Clear Aligner Orthodontics

Treatment is based on a sequence of movements planned on computer after a digital intraoral scan. The orthodontist sets the target tooth position, and the laboratory produces a series of aligners built to this plan, each one differing from the last by a fraction of a millimetre. Every aligner applies a gentle, continuous force to the tooth; bone tissue remodels itself in response, and the tooth is gradually carried into its new position. Patients work through the aligners in the set order, usually changing to a new one every one to two weeks. Because it's so much less visible, the method is popular with adults.

The process starts with an intraoral examination, a panoramic X-ray and a digital scan. The orthodontist feeds this data into the planning software, maps out the sequence of movements from the teeth's starting position to their target position, and goes through the plan with you. Once it's approved, the laboratory manufactures the aligner series; at the first appointment, the dentist tries them in and bonds small composite attachments to the tooth surfaces where needed. You then work through the aligners in order, with clinical check-ups generally every six to eight weeks. Towards the end of treatment, the dentist may plan an additional set of aligners for fine-tuning.

Cases needing simple alignment can be finished within a few months, while plans that also involve correcting the bite can run past a year and a half. The main factor shaping the timeline is the distance the teeth need to move and how many are involved — plans covering both jaws together also need more aligners. The second factor is how many hours a day they're worn. Age is the third factor, since bone metabolism responds faster in younger patients. At check-ups, the dentist recalculates the number of aligners still needed based on actual progress.

Aligners should be rinsed in lukewarm water every time they're taken out, and cleaned gently with a soft brush. Hot water distorts the shape of the material, so boiling water and dishwashers are both off limits. Coloured drinks and smoking can leave the aligner surface looking cloudy; brushing your teeth twice a day helps keep both the teeth and the aligner clean. Cleaning tablets available on the market can help a few times a week. When aligners aren't in use, they should be kept in their case rather than wrapped in a napkin and left on a table — a lost aligner throws off the treatment timeline.

After teeth have moved into their new positions, the surrounding connective tissue and bone keep remodelling for a long time afterwards. During this period, the dentist usually bonds a thin wire to the back of the teeth, or provides a clear retainer to be worn at night. Wear is more frequent in the first few months, tapering down to nights only over time, though we don't recommend stopping altogether. Where this retention stage is skipped, some teeth can move back towards their original position. Check-up appointments continue during this stage too.

In the first few days, some sounds may come out with a slight lisp; this generally settles within a week as the tongue gets used to the appliance. Because aligners come out for meals, there are no restrictions on what you eat, but they shouldn't go back in until you've brushed your teeth afterwards. This rule is a practical inconvenience for anyone eating out, since it means carrying a hygiene kit with you. Nothing except water should be drunk with the aligners in. Aligners can stay in during sport, though a protective mouthguard is recommended for contact sports.