Aligners vs Braces, Which One is Right for My Case?

At Six Month Smiles, we often get this question on the Forum, via email, and chat: “Which appliance, clear braces or aligners, do you think will be best for my patient?

This is an interesting question because the underlying premise is that the selection of clear braces vs. aligners is greatly influenced by the clinical conditions of this case. The reality is more nuanced.

There are three factors that influence the selection of the appliance, clinical conditions is, of course, one of them, patient’s desires and habits and dentist preference and skills are the other two. Let’s delve into each one of these factors so that you can get a better sense of determining the right appliance for your patient.

CLINICAL CONDITIONS

When aligners were first introduced, some 20 years ago, the results they produced were not optimal. Advancements in 3D Dental CAD, aligner plastics and understanding of biomechanics, that is, how teeth respond to forces applied by aligners, has led the industry to optimize movements that are programmed into each aligner stage. Innovations in attachment designs and placement has also allowed aligners to deliver forces more predictably. We think that it is fair to say that the capability of aligners to address clinical conditions, for the most part, is now equivalent to clear braces. This is perhaps even more true for the cases that we treat at Six Month Smiles, as we focus on adults with mature dentition and limit our treatment to cases that can safely be treated by the General Practitioner. What this means to you is that if a case is in scope for Six Month Smiles, there is a high likelihood that the case can be treated with aligners or with clear braces.

PATIENTS DESIRES & HABITS

Now that you know that aligners or braces can treat most clinical conditions, you can focus on listening to your patient to guide them towards the right appliance. A lot of patients will come to your office with their heart set on aligners. Let’s face it, we are all influenced by marketing and the onslaught of companies offering aligners is inescapable. We think, this is an opportunity to win them over. People buy from those they trust. If you can use your insights into patient’s behavior and combine them with your dental skills, you can elevate your case presentation. The goal is to not sell the treatment but become their trusted advisor. If you can do this, sale will follow. Here’s how. Let’s start with the obvious and then dive into some subtleties:

• In your interview with the patient, the question you should answer for yourself is how well does the patient take care of his/her teeth? Ortho requires even more diligence in keeping teeth clean. This is easier to do with aligners than braces. If the patient has poor hygiene, perhaps braces is not for them.
• Next, what is their attitude towards compliance? Wearing aligners is a serious, 24/7 commitment and, after the first few weeks, the novelty wears off. Aligners don’t go back on after each meal, hours pass, then that turns to days. You know your patients and you will know who’s likely to stay compliant and who’s not. After educating them about commitment, some patients will flat out confess, “Doc, I don’t see myself keeping up with aligner changes.” Great, its braces for them, as braces require much less patient commitment. Motivation to finish on-time is another factor that drives compliance. Yes, everyone who is paying for treatment wants straight teeth but someone, who’s getting married in 6-8 months will have far greater motivation to finish on-time.  
• Finally, is the patient organized? Do they keep their appointments? Are they always in a hurry? Organized patients are more likely to stay compliant.

So, there you have it. Motivated, organized, and responsible—the trifecta of traits. Not all patients will exhibit these characteristics but now you can use your insights into patient behavior and their dental habits to have a consultative discussion on the appliance selection.

DENTIST PREFERENCE & SKILLS

We have the privilege to interact with many, many Six Month Smiles Providers and consequently have gathered insights on how you present aligners vs. braces to your patients. It may surprise you to learn that your confidence in the appliance is the greatest factor in influencing your patients’ choice. Would you believe that we have experienced Six Month Smiles Providers who say, “I have been trying to get my patients to accept aligners, but they always chose braces?” People have a great sense for detecting confidence and that comes across in your presentation. What you do more of, makes you more confident.

We think that a second factor that may be driving this is that patients are influenced by their friends so if they came to your office because of a recommendation from a friend, they are likely to ask for the same treatment.

We know that not all of you will have supreme confidence in braces or aligners. If this is you, and after taking patient’s desires and habits into consideration, you still find yourself a little unsure on the braces v. aligners decision, consider this question: How do you feel about control over treatment? If you want to be in control, braces are better. This may be very critical if you have a patient who is going to demand more. This could be a patient who already has pretty white teeth but has slight misalignment and demands perfection. Sounds like a simple case for aligners, right? Maybe. Remember that aligners will address the chief complaint, but fussy patients are likely to say something like this, “Doc, I now see a little gap here, can you fix this also?” Aligners have a pre-determined outcome and only with braces you can make adjustments. For patients who are going to have incremental complaints, braces are better.  

We hope this article gives you insights in choosing braces or aligners. We are proud of the fact Six Month Smiles gives you both, enabling you to expand your treatment options and cater to a wider selection of your patients.