It looks like everything is there. Check with your orthodontist if you still feel like something is missing.
One clear aligner will only keep your teeth from getting any worse. You may need a short treatment with Invisalign or something similar to actually change them back to where they were when the braces came off. I would suggest going back to your orthodontist, or another orthodontic specialist if you prefer, and just fess up and say you didn't wear your retainer and now you have learned your lesson and want them straight again. Then, after you get them where you want them, learn from your experience and wear your retainer like you are instructed. Good Luck!!
As I see it, your main problem is the open bite. That is likely caused by your tongue. Even if you had braces and/or surgery to close the open bite, if your tongue is still pushing/posturing forward, the open bite WILL come back. I would suggest talking with an orthodontic specialist and try to get a referral to a myofunctional therapist. Most likely, you will need to be taught to do some exercises that will train your tongue to not go forward when you talk or swallow. The bottom line is that the cause of the problem (the tongue) has to be addressed in order to have a long term fix of the bite.
You brought up a key point when you said you didn't wear your retainers. No matter how your teeth are straightened, no matter what appliance is used to straighten your teeth, there WILL be a tendency for them to move back. This is key to keeping them straight with some type of retainer. As far as what needs to be done to straighten them, it's really hard to answer that with one picture. Chances are, you won't need to have that tooth removed, but there are many things that factor into that decision. As orthodontists, we don't like to pull teeth. We went to dental school to learn how to save teeth. Sometimes, we do recommend sacrificing one or more teeth in order to make the others healthier (and straighter). That's a decision to be made by an orthodontist, along with your dentist. So, ask your dentist to refer you to an orthodontic specialist. Or, ask your family or friends if they have been treated by an orthodontic specialist. Maybe get a couple of opinions. Ask lots of questions....especially about how to keep them straight after. Good Luck!!
First, you're not the first person that this type of situation has happened to. Things happen! I suggest that you ask your dentist which orthodontist you should go to (not the original orthodontist!). Then, make an appointment to see that doctor. Tell them what happened and explain that money was an issue and that you are embarrassed about your situation. Most likely that doctor's office will call the original orthodontist's office and see what needs to happen to get you back in treatment with the new doctor. Since you didn't finish your original treatment plan, it is very unlikely that you would need to pay the whole balance to the original orthodontist's office. Since it's been four years, they may have simply written it off. It would be helpful, though, to the new orthodontist to have your original records. Sometimes it's best to just start fresh. Good luck!
