Clear
Aligners
Dr. Mohammad Oliur Rahman Khan
BDS, MPh, PhD(Fellow)
What is
Clear Aligner?
Clear Aligner a.k.a Invisialign
Aligners are an alternative to traditional braces and are designed to help guide
teeth into their proper position.
Similar to braces, aligners use a gradual force to control tooth movement, but
without metal wires or brackets.
The aligners are made of a strong plastic material and are fabricated to fit each
person's mouth.
Aligners are worn for at least 20 hours a day to reach the desired maximum
effectiveness.
• Each aligner is worn for two to three weeks before changing to the next
one. The length of treatment with aligners depends upon the severity of
each case.
• Typically, aligner treatment can be as short as three weeks or as long as
six Months or more. Still, a much shorter treatment than traditional
braces.
• Each aligner is designed to move the teeth a maximum of about 0.25 to
0.3 mm over a 2-week period, and is worn in a specific sequence.
• The Invisalign appliance is currently recommended for adults and for
adolescents.
• with fully erupted permanent teeth who meet an acceptable standard of
compliance.
• Excellent compliance is mandatory since the appliance has to be worn
a minimum of 20 to 22 hours a day and each aligner should be worn
400 hours to be effective.
History of Clear Aligners
• Invisible aligners were developed in 1997 by Kelsey Wirth and Zia
Chishti. It was approved by the FDA in 1998 and started commercial
operations in 1999
Aligner work-Flow
There are a few steps to fabricate a clear Aligner
•Clinical steps • • Laboratory steps •
Stage 1
1. Clinical Evaluation and Mouth Preparation for Scan 1. Aligner Case evaluation
2. Impressions / Digital Scans 2. Acceptance
3. XRAY ( OPG + Cephalometry) 3. Aligner design
4. Clinical Photographs 4. Fabbrication of 3D models
Stage 2 5. Abrication of Aligner trays
1. Mouth Preparation 6. Quality Check
2. Attachment Placement 7. Delivary
3. Aligner Insertion
4. Followup
Clinical Evaluation
• This is the first and most important step in aligner treatment protocol
initially patient is examined as any other Orthodontic case
examination.
• Prophylactic Scaling, polishing are done in this stage to remove all the
biofilm, calculus and removal of existing cosmetic filling that might
come in orthodontic teeth movement (i.e: median diastema
correction by composite) as those things interfere in impression and
scan resulting an improper fitting of all the aligner trays and hampers
the treatment process.
• Photographs are also taken in this stage.
Photography Protocol for Aligner
Impression Protocol for Aligner
Radiological Examination
Lab Procedures
Aligner Attachments placement
Aligner Attachments
Buttons
Bite Ramps
Aligner Biomechanics
Aligner Sheets Material
• Invisalign SmartTrack aligners or trays are made of medical grade
plastic: Multilayer aromatic thermoplastic polyurethane / copolyester
to be exact. Also Polyethylene phthalate polymers are also used (PET).
Sheet Thickness
Attachment Template: Aligners: Retainers:
•Scheu Duran+ 0.5 mm •Scheu Duran+ 0.625 mm •Scheu Duran+ 1 mm
•Taglus Premium 1 mm
•Scheu CA Pro+ 0.5 mm •Scheu Duran+ 0.75 mm
•Erkodent Erkodur 1 mm
•Taglus Premium 0.5 mm •Scheu CA Pro+ 0.75 mm •Erkodent Erkodur-al 1 mm
•Erkodent Erkodur 0.6 mm •Taglus Premium 0.8 mm •Zendura A 1 mm
•Erkodent Erkodur-al 0.6 •Taglus PU FLEX 0.76 mm •Essix ACE 1 mm
mm •Taglus Standard 0.762 mm •LeoneAmerica Leone 0.8 mm
•Zendura AT 0.38 mm •Erkodent Erkodur 0.8 mm •Bartmedical Ghost Aligner 1
mm
•Erkodent Erkodur-al 0.8 mm
•Zendura FLX 0.76 mm
•Zendura A 0.76 mm
•Essix ACE 0.75 mm
Zendura Flex Aligner Sheet
Stiff Outter Layer
Elastic MiddleLayer
Stiff Outter Layer
FAQ’s
How long an Aligner to be worn
The recommended amount of time to wear Invisalign aligners is 20 to 22 hours per
day. This means that the aligners should only be removed for eating, drinking,
brushing, and brushing (cleaning the teeth and aligners).
When to Change an Aligner
After 1 to 2 Week. Depending upon the Case.
What to see during a follow up
Check the Fitting of old + New aligners Trays
Check the Attachments.
Take photos and records
How to maintain a 22 hour routine
• Remove your aligners for a certain amount of time every day. Take them out for 15 minutes
at breakfast, 30 minutes at lunch, and 60 minutes at dinner. With this schedule, you’ll have
enough wiggle room for snacks and maintenance.
• Use an app. For example, the Tray Minder app can help track your wear time throughout the
day.
• Multi-task throughout your treatment. While your trays are out for dinner, you can place them
in a glass of warm water with cleaning crystals. That way, they’ll get cleaned while you’re
eating.
• Establish an oral hygiene routine. Make sure you get into the habit of brushing, flossing, and
rinsing right after eating before putting your trays back in.
• Advance to your new set of trays before bed. Doing so will keep your discomfort to a
minimum and prevent you from wanting to remove your aligners.
Limitation of Clear Aligner
Aligner doesn’t have the same force and capabilities to move teeth as braces. Therefore, complex orthodontic treatment or cases that require
significant movement of teeth need braces, not Invisalign to achieve the desired outcome.
Below are some situations where Invisalign may not work as effectively as braces:
• Tooth Shape : Short, round, pegged teeth or those with severe tips may not allow the aligner to get a good grip. Therefore, the aligner isn’t
effective at moving your teeth into the desired position.
• Tooth Position: When a mouth is overcrowded, a tooth may rotate to fit. If the rotation is over 20 degrees for molars, Aligner is unable to
move them into the desired position. The degree of rotation can be more if the rotated teeth are canines, premolars and incisors. Teeth can
also tilt forward or back to fit in a crowded mouth. If the tilt is over 45 degrees, Invisalign will struggle to pull the tooth up into the right
place.
• Large Gaps Between Teeth: Whether there is just one gap between two teeth or several gaps a patient would like closed, Invisalign can only
reliably close up to 6mm of space per arch (top teeth or lower teeth).
• Intrusion and Extrusion: Orthodontics can raise and lower the position of teeth in the jawbone so the height of the teeth is the same. Braces
have the force to move teeth into position while Invisalign can only achieve limited movement in front teeth and almost no movement in
back teeth.
• Midline Shift Movements : Invisalign can correct a midline discrepancy by 2mm to the left or right per arch but anything larger needs to be
treated with braces.
• Previous Dental Work: Some prior dental work can preclude patients from using Invisalign. A dental bridge can make it impossible for using
Invisalign. A patient with porcelain veneers or crowns may not be able to use attachments with their Invisalign because they can’t bond to
the surface.
• New Dental Work : If a patient has dental work such as a crown or porcelain veneers after Invisalign retainers have been made, they may not
fit properly or they won’t be effective in manipulating teeth into place. Once aligners have been made, all dental restoration work must wait
until after Invisalign treatment has been completed. Even work on just one tooth can cause aligners to no longer work.
• Extractions are Required : Invisalign aren’t suitable for patients requiring extractions before or during treatment.
• Use of Visible Attachments: Invisalign patients often choose this treatment because the aligners are virtually invisible. However, some
aligner patients needs attachments, with their aligners. The enamel colored, button like attachments are slightly visible.
Conclusion
Not all malocclusions are amenable to treatment solely with the Aligner System
Treatment of many malocclusions with proper tip torque, arch form and aesthetic crown
inclination is possible to achieve with aligners.
A better understanding of Bio Mechanics is needed, which may lead to treatments that are
more efficient.
All in all Invisalign is a great alternative to braces ,owing to its comfort level and ease of
use. Though its not very cost effective, we hope in the future newer technology and
materials will make it more affordable.
More research in the field of complex tooth movement is still needed, but apart from that,
Invisalign has the potential to replace conventional orthodontic appliances.