Clear Aligners: A plastic economic bubble

Updated: Jun 16

We are in conflict with the principle of our economic model: grow or die!

Should we recycle clear aligners or reduce plastic consumption?

Many of us get bored after a split second of participating in a discussion about climate change or saving the oceans. And sometimes we console ourselves that somehow everything will work out. Climate change and wildlife endangerment are progressing faster than you can imagine. According to the Economic World Forum, every minute a truck dumps an entire load of plastic into the ocean. That will be about five to seven trucks by the time you read my article to the end. At least that's if you don't close your browser tab first 🙂 .

In the 1980s, sales of plastic bottles boomed with technological advances in the production of PET (polyethylene terephthalate). Since then, plastic has been popular in all industries for one simple reason: it is cheap, easy to produce and uncomplicated to transport.

Only 14% of the plastic ever produced was collected and only 5% recycled.

Waste management facilities vary widely around the world. Despite the highly developed infrastructure in countries, such as the Netherlands or Japan, the amount of plastic production waste, has far exceeded the capacity of recycling facilities. For example, China used to take plastic waste from other countries. Now, even in China, there is much more plastic waste than there are opportunities to recycle it. So what do we do? Throw it away or burn it!

Did you know that less than 20% of the plastic currently produced can be recycled? And, that only 9% is actually recycled?

Do you know where the remaining 91% goes?

Yes, so far simply to landfills, oceans, or they are incinerated.

The marketing of recycling may be done out of good will, but there is also a certain ignorance that can be seen. An ignorance that lies in the contemplation and lack of understanding of the actual situation.

The only solution is to stop the main cause and minimize the use of plastic. We need to find alternatives.

However, for many companies, finding alternatives for plastic doesn't really seem plausible. After all, business has been going very well for them so far.

I work in the field of dental correction. In modern orthodontics, we use so-called clear aligners to correct malocclusions. These are clear plastic aligners whose main chemical component is mostly PET, PETG or TPU. This material is classified as medical grade I.

We also use mostly thermosetting plastics with high cross-linking in the production of 3D printed dental models. These are petroleum-based polymers that release a wide variety of nanoplastics.

Our patients receive several plastic aligners, each of which is worn for a week or two. All' of these used aligners are then thrown in the trash with no hope of recycling.

The plastics used in this industry not only impact climate change, the oceans and animals, but also our health. Overall, all indications are that the economic costs of climate change are significant and will actually increase over time.

I found this very discouraging, and after a bit of research, I approached two plastic manufacturers from Germany. I wanted to know why the plastic aligners could not be recycled.

The answers were shocking to me, as neither company seemed to even bother to answer. One CEO said he takes no responsibility for recycling unused plastic. Not even if a lab wants to send back unused plastic for recycling.

But what about the aligners used? Answer: "We can't recycle custom medical devices and we don't take responsibility for them!" The word responsibility was mentioned twice.

I remember a colleague of mine, Amanda Wilson, raising the issue on LinkedIn and asking for help. She was looking for solutions to the plastics recycling dilemma. The Align Tech LinkedIn account took the initiative and responded as follows:

"Thank you for your question. We know that the issue of sustainability is very close to a doctor's heart and we are committed to it as well. 90% of the material we consume (100% of the SLA models and 80% of the polymer we purchase) does not go to landfill, but is used by a cement company, for clean energy, for their production. We also recently launched an aligner disposal pilot in the U.S. to learn from our customers and their patients if they are willing to return used or unused aligners to Align Technology. We are also in discussions with our manufacturing partners about aligner recycling opportunities. We will keep our community informed and updated on our progress in this area."

It's good if you try and analyze. But if you are an industry giant, just trying is not enough. Your obligation as a bandwagon of a market is to change and drive the market for the better!

Nonetheless, I have some comments on the listed statement from Align Tech. The company has not found a way to recycle used aligners, nor does it strive to reduce plastic waste. On the contrary, for five years they make as many aligners as the customer wants. This means that you can always continue to order refinements or more aligners if you are not satisfied with the treatment results. Based on five years and a wearing time per aligner of one week, this means that there is a possibility that some patients will receive 520 aligners if there have been some corrections and adjustments to the treatment plan during the course of treatment!

However, I trust the company to have found a solution to 50% of the plastic problem.

Since recycling plastic, due to the large quantities is still far from being an adequate solution, and the time frame we have to more drastic environmental consequences is very short, we are still left with a solution: we need to curb the use of plastic and find alternatives!

Recycling plastic alone is no longer a sufficient alternative. So far, I have only addressed the physical problem of plastic. What about the health effects of plastics?

Many scientists have researched the effects of plastic in the ocean and also in our food. The results have been frightening.

There is far too much microplastic in our planet's oceans. A 2015 study estimated that there were between 93,000 and 236,000 tons of microplastics in the world's oceans. They found traces of microplastics in most of the seafood we eat!

Even the food or drink you get in a plastic container contains traces of micro or nano plastics that go directly into your gut. The nanoplastics could even penetrate cell membranes and cause cell destruction or mutation.

So let's think before we throw plastic dental trays into the ocean or landfills. Clear plastic aligners are worn nearly 21 hours a day. Fluctuating temperatures, saliva flow, bacteria and the force of the bite all present difficult conditions for the plastic.

Do you think patients who wear clear aligners to straighten their teeth also have nanoplastic traces in their bodies? And can that have health effects?

These questions remain unanswered. In this direction, why have no studies been conducted to compare nanoplastic concentration in blood or stool before treatment and during treatment? Basically, it is a conflict of interest for all service providers.


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