DIY Aligners: Exceptions v Reality


What you see is not always what you get

As a DIYer and tinkerer of many things, I always love to push the limits of the things I can do myself. Half of it is the thrill of seeing the end result and getting the ‘I just did this myself’ euphoria; the other half of the satisfaction is not having to pay someone to do it for me. I love fixing electronics; taking apart computers, replacing the motor on the dishwashers, or even replacing that little flapper on the ice-maker that always seems to get stuck and let the cold air right out.

It always takes about twice as long (or 5 times if you ask my wife) than I thought it would take and costs about twice as much, and that’s non-inclusive of the time it takes me to do it. Then there are the ‘Oh no’ moments when you want to save 50 bucks by replacing your own iPhone battery and realize that somehow the cable connecting the screen to the rest of the phone is bent and replacing it now is going to cost $250 instead of $100, and don’t get me started on the “left over” screw that you notice on the ground once everything is setback up and “fixed.” It probably wasn’t needed, right?

Recently I have seen ads non stop for the at home / no doctor visit tooth aligner systems like Smile Direct Club. As a DIYer, I get why people would want to take the dentist out of the equation and try to correct their teeth and smile themselves. However, as an Orthodontist it scares the daylights out of me; not because I’m worried ill be replaced by a computer- that’s bound to happen eventually. After studying teeth, the occlusion, and the muscles that support the dentition for 7 years in dental school and residency, and the past 8 years clinically as an Orthodontist with some of those years teaching residents; the hands off approach of moving your teeth and then never having a doctor look at it again just doesn’t seem right.

Aligner in mouth

Even with the best computer simulation, and that’s all these systems take into account- simulations based on computer algorithms, the teeth might not move where expected. If the teeth don’t move to where they are simulated to move to and then they are left in a non-ideal position, it is possible to get increased wear of the teeth, jaw pain and discomfort and periodontal / gum issues. If you have crowding or spacing of the teeth I can almost bet there is an underlying or predisposing issue that has caused your teeth to be the way they are. If they have been in this position for some time the teeth are likely in equilibrium with the bone and the musculature. Once you move the teeth, this inherent equilibrium has changed and the idea is to get the teeth to a new “happy” equilibrium. This is the part that these at home aligner systems cannot necessarily achieve.

Ok, so lets just say you try it and it works perfectly, you love your teeth and your smile. Awesome, right? Wrong. The most critical thing about orthodontic treatment no matter if it's done with braces or aligners is the retention. This refers to how are the teeth going to be held so they don’t move again.

Death, taxes, and orthodontic relapse are the 3 things in life you can count on. Throughout life teeth always want to shift. With these at home systems the last tray is probably your final retainer and you can order more of these as you need them. But just like you were really good at taking your cholesterol lowering medicine, or your blood pressure medicine you will probably be great at wearing the retainer for 3 months, 6 months, maybe a year. But there will be point where you stop wearing your retainer and the teeth shift. It's not an if but a when. That’s why when feasible- and most of the time it is, I like to make a “permanent” retainer for my patients that is glued behind the back of teeth- out of sight and out of mind. Retention that lasts.