Exactly 12 years ago, in March 2002,
I received my Invisalign certification. I had completed one of the first training courses
ever held in German-speaking countries . After a dozen years and a large
number of patients treated, I would like to take stock of the tooth correction with the Invisalign technique.
And I would also like to compare the Invisalign technique
with the alternatives that we now have. When I say alternatives, I don't mean the
many imitator products that have only copied the Invisalign technique or modified it minimally, such as
Harmonie splints, Orthocaps, Simply5 and the like.
They are no better than the original. Above all, I think the lingual technique is
an alternative to Invisalign worth considering. Align Technologies did not invent the movement of teeth
with plastic splints, but revolutionized the procedure that we as dentists have
known and used for much longer with the Invisalign technique. We used to move individual teeth with plastic foils
– Jack Sheridan, an American professor, propagated this technique back in
the early 1980s. Align Technologies has upgraded this method for
the 21st century by developing a computer design program for
treatment planning and monitoring on the one hand and industrial manufacture
of the splints on the other. So far, none of the imitators that must
always exist with a successful product can do it as well and no imitators
have materials that are as good as Invisalign. My initial euphoria about the "invisible"
braces has now evaporated because over the years the limitations
of the system have become clear. While we initially believed that Invisalign
could be used just as well as conventional
technology in EVERY malposition situation, I am somewhat sobered today.
Some tooth movements are difficult and tedious with the Invisalign technique
and also take a lot of time, so prolong the treatment time. However, the shortest possible treatment period
is particularly important to me – and to many adult patients as well. The most difficult tooth movements for the
Invisalign technique include rotations of canines and side teeth or intrusions
or extrusions.
This means movements of the teeth
into or out of the bone, e.g. in the case of external canines. A plastic foil – Invisalign calls their
"aligners" – cannot grip a tooth well enough , it only grips it on the inside
and outside. In addition, the aligners tire after a few
days – they wear out, so to speak. And transmit less force to the teeth,
so that at the end of the wearing time of the respective aligners – which is usually two weeks – there
is less tooth movement than at the beginning. This also lengthens the duration of the correction
. Even the improved aligner material launched by Invisalign at the beginning of 2013 does
not completely solve this problem.
➠With brackets and arches, i.e. conventional
"snow chain" or "gartenhag" braces, the forces remain effective the entire time,
there is no fatigue and with the brackets we have safe access to the teeth. Nothing can slip out or slip off. As a result, the duration of treatment in comparable
cases is significantly shorter than with Invisalign. In addition, Invisalign only works if the
patient is very disciplined in wearing it – a fixed
brace, on the other hand, is not dependent on it. ➠For patients for whom it is important that
their braces are not visible, I increasingly prefer lingual technology. In other words, fixed braces glued to the tongue side of the teeth
. In my experience over the years,
the duration of treatment with tongue-side braces is much shorter and the forces can be better
dosed and controlled than with Invisalign. In addition, you really can't see anything from the outside
, not even a plastic sheet.
It takes a few days before you can talk properly with the lingual brace
– just like with an Invisalign aligner. That doesn't take anything. Talking needs a little practice for both of them
. Only chewing is somewhat restricted with the lingual brace
– it takes some time to get used to it. The lingual brace is not removable. And that's another advantage: it works
continuously, without any break. With the lingual technique, tooth movements can also be
carried out that are only feasible with pull-ups and additional tricks with Invisalign. Rotation and movement of teeth at
height – whether moving teeth in or out of bone – can be
controlled and performed with precision. With such teeth, an aligner
simply slips off easily or bends open. ➠Let me show you two similar
cases, one of which we treated with Invisalign – let's call it case 1 – and corrected one
with the lingual technique – let's call this case 2. Here is the initial state of the Invisalign case. notice how deeply the lower incisors
bite behind the upper ones, this is what is known as a "deep bite". As mentioned before, it is difficult to move teeth into the bone
with the Invisalign foils, which the company calls these "aligners"
.
After 30 months, that is 2 1/2 years,
we had this result. You can now also see a few millimeters
of the lower jaw teeth, so we have been able to reduce the deep bite. In the second case, there is also a deep bite
, as you can see here. Here, too, nothing can be seen of the lower jaw incisors
, they bite so deeply behind the upper jaw incisors. And this is how this case looked after – to the day
– 5 months – corrected with the lingual technique. The treatment time was therefore dramatically shorter
– and the deep bite is even better corrected. You can see even more of the lower front teeth
than in the Invisalign case, which was treated from 2007 to 2009. Even if the aligners were twice as effective with the
new material only available since early 2013 , the treatment time would
still be three times as long as with the lingual technique.
If you looked closely,
you saw a few small metal knobs on 2 lower jaw teeth in the after photo of case 1
– here is the picture again. These metal buttons are
not usually part of the Invisalign technique, they rather indicate a problem with the foils. Let's take a closer look. Here is the lower jaw at the beginning of the correction. The red circle marks the problem area. The aligner cannot
grip and straighten or rotate these teeth properly. After 6 months the aligner
no longer fits. Above the teeth is a cavity that
they are supposed to slide into. Because the plastic foil keeps popping off,
even when the patent tries to bite your teeth and although there
are so-called attachments attached to the teeth – small plastic blocks that the aligner should grip over
– you can see the bulges for this here on the aligner above the canine and the
small molars.
One could now speculate whether the
patient might not have worn his aligners with enough discipline or whether it is due to the system. The fact is: such situations are
more common with the Invisalign technique and no matter what, a solution must be found. Even if that is difficult. So we glued these buttons to the
teeth – namely on the cheeks and on the tongue side and pulled the teeth in
the foil, i.e.
The aligner. The patient had to
hang fresh small elastics on it every day, each time after he had taken the splint,
e.g. to eat. A troublesome affair. But he did it for
almost 2 years the rest of the time and so in the end it came to a reasonable
result. As you can see here. Incidentally, in the upper jaw it looked like this at the beginning
and like this at the end. Are you still interested in the remaining
pictures of the lingual case? Here is the upper jaw before……, during….. and after…. the lingual brace. Here the lower jaw also before….., during…… and after removal of the lingual brace. The whole adjustment was rather unspectacular,
as is usually the case with the lingual technique . So my summary after 12 years of Invisalign is
: Complicated tooth movements such as rotations or intrusions or extrusions can be solved
much more quickly and easily with the lingual technique .
The Invisalign technique,
on the other hand, is well suited for simple defects. However, there are now
newer and faster procedures for this, such as the in-man aligners. But that's the subject of a future
video. Thanks for following me through the whole presentation
. If you would like to find out more about braces for adults
, please visit my website http://www.Grimmel.ch or my blog http://www.Zahnspange-Erwachsene.ch. Or even better, visit me in my
practice for a personal consultation. Thank you for your interest and attention..
