If the dentist has recommended orthodontic treatment for your child, the big question has probably already arisen: invisible aligners or traditional brackets?

A few years ago, the answer was almost automatic: metal brackets were the most common option for children and teenagers. Today, transparent aligners can successfully treat children with mixed dentition to teenagers with moderate and complex cases.

But what is the best option?

The answer depends on clinical factors — which only a dentist can evaluate — and also on something that parents know better than anyone else: the child’s personality, maturity and lifestyle.

In this article, we compare the two options based on the latest scientific evidence and present a practical guide to help you talk to your orthodontist.

How do the two options work?

Traditional brackets

Traditional brackets are small metal or ceramic pieces glued to the teeth and connected by an arch that the orthodontist adjusts periodically.

As they remain fixed 24 hours a day, they do not depend on the child’s collaboration and offer the doctor very precise control over more complex tooth movements.

Invisible aligners

Invisible aligners (such as Invisalign®) are removable transparent braces, custom-made using a 3D digital scan of the mouth.

They are normally replaced every one or two weeks and must be used between 20 and 22 hours a day, only being removed to eat and perform oral hygiene.

For younger patients there are specific solutions, such as Invisalign First, developed for children between 6 and 10 years old with mixed dentition, and Invisalign Teen, which includes usage indicators and adaptations for teeth still erupting.

What does the scientific evidence say?

Oral hygiene and gum health

Advantage: invisible aligners

This is one of the most consistent differences in the scientific literature.

A systematic review published in 2025 in the journal Children concluded that children and adolescents treated with aligners have better oral hygiene, less gingival inflammation and better periodontal health than those treated with fixed braces.

The main reason is simple: aligners can be removed to brush and floss, while brackets and archwires facilitate the accumulation of bacterial plaque.

One of the most relevant data comes from a study of 450 patients published in the Journal of the World Federation of Orthodontists: white spot lesions (permanent enamel decalcification) occurred in just 1.2% of patients treated with aligners, compared to 25.7% of patients with brackets.

Pain and comfort

Advantage: invisible aligners

Several clinical trials show that, during the first few days after each activation, patients treated with aligners report lower pain levels than patients with fixed braces.

Additionally, because there are no brackets or wires, there is less irritation to the cheeks and gums and fewer emergency visits due to broken parts or loose wires.

Duration of treatment

Advantage: depends on the complexity of the case.

In cases of mild to moderate crowding, some systematic reviews show faster treatments with aligners.

A recent review found an average duration of 8.4 months with aligners versus 12.1 months with brackets in selected cases.

However, in more complex situations this advantage tends to disappear and may even be reversed.

Complex cases

Advantage: traditional brackets

Scientific evidence continues to show that, in severe malocclusions — such as large tooth rotations, the need for extractions or important skeletal discrepancies — brackets offer greater control and predictability of certain movements.

In these cases, the orthodontist may recommend fixed braces or a combined approach. The clinical decision must always prevail over exclusively aesthetic criteria.

Quality of life and self-esteem

Advantage: invisible aligners

A study published in Angle Orthodontist concluded that adolescents treated with Invisalign® have an overall quality of life similar to that of patients with fixed braces, but report fewer limitations in eating, oral hygiene and daily discomfort.

Furthermore, several studies indicate that many teenagers feel more confident when using a practically invisible device, a factor that may be relevant at a stage in life where image is of greater importance.

Side-by-side comparison

How to choose the best option for your child.

The crucial question is simple:

Will your child wear the aligners between 20 and 22 hours a day, every day?

Much of the advantages of aligners depend on patient collaboration.

The good news is that studies show that most teenagers have similar adherence to that of adults. Additionally, systems like Invisalign Teen include usage indicators that help parents and doctors check whether the device is being used correctly.

It is important to remember that this comparison only serves as a starting point for the conversation in consultation. The clinical indication — including the type of malocclusion, growth phase and tooth development — will always be the main decision criterion.

What about younger children? The importance of interceptive orthodontics

Between the ages of 6 and 10, during the mixed dentition phase, some problems such as crossbites, narrow arches or lack of space can benefit from interceptive treatment (Phase 1).

The aim is to guide jaw growth and, in many cases, reduce the need for more complex treatments during adolescence.

Recent studies demonstrate that systems such as Invisalign First can provide predictable arch expansion and excellent results in moderate and even severe cases in this age group.

At this age, the role of parents is essential to ensure the correct use of aligners. The child’s maturity is always part of the clinical assessment.

The sooner certain problems are identified, the greater the chance of correcting them in a simple and less invasive way.

There is no one best solution for everyone.

The scientific evidence is clear on three fundamental aspects:

• Aligners offer important advantages in terms of oral hygiene, comfort and enamel protection.
• Brackets continue to be the best option in certain more complex cases.
• The success of the aligners depends on the collaboration of the child or adolescent.

Therefore, the best decision always results from the combination of a rigorous clinical assessment and the parents’ knowledge of their child’s behavior and lifestyle.

Schedule an orthodontic evaluation.

At SUN Lisboa, we evaluate each child and adolescent using an iTero 3D digital scan, without traditional molds, allowing us to view a simulation of the treatment before it even begins.

We have experience in children’s orthodontics, Invisalign® First, Invisalign® Teen and fixed braces, helping each family find the most appropriate solution for their case.

Book an evaluation appointment or contact us at 213 900 994.

Frequently Asked Questions

What is the ideal age for a first orthodontic consultation?

The Portuguese Society of Orthodontics recommends that the first orthodontic evaluation be carried out around the age of 7, even if it is not yet necessary to start treatment.

Do invisible aligners really work for children?

Yes. There are specific solutions, such as Invisalign First, developed for children with mixed dentition and indicated for various types of malocclusion, always after clinical evaluation.

Do aligners hurt less than braces?

Generally speaking, yes. Studies show that aligners cause less discomfort in the first few days after each change and reduce irritation caused by brackets and wires.

Can my child play sports while wearing aligners?

Yes. Aligners can be removed when necessary and do not present the same risk of trauma as fixed braces in contact sports.

How do I know if my child is a good candidate for aligners?

The answer depends on clinical assessment and the ability to comply with the recommended daily usage time. The orthodontist will indicate the most suitable option for each case.

References

This article was prepared based on systematic reviews and scientific studies published in international orthodontic and dental medicine journals, including:

• The Differential Impact of Clear Aligners and Fixed Orthodontic Appliances on Periodontal Health: A Systematic Review. Children, 2025.
• Buschang PH et al. Incidence of White Spot Lesions During Orthodontic Clear Aligner Therapy. Journal of the World Federation of Orthodontists.
• White Spot Lesions, Plaque Accumulation and Salivary Caries-Associated Bacteria in Clear Aligners Compared to Fixed Orthodontic Treatment: Systematic Review and Meta-analysis. BMC Oral Health, 2023.
• Quality of Life in an Adolescent Orthodontic Population: Invisalign Versus Fixed Appliances. The Angle Orthodontist.
• Treatment Effectiveness of Clear Aligners in Correcting Complicated and Severe Malocclusion Cases Compared to Fixed Orthodontic Appliances: A Systematic Review. Cureus, 2023.
• Effects of Clear Aligner Treatment in Growing Patients: A Systematic Review. Frontiers in Oral Health, 2024.
• Interceptive Treatment with Invisalign® First in Moderate and Severe Cases: A Case Series. Children, 2022.
• Duration of Orthodontic Treatment with Clear Aligners Versus Fixed Appliances in Crowding Cases: A Systematic Review, 2024.