3 Situations When Braces Are Preferable to Aligners
Melih Motro DDS PhD
20 Oct 2021
Many orthodontic problems cannot be treated with clear aligners. As the problem gets more complex, treatment planning should become more sophisticated, and a removable plastic tray may not deliver what you are hoping to achieve.
Here are three orthodontic problems that are difficult to treat with clear aligners and are better suited for braces.
1. Severe crowding
In cases with severe crowding, extraction of teeth may be required to relieve the crowding. In such cases, clear aligners have limited control over the tipping of the teeth. A randomized control trial showed that aligners resulted in significant tipping of the teeth adjacent to premolar extraction spaces during space closure. Therefore, it is much more preferable to start these cases with braces. Another option is continuing treatment with braces after a period of clear-aligner treatment. However, that option will increase the treatment time and expense for the patient.
2. Rotated teeth
Correcting rotated teeth is one of the biggest deficiencies of clear aligners. Due to the smaller size of the upper laterals and the rounder shape of the canines, plastic aligners do not have much control over the rotational movement of those teeth. As a result, the rotation accuracy is below 30% for those teeth, meaning the intended movement is often not achieved well. This is why braces are preferred over clear aligners when there is significant rotation.
3. Extrusion of teeth
Extrusion of teeth is required for many different reasons: open bite closure, bite opening by extruding posterior teeth, or just for leveling. However, extrusion of teeth is the least accurate tooth movement achieved with clear-aligner treatment. In the study below, clear aligners achieved only about 30% of the intended extrusion. Accuracy gets worse with maxillary incisors—only 18.3%. In this situation, braces are superior to clear aligners.
Today’s tips
When using brackets to align a significantly rotated tooth, always make sure the wire is fully engaged. Additionally, you can place a button on the lingual side of the rotated tooth and a second button on a neighboring tooth and apply a power chain in the opposite direction of the rotation. Creating such a couple on the rotated tooth will speed up the correction of rotation. When you use OrthoTx, we take all this into account in the planning and guidance.
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