Treatment Example: Aligner Treatment for a Child – Gentle Instead of Fixed Braces

A crossbite in a child, corrected with clear aligners instead of fixed braces.

The presentation is anonymized and based on an actual treatment that our practice has published professionally. Every case is different: the treatment approach, duration, and outcome of this individual case cannot be transferred to other patients.

Clear, removable aligners for a child? Many parents are surprised when they first hear this. In fact, some misalignments can be corrected with aligners even during the mixed dentition stage, gently and without disrupting everyday life. At our practice in Cologne-Rodenkirchen, we treated an eight-year-old girl with a crossbite this way. Metal brackets were not needed. Here we describe how the treatment proceeded step by step.

The Initial Situation

The young patient had an anterior crossbite. When biting down, one of her upper front teeth landed behind the opposing lower tooth, not in front of it. In addition, her upper jaw was too narrow and two rear molars were rotated. The parents wondered whether treatment should begin at this age at all, and if so, whether fixed braces were absolutely necessary. With a crossbite, waiting is usually not worthwhile: it can permanently affect growth and the bite.

Treatment Planning

We skipped a traditional impression and digitally scanned the dentition instead. Children find this much more comfortable, as there is no gagging. Based on the 3D scan, we planned the tooth movements on the screen; the clear aligners were then fabricated in our in-house laboratory.

Why did we choose aligners for this child? First, the aligners come out for eating and brushing, so oral hygiene remains simple. Second, their material thickness on the chewing surfaces slightly opens the bite. This immediately disengages the crossbite, and additional bite plates become unnecessary.

The Treatment

First, we bonded small, tooth-colored attachment points to individual teeth, called attachments. They are barely visible and ensure the aligners grip precisely. The girl then wore each aligner for about a week, approximately 22 hours a day, before switching to the next one on her own. Compliance with wearing was reliable. This is crucial, because a removable aligner only moves teeth when it is in the mouth. We monitored progress through brief checkup appointments.

The Result

Just over five months later, after approximately 22 weeks, the crossbite was corrected. The upper jaw had been gently widened, the rotated teeth were in their proper positions, and all without fixed braces. Afterward, the front teeth met in a functionally healthy bite, during a phase when growth can still be optimally utilized. For the child herself, the treatment was straightforward.

Why We Show This Case

Aligners for children are not an off-the-shelf solution. They require careful case selection and reliable cooperation from the child. Dr. Julia Steinmaier has published research on aligner orthodontics in children together with professional colleagues, and this case is based on precisely that documented experience (see our professional publication Aligner Orthodontics in Children).

This also means: Not every misalignment in childhood can be corrected with aligners. Some children need traditional early treatment appliances or later fixed braces. And if the aligners are not worn reliably, a fixed appliance is often the better choice.

Whether clear aligners are suitable for your child can only be determined through a thorough examination. We are happy to take the time to advise you on all options in pediatric and adolescent orthodontics. How a crossbite develops and how it is treated is explained in our guide Recognizing and Treating Crossbite.

Frequently Asked Questions About Aligners for Children

At What Age Are Aligners Possible for Children?

Often as early as elementary school age, in the late primary or early mixed dentition. More important than age, however, are the type of misalignment and how far the dentition has developed. An orthodontic examination provides certainty here.

Are Clear Aligners as Effective as Fixed Braces?

Yes, provided the misalignment is suitable and the aligners are worn reliably. If very complex corrections are needed or cooperation is difficult, fixed braces often lead to the goal more reliably. Which option is better suited is decided on a case-by-case basis.

Will a Child Reliably Cooperate with Removable Aligners?

That is exactly what matters: Aligners can only work if they are worn about 22 hours a day. Many children manage this well, also because the aligners may be removed for eating and sports. Before starting, we speak openly with you about what this means in everyday life.

Does Health Insurance Cover Aligners for Children?

No. If orthodontic treatment is medically necessary, statutory health insurance covers it according to the KIG levels, but only with standard appliances. Aligners are not part of the benefits catalog of statutory health insurance, so clear aligners are always a private service. We present the costs to you transparently in advance.

Does Treatment with Aligners Hurt?

Usually not. When a new aligner is inserted, slight pressure may be noticeable. It shows that the teeth are moving and usually disappears after one to two days.