That $1,500 Online Aligner Deal Could Cost You $15,000 in 2026: How SMILE-FX® Fixes It

Should you buy aligners online or trust a South Florida orthodontist

I see it every week. Someone walks into our Miramar studio frustrated, sometimes scared, after a mail-order aligner experience went sideways. Their teeth hurt. Their bite feels off. And they paid for the privilege. If you are sitting on the fence right now wondering whether to click "order" on a direct-to-consumer aligner kit or drive to a real specialist, let me save you the heartache I have spent years fixing.

The real question nobody asks before ordering aligners online

Direct Answer: Mail-order aligners skip the diagnostic steps that prevent irreversible damage to your bite, jaw joints, and gum health. A board-certified orthodontist uses 3D CBCT imaging and in-person examination to catch hidden problems before moving teeth, while online companies rely on impressions or photos alone.

Moving teeth is not like brightening them with a strip.

Teeth are anchored in bone.

Bone surrounds nerves, airways, and jaw joints.

When you shift teeth without checking what lies beneath, you are gambling with structures you use every time you chew, breathe, and speak.

At SMILE-FX® Orthodontics & Clear Aligner Studio, I personally review every single CBCT scan before a tooth moves a millimeter. That is not a sales pitch. That is how you avoid turning a $1,500 online "deal" into a $15,000 surgical reconstruction.

Learn more about what board certification actually means for your safety.

What online aligner ads conveniently leave out

Direct Answer: No in-person exam means no screening for cavities, gum disease, bone loss, or jaw pathology. No CBCT means no airway assessment. And limited doctor oversight means complications often go undetected until symptoms become severe.

Here is the short list of what gets missed when nobody looks inside your mouth before treatment:

• Active gum disease that accelerates bone loss under orthodontic force
• Undiagnosed cavities that blow up into root canals once aligners trap bacteria
• TMJ dysfunction that turns a cosmetic fix into chronic jaw pain
• Airway restrictions that worsen when arches are narrowed by poor treatment planning
• Root resorption risk that no telehealth app can predict without 3D imaging

I have retreated enough of these cases to tell you plainly: the convenience is not worth the downside.

See how our in-house 3D imaging and AI treatment planning catches what remote companies miss.

The public record tells a story worth reading

Direct Answer: Multiple mail-order aligner brands have faced consumer protection investigations, regulatory actions, and extensive complaint records citing billing disputes, treatment interruptions, and clinical harm. These are publicly documented patterns, not isolated anecdotes.

I am not here to name names.

You can search complaint databases yourself.

What matters is the pattern: patients mid-treatment when the company restructures or folds. Patients still getting charged after services stop. Patients asked to sign confidentiality agreements just to get a partial refund.

That is not healthcare. That is a transaction dressed up to look like healthcare.

Clear aligners are medical devices that move living tissue. They demand expertise and continuous clinical oversight. Period.

Read real patient stories from people who switched to specialist care after online treatment failed.

Side-by-side: what you actually get with each path

Direct Answer: Online aligner companies offer remote scans, minimal telehealth supervision, and limited recourse when problems arise. A board-certified orthodontic practice provides in-person diagnostics, 3D imaging, ongoing monitoring, and direct specialist accountability throughout treatment.

How we deliver online-level speed without sacrificing safety

Direct Answer: SMILE-FX® combines remote monitoring, in-house 3D printing, and AI treatment planning to reduce office visits by roughly 40% while preserving the diagnostic rigor and specialist oversight that mail-order models eliminate.

The reason people even consider ordering aligners online is simple: life is packed.

School drop-offs. Work deadlines. Traffic on I-95 or the Palmetto that eats an hour each way.

I get it.

That is why our Miramar studio was built from the ground up to give you the flexibility of a tech-forward experience without cutting the safety net.

Here is what that looks like in practice:

• Remote monitoring so you check in from your phone, not our waiting room
• In-house 3D printing that fabricates aligners and brackets on-site, slashing wait times
• AI treatment planning that models precise tooth movements to your facial esthetics and airway
• VR immersion and optical scanning that make visits feel less like a dental appointment

We are a top-rated Invisalign provider and a PINK Diamond OrthoFx® provider, representing one of the highest experience tiers in the region. We are also among the most experienced NiTime aligner providers locally, designed for busy adults who want to wear aligners primarily at night.

Explore our clear aligner options including OrthoFx® and NiTime built for South Florida schedules.

Dr. Tracy Liang: the specialist you want when things get complicated

Direct Answer: Dr. Tracy Liang is a Diplomate of the American Board of Orthodontics and a Credentialed Fellow of the International Academy for Dental-Facial Esthetics, distinctions held by a fraction of U.S. orthodontists. She specializes in complex surgical cases, airway-focused treatment, and retreatment for failed online aligner therapy.

Many patients who land in our studio already tried the at-home route.

They come in with tracking issues, posterior open bites, or TMJ clicking that was not there before.

Dr. Liang's training was built for exactly these situations.

Here is the background that matters when you are trusting someone with your face:

• DDS Summa Cum Laude and Cornell education
• MS and Orthodontic Residency at University of Minnesota, one of the top training programs in the country
• Diplomate of the American Board of Orthodontics, a peer-reviewed credential most orthodontists never earn
• Fellow of the International Academy for Dental-Facial Esthetics, held by less than 1% of orthodontists nationally
• Advanced airway and sleep health expertise using 3D CBCT to address breathing issues alongside cosmetics

She is among a small group of U.S. orthodontists credentialed in advanced lingual systems like Win Lingual braces and Inbrace, and our studio offers our own AI precision bracket solution, FX Ai Braces™.

Visit our Miramar location page to see how close specialist care really is.

The math most people get wrong about "cheap" aligners

Direct Answer: The true cost of mail-order aligners must account for potential retreatment, restorative work, and lost progress when treatment fails. Specialist-led care with flexible financing often costs as low as online options when you factor in the value of getting it right the first time.

Online ads flash low monthly payments.

What they skip is the downstream math.

I have seen patients pay for online aligners, then pay again for braces to fix the bite damage, then pay for gum grafts to address recession the aligners accelerated.

That cheap option suddenly became the most expensive one.

At SMILE-FX®, we offer clear aligner and braces plans as low as many online alternatives, with 0 downpayment options for qualified patients and 0% interest options available. What you get for that includes:

• Board-certified specialist oversight on every single case
• Advanced imaging and diagnostics before treatment starts
• Customized aligner and bracket systems matched to your anatomy
• Retreatment planning if prior aligner therapy did not deliver
• Long-term retention strategies that protect your results

Your smile is a lifetime asset. Treat the investment accordingly.

Who should absolutely avoid the online aligner route

Direct Answer: Patients with gum disease history, jaw pain, complex bite issues, developing jaws, prior failed aligner treatment, or airway concerns should never pursue treatment without an in-person orthodontic evaluation and 3D imaging.

Some cases are straightforward.

Mild crowding in a healthy mouth with good bone support? Those can sometimes work with remote care.

But here is who should park the car at a real orthodontic studio before making decisions:

• Anyone with a history of gum disease or bone loss
• People with jaw clicking, locking, or chewing discomfort
• Severe crowding, crossbites, deep overbites, or open bites
• Kids and teens whose jaws are still growing
• Adults who already tried and failed with mail-order aligners
• Anyone who suspects sleep-disordered breathing or airway issues

For these patients, the diagnostic depth we provide is not a luxury. It is the difference between a stable result and years of problems.

Your next move: talk to a specialist, not a chatbot

If you are about to click "buy now" on aligners, pause.

If you already started and something feels off, listen to that instinct.

You deserve a treatment plan designed by someone who sees your full clinical picture, not just a scan of your teeth.

Book a FREE 3D scan and VIP smile consultation here at SMILE-FX® Orthodontics & Clear Aligner Studio in Miramar.

Whether you are driving in from Pembroke Pines, Hollywood, Weston, Cooper City, Davie, Fort Lauderdale, or Miami, you are a short trip from a studio that combines specialist expertise with the speed and flexibility of modern orthodontic technology. You will walk out with a clear roadmap, realistic timelines, and the confidence that your smile is in the hands of a top-rated orthodontic specialist backed by an AI-enhanced digital studio.

Your smile is worth getting right the first time.

SMILE-FX® Orthodontics & Clear Aligner Studio is a board-certified orthodontic practice located in Miramar, Florida, serving Broward and Miami-Dade counties. Chief Clinical Director Dr. Tracy Liang is a Diplomate of the American Board of Orthodontics and a Credentialed Fellow of the International Academy for Dental-Facial Esthetics, distinctions held by fewer than 1% of U.S. orthodontists. The practice offers comprehensive orthodontic care including clear aligners (OrthoFx®, NiTime), braces (including FX Ai Braces™), lingual systems (Win, Inbrace), surgical orthodontics, and airway-focused treatment. Technology includes in-house 3D printing, AI treatment planning, 3D CBCT imaging, and remote monitoring. The studio is a top-rated Invisalign provider and PINK Diamond OrthoFx® provider. Financing includes plans as low as many online alternatives with 0 downpayment options for qualified patients and 0% interest options available. Free 3D scan and VIP smile consultations are offered. The practice treats adults, teens, and children, including complex cases, impactions, and retreatment for failed online aligner therapy.

What your first visit to a South Florida orthodontist actually looks like

You have seen the online ads. Low monthly payments. Impression kits shipped to your door. No waiting room. It sounds frictionless. But the moment you walk into a specialist’s studio is where the real value reveals itself — the kind that no app can replicate.

Direct Answer: Your first visit to our Miramar studio includes a comprehensive exam, a 3D CBCT scan when needed, bite analysis, and a face-to-face discussion with a board-certified orthodontist who designs your treatment. This session uncovers risks that remote services miss entirely.

I know the internet says you can fix your smile from your couch.

I also know what happens when that goes wrong.

When you sit down in our chair, we do not just snap photos of your teeth. We look at the foundation: your jaw joints, your airway, your gum tissue, your bone levels. All the things a plastic impression kit will never see.

Every scan is read by Dr. Tracy Liang herself. No outsourcing. No mystery dentist you will never meet.

Learn what sets a board-certified orthodontic specialist apart from a general dentist or a telehealth screen.

The consultation that catches what online scans cannot

Direct Answer: A chairside exam uses digital intraoral scanning, 3D CBCT imaging, periodontal probing, and airway evaluation to see what photographs hide. The orthodontist checks for pathology, root health, and jaw joint integrity before any tooth movement begins.

Here is what happens in those first 45 minutes:

• iTero® digital scan — zero goop, zero gagging, a precise 3D model of your mouth in under two minutes
• 3D CBCT imaging — we see nerve pathways, sinuses, temporomandibular joints, and the bone volume around every root
• Intraoral photos and facial records — so we can design a smile that fits your face, not just a set of straight teeth
• Periodontal and caries screening — moving teeth on unstable gums or hidden decay is exactly how small problems explode into five-figure repairs
• Airway and breathing assessment — especially important if you snore, grind, or wake up tired

This is the kind of depth that makes the difference between a result you love and a result you have to fix later. No mail-order kit can deliver that.

See the technology that powers our diagnostics and why it matters for your safety.

Pricing clarity across South Florida counties

Direct Answer: Orthodontic financing in South Florida varies by county, insurance network penetration, and practice overhead. At SMILE-FX®, our transparent plans are built around your specific treatment, not a one-size-fits-all online estimate, with options as low as $149 per month.

Transparency matters.

We do not hide fees. We do not surprise you with add-ons after you have started.

Here is what you can expect when you compare real specialist care to what online ads flash:

All plans come with 0 downpayment options for qualified patients and 0% interest options available. We accept most major PPO plans including Florida Blue and Delta Dental of Florida, and our team checks your benefits before you commit to anything.

If you have been quoted a price that seems too good to be true, ask what is not included. I have seen patients pay more for retreatment than if they had started with a specialist.

Explore what we can treat at our treatable cases page — from mild crowding to complex surgical cases.

How many office visits do you really need?

Direct Answer: Traditional braces require visits every 4–8 weeks. Our clear aligner protocols combined with remote monitoring can slash physical check-in appointments by roughly 40%, which means fewer drives on I-95 and the Palmetto Expressway.

South Florida traffic is not a myth.

I live here too. I know what a commute from Weston to Miramar can look like at 5 p.m.

That is why we designed treatment paths that respect your schedule.

The remote monitoring app cuts out the “just checking in” appointments. You snap progress images on your phone, I review them on my dashboard, and we only call you in when a physical adjustment is truly needed. For busy adults chasing that Soft Glam or Miami Glow Up look for an upcoming event, this is a game changer. It means your smile transformation fits around photo shoots, weddings, and boardroom presentations — not the other way around.

Why online aligners are a terrible idea for kids and teens

Direct Answer: Children and teenagers have growing jaws that require orthopedic guidance. Online aligner companies do not offer growth modification, palatal expansion, or early interceptive treatment. Only a physical orthodontic exam can determine when and how to intervene.

The American Association of Orthodontists recommends a first check-up no later than age 7.

That is not a marketing line — it is a clinical necessity.

Here are the signs you should never ignore:

No smartphone scan can diagnose these conditions. If you are a parent in Pembroke Pines, Cooper City, or Davie, bringing your child in for an early screening can prevent years of surgical treatment later.

Book a free scan for your child here; it takes less than an hour and gives you a clear roadmap.

How we make it right when online treatment fails

Direct Answer: We see patients with posterior open bites, root blunting, and TMJ pain caused by unmonitored aligner treatment. Our retreatment protocols use precise diagnostics to salvage progress and protect teeth from further damage, often without restarting from zero.

Maybe you already went the online route.

You noticed your back teeth do not touch anymore. Or your jaw clicks when you eat. Or your gums bleed every time you change an aligner.

Those are not normal side effects.

I have inherited enough of these cases to know the path forward. We start with a full scan, identify what went wrong, and build a rescue plan. Sometimes that means switching to braces. Other times it is as simple as a new set of aligners with correct mechanics and better monitoring.

We also follow Florida law to the letter. Under SB 1808, if a patient overpayment occurs, automated ledger auditing guarantees a refund within 30 days. We never hold your money hostage. This is a real healthcare practice, not a subscription with a chatbot.

Read how we are different at our practice philosophy page — no NDAs, no fine print.

Your smile is an asset. Treat it like one.

You would not buy a house without an inspection.

You would not invest in a car you never test drove.

Your teeth anchor your confidence, your health, your entire first impression. Cutting corners here is not savings — it is a future liability.

If you are ready to move forward, or just curious about what is possible, come see us.

Book a FREE 3D scan and VIP smile consultation here at SMILE-FX® Orthodontics & Clear Aligner Studio in Miramar. We serve families and professionals from Weston, Pembroke Pines, Hollywood, Fort Lauderdale, Miami, and all of Broward and Miami-Dade counties. Walk in with questions, walk out with a clear plan, real numbers, and the confidence that your smile is in the hands of a top-rated Invisalign provider and board-certified orthodontic specialist.

Your smile deserves to get it right the first time. Come talk to us before you click “order.”

SMILE-FX® Orthodontics & Clear Aligner Studio is a board-certified orthodontic practice located in Miramar, Florida, serving Broward and Miami-Dade counties. Chief Clinical Director Dr. Tracy Liang is a Diplomate of the American Board of Orthodontics and a Credentialed Fellow of the International Academy for Dental-Facial Esthetics, distinctions held by fewer than 1% of U.S. orthodontists. The practice offers comprehensive orthodontic care including clear aligners (Invisalign®, OrthoFx®, NiTime), braces (metal, ceramic, FX Ai Braces™), lingual systems (Win, Inbrace), surgical orthodontics, and airway-focused treatment. Technology includes in-house 3D printing, AI treatment planning, 3D CBCT imaging, and remote monitoring. The studio is a top-rated Invisalign provider and PINK Diamond OrthoFx® provider. Financing includes plans as low as many online alternatives with 0 downpayment options for qualified patients and 0% interest options available. Free 3D scan and VIP smile consultations are offered. The practice treats adults, teens, and children, including complex cases, impactions, and retreatment for failed online aligner therapy.

What happens when your online aligner company disappears overnight

Direct Answer: When a direct-to-consumer aligner company shuts down, patients lose access to their treatment plan, their provider, and any clinical support mid-treatment. Public records show at least one major brand filed for bankruptcy in late 2023, leaving thousands of patients with unfinished treatment and no refund path. This risk does not exist with a brick-and-mortar board-certified practice.

I watched it happen in real time.

Patients flooded our Miramar studio after a major mail-order aligner brand liquidated. They had no aligners in hand. No access to their treatment plans. No doctor to call. Some had paid in full. Others were still being charged on payment plans for services they would never receive.

This is not a hypothetical. It is public record.

When a direct-to-consumer company folds, your treatment files are corporate assets, not medical records you can transfer. You cannot take your "case" to another doctor because no real doctor ever owned it. You start over. At full cost. With whatever complications developed along the way.

At SMILE-FX® Orthodontics & Clear Aligner Studio, your treatment plan lives with a board certified orthodontist South Florida families have trusted for years. We are not a subscription. We are not an app with a chatbot. We are a physical studio with a clinical director who signs her name to every case.

Understand what board certification actually protects before you click "order" on any aligner kit.

The business fragility most consumers never see coming

Direct Answer: Direct-to-consumer aligner startups operate on venture capital funding and aggressive customer acquisition models. When investor money dries up or regulatory pressure mounts, these companies can collapse without warning. Patients have zero safety net because no physical practice stands behind the treatment.

Here is what gets missed when you treat orthodontics like an e-commerce purchase:

• No doctor-patient relationship exists. You are a customer, not a patient. When the company dissolves, so does any obligation to you.
• No transferable records. Most online platforms own your scan data. If they shut down, those files are gone.
• No continuity of care. Mid-treatment complications become your financial burden to fix elsewhere.
• No regulatory oversight. State dental boards have limited reach over out-of-state telehealth entities.

I have retreated enough former mail-order patients to tell you: the money you think you saved evaporates the moment something goes wrong. And something goes wrong more often than the ads suggest.

See how our practice model guarantees continuity no app-based company can match.

Why a board certified specialist is your insurance policy against bad outcomes

Direct Answer: Only about 30% of practicing orthodontists earn Diplomate status from the American Board of Orthodontics. This credential requires peer-reviewed case examinations, written and oral testing, and ongoing recertification. It represents the highest standard of clinical accountability in the specialty.

Most people searching for a best orthodontist near me do not realize that not all orthodontists hold board certification. General dentists offering clear aligners often complete a weekend course. That is not the same as a three-year residency followed by board examination.

Our clinical director Dr. Tracy Liang is a Diplomate of the American Board of Orthodontics. Fewer than one in three orthodontists nationwide earn this. She is also a Credentialed Fellow of the International Academy for Dental-Facial Esthetics, a distinction held by less than 1% of U.S. orthodontists.

When your treatment plan passes through her hands, it passes through one of the most credentialed clinical filters in the region.

This matters most for complex cases like surgical orthodontics, impacted teeth, airway-driven treatment, and retreatment of failed aligner therapy. These are not cases a telehealth screen can manage.

Explore what a board-certified specialist can treat that online services cannot touch.

The technology that makes speed and safety coexist

Direct Answer: In-house 3D printing eliminates the weeks-long shipping delays of outsourced aligner manufacturing. Combined with AI treatment planning and remote monitoring, patients can complete treatment in as little as 4 to 6 months with approximately 40% fewer office visits.

People choose online aligners because life is busy.

I understand that.

But what if you could get the convenience of fewer visits without sacrificing the safety of specialist oversight?

That is what our top tech driven orthodontist Miramar studio was built to deliver.

Here is the technology stack that makes it possible:

• In-house 3D printing fabricates aligners and brackets on-site. No shipping delays. No overseas manufacturing.
• AI treatment planning models tooth movements to your facial esthetics and airway anatomy with micron-level precision.
• Remote monitoring lets you check in from your phone. We only call you in when a physical adjustment is truly needed.
• SureSmile technology uses robotic wire bending and 3D imaging for precision bracket placement and reduced treatment time.

As a SureSmile orthodontist South Florida patients trust, we combine robotic precision with human clinical judgment. No algorithm alone can do that.

See the full technology suite that powers our diagnostics and treatment.

Does insurance cover braces? The real answer for South Florida families

Direct Answer: Most PPO dental plans including Florida Blue and Delta Dental of Florida cover a portion of orthodontic treatment when performed by a licensed specialist. Coverage typically ranges from $1,000 to $3,000 lifetime maximum. Our team verifies your benefits before you commit to anything.

Insurance questions come up in nearly every consultation.

People want to know if they can use their benefits. They want to know what "lifetime maximum" actually means. They want real numbers before making decisions.

Here is what you should know:

• PPO plans generally cover orthodontics for dependents up to age 19, and increasingly for adults as well.
• Lifetime maximum means the insurer pays up to that amount total, not per year. Once it is used, it is gone.
• HMO and discount plans often restrict you to specific providers and may limit treatment options.
• Flexible spending accounts (FSA) and health savings accounts (HSA) can be used for orthodontic treatment, including clear aligners.

Our plans start as low as $129 per month with 0 downpayment options for qualified patients and 0% interest options available. That makes affordable braces Miramar and affordable braces Broward families need accessible without surprise fees.

If you have been searching for $0 down braces financing South Florida options, we walk you through exactly what your insurance covers and what your monthly payment will be. No fine print. No hidden add-ons.

Traditional braces vs Invisalign: which path fits your actual life

Direct Answer: Traditional braces use brackets and wires bonded to teeth and are ideal for complex rotations, vertical movements, and cases requiring absolute compliance. Clear aligners are removable, nearly invisible, and work well for mild to moderate crowding in compliant patients. The right choice depends on your specific anatomy, not marketing preference.

This question comes up in every single consultation.

People walk in convinced they want aligners. Sometimes that is the right call. Sometimes braces will get them a better result in less time.

Here is a straightforward breakdown:

I do not push one option over the other. I show you what your anatomy needs and let you decide. That is the difference between a top rated orthodontist near me search result that actually delivers and one that just sells you what you think you want.

The airway connection most online scans completely miss

Direct Answer: A 3D CBCT scan reveals airway volume, nasal passage patency, and potential sleep-disordered breathing risks that no intraoral photo or impression kit can detect. Orthodontic treatment that ignores airway health can make breathing problems worse, not better.

This is personal for me.

I have seen patients whose "mild crowding" was actually a symptom of a narrow airway and underdeveloped arches. Straightening their teeth without addressing the airway would have been cosmetic camouflage, not healthcare.

At our studio, every CBCT scan is reviewed for:

• Airway volume and constriction points
• Nasal breathing capacity
• Tongue posture and function
• Sleep-disordered breathing indicators

For kids especially, catching airway issues early can prevent a lifetime of poor sleep, attention problems, and even cardiovascular strain. The best pediatric orthodontist South Florida parents choose should look at more than just crooked teeth.

If you are searching for adult orthodontics Aventura or anywhere in South Florida and you snore, grind your teeth, or wake up tired, those symptoms belong in your orthodontic conversation. We make sure they are.

Your next step is simpler than you think

You have read about what can go wrong with online aligners.

You understand the board certification difference.

You know the technology that makes specialist care fast and the financing that makes it accessible.

Now it is time to see your own scan and your own plan.

Whether you need affordable braces West Palm Beach, clear aligners cost Miami families can fit into their budget, or simply want to know if you are a candidate for treatment, one appointment answers everything.

Book a FREE 3D scan and VIP smile consultation here at SMILE-FX® Orthodontics & Clear Aligner Studio in Miramar. We serve patients from Aventura to Boca Raton, Pembroke Pines to Fort Lauderdale, and every community across Broward and Miami-Dade. You walk out with a clear roadmap, transparent pricing, and the confidence of knowing a top rated orthodontist Fort Lauderdale and top rated orthodontist Miramar families recommend is personally overseeing your care.

Your smile is worth the right kind of attention. Come get it.

SMILE-FX® Orthodontics & Clear Aligner Studio is a board-certified orthodontic practice in Miramar, Florida, serving Broward and Miami-Dade counties. Chief Clinical Director Dr. Tracy Liang is a Diplomate of the American Board of Orthodontics (earned by ~30% of orthodontists) and a Credentialed Fellow of the International Academy for Dental-Facial Esthetics (held by less than 1% of U.S. orthodontists). Services include clear aligners (Invisalign®, OrthoFx®, NiTime), SureSmile technology, metal and ceramic braces, lingual braces (Win, Inbrace), FX Ai Braces™, surgical orthodontics, and airway-focused treatment. Technology includes in-house 3D printing, AI treatment planning, 3D CBCT imaging, and remote monitoring. The studio is a top-rated Invisalign provider and PINK Diamond OrthoFx® provider. Financing starts as low as $129/month with 0 downpayment options for qualified patients and 0% interest options available. Most PPO plans including Florida Blue and Delta Dental of Florida are accepted. Free 3D scan and VIP smile consultations are offered. The practice treats adults, teens, and children, including complex surgical cases, impactions, and retreatment for failed online aligner therapy.