In my practice, most of the patients I treat who have ortho concerns get referred to orthodontists. That’s just my comfort level. Most general dentists like myself have limited ortho training so knowing our limits is pretty darn important.
Umm... not gonna touch that one.
However I do use Invisalign for minor spacing and crowding concerns. It’s a good system and a nice therapy to add to your cosmetic practice.
But like any procedure, it’s important to make sure that you and your patient are on the same page before you begin treatment. Unrealistic expectations are never a good thing. So I’ve found wording that builds common ground before I even take the impressions.
It’s crucial to realize that people don’t want Invisalign, they want a more cosmetic smile. They want their diastema to disappear and their crowding to become more straight. So present Invisalign as a means to an end, not an end in itself. Here’s what I mean:
Ms. Jolie, we’re going to be able to straighten out those crowded teeth and it’s going to look great. We’re going to get the job done with a few tools. Most of the work is going to be done with Invisalign, the clear trays that you’ve probably heard about. But when the Invisalign is completed, we may need to fine tune some cosmetics with other techniques, like bonding.
Sometimes you know you’re going to need full coverage crowns, veneers, plastic periodontal procedures, and other treatment to complete the case. But even if I think I can accomplish everything with just Invisialign I like to leave myself the option of using conservative, minimally invasive procedures like bonding. Perhaps I want to strengthen a contact or lengthen an incisal edge a little bit? I never want to give the patient the idea that everything can be accomplished only using Invisalign.
If you use interproximal reduction (IPR) for the case, you may find that there are some tiny spaces remaining after the trays are done. This is usually caused by IPR that was larger than the planned amount or by flattening the naturally rounded contours of the teeth. Either way, conservative bonding procedures will save the day. It’s not always necessary, but if you need to do it and the patient wasn’t expecting it… you may have an unhappy person in your chair.
If I need to further explain what I mean by “fine tune some cosmetics,” I say the following:
The Invisalign trays are based upon a guess of how your teeth are going to move. It’s an educated guess, but it’s still a guess. Just because the teeth move a certain way on the computer doesn’t mean they’ll actually move that way in real life. So we may need to fine tune to achieve the smile we want.
And in case you’re wondering, I always show the patient the ClinCheck before I approve the case. Always.