Question for dr. Tam

[Olivia]

First let me tell you that I think it is great that you take time to answer posts here!

I have a question that concerns invisalign treatment in general. I became very interested in the process etc. and did a lot of research on the internet and visited several orthodontists before I decided to go ahead.
I also joined a national message board about orthodontics (I live in Western Europe) and it seems that most orthodontists in my country are weary about invisalign...I even had ortho's tell me that " that stuff from the U.S.A" was a marketing trick. On the national forum the orthodontists are very much against the use of invisalign and discourage people to go ahead...

An article from this February in a popular magazine in which the above mentioned ortho's participated:
(translated quote) " Many orthodontists prefer not to work with this particular type of braces (clear aligners), Because the treatment is set out by a computer, the dr. can't make adjustments mid treatment and the end results are likeley to be not as good as it would have been with fixed braces.This leads to dissapointment for the client and a bad reputation for the orthodontist"

Same article: " Clear aligners only work for minimal irregularities and you can only have up to 30 aligners. The treatment will be longer and more expensive"

I'm not saying that in Europe, all Orthodontists are against the clear aligner type braces, but there seems to be sort of a lobby...Some things they are saying might be correct (more expensive), but others I have seen being contradicted many times (in studies as well as on this forum by you and others)

My question is, why are some orthodontists so enthousiastic about this type of treatment and have excellent results with it, also in more difficult cases, and why do others simply refuse to " embrace" the technique? Is this also a relevant discussion overseas or is this an European debate and more specificly a (somewhat calvinistic ) Dutch debate?

Thanks in advance for reading..Let me in conclusion state that in no means I want to offend anyone with the post and the questions, It's mere an observation and curiosity from my part!

[DrJasonKTam]

I'm always happy to post here and provide information to the board. However, I do think the topic of this thread might be better changed to something else, such as "Some doctors in Europe are against Invisalign... why?".

" Many orthodontists prefer not to work with this particular type of braces (clear aligners), Because the treatment is set out by a computer, the dr. can't make adjustments mid treatment and the end results are likeley to be not as good as it would have been with fixed braces.This leads to dissapointment for the client and a bad reputation for the orthodontist"

This is false. Mid treatment adjustments can be done with new impressions for new sets of aligners, modifications to aligners, use of adjunctive appliances to aligners, etc. The treatment should not be set up by the computer. If it is, the doctor is relying on a computer graphics technician to ensure that teeth move in reality as they do in the movie. This is likely going to result in failure. Unfortunately, many doctors have not taken the time to understand the way aligners move teeth. Biologically, it is the same, but physically, they have to be moved differently.

I do agree to a certain extent with the marketing behind Invisalign. It does lead to a lot of false expectations because the company has spent more on marketing the product than advising the public that it is an orthodontic technique with which results will vary depending on the experience of your doctor. Invisalign is a technique, not a product, and unfortunately, the number of experienced doctors out there is extremely small compared to the number of providers.

You can read more here: http://www.torontobraces.ca/compare/

" Clear aligners only work for minimal irregularities and you can only have up to 30 aligners. The treatment will be longer and more expensive"

We have patients who have over 60 aligners. We closed severe spacing, corrected class 2s, and closed extraction spaces. In some cases, due to the movement required, Invisalign may take longer, but in others, treatment may take less time.

The cost is going to depend on the office you go to. Our Invisalign treatments run very smoothly, there are fewer emergencies, and appointment visits take less time. Therefore, while there is a higher cost to the office because of lab fees, we actually don't charge any differently than for our ceramic braces.

[Advocate]

@Dr. Tam: Thank you for the informative response to the original poster, and I'm sure your opinion about the importance of choosing a good doctor is correct. Do you think the Invisalign Preferred Provider status is a good way for consumers to decide on a doctor? I mean, is it a useful metric for laymen? We don't have any "elite preferred providers" in my area. My doctor is a standard "preferred provider." I hope that is good enough!

Also, in your experience, do the techs in Costa Rica normally get treatment plans right the first time? -- or is it generally necessary to make modifications? I'm definitely glad to have a doctor to check their work, just in case.

[DrJasonKTam]

@Dr. Tam: Thank you for the informative response to the original poster, and I'm sure your opinion about the importance of choosing a good doctor is correct. Do you think the Invisalign Preferred Provider status is a good way for consumers to decide on a doctor? I mean, is it a useful metric for laymen? We don't have any "elite preferred providers" in my area. My doctor is a standard "preferred provider." I hope that is good enough!

Also, in your experience, do the techs in Costa Rica normally get treatment plans right the first time? -- or is it generally necessary to make modifications? I'm definitely glad to have a doctor to check their work, just in case.

A preferred provider saw a minimum of 10 Invisalign patients in the previous calendar year. The other designations also speak for a specific volume, rather than quality result or level of difficulty. There are various doctors who have very low fees in order to get up volume, and exceedingly few who do high volume but of a high difficulty level and excellent final results. My personal perspective is that the doctor search on the invisalign.com website leads patients to believe that across Preferred/Premier/Elite, they will get the same results/have the same experience at the respective levels. I think it is a good initial screening tool but each potential patient should then do their due diligence to find a provider who can adequately treat their specific case.

I have not accepted the initial ClinCheck since the days when I was like other doctors who didn't think that a treatment could fail because a video showed it would work. I usually put in, on average 3-4 revisions, before accepting treatment, and I have a dedicated technician who knows my preferences. To have a doctor "check their work" is setting it up for failure. The doctor must direct, with clear instructions, how teeth should move, when they should move, and their rate of movement in order for treatment to be successful.

[Olivia]

Thank you very much for answering my questions!