Who Are Clear Aligners Suitable For, and Who Not?

Who are clear aligners suitable for?

Clear aligners are an orthodontic treatment that achieves controlled movement of the teeth within the bone using a series of transparent trays. They are widely used for mild and moderate crowding, gaps between teeth (diastema), mild deep bite and open bite, mild crossbite, and relapse after previous treatment. The success of treatment depends on two conditions: your teeth and gums being healthy, and having the discipline to wear the aligners 20–22 hours a day. Some health conditions require extra precautions; in some cases clear aligners alone are not enough, and braces or collaboration with a surgeon is planned.

On this page we distinguish three groups: suitable situations, situations that need attention, and situations that require additional methods. You can compare your own situation with these lists; however, the definitive assessment is made with an orthodontic examination, X-rays and a digital scan.

Which dental problems are suitable for clear aligners?

• Mild and moderate crowding: Teeth overlapping because of lack of space. This is the most commonly treated condition. Details are on the clear aligners for crowding page.
• Gaps between teeth: A space between the front teeth (diastema) and generally spaced teeth.
• Mild deep bite: The upper front teeth covering the lower teeth too much; it can be corrected with bite ramps added to the aligners.
• Mild open bite: The front teeth not touching when biting; aligners can be used in mild cases of dental origin.
• Mild crossbite: One or more teeth closing in reverse; it can be corrected in cases of dental origin.
• Relapse: People who had orthodontic treatment in the past but whose teeth shifted slightly because retention was neglected. Short treatment is usually enough.
• Creating space before an implant or prosthesis: To correct the tipping of neighboring teeth into a missing tooth area. Details are on the clear aligners with missing teeth page.

Which situations require attention and extra precautions?

The following situations do not rule out clear aligners; however, they require evaluation and often preparatory treatment before starting.

Gum disease

Gum inflammation (gingivitis) and advanced gum disease (periodontitis) affect the bone that supports the teeth. Moving teeth while the disease is active can accelerate bone loss. For this reason, periodontal treatment is done first, and aligner treatment begins once the disease is under control. For adults with controlled periodontal disease, clear aligners can be a suitable option because of their light forces and ease of hygiene; periodontal monitoring continues throughout treatment.

Cavities and missing fillings

Decay under an aligner progresses quickly. Before treatment begins, all cavities are treated and fillings are completed. Large fillings and crowns done during treatment can change the shape of the tooth and disrupt the fit of the aligner, so their timing is planned with your orthodontist.

Implants, bridges and crowns

Implants are fixed in the bone and do not move; in the aligner plan, the implant tooth is defined as a fixed point and the other teeth are moved accordingly. Because bridges connect several teeth, those teeth cannot move individually; the orthodontist either leaves the bridge out of the plan or recommends replacing it after treatment. Bonding attachments to crowned or veneered teeth requires special preparation, and the bond is sometimes less durable. These situations do not prevent clear aligner treatment; they are taken into account in planning.

Jaw joint (TMJ) problems

If there is pain, clicking or locking in the jaw joint, the condition is evaluated before treatment begins. Because clear aligners change the bite, they can affect joint symptoms; in some people wearing the aligners at night reduces the effect of clenching, while in others symptoms may increase. If needed, the orthodontist plans a joint evaluation and preliminary treatment.

Pregnancy

Pregnancy is not an obstacle to clear aligner treatment; there is no known drawback to having the aligner material in the mouth. However, gum sensitivity and inflammation can increase during pregnancy, nausea can disrupt the wearing routine, and X-rays are postponed. If you are about to start treatment, your orthodontist will evaluate the timing with you; if you become pregnant during treatment, it usually continues and gum monitoring is increased.

Other conditions

Medications that affect bone metabolism (for example, some osteoporosis drugs), uncontrolled diabetes, dry mouth and some systemic diseases can affect tooth movement and gum health. Be sure to mention your medications and health conditions at the consultation.

In which cases are clear aligners not enough on their own?

Clear aligner technology covers more types of movement every year; however, some situations are still limiting today:

• Advanced skeletal discrepancies: If the problem lies not in the teeth but in the size and position of the jawbones (a marked retruded or protruding lower jaw, skeletal open bite), aligners alone are not the solution. Growth-guiding appliances in growing children, and aligner treatment combined with orthognathic surgery in adults, may be planned. Details are on the can clear aligners correct jaw structure page.
• Severely rotated teeth: Large rotations, especially in round premolars and canines, are less predictable because it is difficult for the aligner to grip the tooth. Attachments help; sometimes short-term braces are needed.
• Large vertical movements: Lengthening a tooth significantly out of the bone (extrusion) or sinking it into the bone (intrusion) is limited with aligners.
• Impacted teeth: Bringing unerupted teeth that remain in the bone into the arch usually requires braces and collaboration with a surgeon.
• Closing large spaces in extraction cases: Closing wide spaces after extraction with parallel root movement is difficult with aligners; a hybrid approach may be planned.
• Serious compliance problems: For people who know they cannot wear aligners 20–22 hours a day, fixed braces are a safer option.

These situations do not mean clear aligners are ruled out completely; hybrid plans that use braces and aligners together are often made. We compared the methods on the clear aligners or braces page.

Why are compliance and discipline decisive?

Braces are fixed; clear aligners are removable. This freedom comes with responsibility: the aligners must be worn continuously except when eating and having hot drinks. When wear falls below 20–22 hours a day, the teeth cannot complete the planned movement, the next aligner does not fit and treatment takes longer. Ask yourself these questions:

• Can I brush my teeth after eating and put the aligner back in right away?
• Do I have a habit of frequent snacking or sugary drinks during the day?
• Can I keep up the routine of putting the aligner in its case when I take it out?
• Can I follow a schedule of changing aligners every 7–14 days?

Answering these questions honestly helps your orthodontist recommend a method. We explain the daily wearing rules on the how to use clear aligners page.

Is age a limit?

There is no upper age limit for clear aligners; any adult with healthy gums and bone can be a candidate. In children, they can be used with special products from the mixed dentition stage; for teenagers, aligners with compliance indicators are used. Details by age group are on the at what age clear aligners page.

How is suitability assessed?

At the examination, your orthodontist examines your teeth, gums and bite; evaluates the jaw relationship with a panoramic and, if needed, a cephalometric X-ray; and creates a three-dimensional model with a digital scan. With this data, they determine whether your case is mild, moderate or complex, which movements are planned and to what extent these can be done with clear aligners. You are then given treatment options, an estimated duration and written fee information. No web page can replace this assessment; the information here is meant to help you go to the consultation prepared.