Orthotown August 2018 - 29

Introduction
Historically, orthodontic treatment
of alignment issues involved metal or
ceramic brackets for the vast majority of
patients-especially adolescents-to realize
the necessary corrections. This orthodontic
patient base consisted mostly of children
between the ages of 6 and 18.
Since clear aligners were introduced,
however, they have increasingly gained in
popularity because they can address the full
gamut of orthodontic needs. Unfortunately,
that wasn't always the case; the first clear
aligners treated only mild malocclusions,
such as crowding and spaces between
teeth.1 As a result, if a patient needed more
complex corrections, they were required to
get ceramic or metal braces.
Adult patients, however, didn't view
these options as an attractive alternative, so
they opted against orthodontics altogether.2
The only other option for patients who
wanted a less noticeable, more aesthetic
alternative for straightening their teeth,
was "clear" ceramic braces. Few teens, but
many adults, chose this option.
Today, adolescents and adults are
enjoying the benefits of clear aligners for
straightening their teeth and addressing
a multitude of orthodontic issues. The
technology has improved greatly in the past
decade, and now, virtually all orthodontic
issues that previously could be achieved
only with ceramic or metal appliances can
be corrected with clear aligners.
In particular, the use of stronger plastics
enables the aligners to withstand tooth
pressure and generate the forces necessary
for more extensive and precise movement.3

Many times, a combination of elastics
or limited fixed appliances is needed to
facilitate aligner treatment. The software
used to plan the patient's tooth movement
(e.g., Invisalign ClinCheck) determines if
composite attachments, bonded buttons or
temporary anchorage devices are needed
on specific teeth, and where, to achieve the
necessary movement for proper alignment.4
Success with clear aligners is predicated
on proper case selection (particularly for
adolescents) and education, and adolescents
are actually fairly compliant. In my practice,
more than 400 aligner cases have been
initiated, and only two teenage patients
were switched to traditional braces. In fact,
selection of braces versus clear aligners is
approximately 70 percent to 30 percent.
Alternatively, adult patients-who are
typically financially responsible for their
treatment-opt for clear aligners. This
decision is almost exclusively based on
aesthetics and a desire to straighten their teeth
in a less noticeable manner. After reviewing
the benefits and potential disadvantages of
clear aligners compared with traditional
orthodontics, 95 percent of adults chose
clear aligner treatment. However, there
is not a good correlation between who is
paying for treatment and compliance with
wearing the appliance. (Many people pay
for a gym membership but still don't go.)
Clear aligners' benefits over traditional
braces include greater patient comfort, easier
oral hygiene and enhanced aesthetics during
treatment.5 Research has shown that patients
undergoing clear aligner orthodontics
experienced less pain compared with patients
wearing fixed orthodontic appliances.6, 7

by Dr. Darren Forcier
Darren Forcier,
DDS, specializes
in orthodontics
and dentofacial
orthopedics
in Depew and
Clarence,
New York. He
maintains his private orthodontic
practices after practicing in the U.S.
Army for nine years as a general dentist
and an orthodontist.
As an Invisalign Elite Provider, Forcier
treats at least 60 Invisalign cases every
six months. He is a member of several
professional dental associations,
including the American Association of
Orthodontists; the Northeast Society
of Orthodontists; the Eighth District
Orthodontic Academy (Western New
York), for which he is a past president;
and the Erie County Dental Society, for
which he is a past president and current
treasurer.

orthotown.com \\ JULY/AUGUST 2018

29
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Table of Contents for the Digital Edition of Orthotown August 2018
