5 Clear Advantages of Aligners by Dr. Jonathan Nicozisis

The ministry of a silly orthodontic appliance

by Dr. Jonathan Nicozisis

In their early history in orthodontics, aligners were the Rodney Dangerfield of orthodontic appliances: They got no respect, because of their perceived limited clinical applicability.

Echoes of this perspective persist today, with detractors eschewing aligners and challenging their legitimacy. Often, research findings assign a percentage of predictability to create science that best quantifies how what we see on a computer screen is expressed clinically. More so, profound statements and conclusions are made after treatment with a single series of aligners, as if a single activation of fixed appliances always does the trick. Detractors run through the halls of orthodontic social media proclaiming these headlines as scientific proof and insinuating that anyone who uses aligners with their patients must be practicing with subpar standards.

Perhaps this is out of fear and loathing of the general perception created by aligners that orthodontics is easy to do and anyone can do it. Perhaps it is the corporate influence from aligner companies that is the proverbial “tail that wags the dog,” and orthodontists don’t like feeling like a canine. But after nearly a quarter-century, aligners’ impact and penetration are undeniable.

Much like the bloke in the Monty Python skit “Ministry of Silly Walks” who wishes to apply for a government grant to help him develop his silly walk, doctors in private practice and academia no longer feel silly for investing in manufacturing equipment for in-house aligners, or applying for grants to investigate this “silly” appliance to help legitimize their teaching position or attempt to stay relevant in their twilight years. (Why does academia not innovate, leaving a void for others to do so? But I digress; that’s another discussion for another time.)

At the 2018 AAO, orthodontic silliness was at its fervent peak when many vendors, 3D-printer companies and software solutions for tooth movement all clamored for attention. Why was that? Patient demand? Practice and clinical efficiencies? Both? Or was it simply the notion that many patents had finally expired and they wanted in on the silliness?

While some orthodontists may still consider aligners silly, what’s not silly are some efficient qualities aligners offer that are unparalleled by traditional fixed appliances. I have been tasked for this article with discussing my top five aligner efficiencies.

1. Aligners are the ultimate of a continuous force system.

Aligners are a customized appliance whose force system is continuous to the end of each set of aligners, whereas traditional braces (customized or stock) need frequent adjustments to reset or recharge force systems with new wires, springs, power chains or other activations. More so, aligners have the better ability to isolate movements during treatment to best move desired teeth—and more importantly, not to move certain teeth—during different times of treatment.

Aligners are also a self-contained force system, with deliberate and precise movements lacking the orthodontic entropy of unwanted or undesirable side effects often experienced with fixed appliances. Think of multiloop edgewise archwire (MEAW) mechanics to alter and upright teeth along the occlusal planes to help close an anterior open bite malocclusion: Vertical elastic auxiliaries are needed in the anterior to transfer the intrusive forces to the posterior dentition. If elastics are not worn with MEAW wires, the uncontained force system allows the movement to be expressed at both the anterior and posterior ends of the wire and the open bite worsens quickly. In this sense, fixed appliances are not limited nor limiting with their activations.

With aligner MEAW mechanics, intrusive forces are limiting with each stage and limited to the posterior dentition, with nary an undesirable side effect on the anterior teeth worsening the open bite despite not using anterior vertical elastics. So being both a continuous force system without the need to be recharged within each series of aligners, and a limiting and limited force system within each aligner, makes aligners superlative in efficiency when compared with fixed appliances.