If you’ve been thinking about straightening your teeth, you’ve likely heard of Invisalign. Invisalign works well for many patients, but not everyone is an Invisalign candidate. About 30 to 40 percent of orthodontic patients aren’t candidates for clear aligners alone.
Dr. Joseph Catanzano at Foxhall Smiles has practiced in Washington, DC, for over 20 years. With his training in periodontics, he evaluates your gums, your bite, and your airway before recommending clear aligner treatment.
Here’s why some patients aren’t candidates for Invisalign in our Washington, DC office, and what you can do instead.
Active Gum Disease Makes Invisalign Unsafe
Invisalign is contraindicated for patients with active gum disease. That means if your gums are currently infected and inflamed, you can’t start aligner treatment.
Why? Moving teeth through inflamed gum tissue can accelerate bone loss. The teeth need healthy support to move safely.
Dr. Catanzano’s periodontal training means he can accurately diagnose gum disease. He’ll check for bleeding, pocket depths, and bone loss. If he finds active disease, he’ll recommend periodontal therapy first.
The good news is that gum disease is treatable. Once we treat the infection and you keep up with regular cleanings, aligners can still work for you.
Untreated Cavities Need to Be Fixed First
You might think a small cavity won’t affect aligner treatment, but aligners fit tightly over your teeth. If a tooth has an untreated cavity, the aligner can trap bacteria and sugar against the tooth surface. That makes decay worse.
Before starting Invisalign, Dr. Catanzano will examine your teeth and take digital X-rays. Any cavities need fillings first. Once your teeth are healthy, you can begin aligner treatment.
Severe Crowding or Bite Problems May Need Braces
Invisalign works best for mild to moderate crowding and spacing. Research shows clear aligners achieve good results for about 70 to 85 percent of patients with mild crowding.
For severe cases, traditional braces often work better. When crowding requires more than 10 mm of space, aligners might achieve goals only 60 to 70 percent of the time. Severe bite problems sometimes need the precise control that brackets and wires provide.
Dr. Catanzano will evaluate your bite and tell you honestly whether aligners can handle your case. If braces would give you a better result, he’ll say so.
Poor Compliance History Is a Red Flag
Invisalign only works if you wear the aligners. You need to wear them 20 to 22 hours a day and only remove aligners to eat, drink anything other than water, and brush.
Studies show compliance drops over time. About 60 to 70 percent of patients maintain good compliance in the first six months. By month 12, that drops to about 50 to 60 percent. By month 18, only 40 to 50 percent still wear them as directed.
If you know you struggle with consistency, braces might be a better fit. Braces stay on your teeth 24/7 and work regardless of your compliance.
Existing Dental Work Can Complicate Treatment
If you have crowns, bridges, or dental implants, Invisalign may still be possible, but it requires careful planning.
Crowns can move with the tooth underneath. Bridges are trickier because they connect multiple teeth. Implants can’t move at all, so treatment planning must account for these fixed points.
Dr. Catanzano’s restorative dentistry expertise means he understands how restorations interact with tooth movement. He can evaluate whether your existing dental work is stable enough for aligner treatment and plan around any limitations.
What to Do if You’re Not an Invisalign Candidate
If you aren’t an Invisalign candidate right now, you’re not stuck. Here are your options:
- Treat dental problems first: If you have gum disease, start with periodontal therapy. If you have cavities, fillings come first. Once your mouth is healthy, you can revisit Invisalign. Many patients become candidates after treatment.
- Consider traditional braces: Braces can handle complex cases that aligners can’t. Modern metal braces are smaller and more comfortable than older versions. Clear ceramic braces offer a less noticeable option. Lingual braces sit behind your teeth.
- Explore cosmetic alternatives: If you want a better smile but don’t need major tooth movement, you can benefit from cosmetic dentistry. Veneers can cover chips, stains, and minor misalignment. Bonding can reshape teeth and close small gaps. These treatments don’t move teeth, but they can improve appearance quickly.
- Ask about combination treatment: Sometimes the best approach combines treatments. You might need braces for the complex movements and aligners for the finishing touches. You might also need periodontal treatment alongside orthodontics. Dr. Catanzano’s comprehensive approach lets him coordinate care for the best result.
Schedule Your Invisalign Evaluation
If you’ve been told you’re not an Invisalign candidate somewhere else, we’d like to take a second look. With some pretreatment, clear aligners could be right for you.
Call Foxhall Smiles at 202-315-2188 or request an appointment online. Dr. Catanzano and his team will help you find the right path to a smile you love.