Do you know the environmental footprint of aligners?

Can we conceive contemporary society without the use of plastic? We live in the age of plastic. While I am writing this article on the train, I look around me and I can only find things made of plastic: the seats and walls of the train, my cell phone case (that's not true, those who know me know that I don't have one), the coating on the cables, my aligners..... If we eliminate plastic from our lives, we would be "naked", unable to perform daily actions such as brushing our teeth or carrying our food in a tupperware. Think about it for a moment... we don't know how to live without plastic.

Like everything else, we can look for alternatives. If we don't want to use plastic toothbrushes, we have bamboo ones. If we don't want to use a plastic bowl to carry our food, we can use one made of glass. If we don't want to use aligners, we can use braces. However, for many reasons, the alternatives are not always as attractive as the first option.

Present and future of aligners

Clear aligners market has been growing continuously in the last few years, and there is still a lot of room for growth. The most optimistic forecasts estimate a compound annual growth rate of 28.7%. Translated into numbers, this market, valued at $4.56 billion in 2021, is expected to grow exponentially to $44.07 billion by 2030.

The number of invisible orthodontic treatments is clearly going to be higher year by year. We also know that recycling these materials is not easy. Aligners are made of different plastic compounds such as polyesters, polyurethanes, or polypropylenes. On the one hand, as they are considered medical material, aligners cannot be deposited in the traditional containers where we deposit other plastics. To recycle them, we must take them to companies specialized in their processing.

Plastic is a non-biodegradable material that takes a long time to decompose. Specifically, the material used to make aligners is one of the most resistant types of plastic, and can take more than 1000 years to decompose. Paradoxically, aligners are "throw-away" items for us, since we normally change them every one or two weeks.

The management of this waste is not simple. It is not economical to recycle them, nor can we incinerate them because of the large amount of toxic elements they release during combustion. So what can we do?

The principle of resource optimization

If we apply the 4R principle (reduce, reuse, recycle and recover) to clear aligners, we can conclude that the "R" on which we can take action is the first one: Reduce. The easiest way to reduce aligners is to place brackets. However, this option is likely to be a no-go. Assuming that we are going to treat our patients with aligners, we should think of a way to make these treatments as non-polluting as possible.

If we reduce the number of aligners per patient, less plastic will be produced, contributing directly to reducing the environmental footprint of each treatment. It may not be the perfect solution, but it is the part of the process on which we can influence the most. And, from this thought, another question arises: How can we reduce the number of aligners? I am going to give you some tips that I apply on a daily basis?

• Spend more time on treatment planning, sequencing the more complex or less predictable movements appropriately. Every detail counts.
• Reduce the number of refinements with proper case monitoring. Planning is an important part of treatment, but it is not the whole picture. For that reason, clinical check-ups are essential to ensure an adequate treatment progress.
• Use auxiliary elements such as micro-screws, sectional wires or power chains to make those movements that are unpredictable with aligners. A micro-screw in time can save us many aligners and refinements. A micro-screw in time can save us many aligners. And, thinking about the patient, we can skip several months of treatment.

I hope that after reading this article you won't feel guilty every time you recommend invisible orthodontics to your patients. The possibility of offering other people a way to improve their smile in a way that is so comfortable and compatible with their daily lives is enough to continue using clear aligners.

Elbe P, Monisha J, Saja AG. Are clear aligners environment friendly?Am J Orthod Dentofacial Orthop 2022;161:619-20.