Take-Out Braces

While there have been many breakthroughs in orthodontics, it would be hard to overstate the impact of Invisalign.

Introduced by Align Technology in 2000, Invisalign is the brand name for a tooth-moving system that uses tight-fitting, custom-molded plastic trays, called “aligners,” to apply force. Every two weeks, the patient receives the next in a series of aligners; over time, the teeth move into the target position.

Although aligners are supposed to be worn at least 21 hours out of every 24, the system’s appeal to adults is that they can take out the aligners whenever they please—for a business meeting, say, or for a date.

Align Technology spent millions on advertising to create what Dr. Harold Frank, an Arlington and Woodbridge orthodontist, refers to as “the Invisalign craze.” As a result of the marketing, he says, “people figure they can get their teeth straightened without braces.”

All the orthodontists I interviewed cautioned that there are limits to what Invisalign—and its more recent competitor, OrthoClear—can accomplish. It can align or straighten crooked teeth, but it cannot correct bite problems. Dr. Frank, who wears Invisalign himself, calls it “a major retreatment tool,” meaning that it works well on adults who wore braces as kids and need touching up. He says Invisalign is “easy and comfortable, not as intense, and it doesn’t change your lifestyle as much” as other kinds of braces.

Invisalign has made it easier for general dentists to get into the tooth-straightening business. Whether because they see business falling away or because they see botched cases, orthodontists can be unenthusiastic about other dentists’ doing orthodontic treatment.

One exception is Dr. John Shefferman, an orthodontist in downtown DC who devotes 60 percent of his practice to adults. “I might as well help them and educate them,” he says of dentists who seek his advice about Invisalign cases.

Patients who don’t want their braces to be visible but whom Invisalign can’t help might consider lingual braces—metal brackets placed on the tongue side of teeth. It’s a 20-year-old technology, says Dr. Allen Garai of Vienna, one of the leaders in lingual orthodontics in the Washington area, but one that is more popular in Europe and Japan, where most of the research has been conducted.

“The problem has always been tongue irritation,” says Dr. Garai. Lingual braces cost two to three times more than traditional ones, but clients who want them will pay, and they’ll travel: Dr. Garai has treated patients from as far away as North Carolina.