Straight Talk On Invisible Braces

From the WebMD Archives

Nov. 30, 2000 -- Forget the gunmetal-gray strapping -- it's not the only way to get straight teeth. That's essentially the marketing pitch behind a new type of orthodontic device that promises a straight smile while being easy on the eyes.

The Invisalign process uses a series of clear, plastic molds to gradually move the teeth. They're kept in place 24-hours a day -- except for when brushing, flossing, and eating -- and changed out every two to three weeks as the teeth straighten. The shape of the molds -- and hence the final position of the straightened teeth -- is determined by creating a three-dimensional "movie" of each patient's mouth. It simulates, from beginning to end, the stages the teeth will go through as they're adjusted.

The manufacturer of the system, Align Technology, Incorporated, of Sunnyvale, Calif., says the molds offer a more efficient way of straightening teeth, because at different stages in the process, only the teeth that need to be moved are moved. Still, that saves no time. The company says the Invasilign process works at about the same rate as conventional braces -- and can cost 20-50% more.

And there's something else: Children can't use them. The company says its computer imaging technology doesn't work for growing teeth.

So where's the market? Right here: "Twenty or 30 years ago we weren't treating too many adults," says Michael Rennert, DDS, an orthodontist in Montreal and president of the American Association of Orthodontists. Today, "I would say the average orthodontist in an urban practice probably has 20-30% of the practice in adults." That's compared to about 5% in the past, he says. Rennert adds the new adult market has money and is concerned with both how the mouth looks and works. But not all of them can use the Invisalign system. "It is certainly something that has a place in every orthodontist's armamentarium ... for select, minor adult cases."

Which does not necessarily mean the other adult cases have to stuff tire chains into their mouths. Rennert says today's conventional braces are smaller and less conspicuous -- and even work better than the old clunkers. "The wire is still there, but the [newer] appliances are much more comfortable," he says. "The traditional metal brace can be replaced by clear braces and braces from behind."


But hold on. Robert L. Boyd, DDS, chairman of the department of orthodontics at the University of the Pacific in San Francisco, says that even with more complicated cases, he has seen good results with Invisalign. "There's no doubt it will take its place as one of the methods to straighten your teeth," he says. "On simple cases, it worked quite well. With moderate to moderate-difficult cases -- those needing the equivalent of one year of treatment with braces -- it worked very well. And that represents 40-50% of the market." Boyd, who conducted studies of Invisalign, says that in three short years, about half the orthodontists in the U.S. have learned to use the system -- and patient demand is high.

"Cost is not as much of an issue because it's less doctor time. So we're charging 20% to 25-30% more than conventional braces." Boyd says in his neck of the woods, few patients worry about the extra cost.

But that may not be the case elsewhere. "The fees are high," says Elidio Deleon, DMD, chair of the department of orthodontics at the Medical College of Georgia in Augusta. "Let's say basic braces are $3,000. If you want Invisalign, there's $500 for the set-up then 'X' number of dollars for each retainer. If you're in an area like California, where it's more affluent, then patients are certainly willing to give it a try. In our area, an excess of money is just not available. Money is a driving force."

Furthermore, that money could be wasted if patients aren't compliant, Deleon says. "This appliance is totally dependent on whether the patient chooses to wear it." Yet to be determined is whether Invisalign can also move teeth in complex cases -- such as when a pulled tooth has created a large space or if there is excessive crowding.

Still, there's no doubt that Invisalign has created a buzz -- even in lower-income areas. "People believe that a smile is critically important to their success and they're really jumping on it," Deleon says. "A lot of people are calling here about it." But, he adds, for every ten that do, just one has a mouth that might benefit.

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