different orthos have so different treatment plans

[wendydong]

I went to another consult today.. this ortho is a diamond plus invisalign provider. I have nailed down to 6 different orthos this time. and since I now have no braces on me, there's no problems of getting a consult...

I told the ortho I had an invisalign express treatment (that's when the nightmare started), sold by a dentist when I went to a dental cleaning. The invisalign express treatment didn't really un-crowd my bottom teeth completely, but gave me TMJ after 5,6 months. I had absolutely no issues with my teeth and jaw before that.

Then I went to an ortho, couldn't deal with braces, didn't want to tell him about the communication problems with my ortho. So i kinda made up a story about wanting to switch to invisalign but my ortho said I wasn't a candidate because i needed elastics...

By the time i finished telling my story, I felt like i am one of those plastic surgery addicts...

First thing out of his mouth is that my jaw is crooked, so I will never have the perfect bite (which i am perfectly fine with).

I first wanted know since I had an invisalign express treatment, invisalign should have a model of my original teeth. Can he make a treatment plan to turn my current teeth to my original teeth... he said no. Basically, I get the idea that no matter how many orthodontics work u've had, the new ortho will treat the teeth to whatever they think is an achievable ideal. He said he can't treat me and give me original overlapped teeth...

then I stated my goal of expanding the arch, make my arch more U shaped, and un-flare my incisors, improve my bite to what I had originally.

To my surprise, he said he doesn't think I need elastics. His plan is to expand my upper arch a little bit. but he can't expand too much because i have some gum recession. He probably would need to make my bottom arch a bit smaller (this is something new), and do IPRs on my bottom teeth to retact the lower incisors.

I get the impression that he thinks my bite is a little bit worse is because my lower jaw doesn't know where to go... (which is something i have been feeling). Once he finishes develop the arch form, and do some IPRs, my bite would naturally settle to a "comfortable" bite.

I then wanted to nail down this "comfortable" bite and want to know if my maloclusion can go back to what I had (class I on the right, class II on the left), I feel he wouldn't commit. Most ortho would use "vague" terms like "comfortable bite...

and his estimate of treatment is only about 12-14 months. 2-3 batches of invisalign, about 20 trays each. The good thing is that he would review the clincheck video with me, and only order the trays after I approve.

my previous invisalign consult is about 18 months, also 2-3 batches of invisalign. but would contain more trays for each batch. The previous invisalign consult would have me wear elastics.

i feel my previous invisalign treatment plan is a bit more "meticulous" than this one?

[wendydong]

also, let this be a lesson to anyone (but probably too late if u r reading this).

If your only complain about your teeth is some crowding.. just be careful of getting ortho treatment. My overlapped bottom teeth were definitely God's way of compensating my unbalanced lower jaw. And once I started down the road of un-crowding my bottom teeth, all hell broke loose.. TMJ, bite problems...etc

so sometimes it could be a very simple problem on the surface...

[assertives]

Yes, different orthos have different interpretations of what they think the problem is. Just like how different musicians have different interpretations of the same piece of music. Their recommendations would also be based on their individual clinical experience, personal philosophies towards treatment, their training and of course the patient. So each ortho would have different treatment plans especially if your issue is a bit less straightforward. I feel that there are many more ways to skin a cat especially in less straightforward cases.

You are also right in that the ortho will treat what they see now to what they think is an achievable ideal. This is something I recently have personal experience in as well after having a couple of constipated appointments and discusssions with my own ortho. My takeaway from that "exercise" is that treatment plans are based on the facts that are presented 'as is' to the ortho or any other clinician for that matter. Past records are good and make helpful notes for the ortho but treatment objectives and outcomes will not be based on that because records are only a replica of 'what was' at best, a gestimate and not a clear definitive goal to work towards to. It's a bit like asking a someone to replicate a product that is already out in the market.

My ortho is also careful not to make any promises as well. But I do get that the human body is complicated and things can end up not happening as expected even if both the patient and the ortho did everything textbook correct.

[Mpkh]

Different orthodontist will treat the same malocclusion and misaligned teeth differently, based on their schooling, past experiences with similar cases, personal practice philosophies, and their own expertise. Some orthodontist are more conservative than others, and some orthodontist push for absolute perfection, and some orthodontist are more opened to trying new techniques and technology as they arise.

Each of ortho will have their own comfort zone in achieving the best result for the patient, so it is important to pick an orthodontist whose treatment plans align with your own goals. With that said, there are limitations to what orthodontics can and can’t achieve, and realigning your teeth back to its original configuration is one of the things that I don’t think any orthodontist can do. There isn’t an archwire in the world that can guide straightened teeth to their original states.

You are correct in that one should do research prior to getting braces, and to pick an orthodontist that you mesh well with.

My main reason for getting braces was to straighten out my teeth. I thought it was relatively simple too—just straighten the top four incisors, round them out a bit, straighten out my bottom teeth, and fix the crossbite I had on the right side, and I’d be done. Turned out I had a Class III edge to edge bite, and my problems were merely signs of a larger problem. What I’m trying to point out is that often times, what we think of as “simple” problems may not be simple after all.