DENTAL TOPICS Dental Treatments and Surgery
Clear Aligners are a form of braces that do not use any metal nor are permanently attached to your teeth. They are typically made of BPA Free plastic and can be removed for your convenience. These devices are used to treat a wide variety of orthodontic issues which fall under the category of “malocclusions,” which are abnormalities in the alignment of your teeth and how they come together when you bite (overbites and underbites are examples of malocclusions).
A big selling point with clear aligners is the lack of metal. Many people do not like the way metal braces look and feel, but clear aligners are made of smooth, clear plastic that both look and feel better than metal. Consumers also enjoy the removability factor of clear aligners which makes eating a more enjoyable proposition – metal braces prevent you from eating certain foods (like gum) and are prone to getting food stuck in them.
Clear Aligners have two distinct categories – Invisalign and all the other brands. The reason I say this is because Invisalign is the only clear aligner brand that you can get in an orthodontist’s office. All the other brands have a DIY element to them where the treatment is done virtually (more on this later). So, let’s compare the 3 overall categories we have:
Final Verdict on Effectiveness: Metal braces are the most effective at fixing the most orthodontic issues across a broad age range and are administered in-person by your orthodontist for an optimal treatment experience. Among the clear aligner brands (who cannot treat serious orthodontic issues), Invisalign wins in the effectiveness category because they can treat patients at a younger age, while also having the advantage of being administered in person by your orthodontist (which lends to more effective treatment). While the other clear aligner brands do monitor your progress virtually, in-person analysis and treatment are always more effective. One other thing to keep in mind is compliance. Metal braces are attached to your teeth and cannot be removed, whereas clear aligners can be taken out. This means that metal braces have a higher compliance rate as it is impossible to take your metal braces off to eat and forget to put them back on afterwards like you can with clear aligners. A higher compliance rate also means shorter treatment times.
Just like we had 3 tiers when it comes to effectiveness, we also have 3 tiers for cost:
Final Verdict on Cost: Non-Invisalign clear aligners are the most affordable orthodontic option by far. This is because these other brands cut costs by doing everything virtually – they have no overhead like an orthodontist’s office (who administer the more expensive metal braces and Invisalign) – and by treating a smaller range of issues. Invisalign is clearly the most expensive option because you get both the clear and sleek clear aligner technology while also getting in-person treatment by your orthodontist. Metal braces fall in the middle, offering a higher range of in-person care, but lacking the look and comfort that clear aligners offer. The cost is easily tied to what you are getting: Treatability + Eligibility + Type of Care + Look and Comfort = Cost
For the Comfort category we are going to be using only 2 tiers – metal braces and all clear aligner brands:
Final Verdict on Comfort: Clear aligners are the clear winner in terms of comfort. The smooth plastic and ability to remove them for eating are 2 key differences between clear aligners and metal braces that make clear aligners the top choice when comfort is the key concern (assuming your issues are treatable with clear aligners).
For the Look category we are going to be using only 2 tiers – metal braces and all clear aligner brands:
Final Verdict: Clear aligners, as their name implies, are clear and will have a cleaner and more elegant look than the clunky looking metal braces. This may not be as big of a deal for children (I for one did not care about how my metal braces looked when I was a kid), but for an adult in a professional environment, it could make a person feel uncomfortable. So, if your main concern is how you will look, clear aligners are probably the right choice for you (assuming your issues are treatable with clear aligners).
I think it is important to break down and rate each potential concern that might come up when considering which braces option is right for you (the higher the score, the better):
Metal Braces: 33
Invisalign: 32
Other Clear Aligners: 29
Some clarity on the final scores. Metal braces offer the best mix of everything you might be looking for. They are middle of the road in terms of costs, and while they might not have the perfect look and feel, they offer the clear-cut best in terms of the overall care and treatment you can receive. Ultimately, the final result is what matters the most, and metal braces are the most reliable when it comes to results. When considering clear aligners, Invisalign is the priciest option, but you do get higher levels of care and treatment compared to the other clear aligner brands. But this does not mean there is no place for the other clear aligner brands – they are perfect for adults with minor orthodontic issues who want to keep costs down but also want a comfortable and aesthetically pleasing experience.
While metal braces make for a great orthodontic solution, clear aligners have been gaining more and more popularity over the years because of their superior quality of life advantage – they look and feel better than metal braces, and you can take them off when necessary (like when eating).
But there is a contentious history to the expansion of the clear aligner industry. Invisalign was the first clear aligner brans, coming out in 1997, and maintained a stranglehold on the industry for many years (more than 80% market share). Orthodontists supported this product because it gave customers more variety, while also generating greater profits for the orthodontists themselves. Happier customers and happier orthodontists – what’s not to like?
But a good business idea always spurs competition. Invisalign had the advantage of holding patents on their products which made it difficult for copycats to enter the marketplace, but in 2014, SmileDirectClub (then known as SmileCareClub) launched a do-it-yourself (though less comprehensive in what it can treat) version of Invisalign . They send you a kit, you take your own impressions, send it back, and they send you your clear aligners. You are then monitored by dentists and orthodontists online – no physical office visits. Only problem was, in 2015 Align (the owners of Invisalign) brough a lawsuit against SmileDirectClub for infringing on 14 of their patents. Align also brough up concerns regarding the lack of oversight associated with the SmileDirectClub model due to the lack of an in-person orthodontist monitoring progress. The lawsuit was ultimately dropped when the two companies settled outside of court, with Align receiving $46.7 million, which included a 17% ownership stake in SmileDirectClub. Align now had the more dominant in-person clear aligner solution (Invisalign) and a large stake in their only DIY clear aligner competitor (SmileDirectClub).
Then in 2017, key patents that Invisalign held expired. This opened the floodgates for the other DIY clear aligner brands to enter the market; Candid and Byte are among the brands that opened shop in 2017 and are still seeing success today. In 2019, Invisalign’s final remaining patents expired, leaving the clear aligner world wide open for copycats, imitators, and maybe even a company that could bring major improvements. It is a very basic capitalistic concept – more competition lowers prices and increases innovation. But there is always a loser in a capitalistic battle. In a world of limited resources, not everyone can have everything at the same time. In the case of clear aligners, the orthodontists are the ones who are losing out.
The American Association of Orthodontists, which counts a membership list nearly 20,000 long, issued a consumer alert back in 2018 warning patients about DIY clear aligner brands. They warned that consumers should reconsider choosing a procedure that does not require in-person treatment. That good orthodontic practice is more than just moving the visible portions of your teeth around.
This was a toned-down, but clear and specific retort to what they felt was a direct attack on their long-standing, effective, and safe business model. Could they be right? Are clear aligners just straight up worse than doing it in an orthodontist’s office? Or are they just afraid of losing money and will say anything to remain as the dominant orthodontic solution?
Let’s delve deeper into the different clear aligner brands and decide for ourselves – is there a place for DIY clear aligner brands in our society?
Created in 1997, as we discussed earlier on, Invisalign is the father of clear aligners. Users of this product can get a more comfortable and better-looking alternative to metal braces, and they are still treated at their normal orthodontist’s office. If you can afford their higher price tag (and assuming you do not have sever orthodontic issues), Invisalign has always been the favorite for those who wanted to avoid the “brace face” way of life, but keep the piece of mind of having an orthodontist monitor and analyze your progress on a regular, in-person basis.
Here are some interesting facts about Invisalign:
This 2014 entry into the marketplace was the first DIY clear aligner brand. While it does not treat as many orthodontic issues as metal braces or Invisalign, SmileDirectClub offers a low cost, DIY alternative to anything you could get in an orthodontist’s office. Consumers can get the benefit of Invisalign without the hefty price tag, all done in the comfort of your own home.
Here are some interesting facts about SmileDirectClub:
The next 2 major clear aligner brands – Candid and Byte – entered the market in 2017, the year Invisalign lost patent protection on some of their key patents. Their goal (and business model) is the same as SmileDirectClub’s; to offer a DIY and cheaper alternative to Invisalign.
Here is a rundown of what these 2 brands offer:
So, you just read all of that and are probably thinking, “So what’s the big difference between the DIY clear aligner brands?” The answer: Not much. All 3 major DIY clear aligner brands (SmileDirectClub, Candid, and Byte) are very similar in all the major categories we discussed in the charts above. There are some minor price differences and variances in their specials and extras, but overall, you are getting relatively the same product with relatively similar features.
Looking at consumer reviews, there are plenty of positive reviews, but the negative reviews usually focus on defective aligners and discomfort with aligners. Some of the more serious complaints revolve around the aligners causing serious orthodontic damage. The theme here being faults in the technology that cause the treatment to not be effective, and sometimes causing new damage. But overall, there are a lot of positive reviews with what appears to be a lot of happy customers.
When it comes down to it, the best option for you depends on what you want. If you want rock-solid treatment with little to no worry of collateral damage, metal braces or Invisalign is the best option for you. The continuous visits to the orthodontist and in-person care ensures that the treatment is as effective as possible. The DIY clear aligner brands are your best option if you have minor orthodontic issues and are looking to save some money, but you should visit a dentist/orthodontist first so you can better understand your orthodontic issues.
One final point – DIY clear aligners are still relatively new in the marketplace and the issues raised by the dental and orthodontic community, while coming off as anti-competition, do make valid points regarding the level of care one receives with DIY dental care. Your bite affects your jaw in complex ways, and like with all complex machinery, constant expert care is recommended. It is up to you as the consumer, using all the information you have gathered (including from your doctor), to determine if a DIY level of care is right for you. If your orthodontic issues are mild, and your dentist/orthodontist thinks it would be ok, then certainly the price is right when it comes to using DIY clear aligners.
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