How at-home aligner treatment works

At-home aligner treatment runs in stages: an examination and records, a clinician's treatment plan, your consent and order, manufacture and shipping, the first fit, remote monitoring, possible refinements, and retainers at the end. You wear the trays at home, but aligners are prescription devices, and the FDA says it has not authorized aligners sold directly to consumers without a prescription and supervision by a licensed dental professional. The American Association of Orthodontists (AAO) advises an in-person examination and appropriate X-rays before treatment starts.

The journey, stage by stage

Before you order

The AAO gave its examination advice on December 14, 2023, after SmileDirectClub stopped operating, and said the same applies before starting with other mail-order companies. It described an in-person examination and X-rays as critical for a diagnosis and a safe plan. The FDA lists loosening of existing crowns, fillings or implants among the risks, which is one reason the examination matters.

Invisalign's overview says the doctor decides who is suitable. Which problems aligners are often used for is in what clear aligners can and cannot fix, and how a clinic plan differs from a remote one is in Invisalign and at-home aligners. SmileDirectClub and Byte no longer sell aligners.

Records

Some offices scan the teeth; some remote plans mail an impression kit. Both record the teeth so trays can be made. If an impression is inaccurate, trays made from it may not fit, so follow the kit instructions exactly.

A usable mold tells the lab it can make trays. It does not tell you that treatment is suitable.

Your first delivery

• Check the box against your plan: number of trays, upper and lower, and how they are numbered.
• Check each tray for cracks or sharp edges before you wear it.
• Put in the first trays and check they fit fully, with no gaps at the edges. If trays are missing or the first ones do not fit fully, contact the provider before you start.
• Note the hours on your plan. Invisalign tells its patients 20 to 22 hours a day; night plans set shorter schedules, covered in nighttime aligners.
• Put tray-change and photo dates in your calendar.
• Ask your clinician whether to keep each previous tray as a backup.
• Store unused trays in their packaging.

Taking trays out for meals and drinks is covered in eating and drinking with clear aligners, and cleaning in how to clean clear aligners.

Clinical support and customer service

Remote providers usually offer both, and they do different jobs. Customer service handles orders, shipping, payments and account questions. Clinical questions need the prescribing dentist or orthodontist: a tray that does not fit fully, pain that is getting worse, a tooth that feels newly loose, a broken filling or crown, or teeth that look off track in your photos. Before you order, ask how to reach the clinician and how quickly they respond. If a tray does not fit fully, contact the clinician before you change trays or force it.

Photos let a clinician see whether trays appear to fit fully. They do not show roots, bone or gum health, so keep your regular dental checkups.

Refinements

Teeth do not always move as predicted, even when the trays are worn properly. Further trays are sometimes made while teeth are still moving, and terms differ: NewSmile's refund policy says extra aligners may be free if you followed instructions and uploaded photos every two weeks, but also that extra aligners cost more, so get its terms in writing; AlignerCo charges $250 for an approved refinement requested within two to three weeks of finishing. More is in refinement aligners.

Invisalign's overview says some mild cases take as little as six months, and its page on more complex treatment says mild to moderate cases often take 12 to 18 months. Both ranges come from Invisalign; a remote plan needs its own estimate from the prescriber.

After the last aligner

The AAO says you will likely need a retainer for life, even if the hours later drop. What changes once the aligners stop is in care after aligner treatment. What the headline fee often leaves out, including records, extra aligners and retainers, is in what clear aligners cost in the United States. Children and teenagers are covered in aligners and braces for children and teenagers.