Clear aligners

What it is

Aligners work by pressing gently and steadily on your teeth. Each set is shaped a little differently from the last, so your teeth move a small step at a time. Over months, those steps add up.

The trays are made from a scan or mold of your teeth and a computer plan that maps each step. Some people also need attachments, small tooth-colored bumps bonded to a few teeth, which give the aligners something to push against.

Aligners only work while they’re in, so most plans ask you to wear them about 22 hours a day.

Who it helps

Clear aligners can treat many common problems in adults and teens:

• crowded or overlapping teeth
• gaps between teeth
• teeth that have shifted since braces years ago
• some bite problems, where the upper and lower teeth don’t meet evenly

They aren’t right for everyone. Severe crowding, large bite problems, and jaws that don’t line up often need braces, and sometimes jaw surgery. You’ll also need healthy teeth and gums to start, and the habit of wearing the trays as directed. Your dentist will tell you whether aligners are likely to work for you, or whether braces would do a better job.

What happens

1. Exam and records. Your dentist checks your teeth, gums, and bite, and takes X-rays, photos, and a scan or impressions. Any cavities or gum problems are treated first.
2. Your treatment plan. A computer model shows how your teeth are planned to move, step by step, and roughly how long it will take. Teeth don’t always move exactly as modeled, so it’s a guide, not a promise.
3. Your first trays. Any attachments are bonded to your teeth first, without numbing. Then you get your first trays and practice putting them in and taking them out.
4. Switching trays. You move to a new set every week or two. Each set feels snug for a day or two as it starts to move your teeth.
5. Check-ins. You’ll come in every few weeks so your dentist can check your progress. Some people need a few extra trays near the end to fine-tune the result.
6. Retainers. When your teeth reach their new places, a retainer holds them there. Without one, teeth tend to drift back.

Recovery and aftercare

There’s no recovery time, but there is a getting-used-to period. You may have a slight lisp for a day or two when you start.

Brush before you put your trays back in, so food and sugar aren’t trapped against your teeth. Clean the trays with a soft brush and cool water, since hot water can warp them. Keep them in their case when they’re out; wrapped in a napkin, they’re easy to throw away by mistake.

Cost and insurance

The cost of aligners depends on how much your teeth need to move, how long treatment takes, and how many trays you need. Retainers afterward may be a separate cost.

Some dental plans include orthodontic benefits, often with a lifetime limit, and some cover only children. Check whether yours covers adults and clear aligners. You may also be able to use a health savings account or flexible spending account. See insurance and financing for payment options.

Alternatives

• Braces. Braces use brackets glued to the teeth and joined by a wire, in metal or a tooth color. They can handle more complex problems, and there are no trays to remember, but they’re easier to see and make cleaning harder. Many people get braces from an orthodontist, a dentist with extra training in moving teeth.
• Veneers or bonding. For small gaps or slightly crooked front teeth, veneers or bonding can change how teeth look without moving them. They don’t change your bite, and they involve shaping or adding to your teeth.
• Leaving your teeth as they are. If your teeth are healthy and easy to clean, crooked teeth may never cause a problem. Straightening is often a choice, not a need. Your dentist can tell you whether your bite is wearing your teeth or making them hard to keep clean.