Invisalign: attachments vs no attachments

[lilymouth]

Hi,

I'm looking into getting Invisalign for severe crowding of my front teeth. The plan at the moment is to extract 4 2nd premolars, straighten the front teeth, and then move the back teeth forward to fill the gap. I don't have any issues with bite etc.

For my top front teeth, 1 tooth sticks right out (has pretty much no space). For my bottom front teeth, they are all very crooked and one is rotated almost 90 degrees.

My first Invisalign video had a LOT of attachments. My Ortho saw that I wasn't very happy about that so he said he would see what the result would be without attachments. The second video had no attachments, but the end result was exactly the same (nice and straight). This really confused me. I don't understand why they would first recommend attachments if they didn't do anything, and how the results could be exactly the same without them. I did ask him and he said something about them being useful for minor adjustments. The impression I get is that almost all Invisalign plans involve attachments.

Has anyone had significant results without attachments?

Thanks.

[nate]

I have not heard of any cases requiring 0 attachments. You're lucky your orthodontist even entertained the idea. Mine didn't even show me the video before he made adjustments and ordered the trays. I think attachments help lock the tray firmly to your teeth and help grip to teeth in order to rotate them. Orthodontists tend to be vague and underestimate treatment time. Are you sure the 0 attachment plan doesn't add a year or more to your treatment?

[lilymouth]

I'm surprised you didn't get to see the video! I had to approve mine before he would order the trays. Although now I think I was too hasty and didn't ask the right questions. The plan without attachments is a little over a year and a half. He didn't tell me how long the one with attachments would be, but I would imagine over a year as I will have extraction gaps to close. I will try to find out. It does seem really odd, given that I am closing gaps and rotating teeth! He has done hundreds of cases, but I'm suspicious because both ClinCheck videos look exactly the same, but one has attachments everywhere and the other has none (how can it be exactly the same!).

[nate]

It's possible that the teeth will move the same in theory, but will end up off track in practice. If you go with the no attachment option don't be surprised if you end up needing mid course correction. I would see if he can meet you half way with just a few attachments. I have 10 and I can tell you that only the ones on my upper canines are even remotely visible.

[DrJasonKTam]

A computer simulation program can do anything you want. For instance, I could flip one tooth from the lower arch to the upper arch in the computer. In other words, the ClinCheck program means very little in terms of what your final result will look like.

We do not show our patients the video before approval because it is simply that... a video. Most of the times, my ClinCheck video final result looks nothing like what I want the final result in my patient's mouth to look like. The reason is because the ClinCheck is not a simulation of how the teeth move, but rather a video showing the series of aligners you are getting.

Think of it this way. If you have a paper clip and want to bend it so that it is straight, you are not going to just bend it straight. You may need to bend it past straight in order to get to where you want it to go. The same may apply to movement of the teeth.

The correct number of attachments is one thing. They also have to be the correct type, in the correct place, and the teeth have to move the correct way.

Remember that Invisalign is not doing your treatment. Your doctor is the one who has to plan how your treatment progresses. Good luck!

[nate]

Thanks for your professional input on this. Are you saying that the video shows how your teeth will move if you don't require any mid-course correction or refinements? I always wondered, what percent of cases don't require either?

[DrJasonKTam]

Thanks for your professional input on this. Are you saying that the video shows how your teeth will move if you don't require any mid-course correction or refinements? I always wondered, what percent of cases don't require either?

Not really. The simulation is not really a simulation of how the teeth will move, but rather a movie of the series of aligners that will be created. As mentioned, most of the times my treatments do not finish looking like the last stage of my ClinCheck.

The chance of refinement is going to usually depend on how good your doctor is at designing the correct force systems to move the teeth. However, don't look at mid-course or refinement as failures. Consider them like repositioning a brace or bending a wire with regular braces.