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

This treatment case shows how a crossbite in a child can be corrected with clear aligners – without fixed braces.

Anonymized presentation of an actual treatment professionally published by our practice.

Aligners for children – clear, removable trays instead of fixed braces – may sound unusual to many parents at first. Yet even during mixed dentition, certain misalignments can be gently and practically corrected with them. This treatment case shows how we at our practice in Cologne-Rodenkirchen treated an eight-year-old girl with a crossbite – step by step and without any metal brackets.

The Starting Situation

The young patient came to us with an anterior crossbite: one of her upper front teeth bit behind the opposing lower tooth instead of in front of it. The upper jaw was too narrow, and two back molars were rotated. The parents were concerned whether treatment should begin at this age – and if so, whether fixed braces were absolutely necessary. A crossbite is one of the misalignments that should not simply be monitored, as it can affect growth and the bite over time.

Treatment Planning

Instead of a conventional impression, we scanned the dentition digitally – much more comfortable for children, as it eliminates the gag reflex. Based on the 3D scan, we planned the tooth movements on screen and fabricated the clear aligners in our in-house laboratory. Why aligners for a child at all? Because they can be removed for eating and brushing – keeping oral hygiene simple. And because the aligners, through their material thickness on the chewing surfaces, gently open the bite and thereby unlock the crossbite naturally, without requiring additional bite blocks.

The Treatment

Tooth-colored, barely visible attachments – small anchoring points – were bonded to individual teeth so the aligners could grip precisely. Afterward, the girl wore each aligner for about one week, roughly 22 hours a day, and then switched independently to the next one. Compliance was reliable – an important point, as removable aligners only work when they are actually worn. We monitored progress at brief checkup appointments.

The Result

After about 22 weeks – just over five months – the crossbite was corrected, the upper jaw gently widened, and the rotated teeth were aligned, all without fixed braces. The front teeth then stood in a functionally healthy relationship to each other, at a time when growth can still be used particularly well – and the child experienced the treatment as uncomplicated.

Why We Present This Case

Aligners in children are not an off-the-shelf solution — they require careful case selection and reliable cooperation. Dr. Julia Steinmaier has published on aligner orthodontics in children together with professional colleagues; this case is based on exactly this documented experience (see our professional publication Aligner Orthodontics in Children). Frankly: Not every malocclusion in childhood can be resolved with aligners — some require conventional early treatment appliances or later fixed braces, and when compliance is unreliable, a fixed appliance is often the more sensible choice. For you as parents, this means: Whether clear aligners are suitable for your child can only be determined after a thorough examination. We are happy to look at the situation carefully and advise you on all options in pediatric and adolescent orthodontics. How a crossbite generally develops and is treated is explained in our guide Recognizing and treating crossbite.

Frequently asked questions about aligners in children

From what age are aligners possible for children?

Often from elementary school age — in the late primary or early mixed dentition. However, what matters less is age than the type of malocclusion and dental development; clarity comes from an orthodontic examination.

Are clear aligners as effective as fixed braces?

For suitable malocclusions and with reliable wear, yes. For very complex corrections or when cooperation is difficult, fixed braces are often the more reliable solution. What works best in each individual case is something we clarify individually.

Will a child reliably cooperate with removable aligners?

That is the crucial point: aligners only work if worn around 22 hours a day. Many children manage this well, especially because the aligners can be removed for eating and sports. We discuss cooperation honestly with you beforehand.

Does health insurance cover aligners for children?

In cases of medical necessity, statutory health insurance covers orthodontic treatment according to the KIG levels — however, typically with standard appliances, not with aligners. Clear aligners are a private service. We disclose costs transparently.

Does treatment with aligners hurt?

Generally not. At the beginning of each new aligner, a slight feeling of pressure may occur — a sign that the teeth are moving. This usually subsides after one to two days.