Will an orthodontist result be better?

[MASinLA]

Hi, I've got a choice of provider for invisalign: orthodontist or general dentist. The general dentist will cost less but I'm concerned that the result may be inferior. Is my concern valid? The case is pretty straight forward - simple straightening and a slight overbite (overjet). I'd appreciate any feedback. Thanks.

[Stephanie]

I would much rather preferred an experienced orthodontist with Invisalign. However with that said, I know a couple very good Invisalign dentist in my area that been providing Invisalign treatment very well for several years now.. I'm curious to see what others say.

Welcome and good for you on researching before diving in...

[Zoso]

You should at least get a second opinion from an orthodontist before proceeding. They have spent years of additional formal education in occlusion and tooth movement. The peril of seeking treatment from a general dentist is that, lacking this additional education, and lacking also the depth and breadth of diagnostic experience, the general dentist can sometimes mis-diagnose a case, or recommend an inappropriate course of treatment. I'm not saying this has necessarily happened in your case, but it's worth being certain before you move forward. From your username, I am guessing that you are based in California, and if so then you should be able to find qualified orthodontists who would be willing to offer a basic consultation free of charge.

[Punkin]

I would agree with the above responses. While I am certain that some dentists can perform simple orthodontic work, you are typically better off with a specialist. They simply have more training and experience in the field.

You state that the general dentist would cost less - does this mean you've met with an orthodontist and they agree that the treatment would be the same as what the dentist proposes? I understand the want to save money, but in most cases, you get what you pay for, and if you end up saving money up front only to have to pay more to fix any potential errors caused by inexperience, is it really worth it?

That being said, if you have met with a qualified orthodontist, and the ortho and the dentist agree on the course of action and what can be done, then I don't see any reason why you couldn't go to a dentist for this work.

[Big_A]

I don't know, it seems to me a general dentist would be fine with a straightforward case. My case is simple and i'm using my dentist. I'm on tray 4 (out of 10), and everything seems to be ok so far.

I mean, Invisalign does all the planning of the tooth movement right? The dentist takes molds of the teeth, sends them off to Invisalign, and Invisalign maps out the treatment plan and sends the aligners.

The dentist would then take care of monitoring progress, attachments, IPR, whatever else. But the overall strategy is already mapped out (and executed) by Invisalign, not the orthodontist/dentist you're seeing, right?

If you already have confidence in your dentist I would think that it's perfectly ok to use them.

[Punkin]

I don't know, it seems to me a general dentist would be fine with a straightforward case. My case is simple and i'm using my dentist. I'm on tray 4 (out of 10), and everything seems to be ok so far.

I mean, Invisalign does all the planning of the tooth movement right? The dentist takes molds of the teeth, sends them off to Invisalign, and Invisalign maps out the treatment plan and sends the aligners.

The dentist would then take care of monitoring progress, attachments, IPR, whatever else. But the overall strategy is already mapped out (and executed) by Invisalign, not the orthodontist/dentist you're seeing, right?

If you already have confidence in your dentist I would think that it's perfectly ok to use them.

Actually, the orthodontist maps out the treatment plan, from what I understand.

[Big_A]

Actually, the orthodontist maps out the treatment plan, from what I understand.

Really? From what my dentist told me, it was "let's take impressions, send them off to invisalign and see what they say".

They're the ones that came up with the computer models of the teeth movement that the trays were made from, correct? I kind of assumed their software went something like this...

1) Scanned the impressions of the current teeth alignment
2) Simulate ending or "goal" tooth positioning.
3) Run models on how to get there.

And it was invisalign's software technology that really did the planning of the actual tooth movement.

I could be completely wrong, though.

Perhaps it's more interactive with more complex cases, but with me it seems like my dentist is acting pretty much as a middleman between me and invisalign.

Which is NOT to say that he isn't a VERY IMPORTANT part of the process. I've been seeing him for probably 12 years and I have great faith and trust in him.

But, count me as one who is using a trusted dentist instead of an orthodontist for my simple case.

Seems to be ok for now - I'll let you know in December how it all turns out!

[Zoso]

Invisalign do indeed prepare a computerised treatment plan based on the impressions that your dentist submits. There's the first potential issue: does your dentist prepare those impressions sufficiently well? Then there's potentially an iterative process in which the dentist or ortho rejects proposed treatment plans, for whatever reason, and Align Tech has to tweak - that's a big place where experience comes in. Ideally too, before the final plan is accepted, the patient should get buy-off on it too. Third place where experience and skill come in is in recognising when things are going awry.

There's also this consideration: if the dentist says the case is suited to Invisalign, how likely do you think it is that Align Tech will say otherwise? I tried their littkle online "suitability" quiz ... many times ... I input the least possibly suited starting conditions I could dream up, and every time was told that Invisalign was just right for me. I am quite convinced that Align will cheerfully take your money even if you're a borderline case.

Also, it's worth a second consultation - from someone who could potentially get your business even if your case is not suited to Invisalign - in the hope that you will be candidly told of any reasons that Invislign might not give you the best possible results.

And lastly, if things do go awry, and so much so that fixed appliances end up being required, if you've used a general dentist then in all likelihood you're completely out of luck and would have to pay in full for treatment from an orthodontist; by contrast, many orthos who do offer Invisalign treatment, will be willing to write into the contract that should fixed braces end up being required, there would be no additional charges for that.

[MASinLA]

Again, my sincere appreciation to all of you for your thoughtful responses. This is my first use of usergroups (I'm really dating myself with that one) and I find each reply valuable. To sum, I've got a 14 year old son with a pair of chipped front teeth. These were beautifully repaired using bonding material. I've seen a well respected ortho who did an exam & recommended conventional braces for less than one year (simple case). Then I remembered the bond. The ortho needed a second look to discover the bonding repair and then suggested invisalign so as not to risk damaging the cosmetic bond with the removal of the brace anchor. When my general dds (who did the bonding work) heard the concerns from me and the ortho, the general dds said he could do the invisalign procedure at a notable savings (both are premiere providers), should I decide to go that route; otherwise, he felt the braces should be fine and the risk to his bonding work minimal. If invisalign does the planning then I'm thinking the ortho and general dds should produce equal outcomes, but I know nothing is ever as it seems. Any thought? All opinions are welcome.

[Zoso]

You seem to have two consultations that concur about the suitability of the case for Invisalign, and both docs seem very experienced. It also struck me that your general dentist did not push the issue himself, but to the contrary gave you reason to be confident you could choose fixed braces if you still wanted to - this tends to make me feel that he is trustworthy. I reckon he'd do his best to do right by you. So the biggest remaining question would be whether you truly think your son will comply with wearing the aligners the required 20 - 22 hours per day, avoid snacking (or drinking pop or sports drinks) with them in place, and clean his teeth after meals and snacks.

[cmhndrsn]

I have just started my treatment and I was referred by dentist (who does invisalign) to go speak with an Orthodontist.

I respect my dentist greatly for his honest referral.

[Bonnie]

I go through a general dentist because there are no orthodontists in the town where I live. My teeth are a very easy case, so I wasnt worried about where I went. I have had no problems, and I see a lot of people in his office with Invisalign. I personally think that a dentist that is a certified provider will do just as well, but thats just my opinion.

[Zoso]

As long as your case is as simple as you and your dentist believe, then as you say, there should be no problems. For the record, I believed mine was a very simple case. Luckily for me, my dentist (who does offer Invisalign) had enough experience to know better.

But the reality is that you are having your teeth moved by someone who has had minimal training in that type of work. And that difference between a short course and, on the other hand, a two to three year post-graduate degree in orthodontistry can and for no small number of unfortunate folks will, lead to problems.

[Big_A]

But the reality is that you are having your teeth moved by someone who has had minimal training in that type of work. And that difference between a short course and, on the other hand, a two to three year post-graduate degree in orthodontistry can and for no small number of unfortunate folks will, lead to problems.

Oh, please. Do you have any facts to support this claim?

[Zoso]

Which part? The part that orthodontists have successfully completed a two to three year post-graduate course in their speciality, the part that most general dentists who dabble in orthodontia do so with minimal training, or the part that this leads far too often to poor results?

[Big_A]

Oh please, again.

We're talking about Invisalign here. You stated that patients who receive Invisalign through dentists as opposed to orthodontists can AND WILL lead to problems. You also stated that the number of people affected by such problems is not small.

Please show me where you get these "facts".

That patients getting invisalign through a general dentist are having problems they would not have experienced if they had invisalign treatment through an orthodontist.

[Zoso]

You've missed a few key points. The first is that an orthodontist might better be able to recognise which cases are/are not suited to Invisalign (Align Tech, not surprisingly, are pushing all the time to stretch the technique to ever more complicated scenarios). Secondly, an orthodontist is more experienced in the fixed appliance techniques that might sometimes need to be brought to bear as an adjunct to Invisalign (e.g. buttons and elastics, or fixed sectionals). And thirdly, if things don't go to plan even after refinements, choosing a general dentist in the first place might leave you boxed into a corner, whereas an ortho might be willing at no extra cost, to place fixed braces to complete the case to the patient's satisfaction.

Now, I'm not saying that all general dentists are poor practitioners in Invisalign. And I'd be prepared to believe that some may be better with this technique than some of their ortho colleagues. (I also acknowledge that some - though probably few - general dentists are highly experienced and skilled at full fixed appliance treatments too.) But the bottom line is that a "motel course" or a correspondence course is nowhere close to the education and experience acquired in completing a full-time post-graduate degree, so it would be laughable for anyone to imagine that these minimal types of training could provide the general dentist with the same depth of diagnostic expertise as the ortho. And, by the way, it takes just a half-day course for any practicing dentist to become an Invisalign provider.

You need only look around the web to find many cases of people who are dissatisfied with their Invisalign results. Many of those people are dissatisfied because Invisalign was being used where it was not really a suitable treatment modality in the first place. And all too often that is because the doctor rendering the treatment had insufficient training and experience to realise that.

Let's start "locally", with an article on this site.

The worse case scenario for Invisalign is when the client is not suited for results and goes with the treatment anyways. In mild to severe cases Invisialign is usually not the right choice as the orthodontist needs to use some of the older and stronger techniques. For a client that goes through a year of Invisalign without results and then is referred to traditional metal braces, this is extremely upsetting. This is why it is highly recommended you seek several opinions from orthodontist in your area to ensure the confidence that Invisalign is the right treatment for you.

Bad Experiences With Invisalign Treatment

This was such a mistake! I've just finished seven months of Invisalign, and my teeth and bite are nowhere near where they are supposed to be according to the computer projection I was shown when I was sold on the job.

I went through this extremely disruptive procedure ... to correct a painful bite problem, which was causing migraines. My bite has improved, but my migraines intensified markedly during the Invisalign treatment. I have had to resort to numerous medications and acupuncture for relief ... Just a couple of weeks ago, my dentist's colleague -- and there is a huge mistake I made...I went to an Invisalign dentist instead of an orthodontist -- dropped the news that the seven months I was quoted was not necessarily the full treatment period. ... I haven't smiled in seven months, and it looks like it will be much longer than that before I can.

...

I do not recommend this treatment to anyone.

Invisalign was NOT worth it: Wish i'd done braces
(And whilst 82% of the people who commented on this blog said they were satisfied with Invisalign, 18% were not - that is not a small percentage in my books)

I hate Invisalign. I started with a small gap to close up and ended 50 trays and 4 years later with overbite.
Has anyone else had a terrible experience with Invisalign? Most search responses are from dentists raving about how great they are. They ruined my mouth. I can't believe I'm the only one this has happened to. I think dentists who use it are paid too much because of how hard they push it. I'm looking for the lawsuits against them...

I hate Invisalign. I started with a small gap to close up and ended 50 trays and 4 years later with overbite. - Yahoo! Answers

I was treated with Invisalign for an overbite/overjet. I had two upper bicuspids extracted. The Invisalign trays did not move my teeth correctly and were incapable of closing the extraction gaps. The trays ended up tipping my teeth severely. I'm now in treatment with a new orthodontist using traditional braces to correct what Invisalign ruined. Invisalign added 4 years to what was suppose to be a 2 year treatment.

Invisalign Braces - Dentistry.com Forum

Dissappointed in Invisalign

I believe I was mislead when I signed up for my invisalign. I told the doctor what my expectations were and he did not really listen. I kept telling him that if he cut my tooth on the top it would look smaller than the rest of my teeth, and I did not want this. He assured me it would not look smaller. Well, it is significantly smaller. Even he was in shock at how small it became. He said well maybe you can get a veneer. I told him that I did not want a veneer because why did I get braces. If I wanted a veneer I would have not gotten invisalign. Now I have a deformed tooth right in the front on the top. I am overwelmed by the dissappointed in these types of braces. If anyone is considering getting them. I would reconsider, because now I need to spend more money to make my teeth look normal. And, the sad part is the tooth he shaved was a beautiful tooth.

Dissappointed in Invisalign -1

REBOOT: (aka mid-course correction):

If an Invisalign case is poorly designed during the “Outcome planning & Design” step, your teeth and bite will start doing VERY ODD things. Your bite and smile may become harmed for life. You may only be able to fix these things later with braces. These problems are avoided by carefully selecting a practitioner in your region. Paients that do not carefully select their Invisalign doctor and are struggling with Invisalign commonly do research after they recognize that a problem exists. They commonly end up at our office, for Dr. Rizkallah to “take over” their treatment. Dr. Rizkallah takes over 100 desperate patients a year.

LONG-TERM POTENTIAL PROBLEMS (Common complaints about Invisalign)

1. “My teeth shift a lot if my retainers are out.”

This is a serious problem if the cause is one of the following: inappropriate widening of the intercanine distance, insufficient interproximal reduction, destabilizing bite design, and undiagnosed speech/ swallowing habits. To avoid these issues, see a board certified orthodontist.

Less serious causes are simply resolved by wearing a retainer properly for 3 months, thereby allowing your teeth to stabilize. When a well designed plan is followed by 3 months of retainer wear, long term shifting is not seen.

2. “My bite feels uncomfortable.”

This is a serious problem caused by a “smile-focused” outcome design. If all you want is a nice smile, you may only get that. It may, however, ruin your bite. A Board Certified Orthodontist is uniquely trained to move teeth in a way that positively impacts both the smile and bite.

[snip]

4. “I have small spaces between my teeth now.”

I have retreated many patients that were originally treated by other invisalign practitioners. The most common complaint that pushes someone into retreatment is “excess spacing.” The invisalign system commonly produces residual excess spaces. Most doctors cannot resolve these issues, and simply say “don’t worry about it.” That usually works for a few months. Eventually, the nuisance spaces collect food particles and cause gum problems.

[snip]

5. “Now I need braces?”

Poorly designed Invisalign treatment can be harmful to a patient. These patients eventually see a Board Certified Orthodontist (because they won’t make the same mistake twice) for a consultation. The board certified orthodontist will, if the situation is bad enough, feel the need to retreat the failed Invisalign case with Braces. I end up fixing other practitioners Invisalign cases with braces at least a dozen times a year.

Invisalign Specialist - Orthodontist | Boston, Cambridge, Arlington, Medford, and Lexington - Invisalign in Somerville MA, Simple Aligner, OrthoClear, Braces and Invisible Braces


In a study in Aesthetic Dentistry Today [2008 2 (1) 36-41] P. V. Humber BDS LDS RCS DipMCS examined 100 consecutive Invisalign cases to assess treatment outcome and patient experience. In this study, 6 cases had one tooth or more that failed to achieve the movements predicted to the satisfaction of both the patient and the clinician.
http://www.sohamdental.co.uk/abstract.htm


Sure, I don't have hard numbers on dissatisfied patients, and different articles above have turned up varied numbers, but with over half a million people treated, I think we might be able to agree that even say few percent of that is not a small number of people - it's thousands!


Oh, please!