Invisalign, Can my dentist do it for me?

Recently I was challenged by a patient: “my dentist has an Invisalign sign at their front desk and the staff say their dentist can do this for me too?”

What are the differences between orthodontist driven Invisalign and general dentist driven Invisalign?

First of all the keys to successful treatment are: patient compliance, the proper plans and proper biomechanics. Notice I said plans! Many dentists are accustom to preparing a crown and then taking an impression and sending it off to the lab to be made by a technician. To that end, Invisalign appeals to them; take an impression, send it off to the lab and get back a kit to move the teeth. Simple right? Well maybe not so fast.

Let’s consider the differences in the process and why they are important to you.

The dentist takes and impression and sends it off to the lab; most orthodontists will not take an impression, but rather obtain a 3D digital scan. This is considered more accurate as it can be refined during the scan to improve the quality (it is also sent in electronically speeding the process) with an impression you get one chance, if there is a bubble or an error, you repeat the impression until all of the teeth are perfect. This does not usually happen so the impression gets sent in to the lab with minor errors, this can affect the fit and performance of the aligners.

If your dentist is going to take a traditional impression, that is an indication that they dabble in Invisalign and do not do it on a regular basis. Another way to check your dentist is to use the find an Invisalign provider web page. If your dentist is not listed, then they do not use the product often enough to be listed as a provider.

Every provider submits a prescription to the lab. The details in the prescription are important in getting a good plan. I do not recall the last time I accepted Invisalign’s first proposal. I will generally modify the plan or four times before I accept it. How many times does the dentist modify the plan? My guess is most dentists accept it as is. Why, well reviewing the plan is a complex process that requires time and knowledge of how teeth move. The plan is an animation, and just because it looks nice, does not mean it will work. Over expansion, too much tooth reduction, teeth moving in ways that cannot occur in the mouth…

It is critical for the orthodontist not only to determine if the plan is appropriate, but achievable. Regularly, the first proposal from Invisalign will not work in my opinion and requires additional changes. What does that say for plans for patients where the initial plan is accepted from the company without changes?

Revisions: most orthodontists know that after the first round of aligners, an additional plan for refinement aligners is necessary. Again, this is where the 3D intraoral scan is helpful. A new scan is obtained and within a few weeks a new plan and new aligners are available to move forward from the initial results. This is common in orthodontics where the orthodontist evaluates what they wanted from their treatment mechanics and what they got and now what is required to move forward toward the goal. The key, as always is understanding the plan and making sure it is realistic (the animation/plan will show anything is possible, it it’s the provider that must determine if it is realistic).

Additional technology: I have a 3D dental radiography machine that gives me a 3D x-ray. This is important to determine when and how much expansion is permitted. If you exceed this amount the teeth will be pushed out of the bone causing relapse and an unhealthy situation.

In summary I would say that while your dentist can take an impression and get back trays from Invisalign, your experience and thus results will be different from the orthodontist driven treatment.

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