The aligner hanging down like this is usually caused by distortion upon removal. Aligners are typically removed by pulling the back molars down, and in your case the attachments on the UL2 and UL3 would resist this, potentially resulting in a bent aligner. This could have happened when the aligner was removed from the model at the time of fabrication, and sometimes it can be due to removal of the aligner by the patient. We are usually able to fix this simply by taking the upper aligner, and bending it, yes, just bending it back up to restore the proper shape. This typically requires bending it past the ideal shape by about 30 degrees, to get the aligner to take the bend. Check with your orthodontist to see if it makes sense to try this in your case.Tip on upper aligner removal: try removing it from the back teeth first, but from the palatal side, the tongue side of the teeth. The easiest way to do this is to use your right index finger to reach to the upper molars on the left side and flip the aligner down. Repeat with the left index finger to release the right side. Once released grab the aligner from the cheek side and peel it from the teeth, not by pulling down, but down and out, toward the cheek. Pulling in that direction tends to release the aligner more easily from the attachments, which are on the outside of the teeth, usually.In general skipping an aligner and wearing it longer is OK to do. Just be sure to remove it gently, or the same issue may occur with the next one.
Opening up space for 4 missing teeth is a big deal. You're talking about creating about 15 mm of new space in each arch. In terms of complexity in a way this would be similar to treating a patient with 15 mm of crowding per arch. In orthodontic diagnosis mild crowding is 1-3 mm, moderate crowding is 4-6 mm and severe crowding is 7 mm or more. Putting in 15 mm of new space in each arch, that's in the super severe category!Now there are things that can be done to lessen the complexity. One is to open up the space farther back in the arch, for example at the second bicuspid positions, even if first bicuspids were originally removed.Another consideration could be to open space, but to open up less space than the full 15 mm for 2 implants. Perhaps a few mm of space can be opened at strategic locations in the dental arches, and those spaces could be restored to fill them in.All in all there is a lot to consider. What is the condition of the roots? Since you've had 4 bi's out, will your teeth withstand several years more of orthodontics? What is the condition of the gums? Is there a risk of gum recession as the teeth are expanded out to this extent? Also, what are the airway considerations, could you benefit from having wider dental arches from that perspective?Lastly in terms of facial symmetry, that may or may not change with dental expansion treatment. Ortho moves the teeth, some bone, but the effect on the soft tissues in particular facial contours with the lips closed is not very predictable.It sounds like you could benefit from a second opinion. Many offices will provide one complimentary.
You're lucky those cupids came in on their own, that's great! You may have to put up with some unsightly spacing during the treatment. More so on the upper right, where the permanent cuspid (#6) is behind the baby tooth. Painting a fake tooth in the aligner would not work there. That is a good option for the upper left, space gets smaller as permanent cuspid (#11) moves into place etc, as explained by Dr. Caballero below. Drawback of this approach: when you take your aligners out to eat, voila the spaces are still there!Now if you absolutely do not want to have a gap showing during treatment an alternative could be to bond temporary restorations on #6, #11, possibly #12 to fill in the spaces. Those restorations would then be trimmed back as the teeth move into place. This is a more labor intensive approach, and will likely add cost, but it's your decision if it's worth it for not having spaces while eating during treatment.Lastly some patients opt to eat with their aligners in to mask a missing tooth. It can get a bit messy, depending on what you eat, and great oral hygiene right after is important to clean it all up and keep your teeth and gums healthy.
Instead of asking which appliance will decrease your overbite, a better question could be: how do they plan to achieve said 50% reduction in overjet? What is the mechanism, which teeth are moving where, will IPR be done, or are we expanding and proclining? And then the next question becomes: what is the most appropriate approach in your case? Is it OK to retract the front teeth, or do we need to look at promoting a more more forward position of the lower teeth and jaw? What does the airway look like, do you snore, have sleep apnea, grind your teeth? Orthodontic treatment tends to be more about the treatment goals, the details of the plan, not as much about what orthodontic appliance is going to be used.There are many ways to move teeth: modern high tech options like Invisalign, classic metal or clear braces, and various old school removable appliances constructed with acrylic and/or soldered wires that have been around for decades. It all begins with a thorough in-person evaluation to look at the underlying causes of your overbite, followed by a review of treatment options to address your concerns, while recognizing limitations to achieving absolute perfection. It sounds like you could benefit from a second opinion. Check out the Invisalign website to look for a provider. Rankings are based on number of patients treated. Most offices will provide a second opinion free of charge.
With Invisalign, at times the teeth in one arch begin moving first, to prevent bite interference issues during the treatment. Nonetheless, 41 months of delay sounds excessive. I suspect that the upper teeth start moving at the 41st aligner, which is still a good 20 months into it, but not 3 years. Double check with your doctor on the timing of upper treatment start.Also keep in mind that Invisalign is an orthodontic lab, that provides treatment proposals and aligners based on the treating doctor's prescription, review and approval. As such, your doctor is the one who decides whether extractions are needed, and not the technicians or the doctors at the clinical support phone lines at Invisalign.In a long treatment time Invisalign case like yours there can be a benefit to using a limited fixed appliance at the same time as the Invisalign trays. For example, if it takes 20 aligers to fully rotate at tooth, adding a short section of braces for 4-6 months may shorten that part of the treatment, and cut down the overall treatment time. Good luck!
