Losing faith in my ortho - need advice

[justjayj]

Hello, everyone. I'm 14 trays into a 22-tray Invisalign treatment for some mild-to-moderate crowding, and I've been having doubts about my ortho since about tray 3. I'm trying to decide whether or not to pay for a second opinion.

First of all, the aligners have been gapping at the top since tray 2 or 3. This is uncomfortable, pinching the inside of my cheeks and leaving calluses. To be clear, this is NOT sharp edges on the trays. They actually stand about a millimeter, maybe more, away from the teeth at the top. This started only on the teeth with attachments (cuspid and first bicuspid on top, cuspids and both bicuspids on the bottom) but is spreading to the teeth beside them.

At each visit, I mention the gaps to my ortho. His answers have ranged from "I don't see any gaps" to "Don't worry about it" to muttering something about refinements and darting out of the room.

As of tray 12, there have been gaps between the bottom of my upper lateral incisors and the trays. In other words, there's a band of empty aligner below those two teeth. He didn't see tray 12 (I get two trays per visit), but when I put on 13, he said to wear it "until the gaps closed up." I wore them for a month, but the gaps never closed, even with use of chewies.

I put on 14 in his office last week, and the gaps are still there. Once again, he said "don't worry about it." However, his assistant pointed out that the upper left lateral incisor, the only really wonky tooth I had in my upper jaw, is not in the position it should be according to my Clincheck. He told her "don't worry about it."

And then I saw him add to my file "Patient advised to wear aligners 24/7."

I should say at this point that, except for Thanksgiving Day, I've been wearing my aligners religiously for 22 hours per day -- which I told him. (The fact that the other 27 teeth -- including my seriously crowded bottom incisors -- are where they should be is pretty strong evidence of good compliance, don't you think?)

Has anyone else experienced these gapping problems? What has your ortho's response been?

: pauses for breath :

Ready for the next part?

I had IPR done on one tooth (a lower bicuspid). No biggie. However, after my second tray, I told my ortho that the bottom cuspid was sometimes tapping against the one wonky upper incisor when I chewed. I said, "It doesn't hurt, and it doesn't bother me, but is this okay?" He said, "Let me see," tossed me back into the chair, and without telling me what he was doing, he had shaved a chunk off the back of the wonky incisor. (There was a sharp little shelf back there I could feel with my tongue.)

Since that time, he has asked me repeatedly whether I was having further clashing. I admit, I lied to him and said everything was fine. Then one appointment, his assistant showed me my Clincheck up close, and I saw the note that my upper teeth were EXPECTED to hit the bottom attachments.

So this time, when he asked me, I described what was happening and said, "But my file says that's supposed to happen." I also said it didn't bother me and didn't interfere with my chewing (both true).

He said, "Well, let's do some reshaping to take care of that."

I asked, "Do you mean reshaping the attachments or my teeth? Because I don't see any reason to shave perfectly healthy enamel off my teeth if it isn't bothering me. I mean, is it medically necessary? Is it going to affect my treatment?"

His response: "Well...I usually have to do it eventually."

So I told him that, when my teeth were in their final position, if my bite was bad, of course I would want it corrected, but I didn't see any good reason to damage my teeth if I wasn't having any problems now.

So now it's two appointments on, and he said, "Your lower teeth will be coming forward a bit while we correct the crowding, and so we'll have to be doing some reshaping of your bite next appointment."

The truth is, those teeth are already coming forward -- pressure but no clashing -- and it STILL doesn't cause me discomfort or trouble chewing and I STILL don't want him damaging my enamel for a TEMPORARY tooth position if it doesn't affect my progress. He's failed to give me any medical reason (prevent teeth from moving properly, cause chipping, etc.) to do so.

Again, full disclosure: I'm almost 38 years old, and I've had ONE cavity in my entire life. My teeth are strong and healthy, and I'd like to keep them that way. Futzing with the enamel before we absolutely have to -- and possibly having to RE-shape the reshaping in a few months -- sounds like a recipe for decay.

So is this kind of bite reshaping normal mid-course, or is my ortho a little grind happy?

Sorry for the very very long post. I've been brooding about this for months. I have the number of a highly recommended cosmetic dentist for a second opinion. Should I call it?

[MCOMarkhamOrthodontist]

Sounds like you should sit down and tell your orthodontist how you feel. I can't comment on the treatment progression, but there is a problem, since you're not happy! Give him a chance to see what can be done. Make sure you communicate openly with him.

As for the cosmetic dentist, if you are going for a second opinion, make sure whoever you see is well-versed in Invisalign.

Good luck!

[justjayj]

Thank you! I'll keep both of those in mind.

[mikeg]

as dr. tam said, I would sit down with the ortho. You are a patient and customer of his/her service and you should be open with your doc.

[justjayj]

Thanks, mikeg, for the input. Unfortunately, I have spoken to him about my concerns, twice formally (the second was the "Why shave my teeth down now?" "Er...because." documented above), plus a half dozen informal attempts during appointments. We just can't seem to communicate clearly.

I was really hoping to find out if the top gapping was a common experience, and if grinding down other than IPR was typical practice. I realize no one can comment on my specific case, and of course the unexpected can happen to any patient. I just didn't know whether my issues were common or unusual.

Thanks for wading through my ridiculously long post!

[MCOMarkhamOrthodontist]

Lateral incisors are some of the most difficult teeth to move due to their size and shape. It may take attachments, specific ordered movements, IPR, elastics, and buttons to get the proper movement. Movement of teeth that is not biologically possible, yet shows up nicely in a clincheck video, is unfortunately, still quite common. Remember that it is the doctor that is responsible for planning the movements and conceptually quite different from fixed orthodontics.

Equilibrating teeth is quite common in orthodontic treatment. While I don't know what is happening with your particular situation, some situations do cause teeth to collide with attachments and it cannot always be avoided. Equilibration of the tooth is not always necessary in these cases since, once the attachment is removed, there is unlikely to be a collision. However, your orthodontist may have found reason to do so. In any case, I would not be overly concerned about the amount of tooth structure removed.

I would book an appointment to speak to your orthodontist, not an appointment for an adjustment. During a busy day, it is very difficult to stop the orthodontist from the pace of the office to go over your list of concerns. Hopefully this will put the orthodontist in a better situation to address your situation. Best of luck .

[mommamorin]

jj, i too have had the gap between the end of the tooth and the aligner, I've had it since day one. Although I believe my teeth (the ones on either side of the front teeth, im tooth name illiterate) may have come out a little more from the gumline if they were a better fit as they would be pushing more from the bottom in, top out, (i may be totally wrong) i am very happy with my final result. Also, my dentist did do some reshaping as well during treatment and I presently am clamping down on my attachments. The attachments come off today and I am going into the retainer stage.
good luck
momma

[radaly]

justjayj, I also had a gap between the end of my tooth and the aligner. When I got my refinement trays, it was gone, and they moved the tooth so it was even (it was slanty before).

[2free]

I would discuss with your orthodontist because in my experience, once I noticed a slight space between my lateral incisor and the aligner, it progressed and in the end I needed refinements. I only needed Invisaligns on my bottom teeth; I first noticed a very, very slight space at tray 5 of 16, which progressed to about 1mm by the time I was on tray 16.

I then got a refinement with 6 trays and again noticed a slight space early on which ended being about .5 mm in the end. I got a final refinement with an attachment and much slower progression between trays (6 total) with no significant space between teeth and aligner, and my teeth are finally straight!

My point is that if you're noticing a fairly large gap between your teeth and the Invisaligns early on, your teeth are probably veering off the intended path of correction and you should address it sooner than later.

[justjayj]

Thank you, everyone, for the advice and anecdotes! The gapping is getting worse (and has progressed to a new tooth, a lower cuspid), so at my next appointment next week, I'll set up a THIRD sit-down-and-talk appointment with my present ortho. I also have my second opinion scheduled, just in case.

I really appreciate the feedback!

[Coop22]

I had that happen with one of my bottom eye teeth and needed refinements when I was finished with my trays to fix it. My ortho said it was caused by one of the trays in the series not snapping all of the way over my attachment on that tooth. I am currently in the refinement stage for the bottoms and they fit perfectly.

Now I can see a gap on one of my top eye teeth and my ortho has already told me that I will need refinements for them also to correct it. I get new impressions for them Feb 1.

I'm sure that somewhere along the line one of your trays didn't snap all the way over your attachment and he plans to correct it in the refinement stage as mine did.

Good luck!