Should you pick Braces, ClearCorrect or Invisalign?

I am asked this question quite often by my consumer followers.

First of all, it’s a personal decision. In the right hands with an EXPERIENCED doctor, almost everything that can be done with braces CAN be done just as well with aligners. There’s a few one offs for me: jaw surgery cases. mixed dentition and impacted canines. Now, that being said, I said CAN do, I didn’t say it is faster. Sometimes aligners are faster for some things, sometimes braces are faster. So ultimately it comes down to what you want.

Aligners are healthier for your teeth and gums as well because you can brush and floss easier and they often (but not always) distribute lower forces and cause less side effects and discomfort. That being said, not all doctors are trained to do good aligner work. Just because they rank high on the Invisalign doctor locator, doesn’t mean they are good.

Here’s a few more facts:

  1. Most orthodontists are indeed very good at braces.

2. Most dentists doing aligners ARE NOT orthodontists.

3. Most dentists doing braces ARE orthodontists.

4. Many general dentists do excellent orthodontic work, some of them better than orthodontists because they take more time and often do the work themselves with the patient instead of outsourcing to a team member.

You need to pick your doctor carefully. For aligners here’s a few good litmus tests to ask the doctor:

1. What percentage of your Invisalign/ClearCorrect cases do you submit as comprehensive or moderate vs Express, Assist, Go or Lite or Flex?

* If the doctor says mostly Go, Assist, Express or Lite or Flex, I would not pick that doctor. They are clearly doing anterior only or just “improved” work and not comprehensive work (ideal). That means they aren’t making things perfect. That’s totally okay if that is what a patients wants as long as the risks, benefits and alternatives are explained…. but for me it’s always the exception in the practice, not the majority of patients.

2. What percentage of your aligner cases need attachments, elastics, bite ramps or IPR (the answer should be 99%+ of one or another).

* If the doctor doesn’t have at least one of these on all their cases, they don’t know how to “idealize” the case and make cases perfect. They are just an “improved” doctor, which again, is “fine” as long as that is what the patient wants (see above). This is NOT fine for children, IMPO.

3. What percentage of your aligner cases need revisions or refinements or mid-course corrections?

*If the answer is over 50%, I would run. They don’t understand aligners and/or they don’t know how to handle compliance or optimize a treatment plan.

4. Can I see my ClinCheck/Clear Pilot before signing a treatment contract or financially to the treatment?

*If the answer is “no”, I would run.

Here’s the real truth. Keep in mind that doctors are charged a hefty lab fee from Align Technology or Straumann (the owners of Invisalign and ClearCorrect) up front. In the US, the fee is between $1500-$1900 for a Comprehensive/Moderate/Unlimited case. We have to pay that fee upfront even though we likely haven’t collected that much from the patient in the form of a down payment or insurance. Insurance pays the doctor over the lifetime of the case. We don’t get a lump sum up front. Therefore we are in the hole/aka negative cash flow when we start your case. When I worked for several large orthodontic practices, we were pressured to tell patients that they should pick braces instead of aligners all the time unless the payment was paying in cash up front. That’s the truth. We make more money off braces cases in theory BUT it does take more chair time/office time which also has a value so I think it’s really about the same but many people don’t think like I do.

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