What is Invisalign First?
Invisalign First is an early orthodontic treatment (Phase 1) approach using removable clear aligners, carried out while a child has both baby teeth and newly erupting permanent teeth. The aligners are designed to leave room for erupting teeth and to fit the different shapes and sizes of baby teeth.
The aim of early treatment is usually not to bring every tooth to its “final” position, but to guide jaw development favourably, prepare space for the permanent teeth and reduce problems that could become more complex in later years.
When may it be considered?
- Narrow upper jaw and palate: Controlled expansion of the dental arch
- Crowding and lack of space: Gaining room for the permanent teeth to erupt
- Gaps between the front teeth: Arranging the gaps where appropriate
- Anterior crossbite: Correcting a reversed bite on one or a few teeth
- Forward-tilted upper front teeth: Correction aimed at reducing the risk of fracture in falls and knocks
For marked skeletal problems (for example a severely retruded lower or upper jaw), functional appliances, a face mask or fixed expansion appliances may be more suitable. The choice of method is made after the examination and X-ray assessment.
Why ages 6–10?
At these ages the jawbones are still growing, and guiding growth is easier than in adults. Also, since the first permanent molars and front incisors have erupted, the bite relationship and space problems can be assessed more clearly. This is why international orthodontic organisations recommend a first orthodontic check-up at around age 7. A first check-up does not always mean starting treatment; for most children, monitoring is all that is done.
How does the process work?
- Examination and records: Clinical examination, necessary X-rays, photos and an intraoral 3D scan
- Digital planning: Planning the tooth movements and the amount of expansion on the computer
- Aligner fitting: Training in wearing, putting in, taking out and cleaning; small attachments bonded to the teeth if needed
- Check-ups: Monitoring aligner fit, tooth movements and erupting teeth
- After Phase 1: Maintaining the result and monitoring until the permanent dentition is complete
Phase 1 treatment lasts around 12–18 months for most children; the length depends on the type of problem and how consistently the child wears the aligners.
The parents' role
Much of the success of treatment in children depends on regular wear. The aligners need to be worn 20–22 hours a day and taken out only for eating and brushing. The main tasks for parents are:
- Keeping track of wear time and making sure the aligners go back in after meals at school
- Following the aligner change schedule
- Helping the child with brushing and cleaning the aligners
- Making sure sugary and acidic drinks are not consumed with the aligners in
- Not missing check-up appointments
Will a second treatment be needed later?
Early treatment can resolve or reduce some problems; however, once all the permanent teeth have erupted (usually after ages 11–13), a second phase (Phase 2) may be needed to fine-tune the final positions of the teeth. The need for and scope of Phase 2 are assessed based on the situation at the end of Phase 1.
How to choose between Invisalign First and a fixed appliance?
| Feature | Clear aligners (Invisalign First) | Fixed expansion appliance |
|---|---|---|
| Removability | Taken out for eating and brushing | Stays in the mouth until removed by the orthodontist |
| Dependence on wear | High; needs the cooperation of the child and family | Lower, since it is always in the mouth |
| Hygiene | Teeth can be brushed normally | Extra cleaning needed around the appliance |
| Skeletal expansion | Limited; mainly expansion of the dental arch | Skeletal expansion possible by opening the palatal suture |
Which method is suitable depends on the amount of narrowing in the jaw, the child's age and cooperation.