Mazyar Moshiri, DMD, MS

Not all crossbites have to be corrected necessarily, either with braces or Invisalign. This really depends on the goals of treatment between you and your orthodontist.

But if you are using Invisalign to correct your bite, fixing a crossbite with the aligners alone can prove to be a very challenging movement, and one that could take more time to correct in aligners alone, versus correcting the crossbite in an intial phase. I would consult your orthodontist to determine the best course of action for treatment.

This really depends on the preference of your orthodontist. Some orthodontists choose to finish their cases with an Essix (or clear) retainer that is thicker, yet similar to Invisalign trays with the exception that in general they do not apply pressure to teeth. You would weat these on the top and bottom, for in general 6 months full time, then to bed lifetime.

However, some orthodontists insist on Hawley retainers. If you are concerned about the metal, there are different varieties of metal that can be used to bend the retainer if you have an allergy, so I wouldn't be concerned with that.

Regardless, follow what your doctor recommends as this will give you the best result for all of your hard work and time in braces.

For many patients, elastic wear is crucial to an excellent result with Aligner wear if their posterior bite is off. Elastics are generally worn off of buttons directly bonded to the teeth, or off of hooks that are milled into the aligners directly. But in all cases, elastics are worn on the outside of the aligners. Your doctor will tell you how often you should wear you elastics, but proper wear is important to treatment success.

The question probably needs to be more specific, however, regarding proper timing or age for Invisalign, generally speaking, you would prefer to have all permanent teeth erupted as Invisalign will only work well if the trays have sufficient surface area of teeth to grab onto. If the child is too young and teeth are partially erupted, this may cause the trays not to work predictably.

Regarding the other end of the spectrum, you are really never too old for Invisalign, you just need to make sure that you have a positive oral health grade as you would not want to move teeth in the presence of any active oral disease (ie periodontal disease). If you have a clean bill of health, then you are good to go. As always, check with you orthodontist first to have a proper consult.

The orthodontist may choose to use braces or Invisalign to correct this problem, but how he or she corrects the underbite tendency depends on if the nature of the correction involves dealing with a skeletal or dental problem. 

If your daughter has a severe skeletal issue where the top jaw is too far back, the bottom jaw too far forward, or a combination of the two, then she may require jaw surgery to correct her bite in combination with braces.

If the underbite tendency is from a dental problem where there is a tooth size discrepancy  (i.e. commonly on the upper, the lateral incisors may be too small causing the upper teeth to be too far back with a resultant edge-to-edge or underbite), then the way to address this would be to create space around affected small teeth to make them the right size, or to remove tooth structure from the opposite arch (lower teeth) with extraction or shaving of the teeth so they can be brought back towards the tongue as space closes.

All the above scenarios have a multitude of variables (i.e. degree of crowding, your daughters' profile, etc) that can alter the decision of the practitioner, so the best idea is to see the orthodontist for a specific treatment plan tailored to your daughter.

We treat many patients that have implants in their mouths with orthodontics, both with braces and Invisalign. Depending on where your crowding is, and your current "bite", your result may be facilitated or hindered with the presence of the implant. Regardless, a successful compromise for you may be quite achievable.

As you noted in your question, you have overjet due to what we call a tooth size discrepancy (TSD) due to the fact that you have one less tooth on the lower. The only way to really address this would be to negate the TSD by either opening space on the lower to address the missing tooth (bridge or implant), or by reducing tooth structure on the top by (in this case I'm assuming since you are saying there is no crowdin) tooth reduction between teeth (IPR) to gently shaving away increments of enamel spread out between the upper teeth to equal the mass of the tooth you are missing on the lower, thus reducing your overjet. There are other factors involved in this decision obviously (ie angulation of your upper teeth, your facial esthetics, etc), but the aforementioned may serve as a couple of options.

This is really a loaded question as the answer completely depends on the patients' existing bite. If she has a strong lower jaw already and her bite in the front is "tight" and she has upper spaces between her teeth, for example, than it may be prudent to wait till growth is finished as she may outgrow her final result if orthodontics is pursued too soon. The orthodontist will look into other factors such as family history and possible x-rays of the hand to evaluate growth remaining to make a prudent decision.

Now, if the lower jaw is too far back, then timing treatment during maximum jaw growth (puberty) will help achieve the desired result, and in this scenario, you would want to start treatment. Thus, to answer your question, it depends!

Orthodontically, there are generally 3 ways to open space: pulling teeth, expanding the arches, or shaving between teeth. The decision on what to do, either alone or in combination, depends on the degree of crowding, the measurements of the angulation of your teeth within the medullary bone of your jaws from your side head film(lateral cephalogram), and the health of your gum tissues.

Its hard to say with certainty without seeing you clinically, but it seems that you should be fine assuming you dont have too much lower crowding, which I cannot see off of the photo provided.

Generally, most orthodontists offer some sort of a payment plan where once you pay a down payment, you may break up the remainder of your treatment fee for Invisalign (or braces) over the estimated time of your treatment, or some months longer or less depending on the patient.