When should clear aligners be used in growing patients and where do their limits still lie?
Dr Emmanuel Dumu’s session at BOC 2026 will tackle both questions
Dr Emmanuel Dumu recalls a recent conference in Copenhagen where he presented a case involving a teenager with two impacted premolars. He had decided against extraction, and not everyone in the room was immediately convinced. However, he showed that as the case developed, the logic of that decision became harder to dispute. It is a useful reflection of the role he now occupies within orthodontics. He is not simply advocating aligners for growing patients, he is suggesting colleagues look again at what is possible, to separate outdated scepticism from current evidence, and to think more carefully about timing, indications and clinical judgement.
Based in Brussels, where he runs Pebs Orthodontics, Dr Dumu lectures internationally, leads two orthodontic practices and established what became the first Invisalign Centre of Excellence in Belgium. He is also head of the orthodontics course at Haute Ecole Libre de Bruxelles Ilya Prigogine, combining clinical work with teaching and a long-standing interest in communication.
What gives his comments weight is that he did not begin as a believer. He started treating growing patients with aligners in 2018, but before that he was doubtful. The hesitation many orthodontists express about the modality for treating growing patients is something he recognises because he shared it. His view now is not that his concern was misplaced, but that the treatment modality has moved on. “For me, the scepticism is no longer about whether aligners can work,” he says. “It’s about where they work best, and what the indications and the limitations are.”
The timing question
His session at BOC 2026, Catch it Early: Clinical Pearls for Aligner Treatment in Growing Patients, is built around one central premise: many orthodontists are waiting too long. “Timing is never based on age alone,” he says. “It’s based on opportunity.” The indicators he looks for include mixed dentition stages where eruption guidance can still change the future trajectory, early crowding, developing transverse deficiencies, anterior or posterior crossbite tendencies, and Class II patterns where earlier correction may reduce complexity later on. His focus is not simply on what can be corrected now, but on what can be prevented from becoming harder to manage in future.
That shift in mindset runs through much of what he says about growing patients. He repeatedly speaks about phase two and how much easier it can be when the groundwork is done earlier. “My new thinking is: how can I simplify phase two? With aligners, we can simplify it so much that it’s a real pity not to use them. You look at a 14-year-old and think, if I could have increased the arch length earlier, prepared the space, I would have prevented those impacted canines. The window closes.” In practical terms, that means treating crowding, arch length and space management in the mixed dentition years as opportunities rather than problems to revisit later.
Where the evidence stands
Dr Dumu is careful not to present the profession’s scepticism as irrational. The first generation of aligners was not designed for growing patients, and the evidence base was insufficient to warrant broad confidence. In that sense, caution was understandable. “In our profession, we need a little bit of evidence before getting enthusiastic,” he says. “That’s healthy.”
What he argues has changed is the quality of the tools and the level of understanding around them. He points to recent studies and systematic reviews supporting meaningful dento-alveolar effects in growing patients, including arch development, space management, eruption guidance and selected Class II correction.
At the same time, he is explicit about the limits. Maxillary expansion with aligners may be effective in some cases, but he does not claim that aligners replace rapid maxillary expansion in severe transverse skeletal discrepancies. “If it is skeletal, I will use an EIP or a hyrax. I would not say I’m going to use only the plastic for that. The point is not to exaggerate what aligners can do, but to understand more precisely where they belong.”
That measured approach is likely to be one of the strengths of the session. The appeal is not that it promises a universal solution, but that it is designed to help clinicians make better decisions. For an audience which may still associate aligners in younger patients with overstatement or weak case selection, that distinction matters.
The compliance argument
If there is one objection that still surfaces quickly in discussions about younger patients and aligners, it is compliance. Dr Dumu does not dismiss the concern, but he does reframe it. “Compliance is not only a patient issue,” he says. “It’s a communication issue.”
He argues that children and parents are far more likely to engage well when the goals are visible, progress is measurable, and the reasoning is clear. Digital planning has changed what that communication looks like in practice. Families can see what is being proposed, why it matters, and what the intended outcome is. “Before, the patient had to believe you. They came because of your reputation. Now, with digital planning, it’s something families can see, understand, and believe in.” He describes his iTero scanner not simply as a clinical device but as a communication tool. In early treatment, where timing, family engagement and long-term planning all matter, that distinction becomes significant.
For those who are hesitant
For orthodontists who are curious but unconvinced, his advice is practical. Start with cases that are highly suitable: mild to moderate crowding, early arch development needs, mild transverse dento-alveolar deficiencies and motivated families. “Do not begin with the case that belongs on a congress podium. Begin with the case that lets you learn the biomechanics, the staging, the attachment strategy, the monitoring.”
He is equally clear about a particular trap to avoid. “Do not copy adult aligner thinking into a growing patient. Growing patients are not smaller adults. Their biology, eruption, compliance, psychology and treatment timing are all different. Once you understand that, aligners become far more predictable.” It is one of the more useful points in the interview, because it moves the conversation away from brand or technique and back to fundamentals.
Why this session matters now
Ask what delegates can expect and the first word he uses is energy. Behind that, though, is something more substantial: real cases, acknowledged failures, honest limitations, and practical strategies that clinicians can take back into practice. “I want them to leave with more than inspiration,” he says. “I want them to leave with clinical confidence.”
That feels well-judged for where orthodontics now stands. Parents increasingly expect aesthetic treatment options. Younger patients expect comfort. The conversation around aligners in growing patients is no longer peripheral. It is becoming part of a broader rethinking of how and when orthodontic care begins, and the evidence is moving with it.
For orthodontists who want a clearer sense of where aligners can genuinely help, how early intervention can be used more strategically, and what more confident case selection looks like, Dr Dumu’s session promises something useful: not just enthusiasm, but a framework for thinking. The British Orthodontic Conference takes place at the Brighton Centre from 24 to 26 September 2026. On this topic, Dr Dumu looks set to give delegates plenty to think about, and good reason to be in the room.
Dr Emmanuel Dumu presents Catch it Early: Clinical Pearls for Aligner Treatment in Growing Patients at the British Orthodontic Conference, Brighton Centre, 24 to 26 September 2026. Details and registration are available via the BOS website.