As a rule, excellent orthodontic results can be achieved with informed and co-operative patients. Thus, the following information is routinely supplied to anyone considering orthodontic treatment in our office. While recognizing the benefits of a pleasing smile and healthy teeth, you should also be aware that orthodontic treatment, like any treatment of the body, has some inherent risks and limitations.
A non-vital or dead tooth is a possibility: A tooth that has been traumatized from a deep filling or even a minor blow can die over a long period of time with or without orthodontic treatment. An undetected non- vital tooth may flare up during orthodontic movement, requiring root canal treatment to maintain it.
Root resorption: In some cases, the root ends of the teeth are shortened during treatment. This is called root resorption. Under healthy circumstances the shortened roots are not of any disadvantage. However, in the event of gum disease in later life the root resorption may reduce the longevity of the affected teeth. It should be noted that not all root resorption arises from orthodontic treatment. Trauma, cuts, impaction, endocrine disorders, idiopathic reasons can also cause root resorption.
Previous Orthodontic Treatment: If you have undergone any braces treatment previously, the teeth may have been moved out of the bone partially. This will be managed either by moving the teeth back into the bone or leaving it in the same position. There may also be signs of root resorption occurring on the root tips of the teeth. There may be a higher risk of root resorption occurring again with orthodontic treatment.
Gum tissues: The bone-gum relationship around teeth is always dependent upon whether there is enough bone to support the gum tissue properly. Many times, when very crowded teeth are straightened, there is a lack of bone support and gum tissues surrounding the teeth. Therefore, the gum tissue contour and support may not be adequate and require periodontal intervention. Poor oral hygiene will result in inflamed gums, bleeding, swelling and increased loss of gum tissue. This is commonly referred to as "black traingles".
Tooth decay: During your teeth movement, spaces may occur between the teeth. These spaces will trap food and bacteria. It is your responsibility to keep your teeth clean with brushing and flossing to avoid cavities. Sometimes, during the movement or after IPR, it will reveal existing tooth decay that were present but not visible previously. These appear as white or brown spots. Cavities will require a filling. Any filling or restoration that changes the tooth shape may cause the Invisalign to not fit and need extension of plan.
Treatment time: The total time for treatment can be delayed beyond our estimate. Poor appliance/elastic wear, broken appliances, poor oral hygiene, and missed appointments are all important factors that could lengthen treatment time and affect the quality of the result. Differences in bone thickness, jaw length, jaw shape and chewing patterns, tongue position can also affect the result significantly.
Need for surgical treatment: If there is an underlying skeletal condition which could include but not limited to jaw asymmetry, discrepancy in size of maxillary (upper) jaw and/or mandibular (lower) jaw, canting causing an uneven smile line, cleft lip/palate, vertical maxillary excess or gummy smile, the orthodontic treatment alone may not be able to correct these issues, and will result in a compromised outcome. Skeletal discrepancies will require surgical treatment to fully correct and will need to be referred to a specialist.
Temporomandibular Joint Disorder: There is a risk that problems may occur in the temporomandibular joints (TMJ) Although this is rare, it is a possibility. Tooth alignment or bite correction sometimes can improve tooth related causes of TMJ pain, but not for all cases. Stress and tension appear to play a role in the frequency and severity of joint pain, and there are many other causes of TMJ dysfunction.
Other Occurrences: Swallowed appliances, chipped teeth, dislodged restorations and allergies to latex or nickel rarely occur but are possible. Contact us as soon as possible. Commonly, patients experience ulcers, pain, difficulty chewing and changes in speech during treatment.
Termination of treatment: It is understood that treatment can be terminated for failure to cooperate, missing appointments, not wearing appliances, excessive breakage, failure to keep financial commitments, relocation, personal conflicts or for any other reason the dentist feels necessary. If termination is necessary, the patient will be given ample time to locate another orthodontist to continue treatment or the braces will be removed. There will be no refunds at any stage for partially complete treatment.
Expectations: All orthodontic patients can expect improvement with their particular problem, but, in many cases, absolute perfection is impossible due to lack of muscle balance, existing facial/jaw structure, tooth shapes and sizes and varying degrees of co-operation during treatment, along with heredity aspects that affects everyone's specific treatment results.
Relapse: Teeth have a tendency to return to their original position after orthodontic treatment. This is called relapse. Very severe problems have a higher tendency of relapse and the most common area for relapse is the lower front teeth. At the end of your braces treatment, you are required to wear a set of retainers every night to avoid relapse. Retainers will need to be remade as they wear out over time and lose their retentive ability. You may opt for an additional fixed wire retainer (at additional cost) to minimize relapse. Full co-operation in wearing these appliances is vital.
Additional Treatment: Unforeseen circumstances such as abnormal growth, dental decay, or gum disease may cause the treating dentist to recommend additional treatment that were not previously discussed. If this occurs, the dentist will carefully explain the reasons for a change in treatment plan and any extra fees before proceeding.
CARE OF DENTAL HEALTH
- The Invisalign visits are soley to assess and provide advice on the Invisalign treatment, and is not a substitute for a dental check up.
- Regular Dental Check ups (recommended every 6 months) are still necessary to check for any changes in dental health and detect any dental disease.
- Diagnostic screening x-rays for dental cavities are recommended every 1-2 years.
- Regular Scaling and Polishing (at least 6 monthly) is necessary to ensure efficient movement of teeth with Invisalign as tartar buildup on the teeth can block the space.
- Good oral hygiene remains important to prevent dental cavities or gum disease.
- If dental fillings or restorations become necessary during Invisalign treatment, please inform your dentist that you are undergoing Invisalign treatment and bring your aligners along. In most cases, the filling can be adapted to still ensure the Invisalign fits well. In larger restorations where the shape of the tooth will be changed, the dentist may recommend that the Invisalign sets be remade to fit the restoration. Your Invisalign dentist will be able to advise on how your Invisalign treatment can continue.