Invisible braces and Invisalign statistics 2024

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Brace yourself: Is the choice clear?

The World Health Organization considers malocclusion — the imperfect positioning of the teeth when the jaws are closed — one of the most important oral health problems worldwide, ranking third after tooth decay and gum disease.

Malocclusion is a problem that is more than cosmetic. Misaligned teeth:

  • are harder to keep properly clean, leading to tooth decay and gum disease
  • may be related to the development of temporomandibular joint disorder (TMJD) — the symptoms of which include jaw pain, difficulty opening and closing the mouth and chronic headache
  • may impair chewing, resulting in inefficient digestion and poor nutrient absorption, and impact growth, development and overall health
  • may increase the risk of sleep apnea and its associated long-term problems with fatigue and memory loss
  • can reduce speech clarity and hinder effective communication
  • can negatively affect self-esteem

Although there is historical evidence that indicates efforts to remedy malocclusion date back to ancient times, it was not until the early 19th century that Christophe-Francois Delabarre invented the precursor to modern metal braces: a woven wire device that fitted over both the upper and lower teeth and was worn for an extended period to straighten teeth gradually.

Lingual braces applied to the inside of the teeth became available in 1979 and offered an inconspicuous option to traditional metal braces. Ceramic braces came a bit later and were a NASA spinoff made of a tooth-colored material called TPA originally developed for the space program. Ceramic braces are glued to the outside of the teeth but are less noticeable than metal braces. Both lingual and ceramic braces are still in use, but clear aligners, which became commercially available in the U.S. in 1999, have become far more popular.

Clear aligners are plastic replicas of a person’s teeth created from impressions or digital scans taken at the beginning of treatment. Treatment requires multiple sets of aligners, with each set used for a week or two and replaced by the next set. The number of sets needed varies from person to person. Like traditional braces, aligners gradually move teeth into their proper position. Unlike braces, they are removable — worn for 20 to 22 hours daily and taken off to eat, brush and floss.

Key insights

The need for braces is a global phenomenon affecting adults, children and all genders alike.

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Invisible aligners have been gaining popularity since they emerged as a treatment modality in 1999.

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Aligners are appropriate for use with many, but not all, individuals. More severe oral cases may require other types of treatment.

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Orthodontists and dentists provide clear aligner treatment. Individuals may also choose to obtain clear aligners directly from manufacturers at considerable cost savings.

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Invisible braces statistics

The first clear aligners were introduced by Align Technology in 1999. By 2018, the product had been used to treat 5 million people, a figure increasing to 10.9 million by 2020. In 2023, the number of people treated had risen to 17 million, including 4.5 million teens.

Both general dentists and orthodontists are using clear aligners in their practices. A recent industry survey reported that 52% of general dentists provide orthodontic treatment. Of those, 45% use clear aligners, and 19% use traditional braces with brackets.

The COVID-19 pandemic helped to enhance the popularity of clear aligners. They had fewer emergencies, required fewer, shorter in-office visits and were easier to monitor using telehealth technologies. Among orthodontists surveyed in 2021, 42% increased their use of clear aligners during the pandemic, largely due to patient demand. Not surprisingly, their reliance on teleorthodontics grew from 8% to 68% during the pandemic. Patients fitted with clear aligners can expect practitioners’ continued use of that technology post-pandemic.

Among orthodontists, reports suggest that aligner therapy represents between 30% and 45% of caseloads. Additionally, general dentists can obtain manufacturer-provided training, certification and ongoing assistance as they incorporate invisible braces into their practices.

How well do invisible braces work?

Clear aligner therapy has become an accepted and effective method of treatment for malocclusion, but there are some caveats.

  • Clear aligners are used to accomplish mild to moderate tooth movements, for which there is a success rate of 80% to 90%.
  • Aligner therapy is beneficial for patients whose malocclusion is not severe and who are concerned about their public or professional appearance.
  • Aligners are inappropriate for treating severe crowding or spacing issues that require extractions or when teeth need to move extensively in multiple directions.
  • Patients must wear the aligners for the time prescribed. Noncompliance will negatively affect the treatment process.
  • Most practitioners recommend wearing a retainer after treatment completion to prevent the teeth from returning to their original positions. This recommendation is also made for traditional metal braces.

Cost of invisible braces

Consumers can obtain clear aligners through their dental or orthodontic practitioner. They can also purchase clear aligners directly from a manufacturer without the intermediary of a personal dentist. This direct-to-consumer (DTC) approach has grown in popularity, primarily because of its substantially lower cost and the convenience of avoiding in-person treatment. However, a 2021 evaluation of the information provided to consumers via DTC aligner websites found the following:

  • Poor or misleading overall content
  • Failure to advise the pre-treatment dental checkup needed to avoid worsening any existing dental problems
  • Readability is more difficult than the 6th- to 8th-grade levels recommended for patient materials by the National Institutes of Health and the American Medical Association

Invisible braces are generally less expensive than traditional metal braces. Prices for aligners start at around $1,000 and may go as high as $7,000. The company selected, the age of the patient and the difficulty of the tooth movement required may all influence the price. When applicable, online ordering and ongoing teledentistry treatment keep aligner costs low, and some DTC clear aligner companies have monthly payment plans available to qualifying customers. Many health savings accounts (HSAs) or flexible spending accounts (FSAs) consider clear aligners an eligible expense and may be used to cover payment. By comparison, traditional metal braces may cost between $3,000 and $10,000.

How do aligners compare to regular braces?

Clear aligners and traditional metal braces perform the same function — tooth repositioning — with some differences in cost, treatment length, treatment restrictions, convenience and aesthetics. Those differences can be summarized as follows:

Sources: Nationwide Children’s; American Association of Orthodontists; International Journal of Environmental Research and Public Health

When choice is a realistic option, one factor to consider is ease of compliance. Removability presents its own challenges. Aligners may be misplaced or lost. Will the wearer be comfortable removing and carefully storing their aligner when eating or drinking? Can they be expected to replace it in their mouth quickly thereafter so that it is worn for the necessary time?

Another consideration may be the availability of expert supervision. The late 2023 bankruptcy and closure of the Smile Direct Club, a DTC aligner company, points to the possibility of aligner clients being left without support midway through the treatment process in the event of company failure.

Regular vs. invisible braces usage data

Braces are a common occurrence in the U.S. The American Association of Orthodontists maintains that age is rarely a factor in deciding whether to initiate orthodontic treatment. In fact, one in three orthodontic patients today are adults.

Clear aligners were originally marketed to adults as a less bulky and noticeable alternative to achieving a healthy smile. As of 2023, the treatment of adults held the largest share, 60.2%, of the clear aligner sales market.

Manufacturers have since seized the opportunity to sell clear aligners to a younger market. Align Technology introduced a product specifically for teens in 2008 and updated it in 2017. Between 2013 and 2017, the sales of its products for teenagers increased from approximately 100,000 to over 235,000. From 2017 to 2019, its sales of products for teens and preteens grew faster than that for adults.

Invisible braces sales

The global invisible orthodontics market size was estimated at $6.1 billion in 2023 with a projected compound annual growth rate (CAGR) of 28.5% through 2030.

Within this market, clear aligners comprised $5.13 billion, projected to grow at a CAGR of 30.7% during the same period. The remainder of the market is taken by ceramic and lingual braces.

North America dominated the clear aligners market with a 54.5% market share in 2023. Factors attributing to this high percentage included the following:

  • clients’ high disposable income
  • availability of certified practitioners
  • established dental care infrastructure
  • increased interest in dental health and aesthetics
  • pandemic and post-pandemic adoption of telemedicine and teledentistry

The use of invisible aligners is increasingly accepted by U.S. dental professionals. Align Technology noted the increased use of invisible aligners among North American orthodontists from 67.3 cases per doctor in 2020 to 89.2 cases per doctor in 2022. Among general dentists, use has grown from 9.6 cases per doctor in 2020 to 13.9 cases per doctor in 2022.

Future projections

Malocclusion is a global problem, affecting a staggering 56% of the world’s population, with no differences by gender. Regionally, Africa has the highest prevalence (81%), followed by Europe (72%), America (53%) and Asia (48%). The condition can occur in primary and permanent teeth — children and adults are both affected.

The global invisible orthodontics market is expected to reach $33.9 billion by 2030.

In the coming years, the Asia-Pacific area, including the rapidly developing economies of India and China, is expected to become the fastest-growing regional market for clear aligners.

Demand for tooth-colored ceramic braces is also forecast to increase through 2030. Aesthetics is a driving factor, along with the suitability of ceramic braces for those cases where clear aligners are not advised.

FAQ

How successful are invisible braces?

According to a review article published in 2023, clear aligner therapy has a success rate of 80% to 90% when used to achieve mild to moderate tooth movements and when the patient is diligent in wearing the aligners as prescribed. However, clear aligners may not be strong enough to treat severe or complex malocclusion.

What conditions might disqualify a person from using invisible braces?

Clear aligners are not recommended for individuals whose teeth are so crowded that extractions are required. They may not achieve the desired result if substantial movement is needed in multiple directions. People with gum disease or untreated tooth decay need to address these problems before beginning clear aligner therapy.

Are clear aligners uncomfortable to wear?

People experience pain differently. Regarding the relative discomfort of aligners versus traditional braces, some small studies found the following:

  • People fitted with traditional metal braces noted greater discomfort and took more pain medication than those who used aligners.
  • The plastic used in clear aligners is less abrasive than traditional metal wires and brackets.
  • Some people reported difficulty chewing because their teeth were sensitive to pressure.
  • Pain lasted for two or three days after moving to a new aligner and eased up afterward. Trays are swapped out every two weeks, so pain is recurrent but temporary.

References

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