Missing Teeth & Invisalign?

[brooke3390]

Hi, I am congenitally missing both upper lateral incisors (teeth right next to two front teeth on each side), had them as baby teeth but when they fell out when I was little the adult ones never came in. I had braces when I was younger to open the spaces for future implants when I was older (late teens/early 20s), and now I am 22 and for the past few years I have been told the spaces are just slightly too small for implants, despite having worn a retainer to maintain the spaces constantly day and night for the past 10 years.

So anyways, I am going to be getting Invisalign in addition to IPR (shaving between teeth) to make room and readjust my teeth so there is more space in the toothless areas for implants as soon as orthodontic treatment is done; right now there is about 4 mm of space in each area, the oral surgeon who will be placing the implants said he needs at the least 6 mm of space in each area. The orthodontist said that the Invisalign trays will have filled in areas where the missing teeth are so that I will look like I have those teeth in place with the trays in. I've had a similar type retainer in the past, a plastic Essix retainer with acrylic teeth set into the spaces in the tray.

Has anyone had a similar experience with filling in gap areas with Invisalign? Just curious! Any Invisalign advice in general is appreciated too

[DrJasonKTam]

Those are known as pontic teeth and can be put into your Invisalign simulation. The issue is creating enough space where the crown is but also where the roots are. The teeth need to be moved into parallel positions to allow for implants to be placed. 2mm per side will involve that much expansion/proclination/IPR per side to achieve this. Implant space creation can be done but it is a more advanced Invisalign treatment. Good luck!

[brooke3390]

Thanks for the reply! I've had a very similar Essix retainer in the past with pontics placed in the retainer tray, so I'm familiar with this type of device and I imagined the pontics in Invisalign aligners wouldn't be much different. But when I was speaking with the orthodontist regarding the pontics, he explained that rather than having the area "filled" with the acrylic pontic material, it would be more like a shell or painted in the inside so that further on down the road after I get implants, I would still be able to wear the last aligner set as retainers... this doesn't really make sense to me, because how would my last set of aligners, without the implants and crowns already in place, perfectly fit over the future implants? I'll have to discuss this further when I have my initial molds taken next week.

Also, regarding the pontics, I am very concerned about the aesthetics of them. In looking through many, many photos of people wearing the Invisalign retainers, it appears that there is often a slight, maybe 1 mm gap between the gumline and the actual teeth where the plastic does not cover, as though the aligner is not completely flush against the teeth. I'm concerned that should the pontics be "painted on" rather than entirely set into the aligner, if the aligner does not ENTIRELY cover my teeth up to/slightly beyond my gumline, then there will be a weird gap and it will be very obvious the lateral incisors are false. Maybe I'm being to analytical, but I just want to be sure the pontics look their absolute best and match up with where the gumline is on the adjacent teeth, one of my biggest complaints now with the flipper I've been wearing for the past 8 years is that the false teeth appear too "short", the top edges start lower than where the gumline naturally is on the adjacent teeth...

Quick question too: If the pontics in the aligners are indeed "painted" on the inside or only a thin shell layer, can this serve as a device to cover healing posts once the implant posts are placed for the 3 to 6 month healing period? I imagine this would be an option, but not entirely sure. I guess only my orthodontist can say for sure, but it'd be great to hear from people who have had similar experiences!

[Stephskare]

Hi there! I had to have a tooth pulled in order to make room for my teeth to move properly so I also had to have a fake tooth put in my trays. I was very worried with how it would look since the tooth that was pulled was my third tooth from the center. But it ended up looking very natural and now that I'm on tray 17 out of 40 the hole is so small I don't have the fake tooth any longer.

[exm]

Ahhhh Brooke I am so right with you!!

I, too, have missing lateral incisors that I had as baby teeth but never grew in as an adult. I now have implants (sometimes wish I had gone the space closure route but didn't want to get teeth pulled to make everything line up).

Brooke -- very important -- too small for REGULAR implants or MINI implants?

I had a similar problem. there wasn't enough room for regular implants. My doctor suggested minis, noting that there may be a greater risk of implant failure, but if it happened I'm only out $900 (much cheaper than the $2200 for regular implants) and better than getting some sort of bridge. The research isn't completely out there, so depending on your implant specialist he might not want to do them. BUT. If he is willing, you may be able to fit mini implants in where regular ones will not go.

Good luck! I feel for you, I had to deal with the same lovely problem you're dealing with.

[exm]

PS -- my implants were done post-braces. I went without teeth for the three hours between implants, and getting artificial crowns. Sorry, can't quite answer your specific question.

[brooke3390]

It's so relieving to know I'm not alone just hearing from other people with same/similar situations reminds me of that fact! I once read somewhere that 2-3% of the entire WORLD population is missing one or more lateral incisors!!! How crazy is that?! I wonder why it's so "common".

When I had braces as a kid (10 to 12 years of age), I didn't have any pontics (fake teeth) in the areas when they aligned my teeth and widened the spaces, but back then I never really thought anything of it because it seemed like everyone my age was going through the whole braces ordeal. But now that I'm 22, going to a new college next fall hopefully, working at a marketing job I love, and meeting new people all the time, I'm super self conscious and anxious about what the pontics on the Invisalign will look like! I've had a very similar clear retainer with fake teeth before, but I know this will be different... Basically, I just don't want them to look obviously fake at all, I have friends I see nearly every day that I've known for quite a long time and have no idea I'm missing any teeth (I've had the same dental dental flipper for 8 years now), and how weird would it be to one day start wearing the Invisalign and have these weird, wonky fake teeth where my "normal" ones use to be?! Haha! I guess only time can tell, I'm due to get the aligners around Christmas time... happy holidays indeed!

I've done a LOT of research as to what all my viable options are for replacing the missing lateral incisors, and I did read a lot of dentistry literature about mini implants. I even discussed this with my dentist and oral surgeon, and both mentioned that there simply isn't a lot of solid case studies/failure rate statistics published yet because in terms of dental technology, they are very new. Given the fact that the failure rate does seem to be significantly higher than traditional implants though, and also because of my steep bite structure, I've decided I would much rather pay extra to have the job done once and done right with traditional, 3 mm implant posts, even though this entails orthodontic work and most likely bone grafts. Better safe than sorry though... but who knows, I'm sure over the next few years there will be improvements made to mini implants and more conclusive information about them available! Dentistry amazes me, it really is a technologically cutting-edge field!

[brooke3390]

So here's an update on my Invisalign journey:

I got my first two sets of aligners on December 10th! My appointment went much quicker than I anticipated, and to be honest I felt kind of "rushed". The actual orthodontist actually only saw me for a total of maybe 1 minute, basically he was like "Do they fit ok? Ok see you in a month!", didn't even really take a moment to physically check the fit or show me my Clincheck video, explain future attachments, or anything of that sort. So that was a bit offputting. I have 19 aligners total (not including any future refinements), so that's not too bad... about 9 months or so. But I'll be getting a whole bunch of attachments (2 on my right canine!! yaaay... not!) and some shaving between my two front teeth to push them closer together.

The part I was (and still am) most anxious about regarding my case is the pontics that are in the spaces where I am missing my lateral incisors. Well, the assistant woman who gave me my starter kit goodies (cases, toothrbush, cleaning tablets, care pamphlet, etc.) handed me my first set of aligners to try on, and I had to ask her if the pontics were in them, which they weren't... so she was like "Ok, I'll be right back!" And took the two sets of aligners I received to fill in the areas with pontic material. I was very worried at this point because she didn't do a shade check for color matching with my natural teeth or anything, she literally just grabbed the aligners and started filling them in a separate area of the office with a type of silicone-ish resin material, like a caulking gun thing. She brought them back and I asked her if that's standard practice not to do shade matching or anything of that sort, and she just brushed it off saying "No, we just use a standard color for the material." Needless to say, I'm quite disappointed...

Initially, the pontics looked pretty good, the size and shape of them is definitely an improvement over my previous flipper I've worn for the past 8 years, and the color seemed to be alright, not perfect but pretty close. So at first, I was ok with them. But as the weeks have gone on and I'm nearing the end of my second set of aligners, I am increasingly disappointed, upset, and frustrated with the whole thing. The two pontics appear unnaturally dark grey/yellowish against my natural teeth, which are ironically becoming whiter as I pay more attention to my oral hygeine habits and am constantly brushing, flossing, rinsing, etc. For the first few days of each set, the pontics look OK- best in bright direct lighting, but in darker lighting they appear to have a slight off-color. But it seems as time progresses, they get darker and darker to the point now where they're quite grey and dead looking!!! It's very noticable, so much that several people (who didn't even know I've been missing these teeth at all or that I was undergoing Invisalign treatment) have commented on their weird, "dead" looking grey appearance.

I am self conscious enough already, and the added frustration of spending nearly $6,000 out of pocket and the next year or so with these stupid things is really upsetting to me. It's not even been a month and already, I am not smiling nearly as much and trying to open my mouth to reveal my teeth as little as possible when I speak, eat, or laugh. It's frankly embarrassing and awkward and I'm not happy.

I have an appointment this coming Wednesday to get attachments (oh goodie... and I even had to specifically ask the assistant about where they would be and when I would receive them!! If I hadn't asked, they wouldn't have mentioned it!!!) and receive the next 5 sets of trays. I'm going to speak with them to see if there is any available alternative for the pontic material. I know when I had my Essix retainer many years ago, the material they used for the pontics was different, harder and not silicone-like. I just really want a better, more aesthetic solution. I'm spending all this money and the whole point of Invisalign (besides moving your teeth and creating a better bite/smile) is for it to be a more aesthetic option than conventional orthodontics. So far for me, I'm not having a good experience with it. It's going to be a long year.

[aaustin96]

Literally that first paragraph is an exact description of my life every detail to a fukkknnn T lol.... Its absolutely wild knowing that someones been through exactly what ive been through missing the same exact teeth going through the whole process being told the gaps are too small braces for years for creating gaps etc. Always felt so different and terrible about it. Never knew someone out there that has been through the same exact thing literally exists. Literally made this account just to write this. Reading that just made my day haha