in my 30-year dental career—but like anything great, it has nuances that need to be fully understood. If you’ve been discussing Invisalign with your dentist, or even just researching it on your own, you likely have a lot of questions. This guide will explore everything you need to know about Invisalign—from whether it’s actually invisible to how well it works to get the results you want.

What Is Invisalign?

Invisalign is a method of straightening teeth that, unlike braces, has made its name in the industry for being “invisible.” Invisalign isn’t invisible. It is, however, a functional and aesthetic option that uses incremental transparent aligners to straighten and realign teeth without the obvious physical appearance of braces. It is, in many cases, an improvement over conventional braces.

So how does it work? After impressions of your teeth are taken, they are placed in a shipping container and shipped to Invisalign in Juarez, Mexico where they are scanned while the impression is still in the shipping container. This digital scan is reviewed by an orthodontic technician in San Jose, Costa Rica and after a digital model is created, the proprietary Invisalign algorithm is applied to the model. The resulting product of this algorithm is called a ClinCheck, which is then sent to the treating dentist. This ClinCheck will inform the dentist how long the treatment will last and what the final result will look like. The dentist is then able to modify and enhance the ClinCheck based on the dentist preference and patient needs. The ClinCheck is essentially a simulation of each incremental movement in 2 week segments equalling .25mm tooth movements until all movements are completed.

Some Invisalign cases, particularly cases that require a tooth to be rotated or pulled down, may necessitate additional small, tooth-colored composite attachments to be bonded onto certain teeth. These generally can make Invisalign slightly more noticeable to the naked eye—and can make Invisalign more uncomfortable, as the attachments can rub and irritate the tongue and cheeks. This is rarely a problem for patients and is not a reason to decline treatment. On the positive side, these attachments can accelerate a case and make the actual result exactly match the ClinCheck. Some dentists will share the ClinCheck with the patients and discuss with their patient. I recommend that you find a dentist that will do this with you as it sets expectations and ensures that your preferences are being considered.

Why Choose Invisalign?

Choosing Invisalign is primarily a lifestyle choice due to the advantages of aesthetics and hygiene.

Benefits of Invisalign

• Aesthetics: You get clear liners that are nearly invisible compared to conventional braces.
• Speed: Often, some Invisalign cases can be quicker than conventional braces by nature of the design which can move many teeth at once.
• Comfort: There are no wires and sharp corners as there are with conventional braces.
• Results: Invisalign can move teeth in ways braces cannot.
• Reduced risk: With Invisalign, there’s less risk of shrinking of teeth roots due to the excessive force that can be applied with conventional braces.
• Time savings: There are fewer dental visits than conventional braces.
• Better breath: It is is almost impossible to completely clean around conventional braces which leaves you with “braces breath.” With Invisalign, you can remove your aligners completely to floss and brush normally. There’s also less risk of gingivitis and hyperplasia (gums growing up over the brackets) because you are able to clean your teeth better.
• Help TMD: Invisalign can help relieve myofascial and TMD symptoms. If worn 20 hours per day, the liners act like a splint to potentially relieve pain.
• Aligners to keep for life: Your Invisalign aligners can double as whitening trays or a mouth guard during and after treatment.

Downsides of Invisalign

The downsides of Invisalign are few compared with conventional braces:

• Speech issues: Because your teeth are covered with a thin layer of plastic, you’ll likely find yourself lisping when you speak the first 2-4 days. This is normal. The good news is that if you are concerned about this—say, for an important meeting, you can just take out your liners and wear them for longer to compensate.
• Discomfort: Despite being far more comfortable than conventional braces, the liners can irritate your gums, tongue and lips.
• Allergic reactions: This is extremely rare. Invisalign offers a full refund should this occur. I have never seen this with any of my patients.
• Cost: Invisalign should cost about the same as conventional braces. Some dentists charge more for the aesthetic benefits of Invisalign.
• Needing to remove liner prior to eating: Allow for time to remove and store liners before meals or snacks. In the beginning of the case, if your teeth are crowded, the liners can be difficult to remove. If this happens, I advise using a Smartie retainer remover.
• Potential weight loss: Of course, this can also be an upside! Many of my patients lose weight as taking out their liners, which makes them stop and think before snacking during the day.

Depending on your unique case, conventional braces may be better for you; there are certain cases that are better served by conventional braces. These tend to be skeletal or developmental cases, and this is a conversation you have to have with your dentist.

What Will Invisalign Cost?

Price will vary depending on where you live and the type of provider you choose, as well as what your insurance covers—generally you’re looking at somewhere between $1,500 and $8,000, depending on the complexity and length of your case. As you can imagine, the more you need to move the teeth, the more it will cost.

In general, whatever orthodontic coverage you have for braces will also cover Invisalign, and while these plans will not cover the full treatment, they will certainly help a lot: some plans have a $2,000 maximum lifetime for coverage, which is usually about a third of the cost of Invisalign. This will sometimes act as a sizable down payment towards Invisalign and can get you into a monthly payment plan with your dentist or orthodontist.

Some patients will be tempted by Invisalign Express, a cheaper product that only uses 10 aligners and is good for very small movements that don’t involve major rotations. Be wary of this option, as 10 aligners is typically not enough to complete all of the movements in a given case (most require between 18 and 50), and while this option may entice you as an affordable alternative, you will likely be bumped up to the full, more expensive product after a consultation with your dentist. Many dentists use Invisalign Express to entice patients into their office for a consultation only to inform the patient that the standard, more expensive Invisalign is the required treatment.

How to Choose a Provider

Both general dentists and orthodontists can prescribe Invisalign. While an orthodontist is a specialist with training in moving and adjusting teeth, many general dentists have been working with Invisalign even longer than some orthodontists and therefore have more experience.

To choose whom to go to, be sure to pick the person with the most experience and the most Invisalign cases a year. Luckily, Invisalign has created several categories of providers to give patients this information.

First, you have the Preferred provider, who treats at least 10 cases per year. Then, you have the Premier provider, who has treated at least 50 cases total and at least 25 cases every six months. Finally, you have the Premier Elite provider, who has treated at least 300 cases total and treats 50 cases every six months.

While contrary to popular belief, there are no continuing education requirements for any of these designations; the more cases a provider has treated, the more experience s/he will have.

You can find a list of these providers at Invisalign’s website. You could also ask for references from actual patients before making your decision, and even check our guide how to find an awesome dentist.

During the Appointment

An appointment to get Invisalign will first start with conventional impressions or digital scans of your teeth. The scanners are quite expensive, so some dentists may send you off to a lab instead of doing it in their office. Be aware: the process of getting conventional impressions with putty can be uncomfortable, and you might gag a bit. Remember to breathe through your nose, breathe slowly, and distract yourself with a podcast, song, or video on your phone.

The impressions or scans are then sent to Invisalign, where a 3D model of your teeth as they are and your teeth as your service provider hopes they will be is made. Once you and your dentist have okayed the model, the aligners are made and sent to your dentist’s office, so you can begin using them.

When you’re at the appointment, there are a few things that you should remember to ask your dentist.

1. Ask to See the ClinCheck.

The Invisalign ClinCheck is a 3D simulation video of your projected tooth movement and clinical result, giving you an approximate look of what your teeth will look like after the treatment is over. It also gives you appreciation for how clinically precise this treatment is, and it’s incredibly motivating!

While some dentists don’t want you to see this, as they think it complicates the treatment planning process, I always recommend that you ask to see it, so that you have a part in the final outcome. Most dentists know what to do, but they can’t read your mind when it comes to your needs, so it’s best to get this hashed out before the aligners are manufactured (and before you shell out for them!).

Also ask your dentist if the first set of liners will complete your case and how likely will it be that you will need a refinement, which will involve taking more impressions and ordering a new set of liners. This is called a refinement and should be included in a full Invisalign treatment until the case is fully completed.

2. Ask How Long the Treatment Will Be.

The length of your alignment treatment will be based entirely on how complex your case is. Most cases are between 10 to 24 months, with the patient switching out aligners every two weeks; the average treatment takes just over a year.

By asking to see ClinCheck, you will get an easy glimpse of how long your treatment plan will be based on how many aligners you will need.

3. Ask How Much a Replacement Will Be.

Things happen, and sometimes an aligner gets lost or even broken. While the latter is a very uncommon situation, if you do find yourself with a broken aligner, don’t worry: Invisalign has a warranty program to protect against this.

Loss is a bit of a different story; if you lose an aligner, the replacement will cost between $75 and $300 depending on your dentist, so be sure to ask him or her up front how much a replacement will be, should you find yourself in that situation. They can be easy to lose, especially in the first few weeks before taking your aligners in and out becomes routine.

That said, depending on how long you were wearing the aligner when you lost it, you might be able to move up to the next week’s aligner instead of replacing the old one.

4. Ask What to Expect After You Go Home.

It’s important to have realistic expectations when it comes to Invisalign: despite the name of the product, Invisalign is actually not completely invisible. It’s pretty easy to tell from a conversational distance if someone is wearing these aligners or not. However, compared to braces, Invisalign is much less noticeable—and it all depends on the person you’re talking to. I had a patient who underwent treatment with Invisalign, and not until a year had passed did she tell her husband, who hadn’t noticed for a full year!

Aside from what they look like, here are a few things you can expect once you get your new Invisalign aligners home.

How Often Do I Wear My Aligners?

Unlike braces, aligners can be removed, but for the best results, it’s recommended that you wear the aligners for at least 20 hours a day—giving you four hours a day of freedom!

While 20 hours per day is the recommended duration—and is backed by Invisalign’s research—some of my patients have done well at 18 hours a day, especially if the case does not involve rotations. I’ve even had patients who only wear them at night (albeit for four weeks per aligner instead of two) and got the desired results.

Do bear in mind that the older you get, the longer you will likely need to wear them. A teen may be able to get away with fewer hours of wear, but seniors will need to wear them for the full 20 hours a day to see effects, since as we get older, the ability to remodel bone (which is the mechanism of how teeth are moved and realigned in the first place) is decreased.

Be sure to check with your dentist to ensure that your teeth are moving as they should be, and makes adjustments as needed to how long you are wearing them and what your actual schedule should be—and above all, don’t try to cheat the system! Invisalign knows what it’s talking about, and you’re not doing yourself any favors by wearing your aligners for less than the prescribed 20 hours a day.

What Does Invisalign Feel Like?

If you had friends with braces growing up, you may have heard about the pain and discomfort that comes with tooth realignment. Thankfully, Invisalign is way less painful than braces. Yes, there will be some pain and discomfort with Invisalign, but it’s more of a soreness rather than the cut-up raw tongue and sharp brackets that traditional braces have (especially if you don’t mess with the aligners when they’re in your mouth – tempting, but a recipe for a sore tongue!).

Invisalign also causes less gum inflammation than braces, which can be uncomfortable when brushing, and has never been known to cause root resorption, which is something that braces do quite often and that can lead to loss of teeth.

Like anything else, it is wise to give yourself time to become accustomed to the liners prior to starting treatment. I suggest to my patients to start Invisalign on a Friday evening so that by Monday morning they used to the feeling of the liners and have gotten the hang of taking them in and out of their mouth.

How Do I Care for My Aligners?

There are lots of products on the market that claim to keep your aligners clean, but I find that the simplest solution is the best one: whenever I’m not wearing them, I keep them wet by placing them in a container with soft water and baking soda (click here for the exact steps for how I keep them clean, with a video). When the aligners are not in your mouth, do not let them dry out! Always keep them soaking in water, preferably distilled. Letting them dry out can allow plaque to build up on them, which is never good.

Feel free to give your liners an occasional scrub with your toothbrush but do not scrub your liners with toothpaste as this will dull the finish of the liners, making them less invisible and making your teeth appear less white. The same goes for your Invisalign retainer, which you get after completing treatment.

How Often Do I Change Aligners?

Invisalign aligners are changed every two weeks. There is a product on the market that claims to reduce that time to a week, but the clinical data supporting this product is not convincing to me.

Aligners can move your teeth the .25mm they are meant to in the first three days, but this is primarily tooth ligament movement, not bone movement. Bone movement is what keeps the tooth in its new position and this requires a full to weeks as the tooth has to be held in the new position long enough that bone cells fill into place and hold the position before the next aligner can be used.

As the case progresses, the “held” position is more difficult to maintain, and the chance of relapse (reverse movement) increases, so it’s even more important to wear your aligners for the proper amount of time towards the end of your treatment protocol.

After Invisalign

After the initial Invisalign period, your dentist may prescribe a “refinement period” to make additional adjustments to your teeth. This will involve ordering more aligners to complete the case.

After your teeth are aligned as planned, you’ll need to wear a retainer to keep them that way. Luckily, as with traditional braces, you only need to wear your retainer at night.

How long will I have to wear my retainer?

So many people ask this question—and my answer is always, “Forever!”

It’s possible that after wearing your retainer for a few years, you may be able to maintain retention. However, as we age, our bites and teeth shift. Because of this phenomena, it is advantageous to wear your retainer for the rest of your life. This allows you to preserve the ideal result that you worked so hard to achieve for the rest of your life.

How often will I need to replace the retainer?

The Invisalign retainer is quite durable and will last much longer than a normal aligner. Most retainers last between five and ten years, especially if you ask your dentist to show you how to remove it properly during your appointment.
How much will the retainer cost to replace?

Replacing the retainer usually costs somewhere between $75 and $300, depending on your dentist. The good news is that you won’t need to take an impression for a replacement retainer—the digital impression will still be on record at Invisalign, so they can send a replacement to your dentist easily.

Can Invisalign address my bite?

Contrary to what many naysayers would have you believe, Invisalign actually does address your bite – something that traditional braces often don’t. The mere act of wearing aligners can help improve symptoms related to TMD/TMJ, which is one side effect of an improper bite.

Aligners can act as a TMJ splint that can equalize or take away any occlusal interferences and help with any muscle pain associated with these problems.

Will Invisalign fix a diastema, underbite, overbite, crossbite, midline, or open bite?

Most likely, yes. Over the years, Invisalign has become a very sophisticated product, and it can address many common orthodontic issues—as long as the dentist with whom you are working is familiar with the problem and knows that it is something you would like to fix.

The only case in which conventional braces may be a better choice than Invisalign is if you’re facing a skeletal issue.

What if I forgot to change my aligners?

If you forgot to change your aligners (or even if you forgot your new aligner at home, and you’re now on vacation), it’s no big deal. Change them when you remember or when you get home. A case can be slowed down without any bad consequences (though it can’t be sped up, so don’t try to change out your aligners before the two weeks are up!)

Can I eat and kiss with Invisalign?

You have four precious hours during which you can remove your aligners—so what you choose to do during this time is up to you, of course!

Kissing is technically not a problem with Invisalign, assuming that your partner doesn’t mind the aligners, but you can also take them out and pop them back in later if you need to.

Eating, on the other hand, is much easier without Invisalign, as the sharpness of your teeth is dulled by the aligners. Just be sure that if you take the aligners out before you eat, you clean your teeth thoroughly before putting them back in. You don’t want to trap food underneath the aligners for too long.

Drinking with the aligners is absolutely fine, even hot beverages like tea and coffee – despite what some naysayers would have you believe. The worst case scenario is a bit of staining on one of your aligners, but since you’re changing them out every two weeks, that’s not the end of the world.

Will my brushing need to be different?

Brushing and flossing will change in only one regard—you may have to do it more often. Other than that, you should have no trouble, and you might even find that your daily brushing and flossing ritual gets easier as your teeth come into better alignment. Most people do a better job of cleaning their teeth when they are using aligners than before.

Can I whiten my teeth with aligners?

Absolutely! This may be the best time to whiten your teeth, as Invisalign aligners double as the best whitening trays on the market. Due to the digital impression of your teeth used to make the aligners, they are more precise than anything else you can find, and they safely maintain a nice thin layer of whitening gel only against your teeth.

Is there an age requirement for Invisalign?

No—pretty much anyone can use Invisalign successfully.
Teenagers can start using Invisalign at age 12 with the Teen Align program, and I’ve even successfully treated senior citizens with Invisalign.

Is Invisalign safe for pregnant women?

Yes! In fact, as pregnant women secrete hormones that help to loosen ligaments, which surround teeth, so pregnancy can actually help women to reap the benefits of Invisalign even more quickly.

Could I be allergic to the trays?

I have never met a patient that has been allergic to a tray, however some reports show that a very rare allergy to Invisalign trays has been experienced by some patients. Invisalign has a 100% refund policy if you have this problem.

What if I have missing teeth?

Even if you have missing teeth or will be having teeth extracted, Invisalign can still be a viable option. In fact, you may want to have the alignment done before implants or crowns are placed, as it allows the restoration of the dentition to be more ideally placed.

That said, be sure to speak to your dentist about this or any other dental work you envision getting done in the future before starting invisalign, so that you can work together to come up with the ideal treatment plan.

Will Invisalign affect my ability to pronounce words?

It’s very common for people to lisp when they first start wearing Invisalign. But your body is smart: your brain will automatically make adjustments with your tongue placement to account for the lisp and will correct this after two or three days. If you’re nervous about lisping at work, I usually recommend that patients start wearing their aligners on Friday evening, so that they have the whole weekend to get used to them, and by Monday, they’re up to speed. That said, if you’re giving a particularly important presentation or are jumping on a crucial conference call, you can always take them out for a few minutes and pop them back in when you’re done.

Can I do just the bottom or just the top?

No. It’s impossible not to treat the opposing dentition if you are treating the other opposing arch. The two arches have to meet, and both always have to be treated in unison.

Will Invisalign make my breath smell?

Invisalign can make your breath smell a bit, mainly because saliva tends to collect in the aligners, and because the aligners also tend to make your mouth dry out. Be vigilant about brushing your teeth every meal, and try to sip water fairly consistently to keep your mouth hydrated to avoid this problem.

If this is a problem brush your aligners with your toothbrush (no toothpaste) and soak in my recommended solution (add link to this here)

How often do I have to see my Invisalign provider?

Once you’ve received your aligners, you’ll need to make appointments about every four to six weeks to ensure that treatment is going as planned and to ask any questions you may have. You will also receive your next set of Invisalign aligners at this point.

So, that’s everything you should know before getting Invisalign!

Do you have any questions I didn’t address in this article? Ask me in the comments below! I read each and every one.

Dr. Mark Burhenne

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