DOES INVISALIGN WORK?

Well the short answer is... yes. 

Invisalign is a unique method of doing orthodontics and it requires a whole different set of skills than what it takes to do braces and wires. The truth is, orthodontic appliances are like musical instruments; some doctors are going to prefer certain instruments over others and each one requires training and experience. You can't master the guitar and then expect to be able to play the banjo. If you want to play the same song on both instruments with equivalent skill you're going to need to spend some time and effort getting good with both. The same goes for braces vs. Invisalign.

When Invisalign first came out it was met with a certain amount of suspicion because removable orthodontic appliances traditionally didn't provide much control over the teeth. They were thus considered a sloppy and inaccurate way to make things "better". One certainly didn't expect the same degree of fidelity that could be achieved with brackets which were directly bonded (or "fixed") to the teeth. Consequently "fixed appliance" therapy was considered the gold standard by which everything else was compared.

Invisalign came on the scene in 1999 and while it's true that it wasn't as accurate as fixed appliances were it set a new standard for what could be expected from removable appliances. Over the past 15 years the appliance has improved by leaps and bounds. Each year Align technology puts forward a set of innovations and advancements that widen the envelope of case types that can be successfully be treated with Invisalign. The truth is that if your doctor isn't keeping up with the latest features from Align then their skill set is rapidly degrading and the types of cases they will be willing to "take on" with Invisalign is probably smaller than it otherwise could be. 

Which brings me to another point: frequently patients come to my office claiming that they went to another orthodontist (or general dentist) and were told that they "didn't qualify" for Invsialign. You should know that this is code speak for "I don't feel confident that I can get your teeth corrected with Invisalign" meaning that it represents a limitation of the doctor as well as the appliance. There's an old saw "a poor workman blames his tools" and this applies to white collar professionals as much as it does to blue collar folks. The fact of the matter is that yes, Invisalign does have it's mechanical limitations and there are certain things that a bonded bracket can do that a plastic aligner can not but that margin of separation is shrinking and will continue to do so as time goes on. But that's not the whole story; there are many situations in which 90% of the case can be completed with Invisalign but there's a 10% residual where a complex maneuver must be accomplished. For example: closing an extraction site. For closing extraction sites there's nothing better than a set of braces bonded to the teeth because you can really drive the roots together. Leverage, root torque and sheer mechanical advantage are required and that's where braces win the day. But does that mean that the patient "doesn't qualify" for Invisalign? Nonsense. There are ways to hybridize the two techniques. In several instances where I wasn't able to achieve the desired root angulation I simply placed three braces on the teeth in question (calling them "root helpers"), modified the aligner by cutting "windows" out for the braces and voila: the best of both worlds. And believe me, most folks are more than willing to accept 3 braces for a limited time if it means they can complete the rest of their orthodontics with Invisalign. It really boils down to who's willing to go the extra mile to get creative and who's got the deepest "bag of tricks" at their disposal.

The fact of the matter is that the wider the envelope of cases your orthodontist is willing to take on with Invisalign the more skilled he or she is going to be when it's your turn. I have taken the plunge many times with cases dubbed "deep end of the pool" so that when a routine, rank-and-file case steps into my office it appears facile by comparison. But why would I be so willing to take on challenging cases? Is it because I have "something to prove"? Not at all. The truth is that I have confidence that no matter what happens I know I will be able to deliver the patient the result they desire with one technique or the other. I routinely tell my patients that if we are somehow unable to achieve the desired results with Invisalign (or hybridized approach) then I will happily place a full set of traditional braces at no additional cost and complete their treatment to their satisfaction. I've never had to follow through with this. Not once. One caveat: this guarantee does NOT apply when the patient simply fails to wear their aligners. You have to do your part just as I am doing mine. A failure to cooperate does not represent a failure of the appliance (or the doctor for that matter).

At the end of the day the process of orthodontics is about the destination, not the vehicle we use to get there. When your teeth are straight and you're thrilled with your new smile it isn't going to matter whether we used braces or Invisalign. Which brings me to my next analysis: which is better, Invisalign or braces? There is no correct answer!

To a certain extent Invisalign has created it's own audience. The folks who come to my office seeking Invisalign are frequently people who wouldn't have even considered getting orthodontics had Invisalign not been a possible option. Sure there are people who come in for a consultation and discover that their cases are challenging and that it might be more predictable if completed with fixed appliances but for many it becomes a question of which appliance best fits the patient's lifestyle? If a case can be equally well-treated with either Invisalign or braces then it's going to come down to comparing the pros and cons of each appliance.

Invisalign requires you to wear the aligners 22 out of 24 hours a day, taking them off only to eat and brush. You need to get involved, be proactive and participate in your treatment. If you're the kind of person who loses their keys or eyeglasses constantly and doesn't feel that you are dependable enough to stick to a project then Invisalign is not for you. Braces on the other hand require a lot less patient participation. Don't get me wrong, compliance is important for both but if you just want to bring me your teeth every 6-8 weeks and let me do the majority of the work for you then choose braces (metal or clear). You will probably be less frustrated. 

No matter what you will know that we're doing stuff to your teeth. It's not magic or telekinesis. Aligners gently press on your teeth and that means it can make them slightly sore and achy. True, they push with less force than traditional braces but any force capable of inducing tooth movement is also capable of causing tooth soreness. 

The other thing that occasionally surprises patients is the presence of aligner "attachments". These are tooth colored bumps or buttons that are bonded to your teeth at the start of Invisalign treatment. These attachments are made of dental restorative resin and blend right in to your natural tooth color but you will feel them and they aren't totally invisible. Think of a piece of ice in a glass of water; you can still see it but it's not completely obvious. Anyway it's these attachments that allow the aligners better "purchase" or grip on your teeth and allow the sorts of complex movements that were traditionally the realm of braces only. In fact the innovations in attachment design and placement are what have advanced the art of Invisalign to it's current state. If you feel attachments are "just as bad" as braces then perhaps it's not a good choice for you. At the end of your treatment we remove the attachments completely.

Another question I hear frequently is "which works faster; Invisalign or braces?" and the truth is they work at about the same rate. Teeth move at a certain biological range of speed and depending on the amount or complexity of your treatment needs your case could take longer or shorter. Generally I would estimate the same duration for either technique. Some doctors say that Invisalign is faster but then again, many doctors only use Invisalign for easier cases and those finish faster and that may be where the confusion lies. 

Finally let's talk about cost. How much does Invisalign cost? This is where things can get confusing because there is a HUGE range of prices out there. 

First let's talk about the difference between a general dentist and an orthodontist. There is no law preventing a general dentist (aka Primary Care Dentist) from doing Invisalign. However an orthodontic specialist (a dentist who has gone through a residency program for an additional 2-3 years of training in orthodontics and who does nothing BUT orthodontics in his/her practice) is generally going to have more skill and experience with Invisalign (and any other orthodontic technique for that matter). So while you might see Invisalign offered on Groupon for $2000 it is almost assuredly a general dentist office doing the work. Believe me, for that price the doctor is making zero profit and is charging you basically nothing for his skill and experience. And for the most part you get what you pay for in this regard. If the dentist doesn't put any value on his skill and experience then why should you? These bottom rung offers are designed to bring patients into the office where their other dental needs can be assessed and addressed. Before you get the rock-bottom Invisalign price you may be asked to do some fillings, crowns and periodontal work. 

On the other hand an orthodontic specialist is going to be more expensive and, frankly, worth it. We make our living on our reputation and skill at orthodontics and we are the indisputable masters of the art. Plus as I mentioned earlier we have back up plans. If your general dentist offers Invisalign and you don't get the results you wanted what's the bail-out option? Is there one at all? Maybe you'll get referred to an orthodontist at that point. Trust me, we don't like cleaning up other people's messes but we'll often do so because we absolutely despise seeing lousy work. 

Now when it comes to pricing Invisalign at a specialist's office there are a few things to consider. First of all many orthodontists charge a bit more for Invisalign than for braces. The average cost for a comprehensive orthodontic treatment nationally is about $5500-$6000 (as per the American Association of Orthodontists). Clear braces or Invisalign often costs a little more (anywhere from $300-$1000 extra). Just so you know, in my office I charge the same for either. My attitude is that I'm charging you for a comprehensive treatment and a good result and you should choose your appliance based on how appropriate it is for your lifestyle and treatment needs rather than a couple extra bucks here and there. 

So if you've read all this and you would like to know if you "qualify" (ha ha) for Invisalign please feel free to contact my office for a complimentary consultation. We'll take your x-rays, review your case and discuss all the pertinent information. We can give you an estimate minus whatever you insurance might pay and help you finance the residual. We are very good at making affordable payment arrangements because we want your business and believe that you should be able to achieve the smile you deserve at a price you can afford. 

You can reach us at (925) 443-3800 or request an appointment online at www.WildSmiles.org where you can enter your contact information and we will reach out to you to arrange a good time.

We are located in Livermore, CA at 4200 East Avenue #100. 

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Methods and Madness

Orthodontics is as much an art as it is a science.

Many times a day I consult with parents and patients regarding the possible treatment plans to correct their teeth and frequently there is more than one solution to the problem.
Headgear or no headgear? Extractions or no extractions? Invisalign or clear braces?
These are the issues we bump into over and over again.

It gets even more confusing for the patient if they have gone for multiple orthodontic consultations and they've been told a different story at each.
In fact, I recently met with a family that had gone for three other consultations and had three different treatment plans! Needless to say they were more confused than when they had started the process.
What I explained to them was that there was merit to each and every treatment plan that they had been presented with and that in their particular case it was possible that they could get a good result with any of them. I discussed my own preferences and then proceeded to articulate the reasons for why I chose my particular route. They were grateful for the explanation and left feeling like they had a better handle on the situation and where they wanted to go with their son's treatment. As they walked out the door the mother asked me: "Why didn't the last three orthodontists explain their reasons like you did?"
To that I had no answer. But I suspect it has something to do with the time allotted for consultations, something to do with a slightly paternalistic approach to patient management and something to do with communication in general.

In medicine we seek "informed consent" before treatment. That means a patient needs to be presented with all the advantages and disadvantages of any particular treatment so that they can make an informed decision to consent to it. Without it the doctor is vulnerable to a malpractice lawsuit. Briefly, it's in everybody's best interest if the patient can't say "if I had know that beforehand I wouldn't have agreed to it." A full disclosure of all the risks and benefits is the only way to avoid this and even then it needs to be documented thoroughly.
Sometimes it can get a little scary when you have to disclose a severe possibility (like death from a rare drug reaction) but informed consent is a double edged sword. We gain nothing from lying to our patients. The way I see it the purpose of an informed consent is to open a dialog about the patient's treatment so we can get it all out in the open before anything irreversible happens. I want my patients to have all their questions answered and to be 100% clear on the "why" and the "how".

So the moral of the story is that it is up to you as a patient to discuss a potential medical treatment with your doctor thoroughly before engaging in any sort of treatment. This applies to everything from orthodontics to brain surgery. If your doctor isn't able to sufficiently articulate his/her reasons for their treatment plan; the "method behind the madness" so to speak, then promptly go somewhere else and get a second opinion.

In my office I follow what I call "the golden rule of diagnosis". What that means is that I ask myself: knowing what I know about orthodontics, if I was in my patient's situation what particular treatment plan would I choose for myself? I don't think you can go wrong with this method of patient care. My father used to tell me "the only thing we owe others is our honesty". I think this is wise advice.

For more information about our office or on orthodontics in general please click through to www.WildSmiles.org. You'll learn something and help us boost our Google ratings all at the same time!