Two paths, one goal
Invisalign and the classic fixed braces pursue the same goal: changing teeth and bite position. Both procedures work, both have been clinically established for decades. The question is not which procedure is fundamentally better but which is right for your findings.
This article explains both procedures, compares them by the key criteria and shows in which constellations which procedure is recommended.
What Invisalign is
Invisalign is the best-known provider of an aligner system. Aligners are transparent, individually fabricated plastic trays slipped over the teeth. A treatment series typically consists of twenty to sixty aligners, changed every one to two weeks. Each aligner moves the teeth a few tenths of a millimeter further into the planned final position.
The aligners are removed for eating and brushing, otherwise worn about 22 hours per day. Treatment begins with a 3D scan of the teeth, which is the basis for the computer-assisted treatment planning. The entire treatment course is simulated in advance; patients see the expected end result before starting.
Other aligner systems work on the same principle. Invisalign has the highest brand recognition and the longest clinical history but is not the only system.
More on Invisalign treatment at our practice is on the service overview for braces.
What fixed braces are
The classic fixed braces consist of brackets, small plates bonded to the front of the teeth, and a wire running through the brackets. Via the wire tension the teeth are moved into the planned position. In orthodontically complex cases additional elastics, headgear or other appliances are used.
Brackets are made of metal (most common and cheapest) or ceramic (less visible). A special form is the lingual braces, where the brackets sit on the inside of the teeth and are thus invisible from outside. It is technically more demanding, more costly and more uncomfortable to get used to than the classic vestibular braces.
During treatment the braces are retightened or readjusted at regular intervals, typically every four to six weeks, in the practice. The braces themselves remain in the mouth throughout the treatment.
Where aligners work well
Aligners have been significantly further developed since their market launch. The indication breadth today is significantly larger than ten years ago. Aligners work well for:
- Mild to moderate crowding in the front area
- Rotation of front teeth
- Gap closure of smaller diastemas and gaps
- Correction of mild bite misalignments such as crossbite of a single tooth
- Relapse treatment after earlier orthodontic therapy (very common indication because the movements are smaller)
- Combination with whitening or aesthetic restorations as an aesthetically motivated full treatment
The most common patient group is adults between thirty and fifty-five years with aesthetically motivated correction, often in the front area.
Where aligners reach their limits
Despite the further development, there are constellations in which aligners are not or only limitedly suitable:
- Pronounced bite misalignments such as open bite, deep bite or Class III malocclusion
- Complex root movements over larger distances
- Combined surgical-orthodontic cases (jaw surgery in combination with orthodontic therapy)
- Gap closure of larger gaps where root parallelism after gap closure is critical
- Auxiliary appliances needed such as palatal expansion
- Compliance problems expected, especially with adolescents
In these constellations fixed braces are usually recommended, sometimes combined with aligner phases.
Where fixed braces are standard
Fixed braces are still the standard procedure with:
- Growth treatment in childhood and adolescence, often in two phases (early treatment and main treatment)
- Complex Class II and Class III bite misalignments
- Multiband therapy over several years with complex movement sequences
- Patients with insufficient compliance, because the braces sit fixed and cannot be removed
- Combined surgical-orthodontic cases
Fixed braces are the “gold standard” of orthodontics. They have over seventy years of clinical experience and the broadest indication spectrum.
Comparison by criteria
Visibility
Aligners are nearly invisible in the mouth. At conversation distance an aligner is usually only recognizable on close inspection. That is the most common reason adults prefer aligners over fixed braces.
Classic metal brackets are clearly visible. Ceramic brackets are significantly less noticeable but still visible. Lingual braces are invisible from outside but noticeable inside in the tongue area and initially require getting used to for speech.
Wearing comfort
Aligners are usually perceived as comfortable because no sharp wire ends or brackets are in the mouth. In the first days after each aligner switch the teeth are pressure-sensitive, fading after one to two days.
Fixed braces often cause pain and mucosal irritations in the first weeks, settling with wax and adaptation. After every retightening one to two days of pressure sensitivity are to be expected.
Treatment duration
With comparable indications the treatment durations are similar. A moderate front tooth correction typically takes six to fifteen months. More complex cases (with fixed braces) take eighteen to thirty months.
Oral hygiene
Aligners are removed for brushing. Oral hygiene with aligners is easier than with fixed braces. Important is the cleaning of the aligners themselves and rinsing before reinsertion, otherwise caries develops at the aligner contact surface.
With fixed braces oral hygiene is more difficult. Special interdental brushes and superfloss are needed to keep the areas around the brackets clean. During wearing time the caries frequency is elevated, a recall program with dental hygiene is important.
Eating and drinking behavior
With aligners you eat as without braces because the aligners are removed for eating. That is a clear advantage with adults with professional eating appointments or a preference for sticky or hard food.
With fixed braces sticky, hard and fibrous foods are to be limited (chewing gum, caramel, hard bread crust, whole hard apples, popcorn). Coffee, wine and strongly staining foods are problematic with ceramic brackets, because the brackets or the bracket bonding can discolor.
Costs
The costs vary strongly by complexity and location. In Switzerland the costs for Invisalign and fixed braces in the comparable indication area are similar. Concrete amounts arise after findings and treatment planning.
A very simple aligner treatment with few aligners can be cheaper than a full-fledged multiband therapy. A complex aligner treatment with many aligners, attachments and long wearing time is not cheaper than fixed braces.
Swiss basic insurance does not cover orthodontic treatments for adults and in children only in rare severe cases with medical indication. More on the insurance question in the article on health insurance at the dentist.
Compliance requirement
Aligners require discipline. Those who do not consistently wear the aligners 22 hours per day significantly delay the treatment or do not reach the planned end result. With adolescents compliance is often the weak point, which is why orthodontists usually prefer fixed braces for growth treatment.
Fixed braces are 24 hours in the mouth without the patient having to do anything. With compliance problems they are therefore the safer choice.
Who treats
Orthodontics can fundamentally be performed by a general dentist or by a specialist for orthodontics. Aligner providers like Invisalign certify both general dentists and orthodontists.
For simple aesthetically motivated aligner treatments in the front area, treatment by an experienced general dentist is a valid option. For complex cases, growth treatments, pronounced bite misalignments or combined surgical-orthodontic cases, treatment by a specialist for orthodontics is sensible.
At Resident Dr. Athanasios Toloudis, certified orthodontist, treats rotating across four locations. Initial consultations and 3D scans take place in the respective location practice, regular check-up appointments with Dr. Toloudis by arrangement. Location-specific information is on the spokes for Invisalign Winterthur and Invisalign Zurich.
Early treatment in children
In children in the growth phase certain bite misalignments are ideally treated early before they consolidate. Classic indications are frontal crossbite, sucking habits with dental consequences or pronounced Class II and Class III findings with medical indication.
Early treatments are usually performed with removable appliances (active plates, functional orthodontic devices) or fixed appliances such as palatal expanders. Aligners are not the standard procedure in early treatment.
The main treatment in the mixed dentition or in the permanent dentition is usually performed with fixed braces. Aligners are possible with adolescents with pronounced compliance but are critically examined depending on findings.
What insurance covers
For adults Swiss basic insurance does not cover orthodontics. Supplementary insurance with dental care module can cover parts of the costs depending on tariff and maximum amount.
For children orthodontic costs are only covered by basic insurance in rare severe cases with clearly documented medical indication, such as cleft lip and palate or very pronounced bite misalignments with functional impairment. Most children’s orthodontic treatments are self-pay services.
More on insurance logic in the article on health insurance at the dentist.
How we proceed at Resident
In the initial consultation we discuss your wishes and expectations. Then follow findings with clinical examination, possibly X-ray or 3D scan. On this basis Dr. Toloudis creates a treatment plan with recommendation for aligners or fixed braces.
If both options are medically valid, we discuss the pros and cons transparently and you decide. You receive a written treatment plan with itemization of all costs. More on the cost estimate in the corresponding article.
Arrange an initial consultation at your location. With specific preference for Dr. Toloudis, state this preference when booking; we coordinate the suitable location and appointment.