It was just 18 years ago now, in 2000, that the first orthodontic patients began treatment with a revolutionary new alignment system called Invisalign. This marked the fruition of three years’ development, including the exacting process of securing FDA approval, by a California startup.  It was also the realization of one entrepreneur’s vision: the vision of invisible orthodonture.

Align Technology founder Zia Chishti was 27 years old when he formed Align Technology to give orthodontists and patients an alternative to traditional metal braces. He had his epiphany while he himself was a patient. When he’d been fitted for his retainer, he wondered why the entire treatment could not have been accomplished with a similar device, removable, less conspicuous, and less awkward than his braces had been.

Align was founded in 1997. At present, the company reports that around 5 million patients in 90 countries have been treated by about 100,000 Invisalign-trained orthodontists.  This is clearly the preferred option for many individuals. For some, those with strong reservations about the cosmetic and other issues with metal, it’s the only option.


Invisalign is a type of clear aligner treatment, the undisputed leader in a field of about 27 competitors. Movement of the patient’s teeth is accomplished with relatively mild pressures applied by a series of high-precision custom-fabricated aligners, made of clear plastic, which cover his or her teeth. Every few weeks new aligners are fabricated based on a precise evaluation of the subtle movements achieved by their predecessors. These aligners (sometimes referred to as “retainers”) are easily removed and replaced by the patient and are nearly invisible to a casual observer.  


Invisalign treatment is effective for most of the issues traditionally addressed with metal bands, including overbite, underbite, crossbite, gap teeth, open bite, crowded teeth, and crooked teeth. That said, it’s up to the orthodontist to make the final determination of the treatment’s suitability for each patient. Each mouth and each patient is unique, and for some, other alternatives are preferable.


For many Invisalign patients, it’s primarily about personal appearance, a cosmetic issue. This was the prime motive in developing this technology and it’s the main reason most patients choose it. The Invisalign retainers are not completely invisible but are very nearly so.

Two cosmetic “side benefits” come out of the structure and removability of the Invisalign retainer. Unlike with traditional braces, unsightly food bits don’t get caught where the world can see them but the patient’s unaware they’re stuck there.  Removable means that when appearance and cosmetics are of extraordinary importance to the patient, like in a critical meeting, he or she can simply take out the aligner and store it for the duration.

These two cosmetic advantages have welcome consequences for oral hygiene, too. Metal braces are harder to keep clean. Trapped food bits can avoid the brush, and so promote plaque formation and tooth decay. Invisalign retainers don’t snag food that way so the problem of enamel decalcification around traditional metal brackets simply doesn’t arise.  Because the aligners are removable a patient is able to brush and floss more effectively than is generally possible with traditional braces installed.  There’s an opportunity to maintain better defenses against decay and periodontal disease.

Invisalign offers some safety advantages over metal braces, too. There aren’t any of the sharp protrusions that can injure the tongue, lips, and inner cheek. The overall risk of damage to teeth is reduced because Invisalign applies gentler pressure to teeth.  

This all adds up to a more comfortable experience than traditional orthodontistry could provide in the pre-Invisalign era. There’s less social stress, there’s the option to remove them when circumstances call for it, they’re less likely to cause complications, and to cap it all off, the duration of treatment is nearly always a lot shorter than could be achieved with metal.  Align Technologies is currently reporting an average treatment duration of 12 months.  


The benefits described so far in this discussion are appealing, indeed. A person considering Invisalign should approach treatment with optimism, enthusiasm, and reasonable expectations. Knowing in advance what to expect of the experience goes a long way toward promoting the best possible outcome.

A bit of extra effort by the patient is called for to realize the full promise of Invisalign. The aligners need to be maintained properly, and oral hygiene practices need to be consistent.

Aligners should generally be worn 20-22 hours out of every 24, and removed only for eating, brushing, flossing, and exceptional occasions. Having eaten with aligners removed, it is of the greatest importance to brush, floss, and clean the aligners before replacing them. The reason this is so important is that replacing aligners on teeth without brushing and flossing traps food residues in the worst possible places and promotes decay.

Yes, this means keeping a brush, floss, and toothpaste on hand.  The orthodontist may even recommend an additional, special retainer brush. Aligners are cleaned by carefully and thoroughly brushing all surfaces, inner and outer, and rinsing in cool water. Every time the aligners come out to eat, the teeth and aligners both should be cleaned before they go back in. It’s a burden, but a small one next to the benefits a successful Invisalign provides.

Rinsing the aligners in cool water is mandatory because warm or hot liquids can easily warp and deform the material they’re made of. This also means that when the aligners are in place, patients should avoid drinking hot liquids. When considering that hot latte, the options are either to decline it or to accept the obligation to remove aligners, drink up, and then clean them (along with brushing and flossing) before popping them back in place.

In fact, the best practice is to remove aligners before drinking any liquid other than water. Pigmented beverages like red wine can stain them, and even clear drinks like dry white wine have residual sugars which can seep inside the aligner and be trapped on the tooth enamel, there to feed the bacteria that promote decay.

Pain is a frequent concern of prospective Invisalign patients. It’s common knowledge that metal braces bring on significant distress when they’re first installed and later after adjustments. Naturally, people wonder whether Invisalign is better, worse, or about the same in this regard.  

The broad consensus of orthodontists is that there’s less pain with Invisalign and what pain there may be is for shorter durations. The research findings support this view, noting that the Invisalign advantage is greatest when patient and orthodontist take care to ensure that aligners are not deformed, as can happen with exposure to hot liquids or foods.  


This discussion has provided a basic introduction to the advantages of Invisalign orthodonture, and also to the commitments a patient needs to make to promote best outcomes. It may not be the right choice for every patient. The specifics of a patient’s orthodontic or dental issues could point to traditional appliances as the better alternative. So can cognitive-behavioral considerations, when for example a patient is unwilling or unable to comply with the requirements of emplacing, removing, and maintaining the aligners and his or her teeth.

The next step for an interested, motivated individual is a consultation with an Invisalign–trained orthodontist.