Guides · Orthodontics
Who is suitable for clear aligners, and how does treatment progress?
How aligner treatment differs from braces, which cases it works for, daily wear rules and the retention phase.
Clear aligners are as effective as fixed braces for mild-to-moderate crowding, spacing and minor bite problems; they are worn 20–22 hours a day, changed every 1–2 weeks, and treatment takes 6–18 months in most adults. For marked skeletal discrepancies, severely rotated teeth and patients who cannot keep to the wear schedule, fixed braces are more predictable; the decision is made after an examination and a digital simulation.
Clear-aligner treatment uses a series of thin, transparent trays produced from a digital plan to move the teeth step by step. Because they are barely visible, adults often prefer them; they are not, however, suitable for every orthodontic problem.
How does it work?
A digital impression of the teeth is taken and the movement to the target alignment is divided into small steps on the computer. Each aligner moves the teeth about 0.25 mm and is replaced by the next one after 1–2 weeks. Small tooth-coloured "attachments" bonded to the teeth give the aligner grip and make complex movements possible.
Who gets good results?
- Mild-to-moderate crowding and spacing
- Relapse after previous orthodontics (teeth drifting back)
- Mild deep bite or open bite
- Minor corrections before cosmetic or prosthetic treatment
When may braces be the better choice?
Marked bite problems arising from the jaw relationship, bringing impacted teeth into the arch, large rotations and uprighting movements, and patients unlikely to comply with aligner wear are managed more predictably with fixed braces. In some cases the two methods are combined.
Daily wear
Aligners must stay in 20–22 hours a day; they are removed only for eating, hot drinks and brushing. Only water is drunk with aligners in. A removed aligner goes in its case — aligners wrapped in a napkin are the ones that get lost. Clean them with lukewarm water and a soft brush; hot water deforms them.
Duration and check-ups
Treatment takes 4–18 months depending on the severity of the problem. Check-ups are every 6–8 weeks; at each visit the next set of aligners is issued and progress is compared with the plan. Poor compliance is the commonest reason for treatment running long.
Retention
Once treatment ends, the teeth tend to drift back. A thin fixed wire is therefore bonded behind the teeth and/or a night-time retainer is issued. It is worn every night in the first year and then long term as the dentist advises; retention is part of the treatment.
Common mistakes
- Drinking coffee or tea with aligners in (staining and decay risk)
- Leaving aligners out for long periods during the day
- Switching to the next aligner early on your own
- Abandoning the retainer
Suitability requires an examination and a digital analysis; the treatment plan is based on that assessment.
Preparation before treatment
Aligners start only in a healthy mouth: cavities are filled, calculus is removed and gingivitis is treated. A digital scan produces a 3-D model of the teeth; the software sets the target alignment and number of aligners, and the patient sees the simulation. Small composite attachments that help tooth movement are bonded at the first visit; in some cases very fine (0.2–0.5 mm) interproximal reduction (IPR) between the teeth creates space.
Discomfort and speech
A feeling of pressure and mild tenderness for the first 2–3 days of each new aligner is normal — a sign the teeth are moving. A slight lisp on "s" sounds may occur in the first week and settles in a few days. Cheek and lip sores are far less common than with braces.
Living with aligners: food, drink, hygiene
- Only water with aligners in; coloured and sugary drinks stain the aligner and cause decay.
- Brush after every meal before reinserting; if that is impossible, at least rinse with water.
- Clean aligners morning and evening with cold water and a soft brush; hot water deforms them.
- Put removed aligners in their case; napkin-wrapped aligners end up in the bin — the commonest cause of loss.
- If an aligner is lost, move to the next one or wear the previous one, and call the clinic.
After treatment: why retention is essential
The fibres holding the teeth "remember" their old position; without retention, relapse begins within months. A thin fixed wire behind the front teeth and/or a clear night-time retainer is worn every night in the first year and then a few nights a week for life. The fixed wire is checked once a year.
Aligners in children and teenagers
They are used in suitable cases once the permanent teeth have erupted (around age 12); compliance problems are commoner at younger ages, so aligners with wear indicators are preferred. Where growth guidance is needed, functional appliances or braces are more appropriate.
Frequently asked questions
Are aligners visible? Attachments may be noticed up close; at conversational distance they are almost invisible.
Is treatment faster than braces? Similar or slightly shorter in mild cases; in complex cases braces are usually faster and more predictable.
Can I wear them less? Below 20 hours the movement no longer matches the plan, the aligners stop fitting and treatment is prolonged or replanned.
Can aligners be used with broken or missing teeth? Yes; a gap can be closed or space preserved for an implant.
Treatment options and process: Orthodontics.
This article is for general information only; diagnosis and treatment tailored to you require a dental examination.
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