Choosing a treatment plan & ortho (invisalign vs. ceramic)

[JACO]

I joined this board a few years ago in anticipation of fixing my bite, however I was not able to go through with treatment at that time. My teeth look fine, however I have a edge-to-edge bite (only my front two teeth touch) that has been seriously damaging my teeth and causing a fair amount of jaw pain. My financial situation has now changed and I am able to (finally) go through with getting things fixed.

I've now seen two orthodontists and am struggling to pick the better path. The options are:

Ortho #1: Invisalign + Acceledent + extraction: The first ortho proposed removing one lower incisor to make space on my lower arch. Treatment time would be 18 months with some elastics towards the end of my treatment
- Pros: a nicer guy (I had a better time at my visit), less time in elastics (my least favorite part of my previous orthodontic treatment in high school)
- Cons: extraction - not sure how things will look with an uneven number of teeth on my lower arch

Ortho #2 Option #1: Invisalign + Propel: no extractions, but consistent elastic wear would be required for the entire treatment time (18 months); attachments on all of my teeth - yikes!
- Pros: no extractions
- Cons: way more elastic wear; Propel kind of freaks me out

Ortho # 2 Option #2: Ceramic braces + Propel: no extractions, but consistent elastic wear would be required. Quicker than invisalign (14-16 months).
- Pros: no extractions, quicker, possibly better outcome, cheaper
- Cons: braces, elastics, Propel

I feel stuck. I perhaps have an irrational fear of the single tooth extraction, however the thought of wearing elastics every day for 18 months is incredibly unappealing. And if I do go with the second ortho, should I suck it up and get ceramic braces to move things more quickly? It seems like having attachments on all my teeth and elastics every day would be no less noticeable than the ceramic option...

Thoughts? Would love to hear from folks who have faced similar decisions (particularly w/r/t extractions vs. no extractions, invisalign vs. ceramic).

[Shelleyt]

Definitely something you are going to have to think about based on your preferences since its your smile and your money, but for me personally the idea of extractions seemed a little odd (I had one ortho recommend two extractions, yet who was dead set on bringing up my highly impacted lower canine). My current ortho says she almost never recommends extractions, but it seems many on this site have had a lot of luck being treated with extractions and it is much more common than I would have thought. I went with my current ortho primarily because she does 30-40% lingual cases, which is what I wanted, but the no extractions was a factor.

I have heard really good things about propel- seems to be a lot more clinical evidence of its effectiveness compared to acceledent, which is mostly anecdotal at this time. I am also going to be using acceledent, with propel performed on that one lower canine during the exposure procedure. So I feel like that plus ceramics or metal should give you a great results!

[oldfart]

I would get more than two options if you can. I am probably one of the few that think invisalign looks worse than braces. I had the invisalign type retainer for a bit, and boy did it cause my mouth to go dry. Even more than when I had braces. It also was a bacteria magnet, even just off saliva it looked and tasted gross after an hour of wear. And it definitely is noticeable as it is shiny, reflects light, and looks very Plasticy. (if that is a word). I ended up switching my retainers to Hawleys.

After a month of elastics you get used to them. After that time the biggest pain in the butt is finding them in your carpet.. in your car.. in your desk.. I'm 8 months out of braces and still finding them in corners.

Also be sure to check on breakage costs.. If they accept email questions.. customer service is also huge..

Was there any time difference if you used metal as opposed to ceramic?

[verso]

I've been told, by my orthodontist, that invisalign must be worn --at minimum-- 22 hours a day in order to be effective. For me, I ruled out invisalign right then and there. Unless you are incredibly disciplined, I just don't see it happening. A mere 2 hours to eat and brush? That's tough.

[Beckett]

My honest opinion? Fixing a bite needs traditions braces. Making things pretty can be done with Invisalign. I'm sure I'm wrong in some cases, but I have read where people had to ditch the Invisalign partway through (or even toward the end!) and end up getting traditional braces anyway. I'm a fan of traditional works well, don't mess with it.

Elastics? Eh, don't worry. You get used to them pretty fast and you'll get to the point where your teeth feel better with them on than when you take them out to eat or brush. Why bother with Invisalign if you'll have to have elastics anyway? I've had mine since 7 weeks and anticipate the entire treatment with them due to pretty much everything getting fixed is bite and not just making things pretty. It's the one thing you have total control over during your treatment and it feels good to know I'm doing my part to make things move along like they should.

And to be honest? The thought of having my teeth covered in plastic 22 hours a day grossed me out. And I think people lisp worse with Inviasalgn than traditional. Just my opinion. I'm sure there are folks who love their Invisalign. You just have to be honest with yourself about what you can tolerate and what you can't, regardless of what someone else prefers. But getting opinions helps you think of things you might not have considered before. Good luck choosing.

[DrJasonKTam]

Keep in mind that these treatment plans are estimates. It is possible that you will need to wear elastics through much of your treatment. A plan of 14-16 months is also not that different from 18 months if looking at average patients. Sometimes 18 month treatments finish quicker and other times 14-16 month treatments may take longer.

The toughest part about elastics for most patients is remember to take them on and off. This shouldn't be an issue with Invisalign since you have to remember to wear the aligners. It is far different wearing elastics with Invisalign than with braces in terms of aesthetics. Good luck!

[JACO]

Thanks everyone for your responses. After posting and reading your helpful responses I had decided that the ceramic/metal braces option was the best choice due to less hassle (trays in/out), better likely results, less cost, and kinda aesthetics (Invisalign + attachments on every tooth looks strange to me). I have been nervous/anxious but was feeling okay about the choice until last night when i couldn't sleep because I was worrying about the decision.

Am I crazy not to choose Invisalign if it is an option? Am I overthinking the hassle involved with Invisalign? And am I wrong in feeling like Invisalign won't produce quite the same results, albeit at a higher cost?

[verso]

Am I crazy not to choose Invisalign if it is an option? Am I overthinking the hassle involved with Invisalign? And am I wrong in feeling like Invisalign won't produce quite the same results, albeit at a higher cost?

I don't think you're crazy at all, but if you are crazy, then so am I because I opted for traditional braces over invisalign as well -- and for the same reasons.

I wasn't prepared to dump that much money into invisalign when it may not produce the results I'm looking for. It felt like too much of a should-work scenario as opposed to a will-work scenario.

[iob]

Hi - I'm sure that as long as you've found two good orthos for those consultations, the plans will all work and you'll get nice results. It seems there are always multiple ways to get to the same end point.

Many of us are prone to overthinking and rehashing decisions. I've found in the past that when I've gotten initially comfortable with a decision, that's generally the best course. So if I had initially settled on your decision to go with ceramics and ortho #2, there are probably some good conscious and subconscious reasons for it, and I'd go that route unless you receive new information or have flat out overlooked something.

I'm not using Invisalign, but I can say that the idea of having attachments on all my visible front teeth would certainly narrow the difference in aesthetics between aligners and ceramics. Also, no matter how aesthetic you try to be, elastics kind of throw it all out the window. I found them to be the most visible, eye-catching aspect of treatment. I didn't find them to be that much of a hassle and they were easy to get used to, but they were SO obvious. If I really thought that an Invisalign plan would involve elastics the entire time and attachments on all of my front teeth, I probably would not have bothered with that option.

That all said, it seems that just about everyone becomes an advocate for their choice of metal/ceramic/aligner/lingual, which tells me that most people wind up satisfied regardless of the choice. Maybe it's because seeing the improvements and results makes any plan worthwhile, or maybe we all just need to justify our own decisions because it's such a commitment. Whichever you choose, you'll be fine.

Good luck!