DIY aligners- what are they and do they work?

Saturday, 07 Dec 2019 Andrew Chang 76 hits Print it

DIY (do-it-yourself) aligners- what are they and do they work?

As an orthodontist with mild crowding and looking to get my teeth straightened, I’ve been looking at different aligners myself. Aligners are a series of clear removable retainers that are changed regularly. Each puts gentle pressure on teeth to move them into their final positions. The most common of these are Invisalign, Spark, Suresmile and Clearcorrect aligners. I do not have any interest in any of these companies, and I’ve used all their aligners, in addition in treating hundreds of aligner patients. All these require supervision by a dental professional to attain the final outcome. 

It is concerning to now hear of DIY orthodontic companies offering products that claim to straighten teeth without ever going to see a dentist or orthodontist, though the claim is their set-up has been overseen by a dentist or orthodontist.

Our national organization, the Australian Society of Orthodontists has also written about these concerns with DIY aligners. You may have seen the names of these DIY aligners on a bus/train billboard advert, or on facebook or Spotify. So if you are a patient or customer, what does this mean for your smile?

4 biggest concerns with DIY aligner products and services

Firstly, it is very difficult to make up what your smile would look like from a set of before and afters of your teeth without doctor input to explain the context of your smile. A smile is made up of how the teeth harmonize with your lips and face and with the lips in motion. Interpreting this from a static pictures of before and afters of the teeth, with the face and lips removed, without the doctor to provide context, makes it difficult for a patient to understand what this means. As you may know, communication and context is best done in person or over the phone as an alternative, as it encourages 2 way communication. One way communication via email and texting is very prone to misunderstanding, misinterpretation, resulting in expectations not being delivered. 

Secondly, as most people seeking aligners have crowded teeth, the space to straighten the teeth has to come from somewhere. DIY aligners often obtain this space from moving the side and back teeth out sideways or moving the front teeth forwards. Too much of this, and your smile will look like bucked teeth, where the front teeth appear too protruded, or the side teeth gums can recede, which can affect the long term health of teeth. Too much of this on the lower teeth and your front teeth would be biting very heavily and you would not be able to bite on your back teeth. Again, this context is not provide through a static set of before and after pictures of the digital simulation of teeth movements. Or if you are seeking aligners to have gaps closed, closing upper or lower gaps by bringing the teeth together will often change how your teeth close together, and can often lead to your back teeth not touching and very heavy bite pressure on the front teeth.  DIY aligners are seeking to find the shortest possible treatment time which can have the above side effects. So the claim of a short treatment time has to be regarded cautiously. 

It is important to note that teeth move differently in different people or within the same mouth and at different rates. So, by changing aligners at the same intervals or having an aligner material which is homogenous, there will be areas of teeth that do not move as well. When seen under the care of an orthodontist, this can be mitigated by varying how often the aligners are changed, by placing temporary tooth coloured bumps on teeth or using tooth coloured elastics. These serve as additional “grips” helping to move teeth. DIY aligner products or services do not allow for this.

Third, a treatment plan is often presented before inspecting any x-rays of the teeth. Many DIY aligner companies only require you to send photos or a scan of your teeth. Without x-rays, it is not possible to establish a complete diagnosis of your teeth condition. There are certain instances where aligners should not be placed to move teeth without examination from a dentist or orthodontist ie: bone loss around the teeth, bleeding gums on brushing, hidden cavities between teeth, chipped teeth and pre-existing old fillings, as doing so can aggravate the teeth conditions.

Fourth, well, it is important to read the reviews of any product or service before you actually use the service. It is particularly important to read the reviews from customers whom have completed treatment or in the process of treatment.

When the teeth do not move as planned, as they often do, due to the above limitations of DIY aligners, several things will happen:

  1. You may find when you bite together, your back teeth do not touch. You will feel very heavy uncomfortable pressure or pain on the front teeth instead when biting together, making the daily task of chewing or eating foods difficult.
  2. The aligners won’t fit in the front teeth, and speaking becomes so awkward, that you stop wearing the aligners altogether.
  3. The aligners don’t fit around 1 or several teeth and get uncomfortable and you try to get in touch with the aligner company.  

And as the aligners do not fit, the final retainer at the end of this does not fit as well. 

You then discover that it takes weeks before any positive action gets done, if it gets done. Or you just simply give up and say I’ve had enough and stop wearing your aligners, in which case the teeth move back. And for the cases where your bite is out of alignment, you then invest extra time and money seeing an orthodontist getting this fixed…. For Round 2 or 3, but doing it properly and with confidence this time.

PS: I did get aligners made for myself and they are not DIY aligners.  

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