Contemporary Orthodontics & Dentofacial Orthopedics
James
R. Waters,
DDS, MSD , PA
Board Certified Treatment for Children, Teens and Adults
Letting your teen guide his/her
orthodontic treatment?
It seems every week I have a new patient exam with a mom and
her teenager to discuss orthodontic correction when I am TOLD the teen wants
Invisalign and nothing else. Typically
it is a moderately crowded teen that has not had any early treatment (or was
treated with some simple early retainer years before) and they simply want
straight teeth. I always begin by
introducing myself and examining the teen’s bite. If it is a simple case, I may give an
estimation of what I would recommend, maybe even a rough cost (however if there
is a more significant issue I prefer to have records before putting my foot in
my mouth) and then I will discuss options of appliances (including clear
aligners if relevant).
In most cases I have to tell the parent and the teen that
Invisalign (really the generic term for a slew of different clear aligners
available today such as Clear Choice and Orchestrate) is not the best option. It may be due to un-erupted 2nd
molars or too great of a tooth to bone size discrepancy (too severe of
crowding), a jaw discrepancy where one jaw is too far forward or backward which
of course makes the teeth not fit at all, or it may be something else
altogether specific with that patient (an overly angled canine, a very deep
bite or crossbite of teeth). After
explaining the issues, it is inevitable that I get the “well my friends have
Invisalign” or “this other doctor/dentist says I can do Invisalign”. I even get the defiant “I’m not wearing
braces, I want Invisalign. I don’t care
if it doesn’t work as well.”
Some teens understand and move forward (most know when it’s
not a good idea and most know they won’t wear the trays as prescribed). But occasionally I see the patient move on
and start Invisalign elsewhere. This is
happening with a wrestling buddy of my son’s currently; friends of my kids
usually ask them why I won’t give them Invisalign but another guy down the
street told him he would. My answer is
simple; I care more. I might know better
and I certainly have much more experience but I think it is not so
complex. The attitude today is that you have
to give the patient what they want since they are paying and a lot of the new
doctors take this path of least resistance.
But I submit that those of us that performed Invisalign 15 years ago
know well what it can and cannot do and we further know compliance is a
nightmare with teens (even my own kids hence they got braces).
Let me also provide a brief description of exactly what
Invisalign trays actually entail:
Invisalign requires a quick digital scan which is emailed to
a non-medical center (Invisalign was in India last I checked, Clear Choice is
local in Texas and Orchestrate can be done completely in-house) to digitize the
scanned teeth. They then simply move the
teeth in the digital image similar to morphing a picture from a start to a
finish, then they send the data file to another lab that prints the models with
a 3-D printer. Another lab tech (I
believe in Mexico) sucks down plastic over each model and sends them to the
doctor back in the US. Then the doctor
is supposed to place the trays every two weeks.
And there it is. $2000+ lab bill,
essentially no time with the doctor and very little opportunity to make changes
along the way when something doesn’t move or when the whole jaw shifts and now
the teeth all fit different than the original scan.
In practice what I see is doctors having assistants (with high
school education only) placing/delivering the trays and giving several months of
trays to the patient so they can essentially treat themselves. If trays are lost, there is a new $500 fee to
replace. When all the trays are
finished, and a few times in between, the doctor looks and MANY times suggests
braces to “finish the bite a little better” which is code for IT DIDN’T WORK. I even know of a local Orthodontist that
evaluates patients via skype then sends them to an imaging center and has a
different dental office deliver the trays.
That really disgusts good doctors.
The results are varied, many cases that are planned well and
are good candidates work out fine (rarely as good as traditional braces but may
be acceptable), many others end up with heavy occlusion on front teeth (because
the lower jaw was locked back before treatment and as teeth aligned, the lower
jaw settled forward, with all the teeth now hitting hard in the front and no
contact in the back), none are allowed to settle due to the trays between the
teeth, and still many others end up with one or more of the worst teeth still
crooked. Teens that treat have a
terrible time holding onto trays and an even harder time wearing something that
hurts full time when they know they can just remove it (For that matter, so do
adults!). Then when they are confronted
about wear time, they swear they have worn the trays and of course the parents
confirm they always see them wear the “invisible” trays! In truth, its no surprise these patients are
just given trays and sent out the door for months; sometimes its just
frustrating as the Orthodontist to the point that the patient compliance is
harder to deal with than the trays.
Regardless, there are too many cases floating around now
that either gave up on the treatment, relapsed and don’t want to do braces, or
were never fully corrected and there are
more started everyday by inexperienced dentists and unscrupulous Orthodontists
just trying to bring in dollars (and I am talking about those “doctors” that
will put anyone who pays into Invisalign) .
These patients then assume that this is what orthodontics is; straighten,
maybe not even all the way, then expect the teeth immediately to move back or just
remain imperfect. The experience for
these patients is long and expensive and may prevent them from achieving the
very correction they paid for and deserved in the first place. Then they spread “the word” telling everyone
they know about their version of the experience. Not good for the Orthodontists and not good
for other perspective patients that really want a good smile.
Teeth are one of the most important things we have during
our lives; if you don’t believe this ask anyone with chronic dental
problems. So just as you would not want
your teenage son/daughter to pick the type of heart surgery he/she gets or the
type of cancer drug they may need, it is unwise to allow them to decide that a
specialist, with a minimum of 10 years of education and up to 20 years more of
experience with aligners as they were being developed (by specialists) may not
know what is the best way to treat their malocclusion.
It would be much easier to be the proverbial doctor down the
street that tells everyone, “let’s just do Invisalign, we don’t use or need
braces”, then sit back and do nothing. I
mean really, if it were that easy and it worked every time don’t you think I
would also say the same thing and just send for the scan and be done, collect
my $5000 and go to the next patient?
Parents should be very wary of the Orthodontist or dentist
that tells them what they want hear for profit.
Keep in mind, we (Orthodontists) ALL know what the patients want to
hear. I have been around when Invisalign
was born, some of us have already gone through the pain of using Invisalign
just to see the cases fail or relapse; having to tell the patient that we need
braces to “finish” for one reason or another.
It is the responsible and trusted Orthodontist, the local doctor that
plans on being around as you and your kids get older, that will tell you what
you need to hear even if it isn’t
what you may wish to hear. Trust this
specialist versus the one telling you just what you want to hear (even when it
sounds too good to be true), for if it were as simple as an impression we
wouldn’t have specialists in the first place and I would set up kiosks at every
mall!
If you have questions or comments concerning this or any
orthodontic question, please feel free to make a complimentary new-patient
appointment at either my Steiner Ranch location or my North-central Austin
location on West 35th street and MoPac.
Central Austin
1814 W. 35th
Street
Austin, TX 78703
(512) 451-6457
Steiner Ranch
4302 N. Quinlan Park
Austin, TX 78732
(512) 266-8585
BracesAustin.com
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