The American Association of Orthodontics estimates that 50-75% of Americans could benefit from orthodontics, and not just for a smile makeover. Aligned teeth simplify oral hygiene and reduce the risk of tooth chipping due to grinding. Clear aligners offer adults and teens a more discreet option for fixing their smile, but do they work as well as traditional, metal braces? It depends on several factors, including what you and your dentist are trying to correct about your smile.

How Metal Braces and Clear Aligners Work

Metal braces and clear aligners function on the same principle: they use constant, gentle pressure to align teeth in stages. Metal braces achieve this with brackets attached to the tooth, connected by a metal wire. For clear aligners, sets of clear plastic trays fit over the teeth.

Metal braces are attached to the tooth at an initial visit, when the orthodontist makes an overall plan for aligning your teeth. The braces are adjusted every four to six weeks according to this plan, and patients typically wear traditional braces for one to three years, depending on the issues being addressed.

With clear aligners, a dentist makes a mold of your teeth, then creates a series of plastic trays that fit over the teeth. The American Association of Orthodontists recommend that patients wear each set of clear aligners 22 hours a day for one to two weeks. Each new set of clear aligners guides the teeth to a different position, working toward an overall aligned smile.

Both types of braces correct tooth position individually and simultaneously for a better bite. Both require an extensive initial exam by a dentist or orthodontist, as well as periodic check-ins and adjustments. Both metal braces and clear aligners can be used to fix crowding, overbites, gaps and crooked teeth. The main difference between the two types of braces is that clear aligners are removable, which can be both a pro and con.

Pros & Cons of Clear Aligners

Clear aligners are most popular with adult patients who value their subtle appearance and ability to be removed. Removability poses both benefits and risks to oral health.

In the pro column: Patients don’t have to worry about food getting stuck in clear aligners like they do metal braces because you can remove them to eat, brush and floss. Removing aligners when drinking anything other than water also negates the possibility of liquids getting trapped between the aligners and teeth, staining both.

However, clear aligners still must be worn for a minimum of 22 hours a day to be effective. This doesn’t pose an issue for compliant adults, but it can undermine clear aligners’ efficacy for younger patients who might remove them when they’re uncomfortable. Removability also means aligners can be lost or broken.

Ideal Use Cases: compliant adult, fixing orthodontic relapse, small gaps or minor tooth crowding

Less Appropriate For: young children, patients with a lot of dental bridges, teeth that need to be raised or lowered

Main Pros: invisible, removable, typically treatment takes slightly less time

Main Cons: removable, can be more expensive

Pros & Cons of Metal Braces

Metal braces are extremely effective for almost all orthodontic issues and typically work better for cases of severe overcrowding or where teeth need to be guided up or down. Most orthodontists also recommend metal braces for children precisely because they cannot be removed and typically require less frequent office visits. Metal braces tend to be slightly cheaper, though the cost of clear aligners is usually comparable.

While traditional braces can’t be lost, they can be damaged, with broken brackets (from sports injuries or even eating ice) requiring emergency visits to the orthodontist. Metal braces can make brushing and flossing difficult and can sometimes leave calcium deposits on the front teeth after they are removed. Treatment can take longer with metal braces in some cases, but their main drawback among most adult patients is that metal braces are so noticeable.

Ideal Use Cases: young children with severe tooth crowding

Less Appropriate For: smaller orthodontic adjustments

Main Pros: not removable, slightly cheaper, fewer adjustments

Main Cons: obtrusive, difficult to clean, treatment might take longer

Top Factors to Consider Between Traditional Braces and Clear Aligners

With all those pros and cons in mind, some of the top considerations when deciding between metal braces and clear aligners are:

  • Noticeability

Does it matter to you that people notice your braces? Many patients prefer clear aligners because they are much less obtrusive than metal braces. Some adults worry about a stigma attached to metal braces or that they will appear ‘childish’ in them.

By contrast, many younger adults and teens treat their metal braces as a form of self-expression. They choose their rubber band colors to celebrate their favorite sports teams or an upcoming holiday.

  • Dental Hygiene

Food gets stuck easily in metal braces, which can be both embarrassing and a risk to oral hygiene. Traditional braces pose a challenge to even the most committed brushers and flossers, often requiring special tools to remove food from between brackets.

Because clear aligners can be removed for eating and cleaning, dental hygiene with them is almost exactly the same as without. The aligners themselves need to be brushed twice a day, and patients should take care to brush after every meal to ensure food is never trapped between the aligners and teeth.

  • Compliance

This is the big one. Compliance is the main culprit when clear aligners don’t attain the same results as traditional braces would. Clear aligners will only work if you wear them for the prescribed 18-22 hours a day, and just like traditional braces, they can be uncomfortable at times. Especially for younger patients, the temptation to remove them might be too great.

  • Dentist Visits

Both metal braces and clear aligners require frequent visits to the dentist or orthodontist. The time you spend in the dental office is about the same for both, though perhaps slightly less for metal braces.

Metal braces take at least two long visits: one at the start to bond them to teeth, one at the end to debond, and, depending on your treatment plan, could include a few longer bonding appointments during treatment. Adjustment appointments are usually short and can be anywhere from two to eight weeks apart. It’s also fairly common for patients to need emergency visits for broken brackets.

Clear aligners require an extensive initial appointment, and a long final appointment to examine tooth alignment. Trays must be changed every week or two, but many dentists don’t require patients to come into the office for each new set. While there are no brackets to break, patients can lose or damage clear aligners, requiring a new set.

  • Comfort

Traditional braces are obtrusive, and not just visually. Metal wires and brackets can rub against the inside of lips and cheeks, and typically each adjustment results in a few days of soreness. The more frequent adjustments for clear aligners mean less dramatic change per adjustment, and less discomfort. Clear aligners can also rub gums at the edges, but adjustments can resolve the issue easily.

What You should Never Use: At-Home or Mail-in Aligners

There is a reason why orthodontics is a highly trained dental specialty. Identifying orthodontic issues and making an adjustment plan is much more complicated than simply taking a bite impression. It requires a thorough oral exam, X-rays and photos of the head and mouth, at least.

Unfortunately, nearly every dentist or orthodontist has a story about at-home aligner treatments gone awry. Without monitoring, there can be irreparable damage like bite issues and serious infections. Not to mention, moving teeth too quickly can result in bone loss, which can lead to loss of teeth.

The American Dental Association (ADA) and the American Association of Orthodontists (AAO)  have all issued consumer warnings against at-home braces. Companies selling these products often boast stellar consumer satisfaction, but the reality is that there are numerous active lawsuits against them by patients and dentists alike.

Clear Aligners from a Knoxville Dentist

A visit to University General Dentists can help you decide if clear aligners are right for you. We have experience using these teeth straightening tools for a number of issues, and as physicians we always put our patients’ best interest first: if your situation would benefit from metal braces, we’ll happily refer you to an orthodontist. University General Dentists has more than 30 years of experience and a long history of training the next generation of dentists. Schedule an appointment at our UT Medical Center office at 865-305-9440 or at our West Knoxville office at 865-500-5700.