Choosing An Orthodontist Or General Dentist For Invisalign Treatment

What’s all the buzz about Invisalign? You can barely turn on the TV without seeing commercials that tout the effectiveness of this treatment. More and more adults and even teenagers are looking into this alternate form of orthodontic treatment. Many of my  patients who come into my orthodontic practice arrive with the idea this is the treatment for them. It’s important to understand that Invisalign is a series of aligners that are custom-made for you. Each aligner moves your teeth slightly in predesigned directions. Each new aligner is typically changed each week, with each one gradually moving the teeth into the new position. Invisalign requires some adjustment in your daily habits and is dependent on complying with its limitations. Many articles are online regarding these facts and should be read before considering this alternative form of treatment.

The important issue here is who is best suited to provide your treatment and what information is important in making that decision?

Invisalign is a type of orthodontic treatment that is an alternative to wearing braces.  For that reason, careful thought should be given to whom will provide your treatment… an orthodontist or a general dentist? An orthodontist is first a dentist, with 2-3 years additional training in their specialty. It’s important for the patient to ask who is a better trained specialist in their field. A good example is to ask oneself “Who would I seek for treatment in problems with the heart? A cardiologist or my family doctor?” That is a choice we should all consider.

As mentioned before orthodontists are dentist, as well. Orthodontists attend dental school with general dentists and then go on to study orthodontics in another school for an average of 30 months. Orthodontics is the study of cranial-facial deformity, occlusion, smiles, and moving teeth. Orthodontists study how to treat malocclusions (or misaligned teeth) and to change and re-direct treatment should they determine their treatment plan is not effective based on the initial diagnosis. The doctor doesn’t just move teeth. The doctor is creating a new and improved bite and beautiful face.

The expertise of an orthodontist when you are being treated with Invisalign is very  important when moving teeth. Through their training an orthodontist learns how to move teeth in the bone by incorporating light pressure and forces. It is very important when doing this for the health of the teeth and gums. This avoids bone, gingival recession, and root resorption.

When studying a case, an orthodontist would be more likely to see the “big picture”. The doctor may be concerned about how to change the occlusion to the ideal position, how to move the teeth more gently, how to change a deep bite or gummy smile, or how to change the entire face. This could result in longer treatment time as opposed to simply aligning crowded teeth. This could potentially affect the cost of your treatment. On the other hand, a general dentist fully relies on the Invisalign technician to design their case and determine how many  aligners are needed. A general dentist is not fully trained to recognize the nuances associated with orthodontic treatment.

General dentists take continuing education courses to become educated in Invisalign treatment. However, orthodontists study Invisalign while attending school in their specialty. Orthodontists are not required to attend Invisalign continuing education courses. Invisalign does offer specific courses for orthodontists and many do take advantage of them. Conversely, Invisalign requires general dentists to attend continuing education courses in order to be a provider.

There are some limitations with Invisalign. In some cases, treatment can be achieved faster with the use of braces. Sometimes treatment with braces can be less expensive than Invisalign treatment or the cost can be more due to the complexity of the case. Should you have dental insurance, it is important to talk to your carrier about your options prior to your consult. The orthodontist should always be willing to discuss all options and the two of you should make the decision together.

Invisalign makes it easier for the patient to choose their provider through their ranking system. The Invisalign Ranking  System is based on the number of cases started annually by a specific provider. Here are the details that rank Invisalign providers…

  • Preferred – Treats 10 case per year.
  • Premier – Has treated at least 50 total cases. Treats at least 25 cases every 6 months.
  • Premier Elite – Has treated a least 300 total cases. Treats 50 cases every 6 months
  • Super Elite – Has treated at least 2000 cases. Is ranked in the top 1% of providers. Many providers have even taught the process to other dentists in special training forums.

Click here to look up providers in your area and their rankings.

For your reference, here is a list of questions you should take to your initial consult..

  • Are you a certified specialist in orthodontics?
  • Is my treatment more effective with Invisalign or braces?
  • Is treatment time different with Invisalign or braces?
  • How long have you been an Invisalign provider?
  • How many patients do you currently have under treatment?
  • How many cases have you completed?
  • Are you confident my case is an Invisalign case?
  • How long will I be in treatment?
  • Do you utilize braces if my Invisalign case can’t be completed or if some finishing improvement is needed?

To be fair, a general dentist who has taken the time to truly understand Invisalign treatment and how to go about diagnosing and setting up the case can provide equally good treatment. This especially applies to simple cases where bite corrections are involved. It is good practice to seek a second opinion with a specialist and let them know exactly what the general dentist recommends. As an orthodontist, we see upward to 50 patients each day and therefore have the knowledge and expertise in orthodontics.

Why Children Should Be Assessed For Orthodontic Treatment At Age 7

Early Treatment

I have many patients who are brought in for their initial consultation by their parents, and I always get questions regarding when the right time to start treatment would be. I don’t have a universal answer for every case, but rather it all depends on each individual patient. Let’s talk about it. When we start Early Treatment, which we also call “Phase I,” we explain why orthodontic treatment can either be postponed or should be started immediately.

According to AOA, the very first time that a child needs to see an orthodontist is at age 7. Why age 7? Can we treat patients at that age and achieve a lot? The most important factor is that we can identify most future problems at that age, and even treat some of these early. What is it precisely that I, as a specialist, look for during the first orthodontic visit for my youngest patients?

Crowding and Spacing

By age 7, we can clearly tell if the patient will have very crowded dental arches, or even problems with teeth erupting into the arches. A crowding case will require some expansion of these arches, or even extractions of some of the primary (baby) teeth.

Premature Tooth Loss

This can leading to space collapsing and a lack of erupting space for permanent teeth. It is important for orthodontists or pediatric dentists to recognize these problems early. We can preserve spacing by placing appliances known as “space maintainers.”

Alignment

Should we align teeth now or wait until the patients has all of their adult teeth? Crooked teeth are more susceptible to the wearing down of enamel edges, trauma, or gum recession. Anterior crossbites of even one individual tooth can lead to severe bone loss, gingival recession, and root resorption at that particular tooth, and these are generally problems that I want to correct. An anterior crossbite with a few teeth involved may cause skeletal problems, leading to mandibular overgrowth (Class 3 Skeletal).

Posterior Crossbites

This not only creates crowding, but also causes the jaw to shift to the side, which leads to facial asymmetry. Expanding the upper jaw at age 7 to 8 reduces the crowding and the risk of potential skeletal problems.

Underbite

In general, this type of malocclusion requires early intervention. Orthodontists can distinguish whether it is a true skeletal problem or related to some dental eruption problems (i.e. upper incisor erupted in palatal position of the lower incisors). Generally, I treat these patients with a Palatal expander and face mask therapy (with partial braces as well).

Protrusive Front Teeth

By age 7, it is obvious whether or not the front teeth stick out forward more than is safe or attractive. We cannot fully correct this problem at such an early age, but can help reduce the severity of the problem and make it much easier for the patient socially and dentally.

Anterior Open Bite or Deep Impinging Bite

We can detect this problem by age 7, and correct it as needed. Usually, an open bite can be caused by two distinct factors: thumb/finger sucking or tongue thrust (or a large tongue). I like to eliminate these habits early so that normal development can occur. I recommend screening all young patients at the age of 7, so as to identify some of these conditions and possibly correct them. In many cases, we put the patient under observation, to treat them later when all adult teeth are erupted. But in some cases, an interceptive treatment can prevent future larger dental and skeletal malocclusions.