Invisalign and Extraction

[applecidar]

Hi everyone,

I am in my twenties and have finally decided to correct my overbite and over jet. I visit two different orthos before who told me I wasn't a candidate for invisalign because my case was too complicated. I thought my best option is to get lingual braces since I am very concerned about the visibility.

However, I went to see another orthodontist who told me that he can apply invisalign for me with 4 extraction and the process will take close to 24 months. I was delighted.

However, I came home and checked that this ortho isn't a premium provider of invisalign. I am concerned whether he is experienced enough to deal with my very complicated case. I don't want to be a guinea pig, but at the same time I really prefer invisalign. Should I bother to go get another opinion (my fourth!)? Would the ortho be offended if i question why despite his claims of extensive experience with invisalign, is not a premium provider?

Thanks so much!

[robin8]

Whether you are a candidate of Invisalign is up to the individual doctor to decide based on his skills and experience. Majority of the providers can handle only simple cases.

I had a complicated case with severe crowding, various bite problems and TMJ pain caused by misaligned teeth. I consulted with 7 orthodontists (not general dentists). One said Invisalign was useless. 3 said I wasn’t a candidate because my case was too complicated. One said maybe. One Elite Provider said yes to 100% Invisalign then after I questioned his ClinCheck treatment plan, changed to using Invisalign to fix anterior-6 crowding followed by traditional braces to fix bites. All 6 said they needed to extract 4 teeth. My current orthodontist has extensive experience with Invisalign (treated 600+ cases) and he said 100% Invisalign and no extractions.

I’m not saying you don’t need extractions. Just that there is a very wide range of knowledge, skills and experience with Invisalign among the providers. The Invisalign provider status (i.e. Elite, Premier, etc.) is based on number of cases sold and does not reflect the completion or complexity of cases. I think you should find an ortho that you'll have full confidence in and ask as many questions as necessary to determine his experience and competence… e.g. how many cases has he successfully completed (not started, less than 50 is considered “new” to Invisalign). Ask to see his completed cases similar to yours. Here’s an article with some examples of questions…

Specialist in Orthodontics Dr. Ted Rothstein Alerts Public to Rising Levels of Substandard Invisalign Treatment by Insufficiently Trained General Dentists

[MCOMarkhamOrthodontist]

Robin8 is absolutely correct. A 4 bicupsid treatment is really not an easy treatment to do with Invisalign. There are likely only a small percentage of doctors who have successfully and consistently completed this type of treatment.

Again, provider status is only a small indicator of "experience" since there are a wide range of different problems that the doctor may or may not have treated previously with aligners.

It can sometimes be dangerous to go with the doctor only because they agree with your plan, unless you really feel confident about their experience. Good luck!

[Dr.B]

Every 4 bicuspid extraction case that I've done with Invisalign has taken at least 3 years. There maybe only 50+ trays (2 weeks a piece) but most patients don't make it in on time for every appointment over 2+ years. Attachments break alot and the more trays you use the more likely the teeth won't move the way you want, meaning more aligners. In the end, a lot of people just give up. I just did a count and almost 40% of my Invisalign patients are either MIA, taking or have taken an extended break. If you stop mid treatment, Invisalign will cut you off and you will have to pay all over again. Have you thought about clear braces? They make them now where you can't see them. Most extraction cases take between 18-24 months.

[applecidar]

thanks for the replies!

I didn't read the replies until now. I just went ahead this morning to take the mold to be sent to invisalign and made almost 75% of the full payment. Now I am seriously worried.

My orthodontist told me I have what is called a bimaxillary protrusion. Both my top and bottom are protruding which according to him is not very common. However, he explained that I am a suitable candidate for Invisalign because my teeth are "slanted" in a particular way and he felt invisalign is very good at correcting these problems. He did say that Invisalign alone may not correct 100% of my problem and I may need to be put on fixed braces for 4-6months at the end. I think I can tolerate 4-6 months of clear braces, but no longer than that. I have also rejected proposals of surgery because I felt it is too intrusive.

Is it normal for the orthodontist to not let me know when exactly my treatment will be completed even after I paid up? Mine told me he would need to wait for Aligners to get back to him with ClinCheck, but he suspects it will take about 24 months or even more.

I did some background check and my ortho seems to be a pretty well regarded orthodontist with every necessary accreditation. I really hope nothing goes wrong- I am really looking forward to correcting my problem and am very motivated to be fully compliant. My parents are paying first since I am still in college, but I would need to pay them when I get out of school. It will be a long time before this debt can be paid...

[Dr.B]

Applecidar, no worries. They should be shipping your aligners out today if they didn't already do it yesterday. Do you have spacing or crowding? Are you getting extractions? The orthodontist really doesn't know exactly when you will be finished, it's an estimate based on other people with your similar teeth. Once Invisalign scans the impressions, they will straighten the teeth out on a computer model (2-4 weeks), then they will send him CAD/CAM models of what they will look like. He will go back an forth with Invisalign to get the right treatment perscription (1-2 weeks). Once he approves, Invisalign will make all of the aligners (1-2 weeks), and ship (1-3 days). I know it's nerve racking, all of my patients go through it. You will soon be on your way to straight teeth! :-)

[applecidar]

My ortho just got back my ClinCheck!

Seems like I will be wearing 46 aligners (top and bottom) so it will roughly be 2 years journey for me.

I will also be extracting all 4 premolars. I am not looking forward to extracting 4 perfectly healthy teeth, but its seems like there is no other way to correct my bimaxillary protrusion problem.

Has anyone done invisalign with extractions? which tooth/ teeth was/were extracted? My main concern is that invisalign will not move my teeth over the extracted spots....

[pmnsk42]

Hi Applecidar! I don't post often but my case is very similar to yours. I had 4 extractions because of over crowding in April 2010 and started invisalign in May 2010. It was very scary for me to get 4 healthy teeth removed but I had to have faith in my ortho. I was originally given 24 aligners at 3 weeks each and 17 attachments. I reached #24 this past October and noone can believe how nice my teeth look. I went in for refinements and got my new clincheck in January...30 more aligners! That's almost 2 more years..I wanted to cry. So my ortho said 4 months in braces, only in the back and using my altered tray #24 in the front was a quicker option and I jumped on it. I had them put on 2 days ago and my teeth hurt more than they ever did with invisalign but I am so happy I did it! No more worrying about having my trays out too long..I like my new freedom!
I am a 45 year old woman and I am so glad I took this journey, but I am glad to be nearing the end. I hope this helps you applecidar!

[xavante]

hey guys, my first time posting on here. I will be on invisalign soon, I just need to have all 4 bicuspids extracted because of protrusion.
im worried about what kind of side effects will I expect after the tooth extraction procedure? Is it as complicated as wisdom teeth surgery?
Ive read about how facial profile might/will be altered after bicuspid extraction...is there any truth to this? how about recovery time?
thanks so much for taking the time to read. I cant wait to start invisalign, but first this big hurdle I have to pass...

[applecidar]

hi! i am the original poster.hope my experience here helps. i have all the same concerns as you did!

i had all 4 premolars extracted and was put on my invisaligns the next day. i am now on my fifth set and will be moving onto my sixth set. things have gone very smoothly for me. i had a very experienced oral surgeon and she took out all the four molars in 30 minutes and by the 2nd day all bleeding stopped. painkillers were my best friend for the first 2 days, and i had solid food from the fourth day. my extraction wound healed completely within 7 weeks and i think the site will be closed in 12-15 months.

there are many stories about people with sunken profile after extraction and there is a school of thoughts that claimed that no extraction is ever necessary. for me, i rather trust the expertise of the orthodontists i saw. i have bi-maxillary protrusion, a condition that affects certain ethnic groups more than others and is the reason why i hated my side profile. every orthodontists i saw (4 in total) recommended braces, or braces plus surgery. I rejected surgery and would not get braces unless it is invisalign. only my fourth ortho is willing to be put on invisalign. i considered carefully for a couple of weeks, read up more about in dental journals, ask for advice and finally decided to take the plunge. my ortho has published research on bimaxillary protrusion and treatment's impact on facial profile. for that i gave him my 100% trust.

now, invisaligns are just part of my life - i dont think much about them (except when i change into a new set), my speech isn't greatly affected and all my friends know i am on them because i tell them.

so my advice as someone on invisalign with 4 premolars extracted and as a non dental professional is to do everything you can to make a sound decision. extracted teeth cannot grow back and you cant stop invisallgn treatment halfway since you have 4 gaps. get as much expert advice as possible and consider if you can really make the long commitment. i have 45 sets of aligner + refinements and should be looking at 2 years total treatment time. i take brushing my teeth after every meals, flossing religiously, not snacking etc all in my stride because i have made this decision myself. so think carefully before you make the decision (both about extraction and being on invisalign) and choose your orthodontist carefully. really take time to find one that you trust! as Dr Tam pointed out in his earlier post, it isnt easy to use invisaligns on 4 extracted bicuspids.