Invisalign and rotated canines? Confused!

[plugnickel69]

Can somebody please give me some input on how well Invisalign works on rotated canines? All my canines are rotated and my lower canines strike the inside of my upper lateral incisors when I close my mouth or when chewing. I had two original consults at which I was told by Invisalign certified orthos that I was not a candidate for Invisalign. I went for another consult this week and was told by the ortho, also Invisalign certified, that he recommends Invisalign, no question. He said braces would be "overkill at my age" (mid-sixties).

He never mentioned the need for attachments or elastics until I questioned him. (I have some rear teeth that need to extruded somewhat.) When I asked if Invisalign could do as good a job as regular braces in my situation, he said yes. However, I have concerns. My need for orthodonture is strictly for functional, not cosmetic, reasons. To spend one to two years in aligners for questionable results seems to be a bad investment.

Back to my question: Anyone have experience with rotated canines and Invisalign?

[sammywantstraightteeth]

My lower teeth were overcrowded, with each one more and more rotated as you move out from the centre (see my blog below for some photos and my clin check images). I've just completed 11 months of invisalign treatment - and all of them have just about ended up where they are supposed to be - except one lower canine. Its not too noticable, but it definitely needed more rotation to be perfect. I haven't yet added my 'finished' photos - I'll try to do that in the next couple of days if it will help you. I was predicted another 12 aligners (after my original set of 24) to correct this tooth, but I declined. I achieved my overall goal of teeth that are easier to clean and a better aligned bite - my motivation was never about cosmetics either.

[plugnickel69]

Thanks sammywantstraightteeth. What you're saying is a great part of my concern. I understand that canines are very difficult to rotate and those canines are a major part of my problem as far as my bite is concerned. I don't want to have the job done half-way.

[sammywantstraightteeth]

Hi plugnickel69. As promised, photos are now on my blog - see link in my signature.

In particular you would be interested in this one:

http://pics.livejournal.com/sammiesbrac ... 024xxh/g41

where you can clearly see my stubborn rotated canine.

[Wireless]

I had first premolars that needed rotation. 20 years ago my dentist tried to rotate them with regular braces. That didn't seem to work and my present doc tried with Invisalign. There was some rotation but not enough to get desired results. A problem resulted where my attachments quit tracking the bubbles on my aligners, so the rotation not only stopped but moved in a direction that couldn't be retraced with the last couple of sets of aligners.

Regard rear tooth extrusion, I had a severe deep bite where my lower front teeth hit the gums behind my uppers. My doc intruded my front teeth with Invisalign which created gaps between my upper and lower molars where we are waiting for them to grow in. This has been a very slow process - 2 1/2 years. Like you, my case was not cosmetic. However, I was experiencing considerable pain from gum inflammation so didn't have much choice about have a correction done. I'm now 61 and my bite is improved enough that I no longer have pain and can do a much better job on chewing things like steak.
While I don't have a perfect correction (was told this ahead of time) its much betterr than other options I could have considered. For now, I'm in retainers at night and a couple of teeth still need to grow out a bit although there is steady progress. I think this is a much slower process for older patients.

[DrJasonKTam]

Rotation of long or multi-rooted teeth is not an easy movement with aligners, but it can be done. It will depend on a number of factors including root angulation, amount of spacing/crowding, rate of rotation, axis of rotation etc. I will tell you that we have many patients who have successfully completed over 50 degrees of rotation correction using Invisalign only, while we have other situations where 30 degrees will require some partial-fixed appliances.

Ask the doctor to explain in detail the way each plans to move your teeth and then figure out who you feel most comfortable with. Good luck!

[plugnickel69]

Dr. Tam, I appreciate your response. Looking at my models, I will need rotations of at least 30 degrees on all my canines plus there are angulation problems on my lower canines as well as angulation problems on my upper second bicuspids due to my previous orthodontia nearly 50 years ago (four extractions). Also, there is crowding on the bottom.

If I'm going to go through with this -- and I don't see where I have a choice because of my bite -- I want to do it correctly. I know there is more control with regular braces than Invisalign.

I have some good genes and hope to live a long time with my own teeth, so if I do this I might as well do it right. I will have the discussion with the other orthos, but I think I've made up my mind.

Again, thanks again for your input.

[goodteethby2013]

I have invisalign on my uppers and regular braces on my lowers, and all my canines needed rotating. While my uppers are rotating successfully with the help of some funky looking attachments, the lower ones seemed to snap into line a lot more quickly with the traditional braces. Good luck!

[plugnickel69]

Thanks. I think regular braces make the most sense. I noticed that on the Invisalign website they don't talk about rotating teeth and you don't see any attachments. I'm sure that many who go with Invisalign are shocked when the attachments and elastics come out.

[DrJasonKTam]

One thing you can consider is to use braces on the selected teeth that will be "difficult" Invisalign movements, and to use Invisalign for the rest of your treatment. We see a lot of patients who have some partial bracketing then move into aligners.

[Toontino]

Great info

[Toontino]

Great info