Is This Best I Can Expect from Invisalign?

I was referred to an ortho to evaluate two lower incisors that were loose due to occlusive trauma. I had braces as a child. My teeth were still pretty straight, and I liked them. But I was afraid I would lose my lower teeth if I didn't do anything. Fast forward, I have completed Invisalign Express and my ortho says I am done. However, I can still feel one top incisor being pushed out by a lower when I chew. I also have small black triangles between several upper teeth and I hate my smile now.

Doctor Answers 4

Some fixes seem simple at first

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Sometimes what might appear to be something simple truly is NOT when in process or at completion.  If the bite is off, a CR (centric relation) relationship can be evaluated (as suggested by another)  but then a NM (neuromuscular) evaluation would be wise as well.  It is possible a simple bite adjustment is all that is needed.

Black triangles between teeth are often temporary when teeth are moved, but not all the time.  An experienced dentist would need to see xrays to evaluate the position of the bone.  The gum tissue will be at maximum 5mm from the bone, so if the position is low, the gums will not come back and the black triangles will remain.  Porcelain veneers can do VERY well to fill in these spaces.

A more conservative option may be the Bioclear method.  Tooth colored material is adhered and shaped to fill in the spaces without removing any tooth structure.

Teeth after Invisalign

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The loose teeth can be addressed by your dentist. The jaw needs to be placed in the correct position, called centric relation and the forces distributed evenly on all of the teeth when you grind around. As far as the black triangles, when teeth are moved closer togher that can help eliminate the dark areas. Also, it the bone is in the correct place, the gum tissue can be expected to fill in. I am sure your smile can be improved with minor corrections.

Fred Peck, DDS
Cincinnati Dentist

Black triangles after Invisalign Treatment.

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Without seeing any pictures its hard to evaluate the treatment.  Black triangles sometimes form between teeth when undergoing adult orthodontics.  This happens because the gum tissue that was supposed to be between the teeth does not readily regenerate once teeth are moved to a proper position, as children undergo orthodontics the gum tissue more readily fills in.  This is true with both invisalign and traditional braces.

As for the teeth pushing up against the upper teeth, I would recommend seeing your dentist and having an occlusal "bite" evaluation.  Sometimes there are underlying factors that lead teeth to knock into one another, it may be relatively simple or complex to correct these issues.

Dan Hagi, DDS
Toronto Dentist

Might be an easy fix

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You mentioned that only one tooth was hitting first. It might be easy for your Dentist to smooth the part that is hitting first or the tooth might be slightly forward. I would certainly have to see the problem to give the best answer. From what you describe it should be an easy  fix.

The black triangles can easily be fixed also if they are not too severe. If the triangles are between your four upper front teeth smoothing down the enamel and then closing the space more will raise the gums up into the space. It is a one to one ratio. One millimeter of smoothing equals one millimeter of increase in gum height as the new space is closed. Smoothing the enamel has its limits. Still it is very routine. Generally speaking you wear down the chewing surface of your teeth more than the smoothing done by the orthodontist. Besides smoothing the sides of the teeth contacting each other makes a flat surface to prevent relapse.

Gilbert H. Snow, DDS
Encino Orthodontist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.