Invisalign treatment at Smile Solutions – Dr David Austin

Media item: video item

Date published: 19 November 2019

Subject: clear aligner orthodontics

Practitioner featured: Dr David Austin

This page records the media item. The original video is the property of its publisher and is not reproduced here.

How clear aligners work

Clear aligners are a series of custom thermoplastic trays. Each one is shaped slightly differently from the position your teeth are in, and the tray's attempt to return to its own shape applies gentle continuous force to the teeth. The service page is Invisalign® No Braces, and Invisalign: straight teeth without braces covers the same ground in writing.

The biology underneath is the same as braces. Orthodontic force triggers bone remodelling — bone resorbs on the pressure side of the root and forms on the tension side, and the tooth moves through bone that is being rebuilt around it. This is why teeth move slowly and why they move back: the periodontal ligament and the surrounding bone need months to stabilise in the new position, and they never fully forget the old one. See Why do teeth shift? and How long does orthodontic treatment take?.

Each aligner produces a small amount of movement — typically a fraction of a millimetre — and is worn for a set period before the next.

Invisalign is a brand of clear aligner system. Several systems exist. The material and the digital planning differ; the underlying biology does not. Conventional braces vs lingual braces vs Invisalign compares them, and Which orthodontic treatment is best for me? works through the choice.

The parts people are surprised by

Attachments. Small tooth-coloured composite bumps are bonded to teeth so the aligner has something to grip. Without them, aligners cannot rotate a round tooth or extrude one. They are visible up close, which is worth knowing before treatment described as invisible.

Interproximal reduction (IPR). Where there is crowding, a very small amount of enamel is polished from between teeth to create space. It is measured in tenths of a millimetre and is generally considered safe within limits — but it is removal of enamel, and it is permanent. Ask how much is planned and on which teeth. Enamel is the hardest substance in the body — so why do teeth break? explains why that matters.

Refinements. Teeth rarely track exactly as planned. Most cases need a second series of aligners to finish. This is normal, not a failure, and it should be in the quote from the start. Invisalign cost in Melbourne: a complete breakdown by treatment type sets out what is and is not usually included, alongside the Price Guide.

Elastics. Correcting a bite relationship, as opposed to just aligning teeth, often needs elastics hooked between arches — which are visible and depend entirely on the patient. The bite problem itself is described in What is malocclusion of the teeth? and Treatment of malocclusion.

What aligners do well, and what they don't

Well: mild to moderate crowding and spacing, relapse after previous orthodontics, tipping movements, and cases where appearance during treatment genuinely matters to the person — which for adults is a real and legitimate consideration, not a vanity. Is having Invisalign as an adult worth it? takes that question seriously.

Less well, or not without adjuncts: large rotations of round teeth (canines and premolars), significant extrusion (pulling a tooth down), bodily movement of roots through bone, closing extraction spaces, and substantial skeletal discrepancies.

Not at all: skeletal problems needing surgery. No appliance moves jaws in an adult — see Jaw Surgery and Orthognathic surgery.

The honest framing: aligners and fixed braces are both tools. For many cases either will work; for some, fixed appliances remain more predictable. A practitioner who offers only one is choosing from a shorter list than the problem may need. Braces and Common complaints about conventional braces cover the fixed option, including what people dislike about it.

Compliance is the treatment

This is the single largest variable and it is entirely on the patient.

Aligners typically need to be worn 20–22 hours a day — out only for eating and cleaning teeth. Wear them less and the teeth do not track, the series stops fitting, and treatment lengthens or has to be restarted. How to protect your aligners — and your smile is the practical guide.

The practical consequences people underestimate:

• You take them out to eat, every time. That includes coffee — hot drinks can distort the plastic, and anything coloured stains it.
• You brush before putting them back in. Sealing sugar and plaque against the teeth for 20 hours a day is a genuine decay risk. See the hygiene benefits — and hygiene demands — of Invisalign, Preventing dental decay and Dental Cleans and Hygienists.
• Losing an aligner costs time, and usually money.

Fixed braces are not compliance-dependent in the same way, which is exactly why they remain the more predictable choice for people who know they will not manage the discipline. For younger patients the options are set out at Children's Braces and Invisalign and When should I take my child to an orthodontist?.

Direct-to-consumer aligners

Aligners ordered online from an impression kit, with no in-person examination and no radiographs, are a different proposition from clinician-supervised treatment, and Australian dental boards and professional bodies have raised specific and repeated concerns about the model.

The substantive issues:

• No radiographs means no assessment of root length, bone level or hidden pathology. Moving teeth through inadequate bone can cause recession and bone loss; moving them where there is undiagnosed periodontitis accelerates it — see What is periodontal disease? and Periodontists.
• Undiagnosed decay and gum disease are moved along with the teeth.
• No supervision during treatment, when problems appear.
• Consent is not informed if the risks were never assessed. Understanding Your Treatment describes what informed consent should look like.

Orthodontics is a medical procedure with permanent consequences, and it needs a diagnosis first. That is the objection, and it is not a commercial one.

Who provides it

Orthodontics is a recognised dental specialty in Australia. An orthodontist holds specialist registration with the Dental Board of Australia after an approved postgraduate program. The title is protected by law. See Orthodontists and Dentists and Registered Specialists.

General dentists lawfully provide aligner treatment, and many are experienced and good at it. But a general dentist may not describe themselves as an orthodontist, and the distinction is worth checking before you start — free, in a minute, at ahpra.gov.au, which shows the practitioner's division and any specialist entry. Two articles work through the choice: Orthodontic treatment: dentist vs specialist orthodontist and Specialist orthodontist vs general dentist — which is best for Invisalign?.

The reasonable question is simply: "Is this case within what you routinely treat, or is it one you would refer?"

The risks, stated plainly

All orthodontic treatment, aligners included, carries:

• Root resorption — shortening of the root during movement. Usually minor and of no consequence; occasionally significant.
• Gingival recession, particularly where teeth are moved outside the bone envelope.
• Decalcification and decay, from plaque held against teeth. What causes white spots on teeth? describes what that looks like afterwards.
• Relapse.

Retention is not the end of treatment; it is the rest of it

Teeth move for the whole of your life. They drift with age whether or not you have had orthodontics.

Without retention, relapse is expected. This is the most common source of disappointment years later, and it is entirely preventable. Will my teeth move if I've had braces and retainers? is the article on this.

Before starting, ask:

• What retainers, fixed or removable?
• For how long? The honest answer is indefinitely, with reducing wear over time.
• What do replacements cost? Retainers break and are lost, and this is a lifelong small recurring cost.
• Is retention included in the quoted fee, or extra?

A quote that does not include retention is not a quote for the treatment.

Related pages: Invisalign® No Braces, Orthodontics, Healthy Teeth & Early Orthodontic Treatment, and the full Our Media archive.

Common questions

Nobody told me how to clean the trays themselves. What am I supposed to do?

This is the gap in most people's instructions, and the trays sit against your teeth for most of the day. The Australian Dental Association's guidance on teeth.org.au is specific: when you clean your teeth, ideally twice per day, clean the aligners at the same time. Its method is that "the trays can be cleaned with an antibacterial liquid soap and a spare toothbrush", then "rinse well following with warm water." A spare brush, not the one you use on your teeth. Warm water, not hot — heat is what distorts the plastic. Your own brushing and flossing carry on unchanged; the ADA notes that teeth "can be brushed and flossed as normal" during aligner treatment. If a tray is cloudy or smells, that is biofilm, and it is the same biofilm you are then sealing against enamel for twenty hours.

Is straightening teeth just cosmetic?

Not only. The ADA's position is that "orthodontic treatment is not just about straight teeth" — it says treatment "can correct a bad biting pattern, help with sleep apnoea, and prevent uneven wear of the teeth." Those are three different arguments and they are worth separating, because only some of them will apply to you. A bite that loads a few teeth harder than the rest wears those teeth; crowding makes cleaning between teeth harder; and jaw position has a bearing on the airway in some people. Equally, plenty of mildly crooked teeth are stable, cleanable and cause nothing at all for a lifetime. The only way to know which case you are is to have someone examine the wear, the gums and the bite and tell you what they can actually see — and to be told plainly if the honest answer is that the reason would be appearance. Appearance is a legitimate reason; it is simply a different reason.

Are they genuinely invisible?

No, and the ADA says so directly: "Although the aligners are clear plastic, they are not invisible." In ordinary conversation at ordinary distance most people will not notice them. Close up, in photographs, and under direct light they are visible — as are the composite attachments bonded to the teeth to give the trays something to grip, and any elastics, if your case needs them. The honest expectation is less obvious than fixed braces, not undetectable. The same distinction runs through the ADA's account of fixed appliances, where it describes lingual braces as "practically invisible" and says of ceramic braces that they "are not completely invisible but are less obvious than metal braces."

My child is seven. Is an orthodontic assessment that early real, or is it selling?

It is a real recommendation, and it is not a recommendation to start treatment. The ADA reports that "the Australian Society of Orthodontists' recommend children have an orthodontic assessment between the ages of 7 – 10", and that "all the adult teeth do not have to be present in the mouth for an assessment to be done. An examination at this age can allow for early intervention treatment should it be needed." The point of looking at seven is to catch the minority of problems where doing something while a child is still growing is genuinely easier than waiting — and for most children the answer at that age is to do nothing and review. That is the result you should expect and it is not a wasted appointment. This practice's own guidance sets the assessment a little later, around nine to ten; both are within the window where the permanent teeth have started to arrive and nothing irreversible is being proposed. See Children's Braces and Invisalign.

Mail-order aligners are much cheaper. Is the objection to them clinical, or commercial?

It is worth being sceptical of a profession warning you away from a cheaper competitor, so here is the ADA's position in its own words rather than ours. The ADA "do not recommend Australians have DIY orthodontic treatment", stating that "there are many risks to this treatment. They can lead to permanent damage to your teeth, gums, and jaw joints", and that it "recommends that you have in-person treatment with a dentist or orthodontist which includes a thorough assessment before starting treatment and ongoing supervision." The substance of that is the assessment, not the appliance: the trays a remote provider sends may be perfectly well made, but nobody has taken a radiograph, measured your bone level, or found the periodontitis or the decay that the teeth will now be moved through. The cost of the aligners is the part you can compare; the cost of moving teeth through a problem nobody looked for is the part you cannot.

Practical details

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment. See also Our Location and Contact Us.

Every practitioner's registration and any specialist entry can be verified free on the AHPRA public register at ahpra.gov.au.

This page records a published item and its date, with general information. It is an archive record of a 2019 media appearance rather than current clinical advice, and guidance, fees, practitioners and services change — use the current service pages linked above. It is not a diagnosis, a treatment plan or a promise of any particular outcome. Orthodontic treatment carries risks and individual results vary. Product names are those of their respective owners and their use here is descriptive. Third-party published content is not reproduced.

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