31 trays for a relatively minor case of crowding?

[LeslieKnope]

IMG01131-20110714-1048.jpgIMG01172-20110804-1059.jpg


Hi all--I'm new here, so apologies if this has been addressed before. My ortho is one of the most highly ranked invisalign providers in the US, so I absolutely trust his judgment. But I'm just wondering why I have so many trays (31 U/14 L) for a relatively minor case of crowding. I had metal braces 10 years ago, but my ortho back then told me to only wear my retainers for a year, so naturally my teeth have shifted and I wanted them perfect. But they're much less crooked than they were when I first got metal braces.

I've attached a pic of my teeth on my first day of Invisalign treatment and a pic of my teeth a few weeks into treatment. I have seen a number of photos on this forum of teeth that look a lot more crooked than mine that have as many, or even fewer, aligners as I do.

What's the deal here? Is my ortho just being super conservative to make sure the teeth settle well?

Thanks in advance for any insight you can offer!

[GoofyGG]

31 uppers for me too! My teeth looked much worse than yours so have no idea, sorry! I'm sure there's a very good & technical reason for it though

[LeslieKnope]

Oh wow and you're almost done! I'm only on tray 5 and I feel like this will never end! A dentist (not an ortho) actually recommended that I get Invisalign Express, a notion at which my ortho guffawed. I trust my ortho over the dentist (said dentist actually screwed up one of my teeth very badly so I no longer go to him), but still, it's just perplexing that I need over a year's worth of Invisalign for my teeth. I mean, my teeth look pretty straight in pictures (including my wedding photos!) so I'm kind of regretting shelling out this much cash and going through the pain in the neck that is Invisalign. But the clincheck video shows my teeth looking stunning at the end!

[magdalene]

My teeth look MUCH worse than yours and I have only 18 upper and lower (with a very highly recommended ortho).

I wonder if there are different kinds of crowding - maybe some are extreme but simple, and others are mild but complex?

Personally I will be happy if I end up with your before-shot!

[LeslieKnope]

Magdalene, I notice that you have a similar issue with your front teeth (one is overlapping onto the other). Have you noticed a change in them after 8 trays? The only change in mine that I can see after 4 trays is that there's a pretty big gap between my crooked front tooth and the one next to it. Presumably, the tooth will move into that new gap.

[MCOMarkhamOrthodontist]

More often than not, Invisalign treatment is attempted too quickly. 31 trays means treatment for about 15 months. Think of how many orthodontic treatments are completed in less time than that (not that many).

From your pictures, it is difficult to see all of the issues affecting your teeth. Your upper left central incisor is tipped, however. This may take quite a bit of time to move as there will be a lot of root movement.

[LeslieKnope]

Thanks, Dr. Tam! Yeah, that darn tooth didn't even fully straighten out the first time I had braces. My orthodontist actually said "well you can't make everything perfect" and removed my metal braces before it was straightened out. So this is my chance to get it right. Thanks for the insight!

[Bekster45]

I believe I was told that gaps are much easier (quicker?) to correct than crowding. This is because they may have to move other teeth first so there is room for the crowded teeth to move where they are supposed to. I have large gaps on the top (closing quickly ) and crowding and overlapping on the bottom. 26 trays with refinements being highly probable.

[LeslieKnope]

That makes sense. I think I have really stubborn teeth, if there is a such thing. IMG01226-20110902-1404.jpg

I've attached another pic of what my teeth currently look like (I just started my 5th tray), in case it may provide more insight.

[magdalene]

In answer to your question Leslie, yes I began to see a difference on tray seven. To others it's probably not a dramatic improvement (you can see my first and eighth trays in my pic to compare) but I am really pleased about the difference.

[lanabyte]

My teeth are pretty crooked and I only have 28 trays, BUT I know I'll definitely have at least one refinement stage, so who knows how many I'll end up with.

[bunnyteeth]

I hear ya, LeslieKnope! I thought mine was gonna take around 20 or so aligners. I have have minor overcrowding issue, and a semi-rotated lateral incisor. So I made self-comparison of my teeth with people online - and some were in worse condition than mine only took 20 trays! So when my results came back, I almost died when I found out it's gonna take 32U/32L for me. Unbelieveable!

Oh well, but I'm determined to get straight teeth - so here I am ... on Day 3 of tray #4. Lol

[Dr.B]

Invisalign has gotten really conservative over the past few years. I think for 2 reasons. 1.) They hope to have less refinement trays. 2.) 31 trays (62 weeks) makes it easier for you to accept treatment because the orthodontist can finance it over 15 (62 weeks) months instead of 6-7 (28 weeks/14 trays).

[LeslieKnope]

Interesting, Dr. B. Thanks for that perspective. I am on my 13th tray and my teeth are nowhere near done (as can be seen in this pic), so I guess I genuinely need the 31 trays. IMG01558-20120105-0029.jpg Or were smaller movements planned for each tray than otherwise would have been? Sigh. I should have just gone with traditional braces.

[MCOMarkhamOrthodontist]

I'm going to agree that Invisalign has gotten more conservative with the amount of movement per tray. Yes this is to decrease the number of refinements, but refinements can be planned as a part of treatment, so it should not change the overall expected treatment time. Treatments that are shorter are less likely to require refinement. Invisalign's website stating that treatment can be completed in as little as 6-12 months is slightly deceiving, because it does not tell us the severity of the malocclusions treated. @ LeslieKnope... looks like you have a posterior crossbite and some anterior alignment issues. I do not think 62 weeks of treatment is unreasonable at all. In fact, I would say that your treatment should likely have more aligners.

With early ClinChecks, they were extremely simple cases, or teeth were being moved too quickly, resulting in "failure" of Invisalign treatment. The amount of time in treatment should generally not differ from braces. As doctors address more complicated treatments, the plans will undoubtedly take more time.

Though I do not have any evidence of for it, I do not believe Align slowed down treatments to help orthodontists lengthen period for payment plans... Each office can stretched out financing for any period of time, and there are a lot of 3rd parties that will stretch out payment plans.

[Lindsey M]

I was shocked when my orthodontist told me that I required 24 trays for a minor case of crooked teeth. After reading stories and seeing pictures on this forum, I expected about 15 trays. The explanations in this thread, however, make sense.

[soph]

I've got a dentist appointment tomorrow after wearing my very first set of invisalign trays for 3 weeks. I assume I'm going to get my next set of trays. I feel like I have learned so much more about this process reading blogs and forums like this than I did from my dentist. She does usually ask if I have any questions, but I think the problem is that I had no idea what questions to even ask until I read through others' experiences. Secondly, to be honest, I don't find her to be particularly knowledgeable. When I do ask questions, she sometimes seems unsure of herself when she answers and sometimes I find her answers implausible and/or not helpful. I like her as a dentist, but I wonder a bit.

Anyway, would love some input from anyone with experience on a few things:

My dentist put these little "holders" - I can't remember exactly what she called them, the best way I can describe them is nodules - on a few of my teeth, and my understanding is that these are meant to allow the trays to "grab" the teeth more easily. I don't really understand that. The little holders are clearly strategically placed in 4 or 5 places on my upper and lower teeth toward the front of my mouth. I'm not fond of these holders. They can be seen when I smile, but the worst part is that they make me feel like I always have something on/in my teeth. I floss and brush several times a day but I feel like I can never get my teeth clean with these nodules stuck on them. I know it's in my head and I can live with it, but I have never read of anyone with the same experience so I'm wondering.

I've read a lot of opposing info regarding daily wear time. Some say if you wear them less than 21 hours a day you can't expect good results. Others say 16 hours will suffice. I wear them as close to the recommended time (22 hrs) that I can, but most days it's realistically probably closer to 19 hours. I have to speak regularly at work and I like to snack on fruit and nuts between breakfast and lunch. I floss and brush my teeth each time after I've eaten something and put my trays back in, but I wonder if and how the process if affected if I take them out and put them back in every hour for 4 or 5 hours straight. I wonder if I'm just better off taking them out when I'm ready to eat breakfast and leaving them out until after lunch. Any thoughts on this?

I've also read that my dentist can show me an animation of what my teeth will look like at various stages of treatment and post-treatment. I had no idea, but I suppose I can ask her about this tomorrow. That seems like something interesting to see.

I'm sorry about the length of this post! I didn't realize how much I had to say & ask.

Thanks in advance for any input from you experienced folk!

[robin8]

You cannot compare treatment time based just on how crooked the front teeth look in pictures. Orthodontic treatment is not about straightening the anterior 6 teeth only. There are many orthodontic issues such as malocclusion, tooth angulation, tooth rotation, etc. that are not easily seen from a picture and they don’t always show up on the front.

Having less # of trays is not necessarily a good treatment. Your teeth can only make so much movement “safely” within a certain period of time regardless of the doctor or the orthodontic appliance used. I had reviewed 2 ClinCheck treatment plans with 2 orthodontists. One had a plan for 18 trays; the other had a plan for initial 35 trays within a 2-year treatment. The difference? The first plan fixes only the crowding on my anterior 6. The second plan fixes the anterior-6 crowding, misaligned midline, bite problems in the front, crossbite in the back, and in the process, treats my TMJ pain.

Leslie, as Dr. Tam said, it looks like your have posterior crossbite (in very simple terms, your upper dental arch is narrower than your lower arch and it should be the other way around). If that’s the case, your ortho has been fixing this first so that’s why you haven’t noticed any significant movements in the front. You should, however, have felt your bite changes in the back. When the treatment completes, you’ll have teeth that not only look good from the front, but function properly and are easier to stay healthy over the long term. Misaligned teeth or bite issues, left untreated, could lead to gum recession, enamel erosion, bruxism and even TMJ pain.

Not all Invisalign providers are capable of treating bite problems and are concerned with all of your teeth. Only the experienced and responsible ones do.

[LeslieKnope]

Thanks very much, Dr. Tam and Robin8 for your insight. I didn't realize that there was an issue with a posterior crossbite, as my ortho didn't mention anything about that. I've uploaded some pictures from before my treatment started. Does it look like the crossbite was there from the beginning, or is it some sort of transitory state due to the shifting teeth during my treatment?

intraoralcenter.jpgintraoralleft.jpgintraoralright.jpg

[robin8]

Yup, you have crossbite from the beginning. Your back teeth also did not interdigitate or interlock properly with each other. You should be able to see some differences in the arches if you compare the trays.

Here's some general info on crossbite ...
http://www.dentistry.com/conditions/...ion-that-bites

[LeslieKnope]

Wow, thanks for the info! I had no idea.

[robin8]

Leslie, just to give you an idea of what a prefect bite at the back look like, here’s a picture … look under the heading “Ideal bite viewed from the side”. Beautiful Smile, Straight Teeth, Ideal Bite, Healthy Gums

With an ideal bite, the upper arch is slightly wider than the bottom arch, the upper teeth slightly overlap the bottom teeth, and the top and bottom teeth interlock together. I think that’s what your ortho is trying to do with your teeth, not just the minor crowding in the front. Obvious crossbite you have are the premolars and molars on the left.