Help- dentist says I am almost done- but I am not happy!

Message

#1 Post by **PinkKitty** » Mon Dec 15, 2008 12:34 pm

(I wish I had pics, but I don't right now, maybe I can figure out how to post some later)

I have one more tray to go, and at my last checkup, my dentist was talking about being all done and how nice they look.

My main problem is my 4 front teeth, they are much straigher up and down, but still go foward, back forward back quite a bit to my eye. I want them to be lined up with each other. When I asked about refinements, my dentist said there is a limit to how much invisalign can straighten the teeth, etc. etc. and that she thought they look pretty good. I just don't see how they will be all done in one more tray.

Also, one of my 2 front teeth doesn't seem to be fitting all the way into the aligner. It was moving at first, but for awhile now, that tooth seems to be having a bigger gap each tray, it doesn't seem to be following the expected movement. This is my shorter tooth, and my dentist seems eager to put a veneer on it, I was hoping to make it look as good as possible with straightening and maybe do some bonding.

Any help or advice appreciated. I don't like to be a pushy patient, but it looks like I will have to be...

#2 Post by **John37** » Mon Dec 15, 2008 2:49 pm

It sounds like your dentist just doesn't want to deal with your concerns. I guess you need to be pushy. Maybe you could get someone to go with you to back you up. I'm not sure how easy it would be to switch dentists or orthos and that might be costly.

I have a problem with a few teeth not moving the way we expected completely, but I'm getting my refinement trays next week. My dentist currently seems to be concerned with my problems, so I hope at the end of my treatment he is still the same way.

#3 Post by **Wobblydeb** » Tue Dec 16, 2008 3:39 am

It sounds as if the plan was to extrude your shorter tooth (ease it out of the gum slightly). Invisalign doesn't do this very well at all - my plan included that, and I was warned upfront that it might not work. I am starting to see a gap in the tray now, so I guess it might fail for me too.

Your dentist should be discussing all of this with you, advising what is (and isn't) possible and then agreeing a refinement plan. The best solution might be a veneer, but it seems that they are pushing you into it for their own reasons at the moment rather than explaining why it is the best option.

Perhaps arranging an appointment to discuss what happens next is the best bet?

#4 Post by **Devushka** » Tue Dec 16, 2008 11:18 am

It was moving at first, but for awhile now, that tooth seems to be having a bigger gap each tray, it doesn't seem to be following the expected movement. This is my shorter tooth, and my dentist seems eager to put a veneer on it, I was hoping to make it look as good as possible with straightening and maybe do some bonding.

That happened to me too. I am now in refinements(for that problem as well as another). I can't tell if it is working this time around and I have no attachments. I haven't noticed a gap between my aligner and the tooth yet(am on 3 or 7) and I hope I don't - pushing my luck to hope I am the one who it works for? A bit.

Veneers scare the crap out of me, so this could just be a personal thing, but I'd talk to him and see if there is another way besides that. It is very expensive and irreversible.

And don't worry about being pushy! When your treatment is completely done you will be greatful that you asked as many questions as possible.

#5 Post by **PinkKitty** » Tue Dec 16, 2008 3:24 pm

I never even heard of "extrusion" before I got on this board! My dentist told me that after she sent my impressions to invisalign, they said I was an "ideal candidate" for invisalign braces. It was never mentioned to me that I might get better results with regular braces, grrrr.

I too, am scared of the idea of veneers. My natural teeth are already nicely shaped, just they are not the same length in front. I don't want to start gluing veneers all over the place.

I have a message in to my dentists office, I may also get a second opinion from an ortho (which I should have done in the first place).

#6 Post by **Wobblydeb** » Wed Dec 17, 2008 3:46 am

Thanks for the link Meryaten - that's really useful. I don't suppose anyone has a guide to decent dentist undertaking bonding in the UK?

I actually have bonding on 2 of my upper incisors, but never knew it was called that

because it was done when I was a teenager by the NHS. The bonding on the face of the tooth has performed really well - its more than 15 years old now, and has been bleached and all sorts. I seem to remember they did the chipped corners too, but that fell off within a couple of years. Upper central incisors need to cope with a lot!

As for the shorter tooth, you could always leave it as it is. One of my upper laterals is stunted rather than impacted and I was surprised when Invisalign tried to correct it. I actually don't think it detracts too much from my smile

#7 Post by **PinkKitty** » Wed Dec 17, 2008 10:34 am

Thanks everyone. The link is great. I got a name of a local dentist from it and have made an appointment this week for a consultation. I will post what the results are!

The short tooth is one of my 2 middle top front teeth (don't know what they are called). There is a pretty noticable difference, if it was a side or lower tooth I would probably not care about it, but this is a bit more "character" than I want my smile to have...

#8 Post by **Wobblydeb** » Thu Dec 18, 2008 8:00 am

Ahhhhh I can understand why you would want to correct that. That's a central incisor, and I have to agree that differences in the length of the centrals is less acceptable than the laterals (the two either side).

I hope your appointment goes well. Meryaten's link has certainly set me thinking about renewing my bonding work, and perhaps getting some additional stuff done!

#9 Post by **PinkKitty** » Thu Dec 18, 2008 3:36 pm

Had my 2nd opinion appointment, and it was well worth the money. The dentist took a through look at my teeth and answered a lot of questions. I feel more confident in the process overall, and she pointed out what refinements she think would help.

After the appointment I dropped by my regular dentist, too see if we could talk about refinement, and she agreed to do the impressions on the spot, yay! We are going to do attachments on the top 4 teeth to try to improve the arch.

Regarding extrusion: the 2nd opinion dentist pointed out that if the tooth is extruded, it can also bring the gum down with it. The lower edge of my small tooth is worn down and would need to be built up regardless. By bringing the tooth forward instead of extruding it down, the gumline could end up needing less work, so I decided not to push my dentist for extrusion.

Bonding - the new dentist quoted 1800 to 2200$ for bonding one tooth. The portfolio of work looks very nice and I am thinking about it, but I may shop around a little more cause that seems expensive.

#10 Post by **PaulInc** » Thu Dec 18, 2008 8:02 pm

I dont really know, but that seems incredibly expensive for what i think amounts to a blob of composite and some shaping. In fact, i know 2 people who've had a tooth reconstructed with composite filling and if it was anything like that price i am sure they'd have mentioned how expensive it was.

I have heard of them using several compounds to make a composite look very natural, so perhaps that's what they're planning to do. Frankly i need less bonding material on the edge of my worn tooth than i have for an attachment, so i couldn't justify spending that kinda money on it. I wouldn't want to pay more than $500 for something that's going to take them 10-15 minutes. (i assume)

#11 Post by **drstraight** » Sat Dec 20, 2008 2:59 pm

Traditional orthodontic appliances (braces) are going to treat cases better than Invisalign. Period.
Your orthodontist (and hopefully you are going to an orthodontist and not a general dentist who has been "certified" by Invisalign in a half day course and has little knowledge or experience in orthodontics) has more control and can treat a case better using braces. Invisalign is limited in what can do. I find that time and time again I am seeing and hearing of patients that are unhappy with their final result. I tell my patients that if they must have Invisalign then they can count on wearing braces the last part of treatment to attain the refinements that are necessary to please both the patient and the orthodontist.
I am not saying that Invisalign is not a treatment option. Just realize that it may be a compromised finished result. You are compromising a better result for the sake of esthetics.
My strong suggestion is to curb your vanity and do it right. You'll be happier in the long run.