By Josh Brower DDS, DIADI, DICOI, DIAMDI, FAASDI, AOS and Morgan Brower O rthodontics can be accomplished in many ways. Clear aligners have treated nearly 4 million people with some people now creating and making their own. Aligners can be useful for a number of reasons and have advantages and disadvantages. (Fig.1) Orthodontics done with clear aligners has seen a massive shift in recent years with clear aligners rapidly approaching a non-dental procedure status of that similar to whitening which can be bought and sold by anyone regardless of educa-tion or training. The Smile Direct Club (SDC) is now offering clear aligner therapy directly for sale through Macy’s stores, both SDC and ALGN technologies are opening hundreds of direct to consumer stores throughout the United States. Sequential movement of teeth with plastic is not a new thought process. In 1968, orthodontist Dr. Earl Bergersen developed the Orthotain plastic positioner. Patients would bite into the appliance and, over time, it would move their teeth to a better position. Further patents expounded upon the benefits with further modification making it more accu-rate in 1976 and again in 1997, as shown in Figs. 2 & 3. The first vacuformed appliance was created by Steven Cain in 1984 but was only used as a method of retention for further movement. (Fig. 4) By the early 1990s, part of my own orthodontic training included scraping away stone on a model from the side you wanted to push on and then adding a hard wax to the other side prior to vacu-forming a tray. Once that tray had pushed the tooth as far as it could, we made a new model and continued the process. I was typically using this process for lower anterior minor crowding since it was slow and always required IPR. This handmade orthodontic movement with vacuformed appliances continued to improve with Dr. Hilliard creating specific pliers that could put more precise movements into the plastic itself by heating the pliers and squeezing the plas-tic to create specific deformations within the plastic. He patented the Hilliard pliers in 1998. (Fig. 5) Computerization of sequential tooth movement with plastic thermoformed aligners arrived as processing power and porta-bility continued to improve by the late 1990s. In 1997, ALGN technology became the first company to patent the process. Invisalign Align Technologies was founded in 1997 by Muhammad Chishti who conceived of the basic design of Invisalign while (Fig. 1) CLEAR ALIGNER ADVANTAGES & DISADVANTAGES Advantages Removable so it is easier for the patient to clean their natural teeth. There is little chance of decalcification. Easy to clean with a toothbrush and toothpaste. Comfortable and less likely to irritate the oral soft tissues. Can prevent tooth wear from grinding. Allow crossbones to move easily since there is no intra-arch interaction. Disadvantages Can not move very long spans quickly. Limited ability to intrude molars without external anchorage. Limited ability to correct larger Class II and Class III malocclusions without extra tools and techniques. 18 Fall 2018 JAOS
Journal of the American Orthodontic Society Fall 2018: Page 18
