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Orthodontics/after invisilign

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Question
For the last couple of years I had Invisalign treatment on my bottom teeth as they were extremely crooked. I am extremely pleased with the results as they are perfect now and are kept in place by a small wire glued behind the teeth. My top teeth were also perfect so I didn't need invisilign on top.  

Since the treatment ended I have noticed one of my top front teeth is starting to stick out and turn slightly. I know this is due to my bite between the top and bottom teeth as now one of the bottom front is pushing slightly against the one that is twisting on the top but only slightly. My bite isn't uncomfortable either.

My question is, will my tooth continue twisting or will it eventually go back to its correct position. My dentist said eventually it will straighten itself but I'm not so sure.
Regards
Lou

Answer
Dear Lou,

Thank you for your question. You would not believe how commonly this occurs, and thank you for making the question public so that others can benefit from your posting.

First, as always, what I write here are only my opinions based on very limited information. My comments should not be viewed as any form of diagnosis, definitive or otherwise,  or any form of  treatment recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.recommendation.  Indeed, in the ultimate analysis all final decisions, particularly clinical ones, should  only be made by qualified doctors who have had a chance to see you in person and who have had an opportunity to take and analyze proper diagnostic records.

Okay… having said  that…  your  questions focused on changes in your tooth alignments after clear aligner treatment with Invisalign brand aligners.

You wrote: "  Since the treatment ended I have noticed one of my top front teeth is starting to stick out and turn slightly. ".  I addition you asked, "  My question is, will my tooth continue twisting or will it eventually go back to its correct position. My dentist said eventually it will straighten itself but I'm not so sure."  

Lou, I am going to answer this but please realize I do not have any images of the current condition you describe. Moreover, I also am lacking information, images, etc of the initial pretreatment condition. When doctors evaluate an orthodontic treatment result, it is critical that the initial conditions be taken into consideration. Imagine a patient with major cross-bites, crowding, skeletal jaw mismatches, congenitally missing teeth, and more. If the final treatment result of this person s slightly less than ideal, then this can be much more readily accepted. In contrast, imagine if a person presents with just one slightly crowded incisor and nothing more. I think the treating doctor would be asked to deliver a more ideal result in the latter case than in the former.

To answer your question, I think you will find that if you take the series of aligners you had, and go back say three or four before the final one, and wear each, then your issues may well be resolved. In other words, say you used 17 aligners to resolve your lower dental arch crowding. Take Aligners # 14, 15, 16, and 17 out of the boxes, and wear each for three weeks. Now, I have had patients that had your similar situation and then LOST...yes LOST their aligners. Sad, but there is a solution.  Invisalign keeps records of your aligners, and if you lost them, he/she can order copies. I do not now what the charge is as of 2015.

Now, if that is somehow not possible, your doctor can perhaps order a new set of THREE or so aligners from sources other than Invisalign if needed. Be sure that you first remove any lingually bonded wire retainers before these impressions are made. From the way you  describe your situation Lou, it seems the teeth will readily realign themselves.

Also, just a short comment on the relative stability of loser incisors. As you know, all teeth have roots, and when you see "teeth" in the mouth what you largely see is the crown of the tooth, while the root is embedded in the bone. As an analogy you might think of an iceberg, where a large portion is below water and out of view.  Anyway, these lower incisor have the smallest roots of any teeth in the mouth. It makes sense that these incisors then are relatively less stable than some larger molars. Molars can have two or three large roots deeply embedded in bone and holding the tooth in a very stable manner.  It is therefore not uncommon to see lower incisor crowding in many adults.

So Lou, to briefly summarize for you then:  

1)  Do not worry too much, the resolution would appear to be readily at hand.  

2)  Your doctor is right in that the teeth should re-align themselves.  

3)  After the teeth have been corrected,ask your doctor for additional retention options. Ask if you are a candidate for double lower retention. This would include a inside (lingually) bonded small wire retainer in addition to the clear removable type retainer which you were provided earlier.  Your earlier clear retainer may or may not be usable if a wore is bonded on the insides of your lower teeth. A new clear lower retainer may be needed.

Lou, if you have any follow up questions, please resubmit, and included some images if you can. That will help me give to better understand what I am dealing with,  and will enable me to give you a more accurate response. Good luck Lou, and thank you for writing.

Paul Supan, DDS, MA, MPH
Board Certified Orthodontist

Specialist in Orthodontics
Specialist in Dental Public Health
http://www.braces.com
http://www.leesburgbraces.com  

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Paul Supan, DDS, MA, MPH

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First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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