I'm unfortunately becoming another Cautionary Tale

[cleveman]

I need your opinion at the bottom of this post, but in short, here's the moral of my story: don't let a general dentist that is "dabbling" in invisalign or a similar treatment convince you that they can move teeth just as well as an Orthodontist... If you're considering treatments like Invisalign - my advice is GO TO AN ORTHODONTIST!

I had been tracking my progress in the thread called "New Kid on the Block" but haven't posted in a couple months.

To summarize, my dentist a year ago recommended that we use the Red, White and Blue treatment (which is similar to Invisalign) to fix some crowding of my front teeth that had caused me to chip #23... So I've been going through that treatment since about the 1st of the year.

Now I'm supposed to be done with the treatment, and my bite is far worse than it was when we started.



I must admit that the RWB treatment did indeed straighten my teeth - they look great! but the don't fit together at all.

Before I started, tooth #9 was leaning on #23 below, but otherwise my bite was ok. Now, #6, #7, and #8 are all impacting the teeth below on the right side, and #11 is impacting the tooth below on the left. It's essentially an underbite or an "open bite" i've heard it called. I haven't been able to close my bite since about February, but my dentist kept saying, "it'll get fixed futher along in the treatment..." Now that we're "done" his solution is to start "countouring" the teeth - for us lay people, he means he wants to start shaving the teeth away to make them fit.

I went and got a 2nd opinion from an Ortho today, and he tells me that I have serious bite issues (tell me something I didn't know), and my options are:
1) stop wearing my aligners and let the teeth adjust themselves back to the point that I can close my bite...
2) let my dentist go to town "shaving" the teeth, or
3) sign up for what will likely be several thousand dollars of more treatment with a real ortho - staring with a jaw-alignment diagnosis to see where my jaw is comfortable and therefore where my teeth need to be.

I need your opinion - I sent my dentist a note today asking for my money back so I can go to an ortho and get this fixed... is that fair? I have an appointment with him tomorrow where we will discuss...

[lionfish]

So sorry to read of your experience, and I understand why you would want a refund. Whether you get it or not is another matter. See how you go in your discussions, anyway.

I would get a diagnosis from an ortho - and costs - regardless.

[roxy83]

In most cases, dentists have great relationships with area Ortho's who will "bail" them out in these types of situations (my best friend works in an Ortho office) for free. I would almost bet that your dentist will recommend somebody.

In addition, I would have the Ortho give you a written estimate detailing the treatment that he is suggesting and bring it with you tomorrow to document why you are requesting a refund.

[roxy83]

I agree that you shouldn't go in angry because I am a firm believer that you will get more "flys with honey than with....".

Good Luck and please keep us posted.

[prettybutterfly]

ohhh my God Cleveman that's terrible!!! Let us know what happens! That dentist should not even be alloved to do ortho stuff screwing people's bite up like that is pretty bad! I hope it all works out great for you in the end! Please do tell what ended up happening! I do think your idea is very fair! Sorry you had to go through that!

[diehard]

im not sure if that sort of thing could happen in uk dentists I think just maintain the teeth as best they can and orthos do braces ect

[rsprouse]

....Before I started, tooth #9 was leaning on #23 below, but otherwise my bite was ok. Now, #6, #7, and #8 are all impacting the teeth below on the right side, and #11 is impacting the tooth below on the left. It's essentially an underbite or an "open bite" i've heard it called. I haven't been able to close my bite since about February, but my dentist kept saying, "it'll get fixed futher along in the treatment..." Now that we're "done" his solution is to start "countouring" the teeth - for us lay people, he means he wants to start shaving the teeth away to make them fit.

So what do you mean by "impacting the tooth below"? Are you saying that the tooth is intruding into the gums (getting shorter)? Or are your teeth occluding in a cusp-cusp relationship rather than a cusp-fossa? I assume that because you are talking about contouring that you have an interference (or two) that are preventing a proper bite. Aligner type orthodontics are limited in the range of movements and how it is accomplished. Traditional brackets may be the best option if you are concerned about reshaping some of your teeth.

I went and got a 2nd opinion from an Ortho today, and he tells me that I have serious bite issues (tell me something I didn't know), and my options are:
1) stop wearing my aligners and let the teeth adjust themselves back to the point that I can close my bite...
2) let my dentist go to town "shaving" the teeth, or
3) sign up for what will likely be several thousand dollars of more treatment with a real ortho - staring with a jaw-alignment diagnosis to see where my jaw is comfortable and therefore where my teeth need to be.

It is good that you have options. It took time and money to get from where you started as a teenager to where you were before treatment started to where you are today. There are usually not an ideal treatment plan. Like anything in life you have to make sacrifices and decisions based on pros and cons for what is best for you. Just another chance to solve a problem...

I need your opinion - I sent my dentist a note today asking for my money back so I can go to an ortho and get this fixed... is that fair? I have an appointment with him tomorrow where we will discuss...

You can ask, if you were my patient I would decline a refund. Unless he was negligent and did not properly set your expectations, he has upheld his part of the bargain. You have presented some roadblocks in treatment and he is offering potential solutions. You have taken up a lot of resources and chair time I am sure. If you look at the opportunity cost of an hour of chair time vs. how much time you have been in his chair i'll bet you that he is thinking of asking you for more money Realize that he is probably disgruntled about the situation as well, if not more than you. There is not many things worse than knowing that you are partially/fully responsible for a problem that a patient has to deal with because of your own mistake or lack of foresight. He is human too.

I would say go with your gut, stick it out with the current clinician and give him a chance to make things right. Or abandon ship and go to somebody else that you have more faith in. You have to decide what is best for your individual situation.

Good Luck,
Rory

[cleveman]

I met with my dentist on Thursday. He was very very good about the whole thing - says he's not concerned about the financials, that we can work that out, but that he wants to figure out how to get me fixed.

He suggested that we get a 3rd opinion from a different Ortho and see if we can build a consensus opinion on what to do next. I think he is hoping that we can find an ortho that will look at my teeth and say "ohh, I can fix that with minimal effort"....

On his recommendation I talked to an ortho on Friday (over the phone) that he has a close relationship with and I'm scheduled to go and see that ortho next week. I think this Ortho will be looking for a minimalist way to fix the problem to sorta offset the pretty bleak 2nd opinion that I got from the other Ortho. We'll see.

Anyway - to clarify my situation in response to rsprouse, #6, 7, and 8 are all occluding (if I understand that term correctly) with the teeth below preventing me from biting down fully. 6 is hitting on the front side of 27, and 7 and 8 are hitting on the top edge of 25 and 26, to varying degrees. On the left, 11 is hitting the top-front corner of 21. All this is preventing me from being able to touch my molars together, even when I TRY to pull my jaw back and press down hard...

The more I talk about it with the professionals, the more I'm coming to believe that my teeth had over the years adjusted to a comfortable bite position (pre-treatment) that was crooked and ugly, but functional. When we did the RWB treatment, the lab and my dentist basically treated the top and bottom seperately, and made all the teeth line up nice and straight, without any real regard for what that would do to my bite. The fact that after the 1st set of aligners I had an open bite indicates to me that there was very little room for error, and we've blown way past that line with this treatment.

There are 2 sides to every arguement, and I could certainly see how someone would make a case that I shouldn't receive $1 back from my dentist - but from my perspective, I went to him to solve a problem (a bite problem, btw, I didn't go to him looking for straighter teeth) and that problem not only isn't solved, it's much worse than before we started. I think that dentists who get into moving teeth are well-aware (or should be) that they are entering a new field (for them) without the training or experience that an experienced Ortho has. Therefore, it should be natural for them to expect some percentage of less-that-successful outcomes that hit their bottom line. If they don't they're kidding themselves. And let's be honest - my dentist is jumping into these ortho treatments as a BOON to his business. He charge me almost $4000 for 9 months of treatment that had probably less than $1000 in lab fees and 9 visits of less than 30 minutes each (I went back and checked). I'm not going to feel too sorry about asking for most of my money back... he didn't feel too sorry for effectively charging me $600/ hour ($3000 / 4.5 hours) for "chair time" when we started this treatment - and I didn't even question it becuase I trusted that he'd get me the result he promised.

[chrisd]

alright lets just clear something up. the red white and blue is a VERY low teech alternative to invisalign. the only similarity is that they both use a clear plastic aligner. the movement of teeth via the RWB is based on the dentist eyeballing where that particular tooth should be. invisalign/orhtoclear use cat scan technology and computer modeling.

i have had red white blue, invisalign and conventional braces. rwb is akin to using a spring aligner or retainer and should only be used for very minimal tooth movements.

red white blue is not invisalign. i would talk to a certified orthodontist or two and really evaluate your options at this point.
good luck
chris

[cleveman]

While I do agree, chrisd, that RWB is not at all as sophisticated as Invisalign, I do think that my experience is similar to that of some other folks that have posted on this board (that went through an invisalign treatment instead of RWB) and ended up with bite problems.

I have consulted with a couple different orthodontist in the past couple weeks and what I have learned is this:

In some cases, a person's jaw has "adjusted" it's movement over time to accomodate crooked teeth. When you begin to move teeth (with any treatment regimen, frankly) you are, in part, allowing the jaw more freedom of movement. In my case, wearing the RWB aligners for a year acted as a kind of TMJ splint, and allowed my jaw to return to a proper mid-line, and allowed it to slide forward a bit. As a result, the bite that we were targetting with the original treatment no longer works, because my jaw angle has changed at the same time. One Ortho I consulted likened this to shooting at a moving target, that you're not sure is really moving. He is a HUGE user of Invisalign, and says that this is a challenge with Invisalign as well - not just RWB.

This issue doesn't tend to be as much of a problem for traditional braces, because every month to six weeks the Ortho is looking at the patient and making adjustments to the program. Threfore, if the jaw angle changes over time, he is constantly adapting to it. With Invisalign or OrthoClear or RWB, the treatment is fairly "set in stone" at the start and the revision process is more difficult than it is with brackets and wires.

This particular Ortho's opinion is that the way to avoid this problem is to "evaluate" the jaw movement before starting a "clear aligners" treatment, to try and determine if the jaw will change its movement when the restrictions of crooked teeth are removed. That way, you can attempt to shoot for the target jaw angle, instead of the starting jaw angle. In some cases its even beneficial for the patient to wear a splint for a couple months to allow the jaw to move before the Ortho treatment, in his opinion.

Anyway - my dentist has been VERY good about this. He is going to work with me to offset of the costs of correcting the problem. He is fully in support of me working with an Ortho from here on out, and he is letting me choose the Ortho.

I am going for a jaw-movement diagnostic treatment next week to see if my jaw has now reached its "ideal" state. If so, we'll start an invisalign treatment (if possible) or brackets and wires to fix the bite issues. I'm very likely looking at several more months of treatment and some, as yet unknown, additional money.

[cleveman]

btw - I read somewhere that Invisalign is "backed up" in terms of new patients... that it's taking longer than usual to get the aligners made. anyone here experienced that?

[chrisd]

i am glad that your dentist is willing to work with yu on cost, and that you are going to try and get your bite sorted out. good luck.

let me just say this, as my switch from invisalign to braces was because of resultant bite issues as well. invisalign corrects the upper arch and the lower arch independant of each other. where as with traditional braces the arches can be adjusted together through things like elastics.

just be careful not to go down a raaod that is going to "maybe fix things." if you have 3 orhos that say invisalign will work go ahead. if you have one that says it will and two that encourage regular braces... you get the point

good luck, chris

[lisaemtp]

Thanks to all of you who shared your negative experiences. My dentist encouraged me to use invisalign to correct my upper crowding despite a crossbite and a too-narrow maxilla...I'm having a consult with an orthodontist next week because of my concerns that changing only the crowding will negatively effect my bite. I'm even more glad I insisted on the consult after hearing that other people have had a problem with this (she assured me that it would be fine). At least if the ortho agrees, i'll be a little more convinced.

[cleveman]

thought I'd give an update after several months of not posting...

my dentist did give me most of my money back and I've turned around and handed that money (and some more out of my pocket) to an ortho in my area that has done over 300 Invisalign cases, in addition to having 25 years of ortho experience. his job is to fix my bite - which was actually made WORSE by my dentist.

he put together a treatment plan based on some bite analysis that he did - he actually took molds and mounted them on mechanical jaws to get a better look at how my bite was fitting and what needed to be done to fix it.

I'm on tray 3 upper and lower of a 15-tray invisalign treatment... keep in mind that my teeth were already straightenend with 12 months of RWB treatment.

At one point he referenced elastics - from the back of my top arch to the front of my bottom - to pull the bottom teeth back and the top teeth forward. He hasn't mentioned that again, tho, so I don't know if it actually is part of the plan or not.

I can certainly atest now to the fact that invisalign is a more "precise" treatment... the trays fit tighter and seem stronger (but thinner!?) and they have much less of an impact on my speech than the RWB trays did - even after a year of wearing them.

I also like the approach of changing trays every 2 weeks instead of every 6. The pain involved is much reduced, they are easier to keep clean, and psychologically I think you feel better when you change trays more frequently - it feels like your actually making quicker progress.

I know that there is still a possibility that I will have to get traditional braces if he can't fix the bite issues with Invisalign, but he seemed confident that he can, and has guaranteed to fix the problem without any more cash from me - even if it means braces after invisalign.

So, at the risk of repeating myself, my recommendations to anyone considering this for the first time is:
1) go to an ortho, not a dentist.
2) consult more than 1 ortho, and ask how many Invisalign treatments they have done.
3) make sure they are committing to a result, not just a treatment. That is, make sure you understand what happens if you end up with bite issues at the end of treatment - who pays for more treatment?? and while you're talking about money with him, ask if retainers are included in the fee?
4) go for it!

[slimjim]

Well this whole topic has just scared the crap out of me... Im on red white and blue and i just went in for my second aligner two days ago. I, like cleveman notice some problems with my bite after the first aligner. My top right central inscisor is hitting my lower right central inscisor not allowing me to close my mouth all the way. I basically had one crooked tooth that this treatment is supposed to fix and if it screws my bite up im gonna be pissed. I guess i was hoping my ortho would make an adjustment after my teeth are straight but after reading all of this Im a little worried.