Ongoing growth of the global clear aligner market

Federica Cogoni

Dr Kamran Zamanian

Wed. 6. September 2023

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BURNABY, British Columbia, Canada: The global clear aligner market was valued at approximately US$5.2 billion (€4.8 billion) in 2022 and is expected to grow at a double-digit rate in the coming years. This growth is being driven by the advantages and popularity of aligners, the rise of alternative and less expensive options offered by direct-to-consumer (D2C) aligner companies, and the expansion of the market to general dentists.

Invisible, practical, comfortable: The main advantages of aligners

Advertising, teleworking, video meetings and social media play important roles in the beauty economy, driving the belief that the appearance of the face and upper body determines beauty and acceptability to others and encouraging the pursuit of straighter teeth and an attractive smile. Aligners are a proposed solution for treating varying degrees of reverse overjet, cross bite, overbite and open bite.

If their malocclusion permits the choice, patients prefer aligners over fixed appliances because the solution comes with multiple advantages. The obvious one is that they are barely visible compared with fixed appliances. Aligners can be removed when eating or drinking, whereas with fixed appliances patients may have limitations on the type of food that they can eat. Sticky or hard food can be a problem. Their removability also promotes hygiene maintenance and gingival health. Significantly better gingival health has been observed in patients using aligners.¹

Additionally, wearing aligners requires less care by dental professionals. As the tooth movement is pre-planned by the dental professional, dental appointments are simpler and assistance from an orthodontist may not be required during each appointment. In comparison, an orthodontist may need to make appliance adjustments, for example to the archwires, every three to four weeks.

Share of patients using traditional braces and clear aligners in 2019, 2022, and 2023, according to iData Research. (Image: iData Research)

Aligners offer greater treatment comfort. Fixed appliances can irritate the oral tissue, whereas aligners only cause some discomfort when new trays are worn owing to the extra pressure applied. Patients treated with fixed appliances report greater discomfort and consume more analgesics than patients treated with aligners do.² Fear of pain is one of the primary reasons that patients fail to seek orthodontic care, and pain has a negative effect on patient compliance.

The business model adaptation of D2C

Patients may be discouraged by the high cost of aligners. By cutting out in-person dental supervision and monitoring, D2C companies offer treatment for considerably less than the cost of an in-office procedure. Proponents of D2C orthodontics argue that the low cost of D2C aligners makes tooth alignment accessible to a greater number of individuals. However, D2C companies have been criticised for their inability to adequately treat malocclusion. In 2018, the American Dental Association passed a resolution against D2C tooth alignment,³ and the American Association of Orthodontists has publicly cautioned against the practice via a consumer alert and has filed legal complaints with 36 dental boards against SmileDirectClub, the leading D2C aligner company.⁴

In order to regain trust and improve their reputation, D2C companies have changed their business model. Whereas the D2C business model previously involved no visits to a dentist or an orthodontist, it is now common for D2C aligner patients to consult either an orthodontist or a general dentist who is employed by the company for an intra-oral scan. This adaptation to the business model results in higher costs for the patient. Customers will still receive their aligners through the mail.

SmileDirectClub, for example, is introducing the CarePlus aligner offering this year, which offers customers the possibility of consultations with their treating dentist in-person or via the company’s teledentistry platform. This programme targets higher-income customers and offers them a hybrid approach including remote and in-person care. The CarePlus offering was priced at US$3,900 (€3,600) when the pilot programme was launched in the first quarter of this year, and further expansion is planned throughout the year.

IData clear aligner research shows that the market share of D2C aligners is forecast to increase. (Image: iData Research)

Expansion of the aligner market to general dentists

Some orthodontists are sceptical about the efficacy of aligners in treating malocclusion. In some cases, for greater efficacy, patients need to switch from aligners to fixed appliances during the course of treatment. For example, one in six patients switched from aligners to fixed appliances to finish treatment because the aligner treatments could not adequately achieve certain tooth movements or correct common malocclusions.⁵

Aligner companies are therefore expanding their products to general dentists for treatment of mild malocclusions or those requiring less complicated movement. Align Technology continues to increase its presence globally by making its Invisalign products available to more customers in more countries. Among other growth strategies, the company is seeking to enable general dentists, who have access to a larger patient base than orthodontists do, to easily identify potential cases they can treat with the Invisalign system and monitor patient progress while providing high-quality restorative, orthodontic and preventive oral care. Align is accomplishing this strategy by providing training and clinical education to general dentists and by offering digital tools such as iTero scanners.

Conclusion

The aligner market is forecast to grow at a double-digit rate in the coming years, and that growth is expected to be driven by the popularity and practicality of aligners, along with various efforts by companies to expand their market share. Although D2C companies have been criticised for addressing malocclusion inadequately, they are adapting their business model to involve consultations with dental professionals. Considering the sceptical stance taken by some orthodontists towards aligners, treatment providers are planning to expand their businesses to general dentists who have larger patient bases than orthodontists do.

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