Invisalign is a popular orthodontic method using clear, custom-made aligners to gradually shift teeth into their desired positions. Patients often ask if they can begin treatment while they still have active tooth decay. In nearly all cases, cavities must be treated and filled before starting Invisalign. This requirement ensures the treatment progresses predictably, protects the integrity of your teeth, and prevents complications that could delay your timeline.
The Necessity of Restorative Treatment Before Alignment
Invisalign aligners are manufactured to fit the exact three-dimensional shape of your teeth captured during the initial digital scan. The entire treatment plan, which dictates the subtle movements of each tray, relies on this precise anatomical blueprint. A cavity represents missing tooth structure, and the filling procedure restores this lost volume and contour.
If a filling is placed after the scan, the repaired tooth will have a different shape than the one captured in the digital model. This change, even minor, prevents the aligner from seating correctly over the tooth. A poorly fitting aligner cannot apply the programmed pressure, leading to “tracking failure,” where the tooth fails to move as planned.
If a cavity is filled mid-treatment, the change in the tooth’s surface contour immediately compromises the fit of all subsequent aligners. This disruption forces the orthodontist to take a new scan and order an entirely new series of aligners. This process, called a “midcourse correction,” adds significant time and cost to the treatment. Completing all restorative work before the initial scan eliminates this risk of tracking issues and maintains predictability.
Health Risks of Delaying Cavity Treatment
Starting orthodontic treatment with active tooth decay poses risks to long-term oral health. Aligners cover the teeth for up to 22 hours per day, creating a sealed environment that can exacerbate existing problems. Bacteria trapped under the aligner trays accelerate the decay process, causing a small cavity to worsen rapidly.
Decay progression can lead to pain, increased sensitivity, and potentially a dental emergency that requires immediate attention. Once the clear attachments—small, tooth-colored bumps—are bonded to the teeth, accessing the decay for treatment becomes complicated. The presence of these attachments can obstruct the dentist’s view and make it difficult to perform an effective filling.
If the decay deepens into the pulp—the innermost layer of the tooth containing nerves and blood vessels—a simple filling will no longer suffice. This necessitates a root canal or even an extraction, either of which forces an immediate halt to orthodontic treatment. Addressing all decay beforehand ensures a healthy foundation, preventing complications that interrupt planned tooth movement and prolong the timeline.
Essential Pre-Orthodontic Procedures
Treating cavities is one part of the comprehensive preparation phase required before orthodontic movement begins. The process starts with a full dental examination, including X-rays, to identify underlying issues like hidden decay, gum disease, or unstable existing restorations. A professional dental cleaning is mandatory to remove plaque and calculus, ensuring healthy gum tissue and a clean surface for the aligners and attachments.
Other significant dental procedures, such as extracting severely crowded teeth or impacted wisdom teeth, must also be completed before the final digital scan. If a tooth requires a crown or an implant, these procedures should be finished beforehand. This is because they permanently alter the tooth’s shape and position. These steps ensure that the teeth and supporting structures are stable enough to withstand the forces of orthodontic movement.
After any surgical procedure, such as an extraction or a deep filling, a waiting period is necessary to allow the gum tissue to heal completely. Only when the mouth is deemed fully healthy and stable, and all restorative work is complete, will the orthodontist proceed with the digital scan used to fabricate the custom set of aligners. This sequence ensures that the final aligners precisely reflect the anatomy of a healthy and prepared mouth.