Chris McConnell breaks down everything you need to know about clear aligners in 2026, from common problems to hidden truths.
Do you do clear aligners? If you do, have you ever had problems such as tracking issues – especially with upper laterals, premolars or canines? Or needing more than one revision set? Or difficulty with deep bites etc? If so, chances are that you may have mistakenly overused or wrongly positioned attachments, had incorrect wear times, used wrong aligner material, had failed patient compliance, excessive torque, insufficient IPR, the list goes on.
I am a general dental practitioner (GDP) and like most of my colleagues provide clear aligners to my patients and have been for the last 22 years. During this time, I’ve seen clear aligner therapy (CAT) explode, and with it an explosion of choice from companies entering the market. There has also been many positive changes in aligner design, attitudes and protocols as technology and materials improve.
What is changing in the demand for clear aligners?
One of the things I’ve noticed change most over the last 22 years however is the commercial narrative, which seems to focus on how quick, how cheap and how few aligners are needed for each case. This is because the CAT market is massive at +£230 million a year in the UK alone and, with public demand increasing, growth of the CAT market is expected to exceed £1 billion by 2030. No wonder everyone wants a slice.
However, with the rise in demand there is a rise in competition. Whether this is clinician to patient, or company to clinician. With the growing focus on the commercial aspect, and the rise of social media we seem to have been directed away from the core principles of CAT. Whether this is intentional to sell product or accidental to compete in a busy market. The fundamental point is that if we misunderstand the core principles of CAT, it will impact upon our treatment outcomes, patient compliance, revision requirements and success. We all want to get it right – right?
A deep dive into clear aligners
It was not until 2020 that I decided to do a deep dive into CAT for the GDP. Looking specifically at research on the biology of tooth movement, biological complications, orthodontic osteogenesis/angiogenesis, torque strengths, aligner designs, aligner materials, wear times, compliance etc. I did this because at the time felt the narrative from companies and social media was too pressured into more, fast, cheap. I was seeing issues outlined above such as tracking, prolonged treatment times and multiple revision sets. Something was wrong somewhere.
What I found was enlightening and completely changed the way that our practice now provides clear aligners. There were a number of key facts and almost hidden truths that are essential for us to be aware of, that differed from the commercial narrative. Especially with respect to wear time, attachments, compliance, aligner design and torque.
So, what did I find? Well to try and cover what the research says in 700 or so words is impossible, but the short answer is the research does not lie. Interestingly the research contradicts many of the commercial narratives.
Hidden truths
To try and raise awareness of the questions we need to ask, and the points we need to action, I have summarised my findings in a free to access video looking at the hidden truths of clear aligner therapy.
What this video covers is that wear times must be nearer two weeks per aligner. Attachment position, not number, is critical. Understanding orthodontic osteogenesis and mechanics of movement is the key. Aligner design and material choice can make you or break you. And that 70% of patients do not comply with wear times, with 17.5% of patients wearing their aligners for less than six hours a day.
If you would like to watch the free to access video, please follow the link below.
And for our clear aligner treatments, lets slow down, think smart and try to cancel out that commercial noise.
This article is sponsored by Straumann.
