Continuing the Braces Versus Aligners Debate

When a patient comes to you with their mind set on straightening his or her teeth using aligners, it is the provider’s responsibility to determine whether or not the patient is a suitable candidate. This decision is based on the provider’s professional opinion, which is influenced by the severity of the patient’s case and the dentist’s confidence in the treatment options at his or her disposal.

For many years, teeth straightening has come down to the choice between aligners and braces. Aligner manufacturers either had little interest in, or lacked the capability to determine, which course of treatment would produce better outcomes. Because of that, patients were likely to receive either an aligner solution (from the dentist’s treatment option of aligners) or a braces solution (from the dentist’s fixed appliance treatment options), but not an ideal solution that utilizes aligners and/or braces, based on the best possible patient outcome.

Until now.

The Hybrid

For the first time, patients and dentists can choose an orthodontic treatment option that utilizes aligners, braces, or both from a single manufacturer. The dental appliances, based on Six Month Smiles (6MS) 3D-guided orthodontic outcomes, are specifically prepared for the patient. If aligners can produce the patient’s desired result, 6MS will propose an aligner-only solution. If the patient wants more orthodontic movement, that necessitates the use of fixed appliances, 6MS will recommend a switch to clear braces.

One exciting hybrid option, Mixed Appliance Therapy, utilizes clear braces for the lower (more crowded) arch and aligners for the upper arch. Dentists and their patients therefore choose the best appliance based on 3D-guided orthodontics outcomes prepared for them.

The appliance selection happens seamlessly from within the 6MS case portal and does not require additional photos, scans, impressions or expenditure. Six Month Smiles is one company offering case-driven optimal options including clear braces, aligners or both.

Case One

Consider the example of case one (Figures 2-5). This young woman has minor crowding in the upper arch, moderate crowding in the lower arch, an UR2 in crossbite, a deep bite with 75% overlap, upper midline shifted to the left by 1.5mm and the lower midline also shifted to the right by 1.5mm, for a total deviation 3mm.

She is orthodontically class 1 so that makes her a very good candidate for short-term orthodontics.

A 3D analysis of her case determined that braces would take five to six months of treatment time while aligners required double the time – 13 months of treatment – driven by lower arch crowding and deep bite correction – the latter is hard to resolve with aligners.

Consider the example of case one (Figures 2-5). This young woman has minor crowding in the upper arch, moderate crowding in the lower arch, an UR2 in crossbite, a deep bite with 75% overlap, upper midline shifted to the left by 1.5mm and the lower midline also shifted to the right by 1.5mm, for a total deviation 3mm.

The clear braces therapy was executed per Confidex guidelines. Recommended interproximal reduction(IPR) was performed and anterior bite guards with posterior elastics for deep bite improvement were used.The braces were initially ligated with 0.014 in archwire, and then switched to 0.016 arch wire in two months, when the anterior crossbite cleared.

In month five, to develop functional overjet, lower arch was retracted by preforming IPR from LR3 to LL3 and using a power chain from 3-3.

Her case was finished in six months, compared with the Confidex prediction of seven months.

Case Two

Case two (Figures 6-12) is a patient that was treated with clear aligners. She has an active lifestyle and did not want braces to interfere with her lifestyle.

The patient’s chief complaint was people noticing her ‘crooked upper teeth.’

She has an UL2 in crossbite that detracts from her otherwise beautiful smile.

Compared to case one, this patient has less malocclusion issues. She is orthodontically class 1 with moderate upper arch crowding, minor lower arch crowding, both midlines shifted to the right by 1mm and a normal bite.

This case was sent to 6MS for aligner therapy. The planning team proposed an aligner solution that consisted of 14 aligners per arch, which is within the guidelines of the 6MS aligner program. Aligners were able to achieve the solution that the patient wanted and we proceeded with this option.

During treatment, the patient requested additional alignment. The 6MS aligner product includes one set of refinement. The additional alignment was achieved with five sets of aligners.

Better Managing Patient Expectations

Today, patients are hyper-aware of orthodontic options and, because of incessant advertising, they assume aligner therapy is their best option.

With Six Month Smiles (6MS), dentists can show patients what can be achieved with aligners. Then, aided by 3D visual tools, they can illustrate whether braces might be a better option.

The ability to seamlessly switch between aligners and clear braces during the treatment planning process allows dentists to satisfy a wider spectrum of patient desires and wants.

By discussing aligner limitations prior to starting treatment, dentists are better able to manage patient expectations.

The ability to seamlessly switch between aligners and clear braces during the treatment planning process allows dentists to satisfy a wider spectrum of patient desires and wants.

In turn, the patients are empowered to make informed decisions, giving them more confidence in starting 6MS orthodontic therapy with the right appliance.

Anterior alignment

Six Month Smiles is a leading short-term orthodontics company that pioneered adult-focused, chief complaint- driven, cosmetic orthodontics: movements focused on anterior alignment that can be accomplished in six to nine months.

6MS offers clear braces, with digital bracket placement and Confidex treatment planning by an orthodontist. 6MS accepts digital scans from all scanners (Itero, Trios, Omnicam, Carestream etc) and dentists can post physical impressions.

Recently, 6MS has incorporated clear aligners into the product portfolio. The 6MS team of orthodontists will produce aligner solutions and, if better outcomes are possible with fixed appliances, or even mixed appliances, 6MS will recommend these as alternative options.