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Some Key Advantages of Removable Aligners and How They Work

Some Key Advantages of Removable Aligners and How They Work

By Dr. John Warford

Patients considering braces today can benefit greatly from the fact that modern orthodontics have come a long way in the last two decades. With the introduction of clear aligner therapy, many patients can achieve an outstanding smile without having to wear traditional metal braces. Although a professional diagnosis is essential to determine what corrections are necessary and to set an optimal treatment plan, clear, removable aligners are a safe, convenient, and highly effective form of treatment for many consumers looking for a transformed smile that boosts their self-confidence.

If you are early in the research process, you may have many questions about how aligners work, how long treatment takes, if they provide permanent correction and how many hours per day aligners should be worn. I will share answers here to the questions I get asked most frequently, and after thousands of patients treated with clear aligners, I’ve likely heard most or all of the questions!

What are aligners and how do clear aligners move teeth?

Aligners are nearly invisible removable plastic “trays” that are custom-made to closely fit your teeth for the purpose of moving them to the desired location. They are custom created by your orthodontist after a physical examination and treatment plan has been devised using 3D imaging and proprietary software. Your orthodontist will be able to show you a 3D simulation of what your finished smile will look like before your treatment begins. Get your cameras ready for that moment! From your diagnosis and treatment plan, your doctor can predict how long treatment will take and how many aligners, attachments or other treatment elements will be necessary to achieve your goals.

Treatment includes a series of BPA-free plastic aligners that are designed to continuously move all your teeth in a specific, carefully planned way. This part can’t be emphasized enough: Think of it like setting the course for a plane trip. Although planes can nearly fly themselves these days, you still need an experienced pilot to get you there safely! Depending upon your doctor’s treatment plan, each aligner is typically worn for about one week and then replaced with the next aligner, each one having the teeth slightly straighter than the one before. Note from experience: keep your first aligner to compare subsequent ones to – the evidence of movement is right there, and people really enjoy doing this comparison. Each aligner should be worn approximately 22 hours a day – basically all the time except for when you with eating, drinking, brushing or flossing your teeth. Heck, even for special occasions, because your teeth look more shiny and sparkly with your aligners in!

Why are clear aligners so popular?

Self-conscious teens and adults alike have grown fond of clear aligners for many reasons:

  1. The obvious “invisible” and discreet aspect that aligners have become well known for.
  2. They are far more efficient and effective (when designed by an experienced orthodontist) than most people can imagine: “plastic can do that?”
  3. The “programmability” of aligners, in addition to not having brackets to break off equals “far fewer visits” than with metal braces. Treatment with less impact on many areas of your life is one of the biggest perks!
  4. Because they are made of tightly fitted clear plastic instead of protruding metal, they can be much more comfortable on the inside of the cheeks, gums, and lips.
  5. Because aligners use lighter forces for continuous movement instead of wires and brackets that need to be changed out and tightened, patients experience less discomfort. I should point out that it is usual to feel light discomfort with each new aligner, but most interpret it as a positive thing: that’s the feeling of progress!
  6. Aligners are also popular because they do not limit what you can eat and drink like traditional wire and bracket systems that can break or create discoloration. Aligners are removable and should be taken out to eat and drink, enabling you to consume chips, popcorn, soda, apples, and other traditionally forbidden foods during your treatment process.
  7. Oral hygiene, which can be difficult with traditional wires and brackets, is a breeze with clear aligners. You just brush and floss your teeth as you normally would.

How long does treatment take?

Treatment time with aligner therapy varies based on individual diagnosis and your doctor’s recommended treatment plan. Many aligner cases can be completed in 12 months or less, while some may take longer if they are more complicated cases. Finishing on time is dependent on following your doctor’s orders and complying with 22 hours of wear a day and using the sequential aligners as prescribed. Due to the custom design “programming” that is done with aligners, in many cases, treatment can be faster than traditional braces.

How do you remove aligners and for what purpose?

Clear aligners can easily be removed every day for eating, drinking and hygiene. Keeping them sparkling clean and nearly clear is easy too. The aligners can be brushed with a toothbrush, soap and water, or soaked in a 50/50 solution of hydrogen peroxide and water, or water and white vinegar. Even denture tablets can be used for soaking aligners clean. The key is to clean, brush and not soak for an extended period or in any substance that can damage the proprietary aligner material, which has been specifically designed with just the right amount of force retention for continuous, incremental movement, and clarity for discreet, nearly invisible wear.

Do all orthodontists offer clear aligners for teeth straightening?

What treatment methods and products orthodontists use usually comes down to how they were trained and what continuing education they have had. All orthodontists are traditionally trained to use traditional metal and wire braces. Then there is a group of more progressive orthodontists who treat with “passive self-ligation systems” that have many benefits related to efficiency that traditional braces don’t have. The Damon Braces System which I use is an example of this approach, which uses lighter continuous forces to move teeth more efficiently with less discomfort and in much less time than with conventional braces. And then there are doctors who use aligner therapy as part of their treatment arsenal or as their only treatment method. Aligners can be an effective approach for almost all types of malocclusion, except for the most severe or complex cases. If you’re wondering about my practice, the vast majority of patients choose aligners, and nearly all patients are good candidates for aligner treatment.

Are all aligners the same?

Although all aligners work off the same premise, (each aligner a bit straighter than the last) not all aligner treatments or materials are the same. The first distinction is how you get them. There are several brands of aligners that you can only get through a doctor’s prescribed treatment plan and ongoing office visits to ensure treatment is progressing as planned. Also, there are a few aligner companies that sell directly to the consumer that cut out the role of an in-person orthodontist and do everything via mail. There are no office visits with these mail-order products as these treatments are marketed directly to consumers and one hopes for great results at a fraction of the cost (be sure to see the next section on cost). However, by limiting the number of aligners, as well as not getting some of the critical features in the system which make the aligners work so well that you get from an orthodontist, the efficacy is very limited to a small subset of potential patients. As a doctor who has corrected smiles gone wrong, I do not advise moving jaws or teeth without a professional specialized in this area of the dental profession who can do everything from diagnosis to treatment plan to course correct if something is not going as planned. This could even include move from one type of product to another to complete a case most effectively. There’s a wise saying that I’ve found to be true over the past 20 years: “orthodontics seems simple, but it’s just not easy”, meaning that some of the really simple treatments can have some big surprises if you don’t have the required experience.

To make a complicated choice even moreso, even the aligners doctors may prescribe have differences. They can be made of different plastic materials with some being more efficient in tooth movement than others. Some are more clear, stain resistant or have features designed for greater patient comfort. My patients prefer Spark™ Clear Aligners. Spark aligners are more clear, more comfortable and stain less than the leading competitor, and Spark’s proprietary aligner material is designed for more efficient and effective tooth movement.

How much do aligners cost?

The investment in orthodontic treatment is an important one to consider, and the “payback” can be huge! The actual investment for your treatment is set by your local orthodontist based on your treatment needs, plan, and duration, as well as the type of braces or aligner system he or she will use. The typical range for braces tend to be $5,500 to $7,500, and most aligner treatment usually fits in that range. However, some orthodontists charge more for aligners, usually those that aren’t as experienced with them. In my office aligners and braces are the same investment, but in cases where aligners are actually faster than braces (a lot of cases fall into this category when you’re experienced with aligner treatment) then the aligners are many times less of an investment than braces.

If you want aligners for your orthodontic transformation and hear the phrase “Aligners won’t work for you”, then I suggest you seek other opinions to find out why, preferably from someone who uses aligners at a high level and is comfortable with providing aligners to a wide range of clinical conditions. Aligner companies, like Spark, are very transparent about the experience level of the orthodontists that use their products, so you can contact them to find an experienced orthodontist in your area.

Is treatment with aligners covered by insurance?

If you have dental insurance, check with your insurer on what is covered under your plan. In addition, your local office likely has experience with most or all of the insurers in your area. If your insurance is through an employer, often the human resource (HR) benefits manager will have this information as well. If your dental insurance covers a portion of orthodontic treatment aligner therapy most likely will be covered. Orthodontic practices are used to working with insurance and usually offer payment plans for the balance not covered by insurance or for those who do not have insurance coverage. The benefits to orthodontic treatment are significant, and most offices have plans to make straightening your teeth more affordable.

Will aligner treatment last a lifetime?

Getting braces or aligner treatment is a significant investment meant to be enjoyed for life. To sustain that great smile, you should follow your doctor’s post treatment protocol. This may include wearing a retainer 24 hours a day or at night for a period of time after your treatment is complete, and most orthodontists recommend at night indefinitely to keep that awesome smile. You’ll need new retainers periodically, but it’s a small price to pay for maintaining your smile.

How do i get started if i decide i want to get aligners?

By now, you’ve likely decided removable aligners might be right for your needs. You might think that you need to choose which type of aligner you might want to have and then find a doctor who uses that type of aligner. Well, yes, and no. Remember, not all doctors can or want to do treatment with aligners and of those that to, they may use Spark, Invisalign or another product. In the end, what’s the most important is that the doctor has the experience level you can trust, and the confidence in the aligner system they choose. They’ll likely be very upfront and happy to discuss all these details with you. As I said before, you can visit the manufacturer’s website to find a doctor trained in the treatment planning software and appliances (aligner, attachments, etc.) of that brand.

To find a doctor trained to use Spark clear aligners, for example, you would look at the doctor locator at sparkaligners.com. Or you can visit the doctor locator on the American Association of Orthodontists website, at AAOinfo.com, to find orthodontists in your area to contact to ask if they do aligner therapy and, if so, which brand.


Dr. John Warford

Dr. John Warford
Bismarck, North Dakota

Dr. John Warford, Jr earned his undergraduate and dental degrees from the University of Minnesota in Minneapolis and completed his residency in orthodontics at the University of Missouri in Kansas City. With a passion for research and technology, he has been a published in the American Journal of Orthodontics and has a professional commitment to drive clinical treatment efficiency in Orthodontics. Dr. Warford employs remote treatment monitoring with clear aligners which has revolutionized his practice with attention getting results for patient convenience, treatment efficiency, and profitability. He is a Top 20 User of Dental Monitoring in the US, and a speaker and advisory board member for Dental Monitoring as well. In addition to a long relationship with Ormco as customer, he’s also a speaker and consultant to Ormco Corporation. and is additionally published in the American Journal of Orthodontics. Dr. Warford maintains his private orthodontic practice in Bismarck, North Dakota.


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