When talking about clear aligners, it is very difficult to get around Invisalign.
Invisalign was among the first pioneers to start orthodontic treatments with clear aligners. They are clearly the biggest player in the market and without comparison the company spending the most resources on product development and marketing.
Invisalign has production facilities spread across the globe and can therefore guarantee a high degree of supply security regardless of demand.
As the only manufacturer of clear aligners, Invisalign spends money on marketing directly to patients.
Brand:
Without comparison Invisalign is the most well-known brand in the general population. It is probably also the most well-known and recognised clear aligner brand among dentists and orthodontists.
Invisalign was developed in 1997, approved by the US Food and Drug Administration (FDA) and began being sold in the US market in 1999.
By 2021, 10 million patients, worldwide, had undergone Invisalign treatment.
Software:
The key difference between Invisalign and all other aligner manufacturers is that they by far have the best software. Every submission form, sent without comments, is read by a computer. Using AI (artificial intelligence), a ClinCheck is autogenerated and sent to the dentist without any human having seen it. Often a decent starting point for a treatment plan comes out of this. But it almost always needs to be modified by the treating dentist.
Fortunately, with Invisalign's 3D controls, it's super easy to change the position of teeth and choose attachments.
Technicians / Digital Designers:
Over the years, Invisalign has built up a team of the most competent technicians (digital dental designers without any dental background) who are skilled at translating the dentist's specific written instructions into the treatment plan. The technicians are good at taking instructions about specific requests for treatment sequences, IPR timing and attachment placement/replacement.
Note that the digital designer is an employee of the manufacturer. The digital designer sets up the teeth in the position that he/she thinks the teeth should be in after treatment is complete. The position of the teeth usually follows a certain protocol. No manufacturer of clear aligners uses dentists or orthodontists for this task.
This is a detail worth noting.
Many dentists mistakenly believe that the ClinCheck they receive from Invisalign is biologically sound, clinically realistic and based on a predictable treatment plan. This is rarely the case. Of all the ClinChecks we see, only about 2-4% don't need any modifications. Either to ensure a realistic treatment plan or to achieve a biologically and clinically valid treatment outcome.
It may seem excessive that 96-98% of all ClinChecks need modification. But let's look at the reasons.
Invisalign aligns the teeth according to American orthodontists' preferences. These differ significantly from the European preferences we prefer to use.
The dental designers at Invisalign do not have any knowledge of the biology related to orthodontic tooth movements and therefore incapable of setting up a predictable and biologically sound treatment plan. Only dentists with extensive post graduate education and orthodontists have the necessary skills to do this.
Invisalign often chooses to move the clinical crowns first, then they move the roots minimally. Any orthodontist will most likely state that the order should be reversed: move the roots first, then the crowns. The reason for this discrepancy is that it is faster to move the crowns, but biologically disastrous. We prefer to move teeth predictably with attention to the biology. This may take a little longer but reduces the risk of harming the supporting tissue around the teeth and minimises the need for additional aligners (and thereby reducing chair time)
Neither AI nor technicians seem to understand the relationship between the different forces used in each patient's orthodontic treatment. We almost always see attachments placed inappropriately, incorrectly or in places where they have no impact on the treatment outcome. In addition, Invisalign has a protocol for prioritizing their optimized attachments that rarely addresses the entirety of the movements planned by the treating dentist. Furthermore, we almost always see movements that counteract each other, which certainly leads to a lack of tracking and the need for additional aligners.
It is IMPORTANT to remember that it is ALWAYS the treating dentist who bears full responsibility for any treatment with clear aligners. This means that although a ClinCheck looks fantastically easy and nice on the screen, it's worth noticing that it's no different from brackets and wires. Clear aligners, and the associated software, require just as much orthodontic knowledge to safely and predictably complete an orthodontic treatment as with fixed appliances. Clear aligners are therefore a working tool in the hands of the treating dentist equivalent to fixed appliances. No software is able to compensate for the lack of orthodontic knowledge.
Aligner material:
Invisalign uses a 7-layer plastic material they have developed themselves. The material has a great elasticity and an ability to keep its shape over a long period of time. To increase flexibility, and therefore ease of use for the patient, Invisalign uses a scalloped trimline.
Whether there is actually anything to be gained from Invisalign's smart track material is difficult to determine. It seems striking that a new aligner material, as well as attachment designs are coming just before existing patents expire. There is very little litteratur to support the new materials and therefore had to judge whether it has its justification or not.
Trimline:
What we can say for sure is that a scalloped trimline is more flexible and therefore requires more attachments to get an optimal power transmission from the aligner to the teeth. This is why we have seen a dramatic increase in the need for attachments at Invisalign over the past few years.
The shape of the trimline makes it easier to put the aligners on- and take them off the teeth, compared to aligners with a straight trimline. Just as it is an advantage to avoid undercuts and the difficulties related to these when you have a straight trim line.
A further advantage of a scalloped trimline is that there is no risk of uncomfortable zones of pressure on the gingiva.
Attachments:
Attachments require a template every time they need to be bonded to the teeth. Including when a lost attachment needs to be re-bonded. This has something to do with the size and shape of Invisalign attachments. On the one hand, they are much smaller than the previous versions. On the other hand, they have a size that is slightly smaller than the shape of the indentation of the aligner.
The template Invisalign uses is in a rather thin material, which makes it relatively easy, both to put the template correctly on the teeth and to remove it again. Especially if you have to bond in a lot of attachments (as is often the case with Invisalign), it's super nice that the template is easy to remove. This also makes it easier to hand off the bonding procedure to a hygienist or a dental nurse (depending on the legislation in your country).
It can be frustrating if an attachment falls off, as you have to spend time ordering a template and then waiting for it to arrive at the clinic. Therefore, following the ideal bonding protocol is highly recommended. Even on ceramic surfaces, it is possible to bond attachments so that they do not fall off. It just requires that a proper protocol is followed exactly.
If you do not have a protocol for bonding attachments, you can download the aligner service start-up guide here on our webpage.
Retainers:
The only company to use a different, thicker and more rigid material for their retainers, called Vivera. Subjectively, these retainers seem more comfortable in the mouth than the retainers of other brands. As well as they seem to maintain their shape for a longer period of time and wear less.
IO scans:
Only a limited number of IO scanners can be used for Invisalign. From the way Invisalign has been behaving towards competitors of their own iTero scanner, it seems likely that this is due to an attempt to promote the sales of their own IO scanner.
The iTero scanner can be used for treatments other than Invisalign like crowns and bridges, but is definitely best for Invisalign. The main advantage of the iTero scanner, is the direct integration with the software in the Invisalign workflow, as well as the software in the scanner allows for an instant pre-view of how the scanned teeth might look after treatment with Invisalign. Clinically, this pre-view is not applicable. But in communicating with the patient, this pre-view is a really good sales tool.
PVS impressions:
If the clinic has a scanner that is not compatible with Invisalign. Or the practice does not have an IO scanner. Is it easy to take conventional PVS impressions.
Invisalign has made it incredibly easy to manage every step of the process.
The impressions are taken in special plastic trays provided by Invisalign. The impressions are packaged in special boxes also provided by Invisalign.
Both impression trays and boxes for shipping are easily ordered on the Invisalign website.
Shipping is super simple. After filling out your order online, a patient label is printed and placed in the box and a UPS shipping label is stuck to the outside of the box. All shipping and handling slips are auto-generated and simply need to be printed. The packing slip has a unique tracking code, so you can always follow the box at UPS. All the clinic has to do is call UPS for pickup once the box is packed.
At the time Invisalign receives the impressions. They are disinfected and mounted in a robot that scans thousands of impressions a day. Invisalign uses an X-ray scanner that is super accurate.
It is worth noting that the impressions must be of the absolute highest quality. Even small errors in the impressions will lead to the impressions being rejected by Invisalign - with good reason. If the impressions are not accurate, it is impossible to get aligners that fit properly and hence the teeth can't be moved predictably.
When an impression is rejected, an email follows with photos from the scan showing the errors, enabling you and your team to learn from your own mistakes.
Receiving the aligners.
Invisalign rightfully markets itself as a premium brand.
This is also reflected in the package with the aligners given to the patient.
The first impression is really really nice. The packaging design clearly has its inspiration from Apple's product packaging. The black and gold colours make the product look exclusive and delicious and this clearly transfers to the patients' first-hand experience of the products. It just looks and feels great.
Personally, I'm not that keen on the latest design og the boxes for storing the aligners. They look nicer and present themselves more attractively than the old ones. But they are actually quite annoying because you have to put the aligners into the case in a certain way to be able to close the lid of the box.
Besides of that. The rest of the packaging is just perfect. Combined with one of Invisalign's bags, the stylish impression is completed as the patient leaves the practice.
Certification:
It is not possible to schedule treatment or purchase Invisalign products without being certified. The certification is basically an introductory course in how their software platform works, the difference between their different product packages and how to handle their clear aligners in practice.
Invisalign is the only brand that charges a fee to complete this kind of certification. The certification courses are quite expensive and are a testament to how good Invisalign is at monetizing every part of their business.
Many dentists over the years have been disappointed when they discovered that Invisalign does not develop any orthodontic skills of the participants in the certification courses. These must be learned elsewhere.
Price:
Invisalign is the largest and best known brand, with the absolute best software and delivery reliability. This is also reflected in the price, with Invisalign being the most expensive clear aligner brand (rightly so). There is no doubt that you pay more for a premium brand and the benefits this brings. Despite the fact that Invisalign is the most expensive aligner brand, there is remarkably little difference in price between Invisalign and their competitors.
Discounts:
A relatively extensive discount system is used, which is somewhat similar to loyalty programmes in the airline and hotel industry. Each purchase at Invisalign triggers a number of points that accumulate on a discount scale. On the doctor account it is easy to follow which step of the discount system you are on and which discount you are entitled to. There is also an overview of how many points you need to reach the next step. Just as there is an overview of how many points are triggered by different purchases.
The discount program reasonably benefits the clinicians who perform many Invisalign treatments, purchase their courses and their scanners. Clinics that carry out the most treatments can thus obtain an overall discount of up to 46%.
The challenge with the discount program is that it can feel a bit cheap to be 10 points away from reaching the next discount level when the year's point balance resets. We've heard several Invisalign customers complain about discounts not being given. Promises of discounts from salespeople that aren't kept. Invoicing for courses dentists never signed up for, etc. etc. However we believe Invisalign is improving this as the competition in the clear aligner market is growing.
Customer service
As the above indicates, for years Invisalign has faced significant challenges in recruiting and retaining employees for its customer service department. Here in Europe, customer service at Invisalign has been virtually non-existent for 10 years.
While it may seem overwhelming with so many years of poor customer service, we have to admit to Align Tech that they are working diligently to improve every element of the customer experience year after year. In fact, over the past year, we've seen customer service staff seem more stable and actually have the energy and skills to solve the problems they face.
Clinical support
Invisalign has hired clinical support staff to help dentists solve clinical challenges. Internally, Invisalign's clinical support policy is very clear. Assistance or advice in designing a treatment plan may NOT be provided. The clinical support team is only allowed to help dentists gain a better understanding of the technical elements of the software and to give advice on how to deal with clinical issues.
There are compelling legal reasons why Invisalign does not provide treatment planning support. Therefore, many of the clinical supporters at Invisalign are either hygienists or dental assistants. However, they all have some form of clinical experience (unlike other aligner manufacturers' support), so they know from their own experience some of the problems that can arise chairside in a dental practice.
Questions:
Should you have any questions or require assistance with one or more clear aligner cases, please don't hesitate to contact us. Aligner service helps dentists and orthodontists design and optimize clear aligner treatment plans, making them more predictable, less time consuming and achieving a biologically and clinically realistic result.
You can always call or write to us.
Just as you can read more at: www.alignerservice.com
Many kind regards
Clear aligner expert
Jesper Hatt DDS
Direct phone number: +41 78 268 00 78