In a society in which the appearance and aesthetics are ever more important, or at least valued to be so, the advertising network and we offer more and more insistently defined invisible orthodontic treatment to correct dental misalignment (crooked teeth) or varying degrees of malocclusion.
What is meant by "invisible orthodontics"?
Contrary to the classic starlets glued on the teeth that are very visible (Ugly Betty style) invisible orthodontics proposes the use of different systems that give the same result, but are less apparent. With this objective in mind several techniques are born, such as the transparent aligners in polycarbonate (Invisalign, Clearstep, and many other registered trademarks). However, real invisibility remains a far away goal for these systems and it would be better if these systems are called "less visible" instead of invisible. As a matter of fact, the real invisibility is attained by not placing anything on the external surface of the teeth. But then how can the problem of misaligned teeth be solved? By applying the apparatus on the internal surface, the side that is not visible to the ordinary observer, in other words on the lingual side. Actually, we talk about lingual orthodontics when we define invisible orthodontics.
So the advertisements ...
In advertisements only the information of interest to the public is reported omitting shrewdly the counter productive part. Note that many transparent aligner producers (like Align Technology, the producer of Invisalign) show photos comparing the "alleged invisibility" of their product with big orthodontic brackets mounted on the exterior, but not with the lingual ones which obviously would have been even less visible since they are absent on the exterior surface.
It is true that they are not noticed much, because they are made of transparent plastic, but from close distance you notice them shining and especially if the treatment is performed on both arches, the thickness between the teeth hampers the pronunciation. The wife of a patient of mine once told me: "they are not very visible, but you feel them quite much!", complaining about the fact that wearing two transparent masks on the teeth for 22 hours a day was annoying both of them and their relationship.
However, these masks still remain valid to correct the defects that are not too significant and have the great advantage that they can be removed to clean the teeth, making them sometimes be preferred in patients with physical disabilities.
How can a little mask made of polycarbonate (plastic) make your teeth straight ?
Meanwhile, it should be noted that it is not a single aligner but of a series of devices that must be replaced every 14 days, and that must be worn for at least 22 hours out of 24. In fact, they are taken off for eating, drinking, and brushing the teeth.
The elastic force on the teeth imprints small movements on them to which the teeth respond by moving slowly. There are no wires or metal brackets, but it is often necessary to glue some accessories in the color of the tooth also on the outside, which makes the appliance even a little more visible.
Every 2 months a visit to the orthodontist is required to check your progress and the average treatment time is just under 24 months, significantly higher than an individualized lingual appliance.
What are the costs of the invisible appliance (Invisalign or Clearstep)?
It all depends on how many transparent masks should be prepared or the difficulty of the case, however, we can say that it starts from € 2500 for cases with low difficulty. In the cost of the appliance the visits of control are included, but not the x-rays necessary to prepare your treatment plan.
Where the transparent aligner can not be used ?
These clear aligners, although they employ technologically very advanced techniques exploiting CAD CAM to produce masks to be used in a sequential way, biomechanically have limitations related to their composition and structure. Therefore, not all orthodontic cases can be treated successfully with these aligners. Moreover, they work on the two arches independently and this sometimes creates unsolvable problems. Other areas where they are not suitable are: orthognathic surgery (or where, for example for impacted teeth, surgery should be associated to orthodontics), when extractions are necessary, when there are intrusive and extrusive issues are involved, and finally the problems of maxillofacial surgery.
Which aesthetic alternatives exist?
As we have pointed out the real invisible braces are the lingual appliances that are applied to the non-visible portion of the teeth. Today, modern computerized techniques allow us to create all the necessary attachments tailor-made, reproducing the tooth surface with a detail never seen before, thus producing a device as small as possible so as not to annoy the patient, but with all the necessary components to get the best result. With the help of computers and robots that shape the arches, we are able to deal with all the issues in a comfortable and precise way. The initial discomfort disappears after the first 2-3 weeks and the result, already visible after the first month, is a smile that improves day by day at a constant and progressive rate.
The most common lingual technique in the world is called Incognito and we use it with great satisfaction since 2006. Having been among the first to try it in Italy, we have the largest number of documented Italian case studies. For this reason, in our offices of Florence and Pistoia Monsummano Terme since 2009 we organize monthly workshops for colleagues who want to learn the method by watching and experiencing it on the field, or in our practices, studying the cases of our satisfied patients.