Finished initial stage but dentist said no refinement. A lot of questions, pls help!

[jenniferbraces]

Hi everyone,

I’m new here. I just found this forum while researching for my Invisalign retainers and I’ve learned so much from here. What a pity that I didn’t find this place earlier. Note to self, always do research before committing to anything. I’m at the end of my Invisalign treatment now and my dentist said I would not need any refinement done. (I never heard of the Invisalign refinement period until I read on this forum. My dentist didn’t mention anything about it up to the point I asked him about it in my last appointment. ) I’m a bit concerned now about the result because my teeth don’t look perfect to me yet. I would really like to hear some advices or suggestions regarding my situation. Thanks a lot in advance!

Here’s a history of my Invisalign journey.

I’m having my Invisalign treatment at a clinic in London. I finished all U23 and L20 last week. About 5 weeks ago, my dentist fitted tray No. 22 on the top and gave me the last tray (No.23) to take back. He then suggested to me to book an appointment with his colleague to have a cosmetic contouring and discuss the retainer option with his colleague the next time I come in. He didn’t mention anything about reviewing the result of my treatment or discuss if there’s any further work needed etc. Without thinking too much, I booked my appointment with his colleague.

Only after researching more and reading on this forum, I realised that I should not move on to the retainers before my teeth are perfect and I’m completely happy with the result. So I booked a new appointment with my dentist and I asked to see my Clinckeck images and discuss about the result during this appointment. I just had this appointment with my dentist yesterday and I asked him about one of my bottom teeth being a bit pushed back. (I attached a picture of my bottom teeth with this post. I circled the parts in pink.)My dentist admitted the problem and said it can be easily corrected by putting a small attachment on the inside of the tooth. He assured me if I wear the bottom tray as usual for 1 week, it should be corrected. As you can see from the picture, there are 2 small attachments on the inside of my bottom teeth. Has anyone here heard of this kind of attachment before? Is this the right thing to do? Now the aligner seems very tight when I put it on and it doesn’t fit in completely because of the attachments on the inside. Should this be something to be corrected during the refinement process? I’m quite clueless at this stage. Please, any advice is greatly appreciated.

I also asked him about refinement and he didn’t deny it but he didn’t elaborate or explain to me about it either. He just said I would not need it because the only problem I have is this one tooth out of place and it should be corrected by next week. I mentioned to him a few other concerns I have. I asked him about the black triangles I have between my teeth which appeared after IPR. He said it’s not the IPR that caused this but the movement of the teeth which created the triangles and he said if I keep my teeth clean and take care of them, the gum will grow back to cover the triangles. It seems to make sense to me but what do you guys think? Has it happened to anyone here before?

Another thing I notice is that 2 of my bottom back teeth are not exactly straightened. My dentist said it’s the best he can do with my teeth and if I want to move the bottom back tooth, the back tooth on the top would have to be moved as well to create the correct bite and there’s no more room for the top one to move. He said the back teeth are just for function and not so much for cosmetics and as long as the front ones are straight, it’s fine. I then asked him about one of my bottom teeth which seems to be a bit slanted to the left instead of upright ( in 2nd picture). He said it’s the best Invisalign can do and if I really want it corrected, I had to go for fixed braces and even then, the movement would be hardly noticeable.

Has anyone had these similar issues before? I’m not sure if I have too high a expectation of the result or my dentist is trying to finish my case and not go on to the refinement phase. He also said it’s not good to keep moving the teeth with regard of the refinement. It doesn’t seem to make sense to me because there’re a lot of people here on this forum have refinements. He also said if the result turns out to the same as the initial Clincheck image, it’s considered done and case closed and no further work would be required. Is that true? How did your guys’ treatment process go? I also attached a 3rd picture of my bottom which was taken before the treatment started.

Sorry about the long post. I have a lot questions and I don’t know who else to turn to for advice. Any suggestion would be greatly appreciated.

Thank you for reading and have a nice day!

Jen

[Phantom Muse]

Dear Jen - Congratulations on such great progress! Your teeth really do look terrific!

I really can't speak exactly to your situation because I don't have the proper expertise, but I do know that for some, refinements are an extra charge. My fee covered three series of refinements (I did not use any of them), but some people have to pay extra to receive them. Is it possible that your dentist is trying to avoid an extra fee for you - or for him?

From my understanding, refinements are often where the "fine tuning" takes place. I had one lower tooth that was a teeny bit out of alignment at the end of my initial series, so my ortho worked an adjustment into my retainer so that I did not need a refinement tray. It has taken care of the issue just fine. I suspect it might be unusual to add attachments if there is no room in the aligner for them...

In addition, the ClinCheck is just an estimate of how your teeth will move. The results are not set in stone and can vary from the video depending upon how quickly your teeth move, compliance with wearing the trays, and so on. I actually never looked at my video because I had a short series (12U/7L) and didn't need it for motivation. I figured my teeth would move as they could as long as I was compliant.

Many people wear Invisalign much longer than you have, so the idea that continuing treatment would be bad for you seems a little strange to me.

I wish I could be more help, but I hope you get things sorted out so that you are pleased with the results. Good luck!

[jenniferbraces]

Thanks very much for your response, Phantom Muse. It's great to hear your experience! I am very happy with my teeth compared to the ones before the treatment started. There are just a few things that I want to understand before moving on to retainers. I think I'm on a full Invisalign treatment so it covers up to 3 refinements, doesn't it? (from what I've read on this forum)

The attachment in the retainer is a great idea! I know refinements might take a couple of more weeks or even months to finish but I don't really mind if it's needed. I'm still not completely clear of what I should do now. My ortho didn't explain anything about refinement to me, actually not much of anything until my last appointment. I don't mind if it's extra charge or anything but I'd like be clear of what my options are.

As for the attachment on the inside of my teeth, it seems I'm the only one having this? Like you said, it's unusual to add attachments if there's no room in the aligner for them. It felt very tight the last few days and it feels kind of weird too because it doesn't fit in completely.

I was also wondering if the Invisalign is designed to correct the back teeth too? Should I make a fuss about it, if it's slightly out of line?

Anyone else has had similar experience before? or any expert here can point me in the right direction?

Thank you.

Jen

[Sunny]

Hi Jen and congratulations on how wonderful your teeth are looking!

About the bonding behind your teeth, this is definitely not used a lot, but it's an option that can be used by skilled ortho's, by designing some bonding material to work 'against' the aligner to achieve movement. I work with an ortho who offers invisalign treatment and he's done something similar a couple of times and usually to complete the 'push' to get a tooth into alignment. These are not attachments that use the aligner to do the work, these are pieces of bonding designed to 'push' movement. Talk to your ortho about what's being done, as this is the professional and will be able to explain the process more clearly.

The molars are often not involved in orthodontic treatment if they don't impact on a person's bite. The reason ... they're not seen, and if they function fine, then why cause more problems by trying to straighten them. Where I work, we only treat the second and third molars if they impact negatively on the persons bite.

Good luck with talking to your ortho and you enjoying your lovely naked smile very soon!

[Sunny]

I asked him about the black triangles I have between my teeth which appeared after IPR. He said it’s not the IPR that caused this but the movement of the teeth which created the triangles and he said if I keep my teeth clean and take care of them, the gum will grow back to cover the triangles.

Black triangles often occur when teeth have been 'forced' to move. Also as we get older, most people find their gums shrink and this is when these triangles become more obvious. Luckily these gaps are rarely noticable. It's important to take great care of your gums by flossing and brushing very gently.

I've had some IPR done between some of my lower teeth to help make the black triangles less noticable ... and although they still can be seen by me ... I know that no one else can!

[Phoenix461]

I know nothing about Invisalign but wanted to pop in to say your teeth look great.

[jenniferbraces]

Thank you for your great advices, Sunny! I didn't know the attachment on the inside on my teeth is called bonding. I remembered my dentist said he's putting some attachment on the inside of my teeth and he did the exact same procedure as putting on my previous attachments. He told me to wear the bottom aligner as usual even though it doesn't completely fit in because there's no room in the aligner for the attachments. I'll definitely ask him about it at my next appointment.

It's good to know that the position of the molars is not a big issue if it doesn't affect the bites. That would be one less worry on my mind. Hopefully, the black triangles will be less obvious over time.

I have another question. I was wondering if refinement would be required for my case. I suspect that my dentist would not want to continue with refinement from what I gather during the appointments I had with him. I'm a bit worried because I've read quite a few complaints about him and the clinic and it seems they just want to finish the case quickly so they can rack up the numbers of Invisalign treatment done rather than making sure each case is handled to achieve the best result for patients. It makes me feel that I cannot just take his word for it. Should I get a second opinion? I heard changing provide is very troublesome so I don't want to resort to that unless it's absolutely necessary. I'd really like to hear some suggestions you all might have. What sort of cases would refinement be required? Please help.

Thank you again.

Jen

[Phantom Muse]

If refinements are included in the fee you paid, then you should be able to move ahead with them without any problem. Do have a "heart-to-heart" with your dentist so that you are clear about what you have paid for.

That being said, if you are unhappy with the final results, your dentist needs to understand this. He/she should be able to explain satisfactorily to you why treatment should not include refinements - perhaps the roots will not allow additional movement, etc. The more open the dialogue, the more comfortable you will be about all suggested treatment options. Actually, when I chose my ortho, I narrowed down a list of qualified people, and then went with the person I most trusted. I am not the expert, so I needed to feel as if I could turn over a bit of control to someone else!

Your teeth really are looking lovely; good luck and keep us posted!

[jenniferbraces]

Hi guys,

I had an appointment with my dentist last week and I'm not going to have refinement. The bottom tooth looks much better after having the attachment on the inside. The only thing is that the tooth moves slightly if I'm off the aligner for a few hours. I also had cosmetic contouring done and the result looks great! I had an impression taken for the retainers after the cosmetic contouring and the attachment on the inside was put back on to keep the pressure on the bottom tooth until I get my retainers.

Thank you guys so much for your help and advices! Great forum and keep up this awesome community!

Jen

[Phantom Muse]

Jen - So glad you are pleased with your results!

I have been in retainers for a few months now, and it might really make sense to wear your retainers full-time for awhile. It takes some time for the teeth to fully settle, but that is completely normal. My ortho suggested I "wean" myself from time with my retainers just a half hour or so at a time every week. That seems to be working just fine.

Good luck, and congratulations!

[Stellina]

Hi Jen, I am glad it turned fine in the end!! I was very interested reading your case as I am also in Invisalign at a clinic in London.. so wonder if it is the same!! Good that my dentist has great reviews but he is a very busy man it seems and he only sees me for the essential, the rest is done by the hygienist.. Anyway! I'm happy with my results so far as I just finished my trays for lower.. And my teeth look fine only thing is they are not same shape? I am not sure if you can picture it but there are edges in some of my front teeth and I am not really sure if this is left like this or if they do some kind of filing to pair them up... I will ask him next week! Can't wait to have them out and then I will just have to finish the other half of the upper teeth.. maybe in 5months I will be happy as Larry or as you Jen!