Hi Liz,
Please note, my answer here only reflects some of the innovations at our office which may not be part of what invisalign teaches nor may be known to any other doctors unless if they have met me when discussing such possibilities:
You may be using elastics for many different reasons: You may be using them to extrude a tooth (pull the tooth away from gum and bone into the aligners) or rotate a tooth or correct a class II or class III bite with elastics and buttons.
In all cases, we are able to place the elastics lingualy inside the teeth with various innovative techniques and/or use different elastic than what is commonly used with invisalign to stretch and hide the elastic so it’s not visible!
Keep in mind, if you are using elastic to correct a bite from upper teeth to lower teeth, it may be harder for your doctor to place the buttons on the inside and a bit harder for you to hook the elastics. We have done this before to accommodate our models, actors, actress patients and business people who had to always speak in front of an audience.
Furthermore in some cases, direction of proper force may be changed or may not be that ideal. For example in a class II bite which is also in cross bite, it may be best to have buttons and elastics start on the inside of the upper front teeth and end up on the outside of the lower back teeth. Various other combinations may be needed as well depending on the specific situation.
If you are using elastic to pull teeth into the aligner, its best to use a thin clear elastic and pull it as much as possible to make it disappear. Commonly this is not possible since invisalign providers are taught to use the aligner edge only as a hook. With this method, if you pull the elastic too hard, it will bend the plastic hook! Instead we use a resin button and a tiny hole in the aligner to overcome this issue. Patients can now stretch the elastic as much as possible without breaking anything which helps make the elastic invisible and yet the force stronger!
Note: Aligners need to be manually cut by your invisalign provider where buttons go or a button cut out needs to be programmed on clincheck computer model before aligners are ordered.
Without knowing your case and without showing specific images of our technique, this answer may be a bit confusing for doctors and patients alike but I will be happy to explain further if anyone needs more info.
***Online Answers should NEVER be substituted for a complete clinical exam and following advice of your treating doctors based on proper and full diagnosis and treatment planning. There is no way anyone can properly diagnose and treatment plan a patient online without an in office exam.