Okay, I'm starting with the disclaimer that I know next to nothing about orthodontics, other than I would rather have my orthodontist move teeth for my patients than subject them to unnecessary tooth preparation whenever possible.

The above photos are of a patient I am currently seeing who has agreed to comprehensive orthodontic treatment. She is very resistant to conventional appliances and is interested in Invisalign.

The goals orthodontically are to rotate the canines in the upper arch, distribute the spaces in order to slightly widen the laterals and to reduce the crowding and align the canine in the lower arch.

My orthodontist, Dr. Cheryl DeWood is extremely competent with both traditonal and Insivalign appliances so this is not an issue.

Here are the clinical realities:

1. Completion time for conventional appliances is six to eight months and the time required for Invisalign could be three to six months longer.

2. Conventional appliances allow the orthodontist to have complete control of the movements, especially if the treatment plan changes because of unexpected circumstances. If we need to change the treatment plan with Invisalign it might mean prolonging the case for new aligners to be fabricated.

3. My patient, while absolutely committed to the process, can get annoyed with the aligners and take them out whenever she likes; this prolongs the process. Invisalign works when the patient wears the aligners 24/7.

4. The cost for traditional appliances is usually less than Invisalign.

5. Traditional appliances may create a greater degree of self-consciousness and discomfort in adults, resulting in failed treatment because they bail before completion.

In this case, I have strongly suggested conventional appliances. It will be faster and ultimately more predicatable. Don't get me wrong, I like Invisalign. I have had patients who got better care because they did Invisalign after adamantly refusing conentional braces.

What do you think? What would you recommend?

The concept of Facially Generated Treatment Planning can greatly simplify treatment planning for wear patients. You can find more information about treatment planning, esthetics and occlusion within the Spear Digital Suite. Download the free resource:
The 8 Steps Checklist-Facially Generated Treatment Planning.



Commenter's Profile Image Paul Ganucheau
January 13th, 2014
My concern is how effective would invisalign be at performing the desired rotation that is needed for the cuspid. Further, if the root is angled lingually, then wouldn't it also be necessary to torque the root to bring it buccally to correct the flaring of the cuspid? I am honestly a fan of conventional treatment because the patient cannot remove the brackets and wire; whereas Invisalign treatment, as you stated before, is entirely out of our control because we cannot make sure the patient is complying with wearing the aligners 24/7. Paul
Commenter's Profile Image Steve Ratcliff
January 13th, 2014
Interestingly Paul, in the hands of a skilled clinician the final result can be equal to conventional appliances if the patient cooperates and wears the appliances as directed.
Commenter's Profile Image Paul Gilreath
January 13th, 2014
True, the rotation on 6 would be challenging but certainly within the scope of what is possible w Invisalign. There are number ways to approach this, but if I were doing the case with Invisalign, I would add attachments to the canine to provide more leverage and then I would over rotate the tooth by about 20°. What will actually happen is that the tooth will not over rotate but will end up being in about the right position. Torque is very easily applied as part of their normal protocol as well these days. It is important when doing challenging movements like this canine rotation, that you over correct in the prescription. Very similar to the way you would approach a traditional ortho case.
Commenter's Profile Image Steve Ratcliff
January 13th, 2014
Yeah, what he said...
Commenter's Profile Image Shapna
March 4th, 2014
The cost of invisalign is slightly higher than the traditional metal braces. But the invisalign never gives pain or any other obvious look. The main advantage of <a href="http://www.clearbracesdublin.com" rel="nofollow">Invisalign</a> is removable and invisible aligner and it can be removed whenever in need.
Commenter's Profile Image Teresa
November 13th, 2014
If the misalignment is not excessive, even invisalign might be fine, but beyond that, what is not said often on these mobile devices is that they are invisible, indeed, you see very well. In fact, the only way to really have an invisible braces do is realize in lingual orthodontics, even better if fixed and no attacks, with the technique developed by Fabio Cozzolino and treated Blog Zerodonto, which provides a fine thread without lingual brackets which can be annoying to the language and produce problems in speaking. The final solution with respect to issues of anxiety and embarrassment, as well as the most effective to correct misalignments strong.