Q&A With Orthodontist Adam Jowett: Part One - Everything a Patient Needs to Know About Aligners

How do Orthodontic Aligners work? The answer might be easy to a clinician, yet to the average person, it’s not quite so simple. When Award-winning writer Lisa Dawson announced to her Instagram followers that she’d chosen Autograph Aligners for her aligner treatment, her inbox quickly filled up with questions like, how much does it cost? How long do you wear them? To get some clarity for everyone, and bust some common myths, she interviewed her Orthodontist, Adam Jowett.

In this three-part blog, we share the topics covered in that interview. In part one, Lisa asks Adam all about the what, when, why and how of Aligners. Here’s how it went ...

Lisa: “Aligners. Do I wear them all the time? How often do I wear them? Can I eat with them? Can I drink with them? What do I do with them?”

Adam: “All great questions. Clear aligners are basically clear plastic, gum shield type items customised to your mouth. You wear them all the time; at least 22 hours a day. You take them out for eating, drinking; anything but water, as well as cleaning your teeth. With Autograph Aligners, and any other aligner company, you tend to change them usually every week. Each one moves the teeth a little bit further along towards perfect straightness.”

Lisa: “So it’s unlike whitening, where you will wear the same one every time?”

Adam: “Yes, so you will probably get a sequence of aligners, the first one will be pretty similar to what your teeth are like at the moment. The last one will be perfectly straight teeth; pre-programmed digitally using modern techniques and a lab technician so that everything is perfect at the end.”

Adam: “They work really nice for correcting mild irregularities and mild crowding or slightly wonky teeth at the front.  During lockdown, when everyone is looking at their own teeth, everyone seems to want clear aligners.”

Lisa: “How many aligners would you get through?”

Adam: “This is a tricky question to answer as some people have really crooked teeth that it would take a long time with aligners. Other people, it will be nice and straightforward and it will take 6 months. But, anywhere from 6 months up to a couple of years, even longer sometimes. But it is all dependent on each case and the amount of crowding, and the amount of movement required to straighten the teeth up.”

Lisa: “Do aligners work the same as retainers?”

Adam: “Good question. Retainers are slightly different. Retainers you typically wear at the end of treatment. That’s once the teeth are straight. Retainers you tend to wear just at night time and they hold the teeth in the corrected position. So, they are fixing the teeth straight after you have had your treatment. Aligners look a bit like a retainer but they work in a different way in that they slowly straighten up the teeth as they go on. They are also made of a slightly different material which is a bit more flexible so they are easier to get in and out and get that tooth movement.”

Lisa: “Cool, so how are they attached? I’ve done teeth whitening, before. So, I’ve just had a tray made for my mouth and I put it up (in my mouth) in the evening and take it out in the morning. Is that the same with aligners? Do they literally slot onto your teeth? Or does something hold them in place?”

Adam: “Aligners themselves are very similar to bleaching trays except they are a bit firmer. Bleaching trays tend to be flexible, so they are easy to get in and out. Bleaching trays are a bit thicker as-well. Aligners themselves are a bit more rigid but they do click in. And, there might be attachments on there. Attachments are little bits of tooth coloured filling material. Those attachments are when you get that satisfying click into position. They improve predictability of tooth movement. Typically, you would have attachments fitted at the start and removed at the end.”

Lisa: “How many attachments do you have? Would you have attachments on every tooth?”

Adam: “It is dependent on each case. You have them on the teeth that are the most crooked. Because they need extra grip to move them.”

Lisa: “So, when you take them off, would you still see the little dots?”

Adam: “Yes, exactly that. The first appointment tends to be fitting the attachments. The dentist uses a template to carefully put these small attachments on the teeth, they are set with the blue light and are held in place for the duration of treatment usually. Sometimes we need to remove them part way through treatment but that is dependent on the plan from the start.”

Lisa: “And how long is an average aligner case? Say if you’re like me, and you’ve had them straightened, and they’ve gone wonky again. You don’t need any teeth out; you just need to get rid of overcrowding.”

Adam: “I’d probably say between 9 and 12 months is the average if you don’t need any teeth out or anything like that. I mention taking teeth out with caution because that tends to be reserved for treatment in adolescence. But it all depends on how much crowding you’ve got.”

Take aligners out for eating and drinking, and brush your teeth before popping them back in.

Adam explains Interproximal Reduction; smoothing between the teeth

Adam:Something that we talked about was smoothing between the teeth. When you’ve got crooked teeth, there’s not enough room for all the teeth to fit in, so you do a bit of smoothing between them (The clinical term is IPR which is short for Interproximal reduction).  It’s like a nail file that goes between your teeth, and if you do that on a few teeth, it gives you enough room to straighten them up them in a straight line. But if they are so crowded and there’s just hardly any room to fit everything in, then you turn to things like taking teeth out. But I would say that is quite unusual. Certainly, it is not in every case.”

Lisa: “Cost is a big question. Are aligners more or less expensive than traditional braces? Does the cost vary?”

Adam: “You nailed it with the last one there! They do tend to vary anywhere from about £2000 for the most straightforward case, up to about £5000 for the more complicated comprehensive ones. That tends to include everything so you get the retainers included, all the data, photographs, and scans of your teeth.”

Making the right choice. Aligners may more cost more than traditional braces.

Lisa: “Do you have to straighten both the upper and lower, or can you do just the one?”

Adam: “It depends, it is quite uncommon just to do the one. You can just do one, but quite often you want the teeth to fit together neatly and so you would do top and bottom. It’s quite unusual to get one arch straight and one crooked, or the other way round. You tend to do two but you can of course do one.”

Lisa: “How do you eat and chew with an aligner?”

“You take it out for eating and drinking and you put it in a little case. Because if you put it in tissue, it tends to go in the bin by accident! As soon as you have finished eating or drinking, it goes straight back in again. That is really important to get into that habit of taking it out, eating and drinking, and straight back in again.”

Lisa: “You can drink water, can’t you? Anything else, you need to remove them?”

Lisa: “Yes, and it’s become a bit of an inconvenience taking them out, and some people even use it to stop them snacking and things like that. Because it’s such an inconvenience, they don’t snack as much.”

Lisa: “One of the things I noticed when I came to my initial appointment with you is that I was expecting to have a mouth full of stuff to make an impression of my teeth, but that did not occur! Can you just explain what you do nowadays which is completely different when you ‘re looking to put aligners on?”

Adam: “The practice; Honesty Dental Care, is forward thinking. We’ve got some things called intraoral scanners. We don’t use the gooey mould type stuff that you’re probably used to. That stuff that makes you feel a bit sick - everyone remembers that. So, a scanner is like a wand - a little camera that goes inside your mouth, backwards and forwards, and it captures a 3D image of all the teeth in place. We do bottom teeth, top teeth, and also scan your bite so that you literally have a virtual model of your teeth and what they look like.

 Instead of traditional impression taking, many dental practices now use scanners, such as these 3 Shape Trios scanners.

And, the great thing about that is you can then send that on to the laboratory at DB Orthodontics (Autograph), and get the aligner digital model cast up, or fabricated and they can do the aligners treatment on those models.”

Lisa: “It’s so clever. What happens if you lose the aligner? Do you get sent a replacement for that specific one? Is that what happens?”

Adam: “Yes, what you need to do is be really quick at coming back to see us to have a new aligner fabricated. What we typically need to do, if you’re on an aligner number say five, and you lost number five, you’d probably have to go to number four and keep that one in to hold the teeth in place. Until you see us, get a new scan and get that number five made again. It is very case dependant because if you lost one of the aligners and you’re almost finished, then you can jump ahead and accept that it might not move as planned but you might get some benefits there. But the key is to keep it in the box and don’t lose it. Don’t throw it away!”

Lisa “How long is each aligner in for?”

Adam: “This depends on which aligner system you are using, but generally it will be a week – seven days for each aligner. It used to be a bit longer but we’ve managed to get reasonably predictable results with seven days. sometimes we might extend the time. If your wear hasn’t been good, we might extend that, but when we see you, we check to make sure the teeth are moving as planned. Technology is always moving on in Orthodontics and we’re even going to remote monitoring of teeth. You can sometimes use pictures of your teeth to record whether or not the aligner is moving the teeth as planned. So, it’s really interesting. And, definitely moving forward I think that’s maybe the direction we are going. Particularly with the pandemic.”

Lisa: “After getting the aligner in, how often do I need to visit for checks? Or do you get your box of aligners and that is it? You don’t need to come back ‘til the end unless there is a problem?”

Adam: “Typically, we get you in for all your records, we send it off to have your aligners made. The first appointment involves fitting the attachments and delivery of the aligners, so the attachments are the little bits of white filling material on the teeth. And then the aligner clips over the top. You then need to come back to a different appointment to have the smoothing between the teeth, if that’s required. You might come back in, I typically do it every 4 weeks, do a bit of smoothing, and then you’re given for example ten aligners. That sometimes is the end of treatment for people, but it all depends on how many aligners you’ve got”.

Lisa: “What happens when you finish a course (of treatment)?”

Adam: “After you’ve finished your aligners you then have your retainers, so your night time “pyjamas” for your teeth, to hold them in the right place.”

The full interview can be viewed on Lisa Dawson’s Highlights page here

Award-winning writer, blogger, creator, presenter, and self-confessed story addict Lisa Dawson is currently undergoing aligner treatment with Autograph Aligners. Follow her on Instagram @ _lisa_dawson_ to see her aligner story in her highlights, featuring the full live Q and A with Orthodontist Adam Jowett at Honesty Dental, Baildon.