A bold decision in practice

“I want to improve my smile, but braces are not an option.” I hear this so often from adult patients. Many have simply given up on achieving the smile they’ve always wanted because they can’t imagine enduring the discomfort and visibility of traditional braces. Often, they’ve already been told that their malocclusion is too severe to be corrected without fixed brackets and wires.

We might default to fixed appliances, especially for challenging cases. However, the landscape of orthodontics is evolving, and with advancements in clear aligner technology, we now have new options that better align with what adult patients seek — effective, comfortable, and nearly invisible treatment.

My breakthrough in treating complex cases came when I stopped relying on the tooth movement staging provided by aligner software and instead planned the movements based on the mechanics I intended to apply. The key to success with aligners isn’t just in the plastic trays themselves — it lies in applying the fundamental principles of orthodontics, such as anchorage and reciprocal movements.

Recognizing the potential of this evolving technique, I made a bold decision a few years ago — I went all-in with aligners. I stopped offering braces altogether, aiming to achieve the same level of precision that we expect from fixed appliances. This journey led me to utilize TAD-borne appliances such as the Beneslider1 for full Class II corrections, the Mesialslider1 for molar space closure, and bone-borne expanders to correct a skeletally deficient maxilla, all in combination with aligners.

From my experience with various aligner brands, I’ve found that Spark™ Clear Aligners stand out in a unique way. In my opinion, the most valuable feature is the visualization of simulated roots. Without a clear view of the roots, how can we truly know what crown and root movement is involved to reach the desired outcome? How can we accurately determine whether lower incisor crowding is being corrected through protrusion or simply proclination? This is especially crucial for patients at risk of gum recession. In these cases, focusing on crown proclination rather than bodily movement of the roots is often the best approach to protect periodontal health. The ability to visualize the roots allows clinicians to better understand which tooth movements are involved to reach the desired position and plan the mechanics accordingly.

Moreover, one particularly useful feature of leading aligner brands is the integration with CBCT imaging for treatment planning. This has proven invaluable when planning the placement of interradicular Temporary Anchorage Devices (TADs). By visualizing both the roots and surrounding bone structures in 3D, clinicians can precisely identify optimal sites for TAD insertion, minimizing the risk of root damage and ensuring more stable anchorage.

The evolution of aligner technology has expanded our toolkit as orthodontists, enabling us to offer patients treatment options that align with their lifestyle and esthetic preferences. By investing the time to master aligner techniques and fully embrace this paradigm shift, we can help more adults achieve the smiles they’ve always wanted — without sacrificing comfort or confidence along the way.