Interesting blog post from a dentist..

[myhollywoodsmile]

I was just browsing around the internet for some Invisalign when I came across the following blog post from a dentist.
http://favoritedentist.com/2010/01/29/i ... it-behind/

I don't know about you, but it actually made me very nervous!

She seems to suggest that she had very little orthodontic training at University as part of her dentistry degree followed up by less than extensive training in using Invisalign. It was all a bit terrifying.

What I took away from it is that it reinforced my feeling that the experience of your provider is vital, and also that thank goodness Align are tightening up their requirements. I know that that wasn't the dentists viewpoint but it was certainly mine!

[Bellalalala]

Don't be freaked, it's one blog entry by one dentist.

Certainly, invisalign is just a tool, and is only as effective as the dentist using it, but that is fairly common knowledge.

As for ortho education, I know that in my school, ortho is known as the most brutal part of dental school. Also, orthodontists have extensive training in ortho, waaaaay beyond what a basic dentist has. Even then, family dentists usually have significant additional ortho training above and beyond what a general dentistry degree involves.

Really, I wouldn't worry about it.
Invisalign has been around long enough for evidence to show that in general it works. Invisalign is a tool, as all dentists on this site attest to, it is not a therapy in and of itself. There are limitations to what it can do, but a qualified dentist uses it, they will know what those limitations are and operate within them.

[drrick]

Even then, family dentists usually have significant additional ortho training above and beyond what a general dentistry degree involves.

There is no such thing as a 'family dentist' all family dentists are general dentists. there is no extra training or anything like that.

[DrJasonKTam]

Certainly, invisalign is just a tool, and is only as effective as the dentist using it, but that is fairly common knowledge.

This is actually not the case. Most of the public thinks that Invisalign's computers develop a treatment plan, and wonder why there is a difference in cost between doctors. We've even had people ask if they can just order Invisalign online...

There are limitations to what it can do, but a qualified dentist uses it, they will know what those limitations are and operate within them.

This is also untrue unfortunately. A "qualified" dentist has taken a one day course in how to submit materials to Invisalign. It teaches nothing about the limitations nor how to move teeth with a removable appliance. The two major reasons for Invisalign failure are lack of patient compliance, and improper treatment planning/case selection by the doctor.

[Second Time Around]

I am unfortunately living proof that this blog entry is 100% correct (i.e. that there are unqualified providers out there offerring this service) and I have to live with the severity of that mistake for the rest of my life.

After orthodontic work as a child, I had two arches of nicely aligned teeth, but the top arch was a lot larger than the bottom arch. I had a signifcant overjet, but no one could ever tell because only my top arch showed when I smiled, and it was so nicely aligned. In my late 30's I saw some minor imperfections for the first time in my life (overet becoming a bit more pronounced, one front tooth slightly longer than the other) and thought it would be nice to bring those minor imperfections back in line if there was a short, discreet treatment method.

I saw a cosmentic dentist's (very established practice) ad in a magazine which referred to Invisalign. I had never used the services of a cosmetic dentist and honestly thought they had different qualifications if they were offering this service. I thought I would just go in and get some information about the product for my top arch only. I though I was conducting due diligence by checking the Invisalign website, but I know now it leaves out many details of treatment.

The dentist and his staff repeatedly made reference to the fact that the practice was extremely experienced in Invisalign. This doctor was in fact a Premier Provider. Up until this point in my life (age 41) I had no reason to believe that a doctor would ever recommend a course of treament that was not in my interest. On the day of the consultation I was misled in the following ways- consider these red flags if you are at the shopping around stage:
- After a very short time of looking into my mouth- I was pronounced a "very simple case". This seemed quite reasonable as I did have an overall nice smile. I know now that two very different size arches are complex for Invisalign to treat.
- I was not told about attachments or filing.
- The computer animation was described as a very effective sophisticated tool that would effectively create a treatment plan.
-I was told it would be much better to treat both arches (even though my bottom was nicely aligned).
- I was still a bit hesitant and it was at that point, I was encouraged to "just take impressions that very day", only committing to a small amount of money. Of course once that part of the process is started, it becomes easier for the dentist to convince the patient to keep moving forward with treatment. I found out it would only be 16 trays- so figured 7.5 months wouldn't be so bad.

As soon as I started, everyone told me I was crazy because I had a beautiful smile. I assured everyone this would be a short process and I would get some improvement that I could maintain for life. Unfortunately, the treatment plan was completely unrealistic (i.e. it was supposed to be making these two hugely different arches perfectly symmetrical with 16 trays and a huge amount of IPR). I did not want the IPR; however the doctor convinced me that based on his tremendous experience, this would provide a beautiful result.

After 8 months, my bite was completely ruined, to the point I could not close my top and bottom teeth. The doctor could not articulate one reason for the terrible result, and could offer no solutions as to how to fix it. I had to start over with a new elith ortho provider, who was excellent by the way. However, we were starting from a position of extreme damage, so the extra 9 months of treatment was to correct the damage as much as possible (not restore the formerly beautiful smile). 2 years after that fateful consultation, I just completed treatment a few days ago. I myself was underwhelmed, and to my dismay, not one person has told me they like the results, they just look at my teeth and sort of nod and smile. The large amount of IPR has taken away the fullness from my mouth area, there are still traces of openbite, and to my horror, a fair amount of staining behind some of the teeth and on the biting surfaces, even though I brushed my teeth religiously, I suppose 2 years of covered teeth takes its toll. After all this, I need to wear retainers every night for the rest of my life.

I hope people out there can learn from my experience. I know that there are great providers out there and there are people on this Board that have had fabulous experiences. The most important thing is to arm yourself with as much info as possible and not rush into type of treatment plan. I myself didn't learn about the red flags and risks to watch for until I found these Boards. Unfortunately, that wasn't until a little after I started treatment. I wish everyone the best of luck and do not wish my awful experience on anyone.

[skymom]

Hi, I'm new to this forum, and Invisalign, and found this dentist's post interesting. When I chose a provider, I saw that there were a few Premier providers in my area, but I opted for the one who was an orthodontist versus a dentist. In my case I didn't give it a consideration -- an orthodontist specializes in this type of thing.

What jumped out at me with this dentist's post was that they don't handle many cases in a year (hence my reluctance to go to a dentist for invisalign). Also, the issues this dentist raises seems to be more their complaints about Invisalign as a practitioner, not in terms of results for the patient. So I take it all with a pretty large grain of salt.

Just my reactions, could be all wrong though!

[drrick]

I am unfortunately living proof that this blog entry is 100% correct (i.e. that there are unqualified providers out there offerring this service) and I have to live with the severity of that mistake for the rest of my life.

After orthodontic work as a child, I had two arches of nicely aligned teeth, but the top arch was a lot larger than the bottom arch. I had a signifcant overjet, but no one could ever tell because only my top arch showed when I smiled, and it was so nicely aligned. In my late 30's I saw some minor imperfections for the first time in my life (overet becoming a bit more pronounced, one front tooth slightly longer than the other) and thought it would be nice to bring those minor imperfections back in line if there was a short, discreet treatment method.

I saw a cosmentic dentist's (very established practice) ad in a magazine which referred to Invisalign. I had never used the services of a cosmetic dentist and honestly thought they had different qualifications if they were offering this service. I thought I would just go in and get some information about the product for my top arch only. I though I was conducting due diligence by checking the Invisalign website, but I know now it leaves out many details of treatment.

The dentist and his staff repeatedly made reference to the fact that the practice was extremely experienced in Invisalign. This doctor was in fact a Premier Provider. Up until this point in my life (age 41) I had no reason to believe that a doctor would ever recommend a course of treament that was not in my interest. On the day of the consultation I was misled in the following ways- consider these red flags if you are at the shopping around stage:
- After a very short time of looking into my mouth- I was pronounced a "very simple case". This seemed quite reasonable as I did have an overall nice smile. I know now that two very different size arches are complex for Invisalign to treat.
- I was not told about attachments or filing.
- The computer animation was described as a very effective sophisticated tool that would effectively create a treatment plan.
-I was told it would be much better to treat both arches (even though my bottom was nicely aligned).
- I was still a bit hesitant and it was at that point, I was encouraged to "just take impressions that very day", only committing to a small amount of money. Of course once that part of the process is started, it becomes easier for the dentist to convince the patient to keep moving forward with treatment. I found out it would only be 16 trays- so figured 7.5 months wouldn't be so bad.

As soon as I started, everyone told me I was crazy because I had a beautiful smile. I assured everyone this would be a short process and I would get some improvement that I could maintain for life. Unfortunately, the treatment plan was completely unrealistic (i.e. it was supposed to be making these two hugely different arches perfectly symmetrical with 16 trays and a huge amount of IPR). I did not want the IPR; however the doctor convinced me that based on his tremendous experience, this would provide a beautiful result.

After 8 months, my bite was completely ruined, to the point I could not close my top and bottom teeth. The doctor could not articulate one reason for the terrible result, and could offer no solutions as to how to fix it. I had to start over with a new elith ortho provider, who was excellent by the way. However, we were starting from a position of extreme damage, so the extra 9 months of treatment was to correct the damage as much as possible (not restore the formerly beautiful smile). 2 years after that fateful consultation, I just completed treatment a few days ago. I myself was underwhelmed, and to my dismay, not one person has told me they like the results, they just look at my teeth and sort of nod and smile. The large amount of IPR has taken away the fullness from my mouth area, there are still traces of openbite, and to my horror, a fair amount of staining behind some of the teeth and on the biting surfaces, even though I brushed my teeth religiously, I suppose 2 years of covered teeth takes its toll. After all this, I need to wear retainers every night for the rest of my life.

I hope people out there can learn from my experience. I know that there are great providers out there and there are people on this Board that have had fabulous experiences. The most important thing is to arm yourself with as much info as possible and not rush into type of treatment plan. I myself didn't learn about the red flags and risks to watch for until I found these Boards. Unfortunately, that wasn't until a little after I started treatment. I wish everyone the best of luck and do not wish my awful experience on anyone.

Is your open bite in the posterior? this is often a transitory effect of proper aligner wear.

Additionally, even though the lower arch may look 'straigh' that doesnt mean there are not other issues. deep curve of spee, improper tooth angulation, etc. these factors (and many others) can have an immense effect on what can be accomplished when treating the upper arch.

I am sorry you had a negative experience but am glad to see it is coning to an end.

[Second Time Around]

I'm not sure if my open bite is posterior, basically the only teeth I was able to bite down on were the very last molars on each side. After contouring, I can close the last 3 molars. Luckily I have long front teeth so the bite appears closed from the front. I wore my aligners 21 hours +/day religiously through both the first and second treatments (ironically because I wanted the best result possible).

Agree with your comment about the lower arch and potential benefits of treating even if it is straight. My frustration was that the first doctor didnt turn out to have a high expertise level, and I was quite upset that he placed both my arches at risk. With the first treatment, my lower arch was expanded to better match the upper arch. My second doctor told me that the lower arch was expanded much too far, and I then needed 20 aligners to push them back in!

The best news after all this is that I was able to go straight to night time retainers, so I'm back to a normal social life and snacking! Whitening the teeth also helped improve the overall appearance.

[Phantom Muse]

Sorry to hear about your less-than-ideal Invisalign journey, but it sounds as if things are improving for you.

Did you experience any tooth movement during the day when you went directly to nighttime retainer wear? I have heard that so many people have trouble leaving them off for more than a few hours for quite some time.

I am looking forward to the day I can resume snacking, too!

Thanks for sharing your experience.

[leevshan]

Second Time Around, were you shown the clincheck?
Were the final result similar to the clincheck?

[Second Time Around]

Phantom Muse, in answer to your question about going straight to night time: I would say in the first 4 weeks or so, I did feel slight shifting during the 12 hours they were out. At times, I did put them in about 4 hours in the daytime for some extra stability. I am now in the 7th week of retainers, and I sense much less shifting during the day. Also as an added bonus, now that I am not wearing aligners all the time, the open space between the top and bottom teeth seems to have closed up a bit. Thankfully, things are looking up.

Leevshan, I did ask to see the Clincheck at the beginning of treatment. The end result showed a complete elination of the overjet and fully closed bite in 16 aligners. By aligner 11, the bite was completely off as my last molars on each side actually extruded and those were the only teeth I could close. At that time, the dentist showed me the Clincheck (as at aligner 11) and he was completely shocked at how far off it was. Please note that his dentist did not participate in the check-ups, he simply had a dental assistant hand me 3 new packages of aligners every 6 weeks. I had to make a special point of seeing him to discuss my problem. I would advise people to ask to see how their Clincheck is tracking during treatment, if the ortho isn't already doing this.

[leevshan]

Your dentist actually didn't check on your progress each time you get new trays? I think that's his job to check on the progress gradually.

At the beginning of my treatment, I asked my ortho if it's Ok for him to just send me 2 new sets every month, because he is about 3 hour drive from where I live. (There isn't any qualified ortho around the area where i live).
He said, just like regular braces, with Invisalign one needs to be checked at least once a month or so to see how things are going. If I can't see him in person at least once a month, then he said he won't do the treatment.
I'm glad that he mentioned this.

Anyway, glad to hear now everything seems to go well with you

[myhollywoodsmile]

One thing that my ortho continually points out to me is that the clincheck is a guide, not a guaranteed result. He is always telling me that just because something works one way on a computer simulation doesn't mean it necessarily will in the mouth. So even though clinchecks may look perfect it doesn't mean there won't be a problem.