My Thoughts on Do-It-Yourself Orthodontics

I have received several questions about advertisements for do-it-yourself home aligner treatment. The slogan on their website is “Invisible aligners done at home” and their claim is “Identical results for less than 50% of the others.” In a nutshell, their process involves taking a set of impressions and photos of yourself at home, mailing them away to their company, and then receiving a set of aligners that you wear to sequentially move your own teeth until you have a “perfectly straight smile” in 4 to 8 months. Could it be that easy? Does it work? Here are my thoughts on do-it-yourself orthodontics. To begin with, a disclaimer is in order. I’m a specialist trained to diagnose and treat all orthodontic problems and every condition associated with them. As you might expect, I see great value in being able to examine my patients face-to-face. Second, I have never actually used the SmileDirectClub product myself, so these comments are not specific to it but rather my thoughts on the concept of remote treatment generally. It will be up to readers to decide for themselves if this new care delivery system is appropriate for them.

I have been using clear aligners to straighten teeth my entire career. In dental school over 25 years ago, I made a clear retainer using a model of my own teeth on which I moved one crooked incisor to make it straighter. I wore the altered retainer all-day, every-day for a month and my crooked tooth moved! I was one of the first doctors in the country to be trained with the Invisalign system back in 1999 and have been using it now for 17 years. I have also used several other clear aligner systems and know that given the right diagnosis, treatment plan, and appliance design, clear aligners CAN move teeth.

The first reservation that I have regarding do-it-yourself treatment is that the teeth are only one part of a complex organism that must be considered in its entirety for an accurate diagnosis and treatment plan. During an initial examination in my office, I begin by evaluating the patient’s chief complaint. Is it realistic? Can it be successfully corrected with the technique they desire? I evaluate the patient’s demeanor. Does the patient have the maturity, manual dexterity, and level of cooperation necessary to be successful in treatment? I also examine the entire oral cavity as well as the head and neck region. Are there other dental conditions that would affect the success of the treatment like periodontal disease, unhealthy teeth, or restorations that need replacement beforehand? Are there signs of oral cancer, swollen glands, or functional problems like “TMJ” (actually called temporomandibular disorder)? I always take an x-ray before treatment because there are conditions that can’t be detected without one. In summary, I believe that a set of pictures and “molds” of the teeth made at home do not provide enough diagnostic information to provide a safe, accurate diagnosis and treatment plan.

Second, orthodontic appliances are only as effective as the skills of the doctor who prescribes and designs them. Although a digital simulation on a computer screen may demonstrate your teeth getting straight theoretically, there are biomechanical and biological principles at play that must be taken into account for a successful result. I love technology, but my experience over the past 15 years has taught me that human bodies don’t always respond predictably to the mathematical algorithms used by aligner manufacturers. When they don’t, it is essential to have a doctor overseeing the treatment to monitor the progress and make the necessary course corrections.

Third, even in the most straight-forward orthodontic cases there are times when patients need to be seen in person by their orthodontist. Sometimes aligners pinch, rub, or just don’t fit right. When this happens in my office, I have the experience needed to either make necessary adjustments or know when to order replacement aligners. Many times, the teeth just don’t move with the plastic (or “track” as we call it). How will a patient know if this is happening and what will they do if it isn't? When I see my patients personally, I make sure that their teeth are tracking correctly and I have the expertise to make changes if things are not going as planned. I don’t understand how this will work in a pure do-it-yourself system.

We live in the age of Amazon and Zappos. We are used to shopping online to get things faster and cheaper. Orthodontic treatment however is more complex and important than buying a book or a new pair of sneakers. When it comes to my teeth, I want a real, experienced doctor who knows me and my mouth. There is value in having a local orthodontist examine you personally, evaluate your overall oral health, determine your individual diagnosis, work with you to devise an appropriate treatment plan, and then see you regularly to monitor your progress, handle problems, and make necessary adjustments so that your outcome is what you want. In my opinion, the jury is out whether or not a mail-order treatment system can really produce the “identical results” they claim.

NOTE: The author, Dr. Greg Jorgensen, is a board-certified orthodontist who is in the private practice of orthodontics in Rio Rancho, New Mexico (a suburb on the westside of Albuquerque). He was trained at BYU, Washington University in St. Louis, and the University of Iowa in the United States. Dr. Jorgensen’s 27 years of specialty practice and 10,000 finished cases qualify him an expert in two-phase treatment, extraction and non-extraction therapy, functional orthodontics, clear aligners (Invisalign), and multiple bracket systems (including conventional braces, Damon and other self-ligating brackets, Suresmile, and lingual braces). This blog for informational purposes only and is designed to help consumers understand currently accepted orthodontic concepts. It is not a venue for debating alternative treatment theories. Dr. Jorgensen is licensed to diagnose and treat patients only in the state of New Mexico. He cannot diagnose cases described in comments nor can he select treatment plans for readers. Because he has over 40,000 readers each month, it is impossible for him respond to all questions. Please read all of the comments associated with each article as most of the questions he receives each week have been asked and answered previously. The opinions expressed here are protected by copyright laws and can only be used with written permission from the author.