Questions To Ask When Trying To Decide Between Aligner Treatment Through An Orthodontist Or At-Home Clear Aligner Trays

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With many companies now marketing directly to consumers about how easy and affordable treatment with at-home clear aligners can be, it surely can be tempting to think this method is the fastest, easiest, least expensive and best way to achieve a straighter, more beautiful smile.

But do a little research first.

What’s More Important — the Treatment You Select or the Doctor?

According to the British Orthodontic Society (BOS), the type of appliance used (the medical term for the type of treatment modality used to straighten your teeth) is far less important than the skill of the person who provides the treatment. And that the most important factor in treatment is selecting the right orthodontist who has the right education, experience and expertise to evaluate your needs and make a clinical diagnosis and then translate that into a treatment plan that will help you or your child achieve a healthy and beautiful smile. What other transforming medical treatment would you undergo without an in-person, pre-treatment evaluation and ongoing in-person supervision from a medical professional?3 Orthodontic treatment involves the movement of teeth and jaws, which if not done correctly could lead to potentially irreversible and expensive damage such as tooth and gum loss, changed bites, and other issues.4

The 411 on Clear Aligner Treatment

Similar to traditional braces, aligners are designed to move teeth a little at a time. Before treatment begins, an orthodontist will examine your mouth, and take diagnostic records including x-rays, photographs, and impressions or digital scans of the teeth. From that information, the orthodontist can arrive at a diagnosis and the best treatment approach. If clear aligners will work based on your diagnosis, the orthodontist will utilise sophisticated software to design your smile and plan the treatment process — which tooth moves where, and in what order — guiding teeth into healthy positions. Treatment is for all the teeth — not just the few that are seen when you smile. The goal is a healthy “bite” — one where your top and bottom teeth fit together properly.1

With the end goal in mind, a series of plastic clear aligners for at home use are created using your initial impressions or digital scans as the starting point. The aligners are plastic replicas of your teeth. Wearing them puts gentle pressure on your teeth, to gently reposition them. It is recommended aligners be worn 22 hours a day — whenever you are not eating, drinking or brushing your teeth. Each set of aligners is worn for approximately 1-2 weeks before going to the next set. Over time, your teeth will reach their ideal locations, according to your orthodontist’s plan. Treatment duration (and the exact number of aligner sets you will need) will be based on your diagnosis and what treatment is intended to fix, which is different from other patients’ treatment plans/duration. Most people see their orthodontist for a check-up about every six to 10 weeks. As with traditional braces, you will need to wear retainers after your teeth reach their new positions.2

How to Evaluate DIY Aligner Companies

Some online do-it-yourself aligner companies make their treatment process sound easy. Some say to just send in a picture or take an impression with a mold kit they provide. Then, you will receive your aligners in the mail and, in a few months, you will have straight teeth. But in-person evaluation and in-person supervision throughout treatment can be very important because there is more to creating a healthy, beautiful smile than moving the visible portions of your teeth.5

The BOS encourages you to ask questions and get the answers you need. In fact, the organization provides this guide to help you in this process.5

Some of the key questions to consider when researching DIY clear aligner companies include:5

  1. As part of your treatment, are comprehensive diagnostic records like x-rays taken before your treatment? Detailed photographs of your face, facial profile, mouth and teeth? Digital scans or other impressions of your teeth? A detailed clinical examination of your jaw alignment, teeth, bite, and the relationship of your teeth to the skeletal structures?
  2. If the answer is no to receiving a comprehensive diagnostic exam and set of records, will you go to another dental professional to obtain these? What will this cost?
  3. As part of your treatment fee, do you receive any in-person visits to an orthodontist’s office during your treatment? If so, how many and will you be seeing a licensed orthodontist during these visits? If not, are you okay with proceeding with treatment that does not involve regular oversight from a doctor?
  4. If an orthodontist is involved in your treatment, will you know the name of the doctor so that you can research his or her practice and reviews or complaints from his/her patients? What do patients say when you review his/her website, Facebook or Instagram communities? If the answer is you don’t have an assigned doctor, are you comfortable proceeding with treatment without having a person you can know, research and feel comfortable with in charge of your treatment?
  5. Is only one treatment method offered (such as an aligner)? How do you know if that is the best treatment for you given your unique situation and oral condition compared to other treatment methods?
  6. How do you know if your teeth and gums are healthy enough for orthodontic treatment? Who is making that determination? If this is not part of the treatment program you are thinking about, who pays for that assessment and what does it cost?
  7. What are the possible risks (financial, health, etc.) associated with your orthodontic treatment?
  8. Who can you speak with at the online orthodontic company about your orthodontic treatment? What is his or her education, background, qualifications and/or experience with orthodontics?
  9. Who is responsible for detecting any issues that may occur during your orthodontic treatment? Is it you? If it is a doctor not associated with your treatment, who pays for those check-ups?
  10. If an issue arises during your treatment, how will it be handled and who will be responsible for handling it?
  11. If a doctor is involved with your orthodontic treatment, how can you contact him or her over the course of your treatment? How can you contact him or her if an emergency arises?
  12. If an emergency arises, does the company have a dentist or orthodontist in your area who you can see in-person? If not, who would cover the costs associated with seeing a dentist or orthodontist in your area?
  13. If you are injured or have another dispute involving your orthodontic treatment, how is it handled (litigation, arbitration, etc.)? State dental boards have their own complaint processes for patients who have had issues with orthodontic treatment. 
  14. If you are injured or have a dispute involving your orthodontic treatment, what rights do you have against the person or company involved with your orthodontic treatment? Are you asked to sign any forms that seek to release them from liability?

It’s important to note that orthodontic treatment is not a product or device — orthodontic treatment is a professional, medical service. When your care is personally supervised by an orthodontist, you can have peace of mind knowing that your orthodontist spent years in a post-doctoral residency program focused on providing orthodontic treatment to patients. Before you make your final decision on what type of treatment (clear aligners versus braces, or DIY aligners versus clear aligners you obtain through an orthodontist), do some research and arrange 1-2 in-person consultations with orthodontists who are highly recommended in your area by friends, family or by doing online research.6

We hope this article and the Patient's Leaflet from the British Orthodontic Society will be helpful to you in determining whether to get clear aligners without going to a doctor or whether seeking the trained guidance of an orthodontist will be best for you. For an example of a consumer who claimed to have had an issue with her treatment with clear aligners by mail, you can read her story here.7

Sources:
1 https://www.aaoinfo.org/blog/orthodontic-treatment-with-clear-aligners/
2 https://www.aaoinfo.org/blog/orthodontic-treatment-with-clear-aligners/
3 https://www.aaoinfo.org/blog/braces-vs-clear-aligners/
4 https://www.aaoinfo.org/wp-content/uploads/2019/03/AAO-Consumer-Alert-DIY-2019-flier-hl.pdf
5 https://www.aaoinfo.org/wp-content/uploads/2019/03/AAO-Consumer-Alert-DIY-2019-flier-hl.pdf
6 https://www.aaoinfo.org/_/online-orthodontic-companies/
7 https://www.aaoinfo.org/_/online-orthodontic-companies/