Aligners Versus Braces: An Honest Comparison
Including the cases where aligners are the wrong answer
I place more aligners than brackets, by a wide margin. I also turn down aligner cases most weeks, which patients occasionally find surprising from someone with Diamond provider status.
Both facts follow from the same thing: aligners are excellent at a specific and quite wide set of tooth movements, and genuinely poor at a narrow set of others.
What aligners do well
- Tipping and alignment. Crowding, spacing and rotation of flat-sided teeth are handled very predictably.
- Arch expansion. Aligners are arguably better than brackets at controlled transverse development.
- Intrusion. Deep bites respond well, which surprises people who assume aligners are only for mild cases.
- Relapse correction. A short aligner series is ideal for teeth that have drifted after previous treatment.
Where brackets are better
- Large rotations of round teeth. A canine or premolar rotated beyond about 40 degrees has no flat surface for the aligner to push against. It can be done, slowly, with attachments — but a bracket does it better.
- Significant root torque. Moving the root while the crown stays put is the hardest thing to ask of a removable appliance.
- Large extraction space closure. Bodily movement of teeth across a premolar space is where aligner cases most often stall.
- Patients who will not wear them. This is not a judgement. Some people know themselves well enough to know that twenty-two hours a day is not going to happen, and for them a fixed appliance is simply the correct clinical choice.
The plan has to match the patient as well as the teeth. An excellent aligner plan worn sixteen hours a day produces a worse result than a straightforward bracket case.
The compliance question
Aligner treatment is calculated on twenty-two hours of daily wear. That is not a target with slack built in; it is the input to the staging.
At sixteen hours, the teeth do not reach the position each tray was designed to achieve, the next tray does not seat properly, and the series stops tracking. The treatment does not simply take longer — it has to be rescanned and restaged.
How to tell which you are
You cannot, from photographs of your own teeth, and neither can anyone online. It requires a scan, a radiograph and about twenty minutes of someone looking at the root positions rather than the crowns.
What you can reasonably expect is a straight answer at the end of it. If your case is better in brackets, you should be told that, by someone whose aligner numbers do not depend on the answer.
