How Does Invisalign Work?

 

We’ve all thought about fixing our smile at some point in our lives.

It used to be something reserved to teenagers and most adults wouldn’t even consider putting on braces.

All that changed when Invisalign® came out...

Nowadays, over 20% of orthodontic patients are adults, and with recent advances, we are now able to treat the vast majority of patients in a comfortable and esthetic way.

But that brought about many questions from patients, including:

1. Does Invisalign® work?

2. How Does Invisalign® Work?

Well, being an orthodontist, I decided to do Invisalign® on myself to fix some minor problems and also to test drive one of the most sought after treatments in the market today.

The following is a summary of my experience and covers everything you need to know if you have been thinking about getting Invisalign® to get that picture perfect smile you have always wanted…


About Invisalign

1. What is Invisalign®?

In case you haven't heard about Invisalign® (they spend millions of dollars a year on advertising. In 2000 alone, Align Technology planned a $31 million television advertising campaign that The New York Times said would be "the most aggressive consumer advertising plan the dental profession has ever seen!"... 

It is a way of moving your teeth that uses clear removable trays, or aligners.

Hence the name Invisalign®, a mix of invisible and align...pretty smart and catchy right?

2.  How long has Invisalign® been around?

Invisalign® was founded on 1997 and started being offered to patients in 1999. Over 3 million patients have been treated since then.

3. How does Invisalign® work?

The concept behind Invisalign® is quiet simple really (every orthodontist wishes they had thought of it before!!! As a side note: it was actually not invented by an orthodontist, but an adult patient that had braces!)

The company manufactures a set of aligners to be used in sequence, each one moving your teeth a little more towards the desired final position. Take a look at this video showing a Clincheck (the software Invisalign® uses to show your doctor what movements are planned)

4. What are aligners made of?

They are actually made of USP Class VI medical-grade, high molecular weight, polyurethane resins (a fancy name for a clear plastic that is safe to put in your mouth!)

5. What does Invisalign® look like?

This is what the aligners look like:

 
Invisalign Aligner
 
 
 
Invisalign tray
 

6. Is Invisalign® noticeable?

Only if someone gets really close to you. Check out these pictures, taken at 1 foot, and 6 inches away, respectively.

 
1 FOOT.jpg
 
 
 
 

 

7. What are the benefits of straight teeth?

A ton (most of which I had no idea about before I became a dentist!) Including:

·      Achieve an amazing smile

·      Achieve a healthy, functional bite

·      Better oral hygiene

·      Improve whole body health

·      Improve speech

·      Improve self-esteem

·      Improve your emotional health

If you want to read more about them, check out our Free Report "Top 10 Reasons to Straighten Your Smile"

8. Does Invisalign® hurt?

Way less than I even expected!

Which makes sense since each tray is designed to only move your teeth ever so slightly, while with braces, every wire we put moves teeth much longer distances at once.

I actually don't feel much pain at all, while I had pain for a couple of days after every braces adjustment!

9. How long does Invisalign® take?

It all depends on how much your teeth have to be moved and if your bite also needs to be fixed. The most minor cases can take 2-3 months, while more complex ones can take over 2 years.

The average case takes between 12-18 months.

10. Can Invisalign® be used for kids?

Sometimes.

Invisalign® has come out with Invisalign® Teen, which is basically the same system with slight modifications to be better suited for teenagers.

One of them is a compliance indicator (blue dot that wears out when the aligner is worn), that allow your doctor to monitor if the aligners are being used as prescribed.

It also includes free replacement of aligners if you lose them (up to 6)

And alterations if extra teeth come into the mouth while in treatment.

Experience has shown me that teenagers are great at using them (even better than adults...Probably because they know the alternative are big old metal braces!)

11. How are Invisalign® aligners manufactured?

The manufacturing process is pretty cool actually.  Take a look at this video:

Cool fact: they are actually made in Costa Rica

12. Will Invisalign® work with crown, veneers, bridges?

Yes, Invisalign® can move teeth with crowns or veneers. Invisalign® usually will not move teeth that are part of bridges.

13. How much does Invisalign® cost?

Ok. Time for the tough questions.

They do cost a little more than braces, since there is a fee to make all the aligners. But the actual cost will depend on a number of factors, primarily how much corrections needs to take place (which will determine how many aligners need to be ordered).

Simple cases might start at around $1,000-$2,000, while more complex cases can be upwards of $5,000-$8,000. Most cases will be somewhere between $3,000-$6,000.

The geographic area in which you live and the doctor you choose can also have an effect on price. I would recommend looking for a doctor that you like and that has a lot of experience with Invisalign®.

Also, don't be shy to look around your area and visit different doctors before making your final decision. This is an important investment, and you want to make sure you do your due diligence before starting on this journey!

14. Does insurance cover the cost of Invisalign®?

If your insurance covers braces, chances are it will also cover some part of your Invisalign® treatment. Most dental insurance plans cover somewhere between $1,000-$3,000, and you will probably be responsible for the difference.

15. Are there payment options available?

Most orthodontists are very good at providing flexible payment options to their patients. These often include accepting Flex Spending Accounts, offering no-interest financing, discounts for payments in full, and accepting third party financing companies like CareCredit.

Using any of these or a combination should make Invisalign® relatively affordable.

16. What does Invisalign® feel like?

At the beginning it actually feels a little bit weird, since you have something new in your mouth!

But after a couple of days, you actually get used to them and stop thinking about it.

Having gone through both braces and Invisalign®, Invisalign® actually feels a lot better. There are no wires and nothing sharp to hurt your tongue or cheeks.

If you are wondering whether you will be able to use them, sometimes I make patients a clear retainer (which feels pretty similar to Invisalign®) and have them wear it for a week, for them to assess how they feel with it. (Your orthodontist might charge a small fee for this). Every patient I've done this for eventually went on to get Invisalign®.


Getting Invisalign

17. How do you get started?

If you're thinking about getting Invisalign®, I would recommend looking for an orthodontist in your area and making an appointment for a consultation.

Most orthodontists offer free consultations where they can answer all your questions and discuss details specific to your case. You can also look for a doctor at the Invisalign® website at Invisalign.com

18. Who qualifies as a candidate?

Since its start in 1999, Invisalign® has undergone many changes, and can now be used to treat most cases. For some patients, they are even more effective and efficient than traditional braces!

19. Should I get Invisalign®?

That's a big YES!

There are hundreds of benefits to straight teeth: Having a great smile, have a healthy, functional bite, better oral hygiene, Improve whole body health, Improve speech, Improve self-esteem, Improve your emotional health, etc. etc.

And with this new esthetic and comfortable technology, there is no reason you shouldn't have a smile that you are proud of!

20. Who should I choose to get my Invisalign® treatment?

I recommend getting your Invisalign® treatment with an orthodontist. I'll explain why:

Both dentists and orthodontists can do Invisalign®. Orthodontists are dentists that became specialists in straightening teeth and fixing bites. They have more experience and expertise to help you.

For example...

One of the most challenging things to do with Invisalign® is to de-rotate a back tooth that is very rotated. In many of these cases, I have put 3 braces around that tooth, de-rotate it in 2-3 months, remove them, and keep going with Invisalign®.

This has allowed me to treat many patients that wouldn't have been Invisalign® candidates otherwise!

21. What happens during the initial consultation?

The first step to get Invisalign® - besides reading this post!- Is to visit an orthodontist for an initial consultation.

During this initial visit they will probably take an x-ray of your teeth and perform an examination. The doctor will discuss all the findings and treatment recommendations.

They will also discuss the fees and any financial arrangements. Take this time to ask all the questions you may have and to make sure that you like the doctor and that the treatment suggested makes sense to you!

After all is agreed upon, many times you can get started on the same day with the first step – diagnostic records.

22. What are diagnostic records?

So you've decided to get Invisalign® - now what?

The first step is for your doctor to obtain diagnostic records (a fancy word for information about your teeth)

These usually includes any additional x-rays, pictures of your face and your teeth, and molds (or digital scans) of your teeth. The molds or scan will be sent to the Invisalign® lab to start the process.

23. How long do the aligners take to come back?

Getting the trays back to the office usually takes 2-4 weeks (it's faster if your doctor obtained a scan of your teeth instead of physical molds, since these don't have to be sent my mail)

24. How long does it take to put them on?

The first appointment will usually take anywhere from 10 minutes to 1 hour, and this will depend on whether the doctor is just giving you your first trays and making sure they fit, or placing attachments on your teeth (more on them later)...


Life With Invisalign

25. How long are aligners worn for?

Each aligner is worn for 2 weeks (there are some exceptions, discussed below)

26. Do aligners stain if I smoke?

I won't lecture you about smoking in general (even though I should!)

Smoking with the aligners on will stain them faster and make them smell.

More of a reason to quit smoking!

27. Can you drink alcohol with Invisalign®?

You can, just as long as you remove your trays, especially when drinking darker drinks like red wine. This will avoid staining them.

28. Can I chew gum with Invisalign®?

I recommend that you don’t chew gum with the Invisalign® aligners on. There are two reasons.

The first one is that you most likely won’t be able to, as it will grab the aligners and dislodge them.

The second being that chewing with your aligners on might break them or wear through the biting surfaces.

29. What are attachments?

Invisalign attachments

Attachments are little tooth colored shapes that are added to some of your teeth to help during the Invisalign® treatment.

Think of attachments like handles on your teeth. Whenever a tooth movement is challenging, Invisalign® adds an attachment to help the aligner grip the tooth better and assist with the movement necessary.

After treatment is done, the attachments are removed by polishing them away.

30. Can the aligners come out accidentally?

Not likely.

The aligners are made specifically for your teeth, which means they fit very snuggly. They are even hard to remove sometimes, especially if you have many attachments.

31. Will Invisalign® affect my speech?

Bad news: Yes.

Good news: only for a little.

Having plastic behind your upper front teeth (where our tongue touches when pronouncing the S sound) will give you a slight lisp.

The good news is that your tongue will get used to it and the slight lisp will go away in a couple of days (even though you will subconsciously think you still have a lisp!)

32. Are there any diet restrictions with Invisalign®?

Another huge difference with braces: NO DIET RESTRICTIONS!

You can eat and drink whatever you want while in treatment, as long as you remove your trays to eat and drink anything other than water.

33. How often do I have to come in for adjustment visits?

Time between appointments will vary by doctor and treatment.

Invisalign® appointments are usually more spread out. I usually see patients anywhere between 8-12 weeks.

34. Can you whiten your teeth with Invisalign®?

Yes!

Since the trays actually fit perfectly over your teeth, you can use them as whitening trays.

Talk to your doctor and ask them for whitening gel so you can have both a straight and bright smile by the time you're done!

35. Will people notice I’m wearing Invisalign®?

Yes. But much less than you think.

I actually felt like everyone could see them, but most people had no idea unless I told them!

My suggestion is to pretend they are not even there and just smile and talk like you usually do. Even if someone does notice them, it usually makes for an interesting conversation.

(Side note: most people have actually thought about improving their smiles a lot! And they may have a lot of questions about it - Most of them actually admire people that have taken the plunge!)

36. How long are check up appointments

Check up appointments are actually super short, 10-15 minutes in most instances.

37. How do I brush and floss with Invisalign®?

This is one of the best parts of Invisalign®. Your oral hygiene routine, aka. brushing and flossing (hopefully), will not have to change at all.

Since you remove the trays to brush and floss, you can continue doing them as you normally would.

38. How do you remove the Invisalign® aligners?

Check out this video to see how to remove your aligners:

Even though some people have reported having trouble removing the aligners, I have found it to be pretty easy. It could get a little harder the more attachments that are present.

39. Use this device and cut your treatment time by 50%!

One of the main barriers to straight teeth is the length of time it takes...

Acceledent is a medical device (pictures above) that speeds up your Invisalign® or braces treatment and can cut it by half in most instances...

Your use this device for 20 minutes every day.

And instead of changing your aligners every 2 weeks, I have my patients change them every week...

This cuts down treatment time and also helps with other things such as aligner staining and smell!

40. What is IPR

IPR stands for Inter Proximal Reduction. It is the removal of tooth structure at the contact between the teeth.

It is usually very minimal, just a hairline of space, and helps to make some room to align teeth.

IPR is usually needed with Invisalign® to make room when teeth are very crowded. It is usually created with a strip or a wheel.

Watch this video that shows how it’s done with a strip:

41. How do I clean the aligners?

Cleaning the aligners is pretty straightforward.

All you need is to brush them with your toothbrush under warm water when you take them out. Make sure the water is not hot, since it can distort the aligners.

You can also use other products, some of them offered through the Invisalign® website, that help in cleaning them.

Keeping your aligners clean is very important since they can sometimes start to smell after a few days if you don’t clean them properly.

42. What are chewies?

Chewies are little rubber cylinders that are used to help seat the aligners. They may be prescribed by your doctor throughout treatment. You usually have to bite on them for 5-15 minutes a day.

43. Some of my teeth feel loose during treatment, is this normal?

It usually is.

As teeth start to move, the space around the roots becomes a little larger, and teeth can sometimes feel a little loose.

You should still check with your doctor to make sure this is normal. In some cases, excessive mobility of teeth can be a sign of another problem that need to be addressed now.

44. My aligners smell. Is this normal? What can I do?

Aligners start to smell after a while, especially if you don’t brush them regularly.

I’ve found that even with regular brushing, they may start to smell a little after the first week.

My first tip would be to carry a toothbrush with you so you may brush your aligners whenever you take them out.

The second would be to buy the Invisalign® cleaning kit, which cleans your aligners in about 15 minutes. You can get it here: http://www.Invisalignstore.com/

45. Does Invisalign® stain?

Invisalign® shouldn’t stain if you don’t eat or drink anything other than water with them.

After they stain, it’s usually hard to remove the staining, and you may have to wait until your next set of aligners.

46. My aligners show signs of wear because I grind at night…Is this normal?

I have had some patients that are heavy grinders chew through the aligners.

However, this is usually only through a small spot where teeth meet and does not affect the integrity of the aligner. It also usually happens during the last few days of each one, so that it is replaced shortly after.

47. Can you kiss with Invisalign®?

You can!

Aligners are very esthetic, and most people won’t even notice you are wearing them even if they are very close to you.

My advice with Invisalign® is not to be self conscious about them and to just carry about your day as you usually do. Most of the time, it’s only in your head!

48. How about for more intimate situations? Should I remove my aligners?

You can if you want to.

Remember, Invisalign® recommends wearing the aligners for 20-22 hours a day, but if you wear it less some days, it will still work fine.

So if you have a date or just want to remove them for a couple of hours some days, that should be fine!

49. How long should I wait to wear my aligners after I eat?

One thing to consider after eating is that small pieces of food are often left in the biting surfaces of your teeth where it’s hard for your tongue to remove them.

Saliva often cleanses the teeth, but if you put your Invisalign® on, saliva won’t be able to reach your teeth and the food might be left there for a while.

What I usually do is wait about 30 minutes after eating, then brush or rinse really well if I don’t have a brush, and then place the aligners back on. This should give your saliva some time to clean your teeth.

50. I dropped my aligners on the floor, what should I do?

After picking them up as fast as possible (obviously!), you should rinse them well with water and brush them.

You have to be careful about using soap or detergent as it may sometimes have staining solutions that stain your aligners!

51. My aligner cracked, what should I do?

Aligners can sometimes crack, especially if not removed properly.

I suggest you consult with your doctor. If you are close to the next one, aka after the first week, I recommend to just jump to the next one in the set. If you are still in your first few days, you may be better off going back to the previous ones and having your doctor order you a replacement aligner.

52. What if one of my attachments comes off?

If one of the attachments comes off, call your doctor and schedule an appointment to have it put back on.

Don’t let a lot of time (more than a week) go by since that may cause teeth to move and the aligner might not fit well anymore once your attachment is replaced.

53. Can you wear rubber bands with Invisalign®?

Yes!

Your doctor is now able to include little cut outs in your aligner where you can place rubber bands.

Rubber bands are used to correct your bite, and their use means many more cases can now be treated with Invisalign®.

Here is an example of a patient using rubber bands to correct a deep overbite:

 
Rubber bands with invisalign
 

54. How about snacking with Invisalign®?

Since you have to remove your trays to snack, most people actually report that they snack less when they have Invisalign®.

55. Is it true that most people lose weight with Invisalign®?

Yes, a lot of people have reported losing a little bit of weight with Invisalign®.

This is due to the fact that you have to remove them for meals, which means you will most likely cut back on little snacks throughout the day and stick mostly to whole meals.

56. What is a refinement? Will I need one?

After you go through your set of Invisalign® aligners, your doctor will sit down with you and evaluate the results obtained.

Sometimes, the expected result is not obtained completely, and some extra aligners need to be ordered to finish the job.

This is called a refinement stage, where things are fine tuned to obtain a perfect result.

A new mold or scan of your teeth might be needed to fabricate new aligners.

When choosing your doctor, make sure to discuss if there will be any charge for any refinement stages of treatment.

57. Can I wear lipstick with Invisalign®?

You can, but the lipstick may stick the the front of the aligners a little bit.

This depends on the position of your teeth and lips.

I would recommend you try it and see if it sticks to your aligners a lot.

58. Does the length of my nails affect my ability to take out the aligners?

It may. Since you use your nails to remove your aligners, it may help if your nails are not super short.

If this is the case, you may try removing the back with your fingers only or buying an aligner removing tool.

If your nails are very long, you have to be careful not to brake them while removing your aligners!

59. What are black triangles?

Black triangles are little triangular shaped spaces between your teeth.

They are caused by the loss of gum between your teeth. This is sometimes seen in adults when teeth that were very crowded are aligned.

One way to remove black triangle is with IPR (discussed above) to remove a little bit of the contact between the teeth and bring them together. Check out how this is done with Invisalign®:

Another way may be to fill the space with a tooth colored filling material or veneer. This option is used if the black triangle is very large and would require the removal of a lot of tooth structure to fix.

60. Where should I keep my aligners when I remove them?

Invisalign retainer case

Invisalign® provides you with two retainer boxes to store your aligners. Your can leave one at home and take the other one with you.

You may ask your doctor for a replacement one if you loose them.

61. What if I lose a set?

If you lose a set of aligners, the course of action might depend on where you were with your current aligner.

If you are close to the next one, aka after the first week, I recommend to just jump to the next one.

If you are still in your first few days, you may be better off going back to the previous ones and having your doctor order you a replacement aligner.

62. Do I need to save my old aligners?

I usually recommend saving the previous aligner to the one you are currently on.

For example, when moving from aligner #9 to #10, keep #9. And when moving from #10 to #11, throw away #9 and keep #10.

This way, if you ever lose an aligner in the first few days, you can go back to the previous one while a new one is ordered. You should also contact your doctor to determine the appropriate course of action.


After Invisalign

63. Will I need retainers

Most likely, yes.

Once your teeth are done moving, your doctor will probably make you retainers to maintain all the corrections made.

Teeth always have a tendency to shift back to their previous position, so retainer wear is very important, especially for the first year after treatment is finished.

Click here to read about the different kinds of retainers.

64. What are vivera retainers?

Vivera retainers are the retainers made by Invisalign®.

They include 4 sets, so if you lose them, you can order a replacement.

Your doctor may choose to make you traditional retainers or to order Vivera retainers though Invisalign®. Your doctor may charge an additional fee if you prefer Vivera retainers.

One advantage of Vivera retainers is that they are made from the final digital mold of your teeth, which Invisalign® keeps in their database. That way, if your teeth move slightly, ordering a retainer based on the previous position of your teeth may help shift them back.

With traditional retainers, if a new one is made, it will only maintain the new position of your teeth.

65. Will I need to visit my doctor after being done with my Invisalign® treatment?

Yes. Most doctors will ask you to keep coming in for retainer checks after your treatment is completed.

This is an important step to make sure that your teeth are staying in their new position and not shifting back.

They also serve to make sure your retainers are fitting well and to make adjustments to them if necessary.

 

Conclusion

I hope this article served to answer many of the questions people have when considering improving their smiles with Invisalign®. With the recent advancements in Invisalign's technology, there has never been a more esthetic and comfortable way to straighten your smile and I hope reading this article has inspired you to take the first step in achieving the confident smile you have always wanted!

If you have any questions, let us know in the comments section below.

I hope you liked the article and please share with anyone who might be interested!

Agustin Drubi, DMD

Dr. Agustin Drubi is a specialist in Orthodontics and Dentofacial Orthopedics. He specializes in braces, clear braces, Invisalign® and lingual hidden braces for both children and adults. He is the author of "The Ultimate Guide to Getting Braces" and maintains a private practice in Miami Lakes and Hialeah, FL.