Orthodontics
Clear aligners in Varna
Tradition looking forward.
Aligners are a series of clear trays that move teeth in small increments. In the right cases they work predictably and faster than fixed braces. In the wrong cases they do not work well, and that is worth saying before you start.
Tooth position is not only an aesthetic matter
Crowded teeth trap plaque where a brush cannot reach and create sites with a persistent risk of decay and gum inflammation. Uneven contact during biting loads some teeth more than others, which shows up over time as wear, cracks and sensitivity.
That does not mean every deviation needs treatment. A large share of mild irregularity carries no risk and needs no intervention. The purpose of the examination is to separate a genuine functional problem from an aesthetic preference, and to tell you which of the two we are looking at.
What the evidence shows, including the inconvenient part
A systematic review comparing aligners with fixed appliances reports a weighted mean difference of minus 6.31 months in treatment duration in favour of aligners (95% CI minus 8.37 to minus 4.24). That is a real advantage for adults who do not want eighteen months of visible metal.
The same body of evidence also shows the other side: aligners are less effective than fixed appliances at achieving adequate occlusal contacts, at controlling root torque and at maintaining the result. The evidence supports their use for mild to moderate malocclusion in non-growing patients who do not require extractions.
So the first question at your consultation is not which aligner brand you prefer, but whether your case sits inside that frame. If it does not, we will say so and refer you to an orthodontist working with fixed appliances rather than stretching the method beyond what it does well.
Retention is part of the treatment, not an add-on
Teeth want to move back. A Cochrane review of 47 randomised trials found low to very low certainty evidence and reached no firm conclusion that any one retention approach is superior to another.
Relapse also continues in the long term. In one 20-year follow-up, only 10% of cases had clinically acceptable alignment of the lower front teeth at twenty years. We therefore plan retention from day one and tell you plainly that wearing a retainer is a long-term commitment, not a six-month formality.
Tradition looking forward.
Who runs the treatment
Aligner treatment is planned and delivered by Dr Damyan Karadjov. The practical advantage here is that the aesthetic result is planned alongside the restorative work: sometimes alignment removes the need for veneers altogether, and sometimes a small amount of bonding afterwards achieves what aligners on their own cannot.
The plan is built digitally from an intraoral scan. You see a simulation of the movement before we begin, and you receive the duration, the number of trays and the price in writing.
Stages of treatment
How treatment runs
Usually 6 to 18 months depending on the case, with reviews every 6 to 10 weeks.
Examination and case assessment
Consultation, clinical examination, photographs and X-rays. This stage decides whether aligners are the right method, not merely whether they are possible.
Digital plan
Intraoral scan and step-by-step movement planning. You see the simulation, the timeline and the price before anything is ordered.
Fabrication and start
Trays are produced to the plan. Small tooth-coloured attachments are bonded where they are needed to allow controlled movement.
Wear and reviews
Trays are worn 20 to 22 hours a day and changed on schedule. Reviews check that real movement matches the plan and catch any drift early.
Finishing and retention
Final refinements, light contouring where indicated, and fitting of a retainer. Retention begins the day the last tray comes out.
What the evidence shows
−6.3
months shorter treatment with aligners than fixed braces
Systematic review of 8 comparative studies: weighted mean difference −6.31 months (95% CI −8.37 to −4.24). The same body of evidence shows aligners are less effective than fixed appliances at producing adequate occlusal contacts, controlling torque and maintaining the result. The evidence supports aligners for mild to moderate malocclusion without extractions.
Sources
Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health 2019;19:24. (opens in a new window) · Rossini G, et al. Efficacy of clear aligners in controlling orthodontic tooth movement: a systematic review. Angle Orthod 2015;85(5):881–889. (opens in a new window)
Who this is for
Who this suits
- Mild to moderate crowding or spacing
- Adults whose growth is complete
- Cases that do not require extractions
- Patients who will realistically wear trays 20 to 22 hours a day
Good to know
- Severe malocclusion or significant skeletal discrepancy
- Cases requiring extractions and large root movements
- Untreated gum disease or active decay before starting
- Circumstances where consistent wear is not achievable
Good to know
Limitations you should know
Aligners only work while they are in the mouth. Below roughly 20 hours a day, movement falls behind the plan and treatment either extends or stops following the simulation. This is by far the most common reason for a disappointing result.
Compared with fixed appliances, aligners give weaker control over occlusal contacts and root torque. In a proportion of cases the finish requires fixed appliances, or acceptance of a compromise that we discuss with you in advance rather than at the end.
Expect a temporary lisp in the first days, sensitivity on changing trays, and mild irritation from attachments. Some relapse is expected without retention, and long-term data show gradual change even with it.
Alternatives
Alternatives
Fixed braces
Better control for complex movements and extraction cases. Longer average treatment time and visible appliances.
Composite bonding
For very minor discrepancies, bonding can produce the desired shape in a single visit without moving teeth.
Ceramic veneers
Change shape and shade but do not correct a functional problem, and require removal of enamel.
Monitoring
Where alignment is stable, symptom-free and carries no risk, choosing no treatment is a valid decision.
Meet the dentist
Dr Damyan Karadjov
Doctor of Dental Medicine · Prosthetic and Aesthetic Dentistry
Prosthetic and aesthetic dentistry: digital smile design, veneers, crowns, implants, aligners, bonding. Consultations in English, French and Russian.
- DMD, Medical University of Varna
- Leads the clinic since 2022
- Prof. Giovanni Zucchelli: mucogingival aesthetic surgery, soft tissue around implants, 2021
- Dr Mauro Fradeani and Dr Leonardo Bacherini: aesthetic rehabilitation with ceramic veneers, 2020
- Prof. Gianluca Plotino: endodontics, 2019
Frequently asked questions
Frequently asked questions
A systematic review reports a weighted mean difference of minus 6.31 months in treatment duration in favour of aligners (95% CI minus 8.37 to minus 4.24). That applies to cases where aligners are an appropriate method, meaning mild to moderate malocclusion in non-growing patients without extractions. For complex cases the comparison does not favour them.
Yes, and we say it before you commit. Clinical evidence shows aligners are less effective than fixed appliances at achieving adequate occlusal contacts, at controlling root torque and at maintaining the result over time. That is why selecting the right case matters far more than choosing between aligner brands.
Between 20 and 22 hours a day, removing them only to eat and to clean your teeth. Below that, movement falls behind the plan and treatment lengthens. If you already know that this routine is unrealistic for your work or travel, tell us at the consultation and we will discuss a different approach.
Some change over time is expected. A Cochrane review of 47 randomised trials found low to very low certainty evidence and no firm conclusion that any retention approach is superior. In one 20-year follow-up only 10% of cases had clinically acceptable lower front tooth alignment. Retention is a long-term commitment.
The price depends on the number of trays, the duration and the complexity of the case, so we do not publish a headline figure that later changes. You receive the exact amount in writing after examination and digital planning, before anything is ordered.
Yes, and the sequence matters. We usually align first, then whiten, then carry out any restorative work last, on teeth that are already in the right position. Sometimes alignment removes the need for veneers entirely, which is one reason we start with diagnosis rather than with a quotation.
The evidence supports aligners in non-growing patients. In growing patients the judgement is individual and depends on the type of discrepancy and on the level of cooperation. For many of those cases fixed appliances with an orthodontist are the more predictable route, and we will tell you that directly.
Related treatments
Discover the smile that suits you
Discover the smile that suits you.
Book a consultation with a digital scan. We will tell you whether aligners suit your case, how long treatment will take and what it costs, in writing.
We reply within one working day.