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  • Dr. Tanner

Direct to Consumer Aligners—Are they safe and effective?

Direct-to-consumer aligners have gained more and more popularity. SmileDirectClub, Byte, NewSmile, AlignerCo are some of the well-known names in the industry. Most of these companies charge a fee that is 50% to 60% less than orthodontic care in a traditional office setting. In addition, these businesses state that treatment takes 6 months or less, patients are “overseen” by a licensed dentist and they offer a “nighttime only” version of their product (though treatment takes longer—up to 10 months). A quick Internet search shows that most patients are pleased with the service and results they receive. SmileDirectClub’s website has over 61,000 5-star reviews (out of 65,000 reviews) and Byte has a 4.6 rating based on 24,000+ reviews. Pretty enticing for someone seeking a simple and inexpensive way to straighten their teeth!!!



However, there is more to the story . . .


A deeper and more thorough Internet search reveals a truer picture about the safety and efficacy of direct-to-consumer aligners. There have been public warnings and litigation from dentists, orthodontists, the American Association of Orthodontists the American Dental Association, State Dental Boards, Congress, the Food and Drug Administration and the Federal Trade Commission regarding this type of orthodontic care. SmileDirectClub, the first company to offer this product, has been involved in multiple lawsuits since their inception in 2014. In addition, there have been thousands of complaints lodged against SmileDirectClub through the Better Business Bureau—issues ranging from customer service to treatment results. Finally, a search on YouTube brings up an abundance of “horror” stories or bad experiences from patients who used direct-to-consumer aligners and ended up with unsatisfactory results and in some cases, serious dental problems.



Why are direct-to-consumer aligners not a good idea?

  • There is no pretreatment assessment by a dentist as to the health of the teeth and gums prior to the start of the treatment. It is the patient’s responsibility to make sure their mouth is disease free and in optimal condition before starting treatment.

  • There is no radiographic and clinical assessment of the teeth and occlusion by a trained professional which is paramount for the development of an accurate orthodontic treatment plan.

  • Unlocking the occlusion with aligners can sometimes lead to unwanted changes to the bite. This cannot be anticipated through a scan or at home impressions of the teeth but can be discovered with an accurate clinical exam.

  • Direct to consumer aligner companies state that “a dentist or orthodontist supervises treatment”—the truth is that a quick evaluation is done at the initial assessment as to the viability of the case. Thereafter, there is little oversight during orthodontic treatment. Furthermore, if it is a dentist who is responsible for “overseeing” treatment, dentists do not have the same level of training or experience as an orthodontist.

  • Direct to consumer aligner treatment can only correct mild malocclusions (mild crowding and spacing) even though they state that they can correct mild to moderate malocclusions. The more complicated the bite or malaligned the teeth, the less likely treatment will be successful. These systems do not have the sophistication of Invisalign, which is engineered to handle a much greater range of cases.

  • Successful orthodontic treatment requires direct supervision by an orthodontist on a regular basis to ensure proper tooth movement, monitor gingival health, assess TMJ function and make necessary adjustments/corrections throughout treatment. This is not possible with at home orthodontic care.



Candid, one of the former industry leaders in direct-to-consumer aligner therapy, recently made a major course change with their business model after recognizing that teledentistry was not in the best interest of their patients. Here is an excerpt from their CEO, Nick Greenfield:


“It was incredibly difficult to close the DTC business and our Studio doors; but, for us to live out our mission of helping as many people as possible access affordable and efficient care, we need to work in partnership, not in competition, with dental professionals.”


Candid now works directly with dental providers as a hybrid remote/in-office model.


On a final note, I reviewed before and after photos on SmileDirectClub’s website—their “success stories”. I looked at over 100 cases and came to the following assessment on their treatment results:

  • Insufficient leveling of the front teeth

  • Incomplete space closure

  • Teeth not fully aligned

  • Incomplete correction of crossbite(s)

  • Lack of vertical correction of deep bites

  • Insufficient correction of open bites

  • Increase in the “overbite”

  • Teeth moved too quickly



Gambling the health and well-being of your teeth and bite to at home orthodontic care is a risk not worth taking. Straightening teeth should be overseen by a professional—it is a type of medical care and treatment that requires the expertise of an orthodontist.


If you have questions about the benefits of Invisalign treatment, please call Visage Orthodontics to schedule a visit with Dr. Tanner, your Santa Fe Invisalign specialist. Dr. Tanner will review everything in detail and develop a customized treatment plan to fit your lifestyle and budget.


A confident and beautiful smile is right around the corner!

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