This is an excellent question that I think a lot of patients have considered, especially now that aligner treatment is seemingly being offered everywhere; orthodontists, general dentists, even online! In general, the phrase "you get what you pay for," is very applicable to this situation. The most important part of the orthodontic process is the proper diagnosis and treatment plan formulation; every patient is different and the only way to get a safe, effective result is with the proper plan. The type of appliance to use (braces, aligners, headgear, etc) is just a part of the plan; "Invisalign" is not a treatment, it is an appliance. Since dentists receive virtually no orthodontic education in dental school, orthodontists spend another 2-3 years after dental school in full-time residency training to learn how to properly plan and deliver orthodontic treatment (there's a lot to learn!). When sending the patient information to Invisalign (photos, scan/impressions, xrays) the doctor is able to give direction on what exactly he/she wants done with the case (or they can give very little direction). The technician then enters the information and the software creates an initial setup for the case. This is why aligner treatment has become so attractive to doctors with little or no ortho training; at this point the doctor can simply accept what the computer software creates and give the aligners to the patient. Done! The problem is that while the software is very advanced, it's just software, it's not a doctor with the proper education and experience. I NEVER blindly accept the first setup that comes back to me from the technician. I always modify tooth movements, sequencing, and final tooth position; I evaluate the whole sequence to be sure the movements are reasonable and anticipate any potential problems we could encounter along the way. Then it's important to monitor the patient to ensure everything is progressing as expected. Another issue to consider in your situation is what the final goal is for treatment. A plan that will simply align (straighten) your teeth is going to be faster and less expensive than a plan that will address other bite issues. In my practice, I have some patients that request to be treated on a limited basis, meaning we don't aim for an "ideal" result (perfect alignment and bite function), but simply try to make specific changes that satisfy the patient's main concerns. If I feel that it is safe to do this, and the patient understands the limitations, then I'm usually happy to do this and the treatment fee is often less than a "full" case where an ideal finish is our goal. This is something you can discuss with your orthodontist and he/she can tell you whether limited treatment might be an option if you're concerned about the cost of treatment. I hope this helps answer your question, good luck to you in your orthodontic treatment!
I personally avoid tooth extractions whenever possible, however, there are many cases when removing teeth is necessary. While I don't have your full diagnostic records available to review and have never examined you, from the photos you provided it appears you have severe crowding and very proclaimed/protrusive (teeth tipping forward) front teeth. Yours appears to be a case that definitely requires tooth extractions to safely align the teeth and obtain a proper bite. Everyone who gets braces will experience some expansion, or widening, of the dental arches, which in many cases is enough to allow for alignment of mild-moderately crowded teeth. We are limited, however, in the amount of expansion we can do by the amount and quality of gum and bone supporting the teeth. It is very possible to cause damage to the gums, bones, and teeth by pushing them too far out to the sides (expanding) or the front (proclaiming) in an attempt to avoid extractions. There are claims made (generally by companies/doctors trying to sell a particular appliance or product) that bone can be grown/developed and thus extractions are not necessary; this is false and not supported by any independent research. In children and young teenagers, it is possible to use an expansion appliance to widen the upper jaw bone which can help gain some space for crowding. This does not work in adults as the mid-palatal suture is fused, thus any expansion gained is purely dental and runs the same risk of over-expanding with braces. If you have questions about your treatment plan, don't hesitate to talk with your orthodontist about your concerns. You could also seek out a 2nd opinion from another orthodontic specialist to confirm your plan is reasonable; just be sure to do this quickly as you don't want to go very long after having extractions before beginning treatment. The teeth will begin to move on their own and it's important that the doctor is in control of what movements are occurring to make the best use of the space created by the extractions. I hope this is helpful for you and wish you the best in your orthodontic therapy!
I would definitely visit your orthodontist to have this evaluated. In general, a well-fitted retainer should limit rotation of the lower teeth. However, if space is forming there may be pressure on the teeth causing them to move forward. This could come from the retainer itself (they can be bent or distorted during eating), the tongue or some other habit (chewing on pencils, bottle caps, etc), or even the way the teeth are biting together. The sooner you can address the movement the easier it will be to fix!
The first thing you can try is to continue wearing your #1 aligner for another week, making sure that you're wearing it 22+ hours per day. You can also try gently biting down or "chewing" on the end of your toothbrush in that area for a few minutes each time you put the aligner in to ensure it is fully engaging these teeth. Be sure that you are able to easily slide floss between each tooth; sometimes tartar can build up in the area and essentially "glue" 2 teeth together. If after trying these tips you're still not seeing the aligner fit better, stop progressing through your aligners and contact Smile Direct Club. If these teeth are not "tracking" this early in treatment, it will not improve and will likely just get worse as you continue through the set. One of the problems with "at home" orthodontics is that your progress is not being monitored by a doctor, and this is just one of the many reasons why monitoring is important! I'm not familiar with the SDC "warranty" or customer service protocols, but there should be some way for you remedy the situation. Whether it's to make a new set of aligners, they may be able to arrange for you to see a doctor, or possibly to discontinue the SDC aligners and seek treatment with an orthodontist who has experience using aligners. Best of luck to you, I hope this helps you get to the beautiful smile you've been wanting!
I'm sorry to hear this happened! It must have been very upsetting, especially after waiting so long to get started with your orthodontics! You'll need to speak with your orthodontist about your specific situation as the cost of additional aligners is different depending on which company is making the aligners (Invisalign, ClearCorrect, etc) and which product your doctor is using (a limited system with only 10 trays vs "full" treatment with unlimited trays). In a "full" Invisalign case, for example, the cost of any additional aligners is included in the lab fee the doctor pays upfront for the product. So if you lose a crown or need a new filling, you can simply take a new impression or scan once your new crown/filling is in place and get a new setup. This would be a good situation to have your dentist and orthodontist put their heads together and see what the best option is for you depending on the status of your tooth (Does it need any other treatment like a root canal or core build up? Does it have a good long term prognosis with a new crown?) and the orthodontic plan (Which aligner product is being used? Will losing this tooth change the treatment plan?). Don't be afraid to ask all of these questions to your doctors as I'm sure they will be happy to work with you to find a good solution. Best of luck to you!
