At a glance
Clear aligners and braces move teeth on the same principle: gentle, continuous pressure. Where no extractions are planned, published studies find comparable results; with extractions, fixed braces usually do better. Aligners must be worn 20 to 22 hours a day; braces need regular adjustments. Only an examination tells you which suits your case.
What is the difference between aligners and braces?
Braces, or a fixed appliance, are small brackets glued to each tooth and joined by a wire. The wire applies light pressure that moves the teeth, and it is adjusted over the appointments, usually every 6 to 8 weeks. The appliance stays in day and night until treatment ends.
Clear aligners are trays of transparent plastic, made to measure from a scan or an impression of your teeth. Each tray moves the teeth a small distance set by a 3D treatment plan, then the next one takes over. They come out to eat and to brush, and are worn the rest of the time, so 20 to 22 hours a day.
What are the pros and cons of each?
| Criterion | Clear aligners | Braces (fixed appliance) |
|---|---|---|
| Appearance | Discreet, but visible close up, especially with attachments | Visible brackets, in metal or tooth-coloured ceramic |
| Wear | Removable, 20 to 22 hours a day | Fixed, in place day and night |
| Meals | Trays out for every meal | Hard or sticky food to avoid |
| Cleaning | Usual brushing, trays cleaned separately | Small brush between brackets and under the wire, daily |
| First days | Pressure with each new tray | Sore teeth for a few days after fitting and adjustments |
| Appointments | Spaced check-ups, trays changed at home | Wire adjusted usually every 6 to 8 weeks |
| Cases with extractions | They usually do less well | They usually do better |
| After treatment | A retainer is needed | A retainer is needed |
How do you choose between aligners and braces?
Five questions settle most situations. The first two are for the examination; the other three are up to you.
- Does your case need extractions? When teeth have to come out to make room, fixed braces usually do better. For some patients, extractions are the only way to a good long-term result.
- Is the problem in the teeth or in the jaws? Crowding, gaps or a tooth that sticks out are often treated with aligners; a marked mismatch between the upper and lower jaw calls for a thorough examination.
- Will you wear the trays 20 to 22 hours a day? That is the condition for the result. If you know you will forget them at work or when travelling, say so before you start.
- How do hygiene and meals fit your day? The trays come out to eat and brush, which makes cleaning simpler; in return you brush before putting them back in, several times a day.
- What budget, and over how long? The price of aligner treatment varies with the complexity of the case and with whether one arch or both are treated. Ask for a written quote that says what it includes: trays, check-ups, finishing trays, retainer.
Are clear aligners as effective as braces?
It depends on the case. Without extractions, published trials show comparable results for aligners and fixed appliances; with extractions, fixed appliances usually do better. The evidence is still limited: the studies are hard to compare with one another and follow patients for a short time.
Faster, then? Without extractions, studies show no clear difference in treatment length between aligners and fixed appliances. Either way, the length depends first on what needs correcting: in university settings, comprehensive treatment with fixed appliances takes about 20 months on average.
Which hurts less, and which is easier to keep clean?
Both cause some pressure, since the teeth are moving. On average, pain is lower with aligners in the first days; after that, and up to three months into treatment, studies find no difference. These studies covered only one aligner brand and mild cases, though.
With braces, teeth can be sore for a few days after fitting and after adjustments, and soft food helps during that time. With aligners, the pressure comes back with each new tray and usually passes quickly.
The gums are generally healthier during aligner treatment, especially compared with fixed appliances, though published studies urge caution. In practice, aligners come out for brushing, whereas braces are cleaned with a small brush passed between the brackets and under the wire.
Can you switch from braces to aligners mid-treatment?
Dr Babaammi Menoubia has seen this happen. A patient had worn a metal brace for about three months and could not get used to it: it showed a lot, made her self-conscious and rubbed against her cheeks. After a new examination, she was offered aligner treatment, with a new plan.
Changing treatment part way through is possible in some cases, not all. Everything has to be reassessed: where the teeth are now, what is left to correct, and whether trays can do it. A new plan also means a new quote. Comfort matters, but it does not decide on its own.
How do you know what suits your case?
Through an examination in person, not a photo: orthodontic treatment should start only after a clinical examination. The examination, X-rays, photos of the teeth and face, and a scan or impression show what needs to move, by how much and in what order. Only then is a treatment proposed, with its estimated length and its price.
The clear aligners page describes the full course of treatment, and the braces page explains how a fixed appliance works.