Help - advice please! =(

[fraggle80]

Hi everyone!

I've been reading your posts and finding them so incredibly helpful since I started my Invisalign treatment back in June last year. The time I've been wearing Invisalign has gone so fast and I have been feeling so incredible about my smile (and it's not even done yet) that I find myself wishing I had done this so much sooner!! Yesterday, however, I got some bad news...

I started my Invisalign in New Zealand (where I was living). I was born without my left lateral incisor (my left canine was pushed up against my front tooth and there was a gap beside it). My goal with orthodontic treatment was to move the canine to the position where it was supposed to be, creating a gap for the lateral incisor where I eventually hoped to have an implant placed. I have all but decided that the implant is the best way to go in terms of longevity and cosmetically. However, I just recently had to move back to the US, so had to seek out a new orthodontist.

The new ortho (who seems very legitimate, good education, tons of experience, located in a major city) has gotten back to me after looking at my x-rays and says there is absolutely no room for an implant to go into the space (at the moment I've just completed my first round of Invisalign 26U/19L and about to start first set of refinements). Ortho says that if I am set on an implant I will need traditional braces for a minimum of 9-12 months. My other option is to continue with Invisalign (until whenever they finish) and get a "Maryland Bridge" to fill my gap.

I'm very confused and not sure if I should get a second opinion. I don't want to just "shop around until I get the answer I want" because I don't see any value in that if it's a bad opinion - however, I don't have a lot of money and I'm not sure that I can afford to start all over with orthodontic treatment (the traditional braces will be a whole new set of fees). If I choose to just do a bridge, I'm unsure about that either as I had pretty much decided that it was "second best" to the implant and now feel discouraged that I have spent so much time and money on my teeth only to have to "ruin" them with a bridge that won't be a very permanent fix.

Can anyone offer me any advice? Would it be helpful to meet with an oral surgeon to get a different opinion? Or will they just go with the ortho's opinion? I just feel so down and discouraged.

Thanks for your help!

[Phantom Muse]

Dear Fraggle,

This must be so frustrating for you! I would still suggest, however, that you get another few opinions - not necessarily to find someone who agrees with you - but rather to have a more complete picture of how professionals view your situation. If they all say there is no room for an implant, I suspect it will be easier for you to accept that decision.

When I had consults for Invisalign (after having braces for three years as a teenager) I had such a variety of opinions given to me. It was so helpful to be able to sit down and evaluate them all and then go with what was most comfortable to me.

Do keep us posted...

[fraggle80]

Thanks so much, Phantom - I appreciate it. I just feel distraught and not sure what to do. Here's a copy of my x-ray to give you an idea of what I guess they are looking at (it does look as though the root is tipped) - but I have no idea how likely it is that the root can be moved (via either invisalign or traditional braces). I just feel like I've wasted a year's time and a lot of money only to be told that I need regular braces anyway, which makes me feel like an idiot since that's what I would have done in the first place if that was how it was presented to me. My initial dentist (the one who placed the invisalign) assured me wholeheartedly that I could have an implant and that I should have an implant since it would last longer/look better. I know there's no sense beating myself up or holding grudges (what's done is done) but it feels pretty crappy.

[MCOMarkhamOrthodontist]

Although other diagnostic material would be required, an implant usually needs at least 7mm of space to be placed safely between teeth. It is not only the crown area that needs 7mm, but also the space between the roots. Therefore the roots of the teeth adjacent to the proposed implant must be at least parallel, if not directed away from the implant site. While it is possible, it is extremely difficult to move teeth properly with Invisalign and requires an extremely experienced provider.

In your particular situation, it appears that your roots converge into the implant site, making it unsuitable at this current time for implant placement. An implant would definitely be the most secure, and aesthetic. I don't disagree with the orthodontist's assessment. Sorry .

[fraggle80]

Thanks, Dr Tam - I really appreciate your thoughtful response. I was able to make an appt today to get a second opinion with another ortho and I think it's helped put my mind at ease. Both orthos (the one I saw first and the one I saw today) are very experienced Invisalign providers (have each treated like 900+ patients), so I don't think that it's that they are "anti Invisalign" or anything of that nature, which is good.

The second opinion guy told me that there is absolutely no room for an implant and he was quite skeptical that one would fit even after 14 months of traditional braces. He said that it is a very difficult root to move and I just don't have the space. He recommended that I continue my course of Invisalign and use all of my refinements (I should still have 2 left) and then get a Maryland Bridge. He also said the bridge is sometimes more aesthetically pleasing than the implant in terms of sitting in the gum (I hadn't heard that before, I'd only ever heard the pro-implant argument so I'm not sure about that). Regardless, he made me feel a bit better about the possibility of a bridge and also that it would mean that my treatment would be significantly shorter (only about 6 months more of Invisalign then a bridge - which would be fantastic!).

Now, my problem is I'm not sure how I'll decide between the two orthos I saw. Both seemed very knowledgeable and experienced and both have competitive prices. My main concern is that I'm afraid I won't trust the first guy now, seeing as he wanted to put me in traditional braces and the other guy thinks it won't work. But maybe I'm being too picky - both did say I could continue Invisalign and get the bridge.

Does anyone know if it's very common to get a bridge in this area? I'm so nervous about having spent so much money and just "wrecking" my entire smile. I'm terrified I will end up with a false-looking tooth and two damaged teeth on either side of it. Am I just being paranoid??? =(

[angel9165]

I have 2 bridges (after my first go around w/ traditional braces at 30) but they are both on either side on my lower and not the front. I was distraught that they had to "drill down" 4 perfectly healthy teeth to fill 2 gaps (after paying so much for braces AND having 4 teeth removed) but the bridges have been fine. I'm doing invisalign because I broke off one of my front lower teeth so the dentist pulled it and we are moving just the front teeth in (can't move any teeth from the bridges back) and it's been about 3 months and the gap is almost gone. I have another 3 or so months to go and am looking forward to smooth teeth again (hate these attachments). Also, the minor gaps left on top (from the 2 teeth pulled on either side) are filling in very nicely. Not sure why they didn't with the traditional braces.
If I were you, I'd go with the second ortho only because you already seem more comfortable there (and you're still questioning the first one). Good luck with whoever you choose.