Next Level Dentistry patient resource
clear aligner patient information
A balanced guide to clear aligner treatment, benefits, limitations, risks, retention and informed consent.
before starting clear aligners
Clear aligners are orthodontic treatment, not a consumer product. They move teeth, can change the bite and surrounding tissues, and require diagnosis, prescription and professional supervision.
The aligners are appliances made from a clinician-prescribed plan. They do not diagnose the problem or replace clinical judgement.
Treatment success depends heavily on wearing aligners as prescribed and attending reviews when required.
A digital setup helps with planning and communication, but it is not a photograph of the future or a guarantee of tooth movement.
Teeth tend to move after treatment. Retainers, replacement and long-term review are part of the commitment.
resource basis
how this resource was developed
This resource uses the supplied Invisalign informed-consent form as a starting point for the risks and practical issues traditionally disclosed in aligner treatment. It has been expanded and adapted for an Australian patient-information context using current AHPRA and Dental Board principles on informed consent, balanced advertising and acceptable evidence, together with contemporary peer-reviewed reviews of clear aligner treatment.
The source form is dated 2010 and contains US-specific privacy and age provisions. Those provisions have not been adopted into this Australian patient-information resource. Invisalign is one brand of clear aligner; not all systems, materials, software or clinical protocols are equivalent.
Clear aligners move teeth and can change the bite, supporting bone, gums and tooth-root positions. They require diagnosis, prescription and professional supervision.
The resource covers possible benefits, limitations, inconveniences, material risks, alternatives, retention and the option of no treatment.
A digital treatment simulation is a prescription and planning tool, not a guarantee that each tooth will move exactly as displayed.
Read the whole resource before deciding. Mark questions that apply to you and discuss them with your treating dentist or orthodontist.
Understanding clear aligner treatment
01What are clear aligners?
Clear aligners are removable, custom-made orthodontic appliances that apply controlled forces to move teeth in planned stages. You wear a sequence of aligners, with each aligner intended to produce part of the prescribed movement.
The aligners themselves do not diagnose your problem or decide the treatment. Your treating dentist or orthodontist is responsible for the diagnosis, prescription, review of the digital setup, monitoring, clinical decisions and management of complications.
Evidence noteThe supplied manufacturer consent describes aligners as a series of customised removable appliances produced from the clinician's diagnosis and prescription. [4]
02Is Invisalign the same as clear aligner treatment?
Invisalign® is a brand of clear aligner system manufactured by Align Technology. Other clear aligner systems also exist.
Much of the published evidence has studied Invisalign, so findings cannot always be assumed to apply equally to every brand, material, software platform or direct-to-consumer service. Your clinician should explain which system is proposed and why.
Evidence noteRecent reviews note that a large proportion of the published clinical literature involves Invisalign systems. [6,7]
03What problems can clear aligners treat?
In selected patients, aligners may be used to improve crowding, spacing, tooth rotations, overjet, overbite, open bite, crossbite and other dental alignment or bite relationships.
They are generally most predictable for selected mild-to-moderate problems. More complex movements, significant skeletal jaw discrepancies, severely impacted teeth, some extraction cases and certain vertical or root-control movements may require additional appliances, fixed braces, temporary anchorage devices, surgery, specialist referral or a different treatment plan.
Evidence noteAn overview of systematic reviews supports aligners as an alternative for selected mild-to-moderate malocclusions, while outcomes are less predictable in severe cases and for specific movements. [5-7]
04Who may not be suitable for clear aligners?
Clear aligners may be unsuitable, inappropriate or need to be delayed where there is active decay, uncontrolled gum disease, inadequate bone support, poor oral hygiene, untreated infection, unrealistic expectations, inability to wear the aligners consistently, or a problem that is unlikely to respond predictably to aligners alone.
Previous trauma, short or unusual roots, impacted teeth, severe jaw imbalance, significant tooth wear, multiple missing teeth, extensive restorations, implants or complex functional problems may change the treatment options and risks.
Important
A desire for straighter teeth does not establish that clear aligners are the most appropriate or conservative treatment.
05Why is a full examination needed before treatment?
Teeth can look crowded or uneven for many different reasons. Safe planning requires assessment of the teeth, roots, gums, supporting bone, bite, jaw relationship, existing restorations, oral hygiene, medical history and treatment objectives.
Moving teeth without identifying underlying dental or periodontal disease may worsen an existing condition or create an unstable result.
Evidence noteThe Dental Board's shared Code of conduct requires assessment, a suitable management plan, consideration of benefit and harm, treatment options based on the best available information and informed consent. [1]
06Will I need X-rays, photographs or scans?
Appropriate records depend on your age, history and proposed treatment. They may include intraoral and facial photographs, digital scans or impressions, bite records and radiographs where clinically indicated.
Records are used to assess tooth roots, bone, impacted or missing teeth, existing disease, facial and dental relationships and treatment risk. Radiographs are not taken simply because aligners are being considered; they should be justified by clinical need.
07What is the digital treatment simulation?
Aligner software can show a staged digital model of the tooth movements prescribed by the clinician. It is useful for planning, communication and manufacturing.
It is not a photograph of the future and should not be interpreted as a guaranteed outcome. Teeth do not always move exactly as planned. The final result may differ because of biological response, aligner fit, wear time, movement complexity and other patient-specific factors.
Evidence notePublished reviews report that the planned degree of movement is often overestimated; rotation, intrusion and extrusion are among the less predictable movements. [7]
08Who is responsible for the treatment plan?
Your treating dentist or orthodontist is responsible for the diagnosis and clinical prescription. The manufacturer and software assist with planning and appliance production but do not replace the clinician's professional judgment or duty of care.
You should know who is supervising your treatment, how to contact them, how progress will be monitored and what happens if treatment is not tracking as planned.
Evidence noteAlign Technology's responsible-treatment guidance emphasises in-person assessment, clinician review and a direct doctor-patient relationship throughout treatment. [14]
09How many hours a day must I wear the aligners?
Unless your clinician gives different instructions, aligners are commonly prescribed for approximately 20 to 22 hours each day. They are usually removed for eating, drinking anything other than water, brushing and flossing.
Wear time is one of the most important factors you control. Insufficient or inconsistent wear can lead to poor fit, unwanted movement, longer treatment, additional aligners or an incomplete result.
Important
Do not move to the next aligner merely because the calendar says so if the current aligner is not fitting. Contact the practice for advice.
10How often will I change aligners and attend reviews?
The change interval and review schedule are prescribed individually. They may vary during treatment depending on the movement, fit, oral health and use of auxiliaries.
Remote monitoring or an app may supplement care, but it does not remove the need for in-person examination when clinically required.
Potential benefits, limitations and alternatives
11What are the potential benefits of clear aligner treatment?
Where clinically indicated, treatment may improve tooth alignment, space distribution and some bite relationships. This may improve function, make certain areas easier to clean and create space for restorative treatment where required.
Clear aligners are less visually prominent than conventional braces, are removable for eating and oral hygiene, and do not use conventional brackets or archwires.
Digital planning can help patients understand the proposed sequence of treatment. These are potential benefits, not guarantees.
Evidence noteSystematic reviews support effectiveness for selected mild-to-moderate malocclusions. [5,6]
12Are clear aligners better than fixed braces?
Neither option is universally better. The appropriate appliance depends on the diagnosis, movement required, your oral health, lifestyle, ability to comply and clinician experience.
Aligners may offer aesthetic and hygiene advantages and may have a smaller short-term impact on comfort or daily activities for some patients. Fixed appliances may provide more predictable control for certain complex movements and do not depend on the patient remembering to wear them.
Evidence noteComparative reviews report possible advantages for hygiene and early comfort, but evidence quality varies and aligners may be less effective for severe cases or particular movements. [5,8-10]
13Do aligners improve gum health?
Aligners do not treat gum disease. Active gingivitis or periodontitis should be assessed and stabilised before orthodontic movement.
Because aligners are removable, brushing and flossing may be easier than with fixed braces. Some studies report more favourable plaque and gingival indices with aligners, but the benefit depends on excellent hygiene and consistent professional maintenance.
Wearing aligners over unclean teeth, or after sugary or acidic drinks, can trap plaque, sugar and acid against the enamel and gums.
Evidence noteReviews often report favourable periodontal or hygiene measures with aligners, but findings are heterogeneous and certainty is limited. [8,9]
14Will aligner treatment be faster?
Treatment time cannot be promised from the appliance type alone. It depends on the problem being treated, movement complexity, biological response, wear time, missed appointments, lost aligners, refinements and whether additional appliances are required.
Some studies suggest shorter treatment in selected mild-to-moderate non-extraction cases, while other evidence is conflicting. A short estimate should not be interpreted as a guarantee.
Evidence noteThe overview of systematic reviews found conflicting results for treatment duration. [5]
15Will treatment improve my confidence or quality of life?
Some patients value the appearance and removability of aligners and may experience less short-term disruption than with fixed appliances. However, orthodontic treatment cannot guarantee increased confidence, self-esteem, happiness, social advantage or a particular quality-of-life outcome.
Treatment changes tooth position and bite relationships. Psychological or social outcomes are individual and should not be promised.
Evidence noteReviews suggest some short-term oral-health-related quality-of-life advantages over fixed appliances, but effects vary and are not a basis for promising psychological benefit. [10]
16What are the alternatives?
Depending on the diagnosis, alternatives may include no treatment, monitoring, fixed braces, limited orthodontic treatment, expansion appliances, functional appliances, extractions, restorative treatment, periodontal treatment, orthognathic surgery or a staged interdisciplinary plan.
Where tooth position is the underlying problem, moving the teeth may be more conservative than removing healthy tooth structure to make them appear straight. Conversely, aligners should not be used when another treatment is more appropriate or predictable.
You are entitled to understand the advantages, disadvantages, cost, time, limitations and likely maintenance of reasonable alternatives, including no treatment.
Evidence noteThe Dental Board Code requires enough information for informed decisions, including material risks, expected outcomes, costs, alternatives and the patient's right to choose no treatment. [1]
What treatment may involve
17What are attachments?
Attachments are small tooth-coloured shapes bonded temporarily to selected teeth. They help the aligner grip the tooth or deliver particular forces.
Attachments may be visible, may temporarily affect how the bite feels and can stain or wear. They may debond and need replacement. Removing them requires care, particularly from teeth with existing restorations or altered enamel.
18What are buttons and elastics?
Buttons, hooks or elastics may be used to improve bite correction, anchorage or movement that aligners alone cannot reliably produce.
They can be visible, cause irritation and depend on correct patient use. Breakage, loss or inconsistent elastic wear can delay treatment or alter the result.
19What is interproximal reduction (IPR)?
IPR is controlled removal and reshaping of a small amount of enamel between selected teeth to create space, improve tooth-size relationships or reduce black-triangle risk.
IPR is permanent and should only be performed after diagnosis, measurement and informed discussion. The surfaces should be finished and polished, and preventive advice may be recommended.
Potential risks include temporary sensitivity, surface roughness, excess enamel removal, change in tooth shape, increased plaque retention or caries risk if performed or maintained poorly.
Evidence noteClinical reviews have not shown increased caries, periodontal damage or sensitivity after properly performed IPR, but the certainty of evidence is low to very low and the procedure remains irreversible. [12]
20Will I need teeth extracted or surgery?
Most clear aligner cases do not require surgery, but extractions or oral surgery may be recommended for severe crowding, impacted teeth, significant jaw imbalance or other conditions.
In some complex cases aligners may be only one component of treatment. The separate risks of extraction, anaesthesia, surgery or temporary anchorage devices must be discussed if relevant.
21What are refinement aligners?
Refinements are additional aligners prescribed after reassessment or a new scan. They may be needed because some teeth have not tracked, the bite requires further correction, or the original plan needs modification.
Needing refinements does not necessarily mean treatment has failed. It reflects the biological and mechanical limits of predicting tooth movement. Several refinement phases may sometimes be required.
Evidence noteThe gap between planned and achieved movement is well documented, especially for rotation, intrusion, extrusion and some complex corrections. [7]
22Can fixed braces or other appliances become necessary?
Yes. If aligners cannot produce a required movement or the result is not progressing safely, treatment may need buttons, elastics, sectional braces, temporary anchorage, a different appliance, referral or a revised endpoint.
Refusing an indicated adjunct may limit the result or make continuation inappropriate.
23Can restorative dental work be needed?
Alignment may reveal differences in tooth size, shape, wear, colour, gum level or old restorations that were less obvious when the teeth overlapped.
After orthodontics, some patients may benefit from recontouring, bonding, replacement of restorations or periodontal treatment. These procedures are separate treatments with separate costs, risks and consent.
24Will my records be sent to a manufacturer?
Custom aligner manufacture may require your scans, photographs, radiographs, prescription and relevant health information to be provided to the aligner manufacturer and service providers, which may include overseas processing.
The practice should explain how your information is used, stored and shared under its privacy policy. Consent to clinical treatment is separate from consent to use identifiable images for advertising, education or unrelated research.
Evidence noteThe supplied manufacturer form contemplated transfer of records to Align. This document does not adopt its US HIPAA wording or liability waiver; Australian privacy and consent requirements apply. [4]
Risks, side effects and complications
25Will clear aligner treatment hurt?
Pressure, tenderness and altered chewing are common when treatment begins or after changing aligners. The discomfort is usually temporary but varies between patients.
Aligner edges, attachments, buttons or elastics can irritate the lips, cheeks, tongue or gums. Persistent, severe or localised pain should be assessed rather than assumed to be normal.
Evidence noteComparative evidence suggests aligners may cause less pain at some early time points than fixed appliances, but pain still occurs and results vary. [10]
26Can aligners affect speech, saliva or mouth dryness?
A temporary lisp or change in speech may occur, particularly at the beginning of treatment. Most patients adapt, but the time required varies.
Some people experience increased saliva; others experience mouth dryness or irritation. Medications, dehydration and mouth breathing may worsen dryness.
27Can I develop decay, white spots or gum inflammation?
Yes. Aligners can trap plaque, food residue, sugar and acid against the teeth. Decay, white-spot demineralisation, gum inflammation, bad breath and periodontal deterioration can occur if hygiene or dietary control is poor.
Remove aligners for eating and for drinks other than plain water unless specifically instructed otherwise. Clean your teeth before reinserting them and attend recommended preventive and periodontal reviews.
Important
Do not repeatedly sip sugary, acidic or hot drinks while wearing aligners. Hot liquids may distort the plastic; sugar and acid can be held against teeth.
28Can gum recession or 'black triangles' develop?
Alignment can reveal spaces near the gum line where overlapped teeth previously concealed reduced gum fill. These are often called black triangles or open gingival embrasures.
Gum recession or loss of support can also occur or progress, particularly where gum tissue or bone is thin, teeth are moved outside the supporting envelope, inflammation is present or brushing is traumatic.
IPR, tooth-shape modification, periodontal treatment or accepting a limited space may be discussed, but complete closure is not always possible.
29Can the roots of teeth shorten?
Orthodontic tooth movement can cause external apical root resorption, meaning loss of a small amount of root length. It is often minor, but occasionally it may be more significant and can affect long-term tooth prognosis.
Risk varies with root shape, previous trauma, treatment duration, movement distance, force, biology and other factors. Monitoring records may be recommended where risk is higher.
Evidence noteA 2024 systematic review and meta-analysis using CBCT found a small average reduction in root length after comprehensive clear aligner treatment, with greater changes in some incisors. [11]
30Can a tooth lose vitality or need root-canal treatment?
A previously traumatised, heavily restored or compromised tooth may react adversely to orthodontic movement. Rarely, pulpal inflammation, loss of vitality, colour change, root-canal treatment or tooth loss can occur.
Tell your clinician about previous trauma, even if it occurred many years ago, and report spontaneous pain, swelling, colour change or loss of sensation.
31Can existing crowns, veneers, fillings or bridges be affected?
Attachments may not bond reliably to some restorative materials. Crowns, veneers or fillings can loosen, chip, fracture, stain or require replacement during or after treatment.
Tooth movement may alter contacts around bridges or implant crowns. Restorative treatment may be required once the final tooth positions are known.
32Can dental implants move?
Dental implants are fused to the bone and do not move like natural teeth. Natural teeth may be moved around an implant, but the implant position can restrict the treatment plan.
The final bite or appearance may require restorative modification of an implant crown or other teeth.
33Can the bite become worse or feel uneven during treatment?
The bite changes as teeth move. Temporary uneven contacts, difficulty chewing or a sense that the teeth no longer meet normally can occur.
Some patients develop incomplete posterior contacts or an open bite while wearing aligners. Additional movements, elastics, refinements, settling time, occlusal adjustment or other treatment may be required.
A final bite cannot be judged from the digital animation alone.
34Can aligners cause jaw-joint pain, headaches or ear symptoms?
Jaw-joint or muscle symptoms can begin, improve, worsen or remain unchanged during orthodontic treatment. The relationship between orthodontics and temporomandibular disorders is complex.
Clear aligners are not a guaranteed treatment for jaw-joint pain, clenching, headaches or sleep-related problems. New or worsening symptoms should be assessed.
35Can aligners or attachments cause an allergy?
Allergic or sensitivity reactions to aligner materials, bonding agents, latex-containing auxiliaries or cleaning products are uncommon but possible.
Stop use and seek advice promptly if you develop swelling, rash, breathing difficulty, severe burning or persistent ulceration. Breathing difficulty or facial/throat swelling requires urgent medical care.
36Can aligners break, warp or be swallowed?
Aligners may crack, split, distort, stain or lose fit. Heat can warp them. Broken pieces or small orthodontic components can rarely be swallowed or inhaled.
Do not wear a sharp, severely cracked or distorted aligner without advice. Seek urgent medical assistance if there is choking, breathing difficulty or suspected aspiration.
37Can teeth move too far, not enough or in the wrong way?
Yes. Some teeth may not track; anchorage teeth may move unintentionally; a tooth not fully covered may over-erupt; spacing, crowding or the bite may change in an unintended way.
Early identification is one reason reviews and fit checks matter. The plan may need to be paused, revised or supplemented.
38Can aligners damage the gums or supporting bone?
Orthodontic movement places force on the periodontal ligament and bone. Where bone support is reduced, gum disease is active or movement exceeds biological limits, mobility, recession or attachment loss may worsen.
Patients with a history of periodontitis may require co-management with a periodontal practitioner and more frequent maintenance.
39Can medical conditions or medications affect treatment?
Yes. Conditions or medicines that affect bone metabolism, healing, inflammation, salivary flow, immunity or bleeding may alter tooth movement or risk.
Tell your clinician about all diagnoses, medications and supplements, and update them if anything changes. Also disclose pregnancy or planned pregnancy because imaging, gum response and treatment timing may need consideration.
40Are there special risks for younger patients?
Young patients may have erupting teeth, developing roots, changing gum levels and many years of retention ahead. Compliance, maturity, hygiene and parental involvement are important.
An unerupted or partly erupted tooth may not be fully controlled by an aligner. Growth can change the bite after treatment. The patient and parent or guardian should understand the treatment, alternatives, responsibilities and long-term retention.
Retention, responsibilities and informed choice
41What happens if I do not wear the aligners as prescribed?
The aligners may stop fitting, teeth may move unpredictably and treatment may take longer or require new scans and additional aligners.
Repeated non-compliance can make the planned result impossible or unsafe. Your clinician may recommend changing the treatment method or discontinuing treatment.
42What should I do if an aligner is lost or broken?
Contact the practice promptly. Do not guess whether to move forward, go backward or stop wearing aligners. The correct action depends on how long the aligner was worn and how the next or previous aligner fits.
Replacement aligners, new scans or changes to the schedule may involve additional time or cost according to your treatment agreement.
43What if I miss appointments?
Missed reviews can delay identification of poor tracking, decay, gum inflammation, attachment loss or unwanted bite changes.
Continue wearing the current aligner as instructed and contact the practice to reschedule. Do not keep advancing through aligners without review when you have been told an examination is required.
44Will I need retainers?
Yes. Teeth have a lifelong tendency to move. Retainers are needed after active orthodontic treatment to reduce relapse.
Retention may include removable retainers, fixed bonded retainers or both. Retainers can wear, fracture, debond or permit unwanted movement and require ongoing review, replacement and maintenance.
The required schedule is individual; long-term or indefinite night-time wear is commonly recommended.
Evidence noteRelapse is multifactorial and difficult to predict. Retention reduces, but does not eliminate, post-treatment movement. [13]
45Is the final result permanent?
No result can be guaranteed to remain unchanged. Growth, ageing, gum and bone changes, tooth wear, oral habits, loss of teeth, restorations and retainer use can alter alignment and the bite.
Not wearing retainers substantially increases the risk of relapse. Even with retainers, some change can occur.
46What are my responsibilities during treatment?
Treatment is a shared process. Your responsibilities usually include:
- wearing aligners and elastics exactly as prescribed
- changing aligners only when instructed
- keeping teeth, gums and aligners clean
- removing aligners for food and drinks other than plain water unless advised otherwise
- attending appointments and monitoring checks
- reporting poor fit, pain, swelling, breakage, attachment loss or medical changes
- protecting aligners from heat, pets and loss
- wearing retainers after treatment; and
- continuing routine dental and periodontal care
47What costs should I clarify before starting?
Ask what is included in the quoted fee and what may incur additional cost. This may include diagnostic records, refinements, replacement aligners, broken or lost appliances, retainers, fixed auxiliaries, extractions, periodontal treatment, restorative work, specialist referral or treatment extending beyond the original plan.
Financial consent should be documented before treatment where possible.
Evidence noteThe Dental Board Code includes financial consent and discussion of the costs of required services. [1]
48What happens if I choose no treatment?
No treatment is a valid option. The likely consequences depend on the diagnosis. Some conditions may remain stable; others may worsen, contribute to tooth wear, cleaning difficulty, gum trauma, restorative problems or functional concerns.
Choosing no treatment avoids the risks and costs of orthodontics but may also leave the existing problem unchanged. Your clinician should explain the likely natural history where it can reasonably be predicted.
49What should I understand before I consent?
Before starting, you should understand the diagnosis, goals, expected limitations, reasonable alternatives, material risks, likely duration, appliance requirements, retention, fees and what may happen if the plan does not track.
You should have enough time to ask questions, seek a second opinion and decide without pressure. Signing a form does not replace a genuine consent discussion.
Evidence noteUnder the shared Code of conduct, informed consent is a voluntary decision made with knowledge and understanding of benefits and risks; material risks and expected outcomes should be discussed and consent documented appropriately. [1]
risk and evidence context
risk reduction does not remove risk
Risk cannot be eliminated. The measures below may reduce avoidable risk, but they do not guarantee a particular result, timeline, comfort level or final bite.
Accurate diagnosis, realistic movement design, attachments or auxiliaries, regular fit checks and refinements where appropriate.
Wear aligners as prescribed and report gaps, rocking or trays that do not seat fully.
Disease control before treatment, preventive review and hygiene instruction.
Remove aligners for food and drinks, then brush and floss before reinsertion.
Periodontal assessment, biologically realistic tooth movement, maintenance and referral where needed.
Attend maintenance, avoid traumatic brushing and report bleeding or recession.
Risk assessment, appropriate forces and movement, and imaging when clinically indicated.
Attend reviews and disclose prior trauma or relevant dental history.
History, testing, monitoring, conservative movement and referral where needed.
Report pain, swelling, colour change, unusual sensitivity or loss of sensation.
Occlusal planning, monitoring, elastics, refinements, settling or adjustment where clinically appropriate.
Follow wear and elastic instructions and report bite instability early.
An individual retention plan plus review and replacement of retainers.
Wear retainers long term and report breakage, poor fit or loss promptly.
Measurement, controlled reduction, finishing, polishing and preventive care.
Maintain hygiene and attend review appointments.
Material-specific bonding and careful attachment removal.
Avoid picking attachments and report debonding or restoration damage.
A clear replacement protocol and advice on whether to move forward, pause or return to a previous tray.
Keep aligners away from heat and damage, use the case and contact the practice promptly.
contact the practice promptly
- an aligner no longer seats fully or repeatedly lifts away from a tooth;
- an attachment, button, elastic hook, retainer or restoration breaks or comes off;
- pain is severe, localised, spontaneous or persists rather than settling;
- there is swelling, pus, fever, facial swelling or a dental injury;
- a tooth changes colour, becomes very sensitive or loses sensation;
- there is new or worsening gum recession, bleeding, mobility or bite instability;
- an aligner is lost, severely cracked, sharp or distorted;
- you suspect a piece has been inhaled or swallowed; or
- your medical condition, medications or pregnancy status changes.
Call emergency services for breathing difficulty, choking, severe facial or throat swelling or another medical emergency.
evidence notes
The evidence base for clear aligner treatment is developing. Many studies involve selected mild-to-moderate, non-extraction cases and the Invisalign system. Study designs, aligner materials, software, movement protocols and outcome measures vary. Findings about average groups do not predict an individual patient’s result.
The references below are used according to their evidentiary role. Systematic and scoping reviews support general statements about effectiveness, predictability, comfort, periodontal outcomes and adverse effects. The manufacturer’s consent form is used as a source of traditionally disclosed practical risks, not as proof of treatment effectiveness.
questions to ask before you consent
Use this checklist as a starting point for a personalised discussion. A reasonable consent process allows time for questions, alternatives and reflection.
- What is my diagnosis, and which parts are dental versus skeletal?
- What are the objectives of treatment, and what is unlikely to be corrected?
- Why are clear aligners recommended instead of fixed braces or another option?
- Is my gum and bone support healthy enough for tooth movement?
- Are radiographs or other records required, and why?
- Will I need attachments, elastics, IPR, extractions, fixed appliances or surgery?
- Which movements are expected to be less predictable in my case?
- How many hours must I wear the aligners, and what happens if I cannot?
- How will treatment progress be monitored?
- What happens if the teeth do not track or the bite does not finish as planned?
- Are refinements included, and are there limits or additional fees?
- What risks are especially relevant because of my roots, gums, restorations, trauma or medical history?
- What dental or periodontal treatment must be completed before starting?
- What retainers will I need, for how long, and what do replacements cost?
- What are the reasonable alternatives, including no treatment?
- Who is responsible for my care and how do I contact them if a problem occurs?
- What information will be shared with the aligner manufacturer or other service providers?
- Do I understand that the digital simulation and estimated timeline are not guarantees?
Evidence sources and bibliography
- 1. Australian Health Practitioner Regulation Agency and National Boards. Shared Code of conduct. In particular: good care, effective communication, informed consent and financial consent. Current web version accessed July 2026.
- 2. Australian Health Practitioner Regulation Agency and National Boards. Guidelines for advertising a regulated health service. 2020. Current web version accessed July 2026.
- 3. Australian Health Practitioner Regulation Agency and National Boards. Acceptable evidence in health advertising: source, relevance, inclusion, level, quality and strength. Current web version accessed July 2026.
- 4. Align Technology, Inc. Patient's informed consent and agreement regarding Invisalign orthodontic treatment. F16015, Rev B. 2010. Supplied source document. The US-specific HIPAA, liability and age wording has not been adopted in this Australian FAQ.
- 5. Yassir YA, Nabbat SA, McIntyre GT, Bearn DR. Clinical effectiveness of clear aligner treatment compared to fixed appliance treatment: an overview of systematic reviews. Clin Oral Investig. 2022;26:2353-2370. doi:10.1007/s00784-021-04361-1.
- 6. Hartogsohn CR, Sonnesen L. Clear aligner treatment: indications, advantages, and adverse effects – a systematic review. Dent J (Basel). 2025;13(1):40. doi:10.3390/dj13010040.
- 7. Muro MP, Caracciolo ACA, Patel MP, Feres MFN, Roscoe MG. Effectiveness and predictability of treatment with clear orthodontic aligners: a scoping review. Int Orthod. 2023;21(2):100755. doi:10.1016/j.ortho.2023.100755.
- 8. Di Spirito F, D'Ambrosio F, Cannata D, D'Anto V, Giordano F, Martina S. Impact of clear aligners versus fixed appliances on periodontal status of patients undergoing orthodontic treatment: a systematic review of systematic reviews. Healthcare (Basel). 2023;11(9):1340. doi:10.3390/healthcare11091340.
- 9. Llera-Romero AS, Adobes-Martin M, Iranzo-Cortes JE, Montiel-Company JM, Garcovich D. Periodontal health status, oral microbiome, white-spot lesions and oral health-related quality of life – clear aligners versus fixed appliances: a systematic review, meta-analysis and meta-regression. Korean J Orthod. 2023;53(6):374-392. doi:10.4041/kjod22.272.
- 10. Li Q, Du Y, Yang K. Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis. BMC Oral Health. 2023;23:920. doi:10.1186/s12903-023-03681-w.
- 11. Butsabul P, Kanpittaya P, Nantanee R. Root resorption in clear aligner treatment detected by CBCT: a systematic review and meta-analysis. Int Dent J. 2024;74(6):1326-1336. doi:10.1016/j.identj.2024.04.008.
- 12. Gomez-Aguirre JN, Argueta-Figueroa L, Castro-Gutierrez MEM, Torres-Rosas R. Effects of interproximal enamel reduction techniques used for orthodontics: a systematic review. Orthod Craniofac Res. 2022;25(3):304-319. doi:10.1111/ocr.12555.
- 13. Chacon-Moreno A, Ramirez-Mejia MJ, Zorrilla-Mattos AC. Relapse and inadvertent tooth movement post orthodontic treatment in individuals with fixed retainers: a review. Rev Cient Odontol (Lima). 2022;10(3):e116. doi:10.21142/2523-2754-1003-2022-116.
- 14. Align Technology. Responsible clear aligner treatment: questions to consider before starting treatment. Current manufacturer information accessed July 2026.
Publication note: This resource is for general educational purposes and should be read alongside advice from your treating dental practitioner. It does not promise suitability, treatment duration, appearance, comfort, longevity, psychological benefit or any other individual outcome.