Tracy Shaw, DMD

File separation is an unfortunate, but normal event to take place when doing a RCT. The best thing is to be straightforward with your patient, explain what happened and your efforts to make iit right. If youre unable to remove the file yourself, you should at least make the effort to have the patient seen by a specialist who will be able to use microscopes and ultrasonics to try to remove the file fragment.  

I like how Dr. Jay Neuhaus answered this question referring to trusting a $0.50 parachute.  It's true: you will get what you pay for. 

I highly suggest spending your time researching reputable dentists in your area instead of searching out the ones offering the "best deal."  To do great work, sometimes dentists have to charge higher fees because they are using superior materials, better labs, or are setting aside more time to give you and the case the proper attention and not rush (as some of these "dental factories" do), for example.  

My advice: Get it done the right way once....in the long run, you will absolutely be better for it. 

If the metal fillings (amalgam) that you're speaking of are on teeth that are treatment planned to have veneers on them, then the answer is yes, you should have the amalgam fillings removed and replaced with a tooth colored material, or incorporated into the prep design of the veneer.  The reason for this is two fold, aiming to achieve the best result in the long run.  #1: shade match.  The metal will show through the veneer and even the tooth (if the filling is behind the tooth) causing an undesirable grey shade.  #2 The porcelain cannot be bonded to the metal filling.  

If the metal fillings are in teeth that are not treatment planned to have veneers, then there is no real indication to have them removed (unless of course there is decay beneath them).  If you are seeking to achieve optimal esthetics, (which maybe your dentist is trying to help you lean towards) then taking out the existing metal fillings (if they're visible when you smile)  and replacing them with tooth-colored fillings will help with that.

Hope this helps!

 

Perhaps you should consider asking your dentist or orthodontist to bond an ortho wire behind the teeth on the lower to stabilize them in their position.  Its a small wire, precisely adapted to the surface of your lower teeth (on the tongue side) and then bonded into place.  This is done quite frequently at the end of treatment since patients so often lose their retainers/don't wear them etc.  Ask your dentist to make sure you are a candidate for this.  If you are, then you won't have to worry with making another Invisalign tray/retainer as this is a more permanent solution.  

The first "red flag" in your question is the point that you mentioned that the spacing between your teeth is getting worse.  You also mentioned an overbite.  With those two clues, I would explore the possibility of your occlusion (the way your teeth come together when biting, chewing etc) being one of, if not the main insulting factor. 

Sometimes, if a patient has a heavy bite, the bottom teeth can put too much force on the back of the upper teeth, causing them to flare out.  If this is the cause of your spacing, simply putting veneers on your teeth may  work temporarily, but then your teeth will probably flare out once again if the underlying cause hasn't been addressed.  

Since you are so young and these teeth are "virgin teeth" as we call them (they don't appear to have any fillings or crowns on them etc) I would recommend that you go with the most conservative treatment plan.  Consider seeing an orthodontist or a general dentist licensed in Invisalign (clear braces).  By realigning the teeth, you will remove excess force on them, stop the pattern in it's tracks and perhaps even close all of the gaps between the teeth.  After ortho is complete, if there are still some minor areas of excess space that bother you, you can repair this conservatively with bonding or veneers.

Hope this helps!