Orthodontic Blog with Topics from Invisalign and Damon to Metal Braces
If you have been told that you are not a candidate for Invisalign, even after asking for this treatment option, then you should get a second opinion. This should preferably be from an orthodontist that has a significant amount of experience with Invisalign. The reason is simple. Virtually all cases, no matter how difficult, can be treated with Invisalign. So, why are patients still told they can't use Invisalign, and must instead wear full braces for their entire treatment? We have broken this down into the following reasons, based on patient interviews presenting for second opinions.
1-Lack of Practitioner Experience
These are the practitioners with the best intentions, who want the best outcome for their patients. However, due to lack of experience with Invisalign, they believe full braces to be not only easier (for the doctor), but also better (for the patient). These viewpoints are wrong, in my opinion, based upon the basic science of tooth movement. Teeth are moved as a result of physiologic forces being applied in a given desired direction. It does not matter whether these forces are applied as the "pull" of arch-wires (braces) or the "push" of aligners (Invisalign). While there are a few movements that the pull of wires can bio-mechanically accomplish better than Invisalign, there are many more movements that Invisalign can perform better due to the push on an infinite number of tooth contacts. In extreme movements that only wires could more efficiently perform, application of a few braces for a few months can accomplish this. Our patients are more happy to wear braces on a few teeth for a few months (when rarely needed) and Invisalign the rest of the time, as opposed to wearing braces for the full period of treatment.
2-Lack of Will
Just as in braces, Invisalign can only move teeth in each arch within certain parameters. Some limitations are biomechanical, and some are skeletal constraints. As a result, we use expanders, molar distalizers, functional appliances, surgical corrections, etc.. These are all treatment modalities needed as adjunctive appliances, whether treating with braces or Invisalign, to allow for optimal treatment outcome regarding alignment and bite correction. The only difference is, with Invisalign, it just takes a little more planning and thought for proper sequencing of treatment. Consequently, this may lead to the patient who expresses a desire for Invisalign to be told they are best treated otherwise. While Invisalign combined with other modalities may incur some additional expense, these options should still be presented so that the patient can make an informed decision.
3-Lack of Intent
There are a lot more practitioners advertising that they provide Invisalign treatment than there are that actually do provide the treatment on a regular basis. When a patient desires a more attractive smile, but are told they could only be treated with full braces, some patients opt for other treatment alternatives instead, such as crowns, veneers, etc.. While this may not be intentional, these patients should have been referred to a specialist so the patient can make an informed decision after knowing all the facts. While veneers or crowns are essential in many cases to restore worn or discolored dentition, they are never the best choice for creating a length"straighter appearance" of the teeth.
In closing, nearly all malocclusions can be treated with Invisalign, and this is a preferred treatment modality due to all its inherent advantages. The only patients that should not be treated with Invisalign are those that make a conscious, informed decision not to due to cost, length of treatment, or compliance issues. I welcome any constructive comments or questions, as well as any input into future topics of discussion.