Pros and Cons of Invisalign, 410-696-4624, Dr. Trepp, Orthodontist

The Pros and Cons or Informed Consent For Clear Aligners

The following information is provided to patients who will be starting clear aligner treatment in our office. While recognizing the benefits of teeth that function well and have a pleasing appearance, a patient should be aware that Clear aligner treatment, like any other treatment of the human body, has inherent risks and limitations. The response of a living system cannot be predicted perfectly. If a patient decides not to proceed with treatment, then the state of the dentition (teeth) can be expected to continue on its present path. Any unwanted changes that are occurring can be expected to continue, but the rate of these changes are very unpredictable. In general, dental change tends to be very slow, but as much as we would like to, we cannot tell a patient exactly what might happen if they decide not to proceed with our recommendations. A patient must balance the risks of non treatment against the risks of treatment. In our opinion, the risks of treatment are not enough to rule against proceeding; nevertheless, a patient should consider them carefully before they make a final decision. Please note that it is not possible to list every circumstance, so the following list is necessarily incomplete.

THE PATIENT'S RESPONSIBILITIES

Orthodontic treatment will not be completely successful unless you comply with our directions. You must make sure that any dental work that will alter the shape or size of your teeth is completed before the Invisalign impressions are made. You must wear the Invisalign aligners 20 to 22 hours per day for them to be effective, you will only move to the next aligner when your present aligner fits your teeth well and you must aware that the loss of an Aligner could prevent your treatment from being completed.

CLEAR ALIGNER DESCRIPTION

The system consists of a series of clear polymer, removable appliances (aligners) that move your teeth in small increments from their original position to a more ideal position. Some patients require bonded aesthetic attachments (small, tooth-colored dental composites) and/or elastics on their teeth to facilitate specific dental movements. You typically wear the aligners in pairs, one on your upper teeth and one your lower teeth. Each aligner fully covers your teeth and is virtually invisible when in place. The total number of aligners varies depending on the complexity of your orthodontic problem. The aligners are individually numbered and worn in sequence. The only times you remove your aligners are to eat, drink and clean your teeth. Approximately every two or three weeks, you will switch to the next aligner in the series. Your orthodontist will monitor your progress through a series of follow-up visits.

PERIODONTAL DISEASE, TOOTH DECAY, DECALCIFICATION

The bacteria present in plaque (the white, sticky material that is constantly forming on tooth surfaces) release acids that draws the calcium and phosphorous out of the outer surface of the tooth. This will damage a patient's tooth surfaces if the plaque is not removed several times each day by thorough brushing, flossing and rinsing. This damage includes tooth decay and permanent white decalcification markings. The bacteria that live in plaque thrive on refined carbohydrates (sugar!). While a patient is undergoing Invisalign treatment, they should minimize the amount and frequency of sugar in their diet. Cleaning by your family dentist is necessary during treatment. Daily fluoridated gel use is helpful in this area.

TREATMENT GOALS AND TREATMENT COMPLETION

We have tried to establish realistic and achievable goals for treatment. We know that patients share our desire to produce the best result that is possible. As we begin treatment, we believe that we will be able to achieve those goals. Nevertheless, unforeseen factors may interfere with our intentions. As treatment proceeds we will keep a patient fully informed as to treatment progress. If our original goals become unreachable, we will discuss the alternatives with a patient.

TREATMENT DURATION

Although we give a patient an estimate of their treatment time, we do not know exactly how long their treatment will take. Individuals vary considerably in their response to orthodontic forces, so treatment time may be more or less than our estimate. Poor cooperation in wearing the appliances or auxiliary elastics the required hours per day, poor oral hygiene, lost appliances, missed appointments, and other factors can lengthen the treatment time and can adversely affect the quality of the end result. It is our general intention to have the treatment move along in a fashion that is consistent with tissue health, minimal discomfort, and long term stability.

ENAMEL REDUCTION\REMOVAL

Interproximal enamel reduction or thinning the width of teeth is often part of clear aligner treatment. It is a procedure to remove a slight amount of enamel between the teeth to create space for the correction of crowded teeth or to enable the teeth in each jaw to come together more efficiently. The enamel is removed with a high-speed drill and sandpaper like strips\discs and does not require anesthesia.

ATTACHMENT PLACEMENT

Little bumps of tooth colored acrylic called attachments may be bonded\glued to the front or back side of specific teeth to give your aligners more grip on your teeth for moving them up\down, changing their tilt, or spinning them straight. You must remind personnel at your family dentist's office that these bumps are part of your treatment and should only be removed by your orthodontist when your clear aligner treatment is complete.

PAIN OR DISCOMFORT IN THE JOINT OF THE JAW

Pain, discomfort, clicking or popping noises may occur in or near the joint of the jaw at any time, including during orthodontic treatment. Just as with any joint discomfort, the possible causes vary widely. It is important that we be told about jaw joint problems so that we can deal with them promptly.

LOSS OF TOOTH VITALITY

It is possible for the nerve of a tooth to die during orthodontic treatment, especially if a tooth was previously injured, bumped, or impacted. It is helpful in our monitoring the health of each tooth for a patient to tell us about any previous injury or stress to the tooth. Sometimes seemingly minor bumps can result in nerve damage that is unknown to a patient. Such previous injuries cannot always be detected during the orthodontic diagnostic process. Root canal treatment may be recommended if such a problem occurs. Extraction is necessary occasionally.

SPEECH

For many patients, orthodontic treatment temporarily affects their speech and they may experience a lisp. Most speech impediments caused by aligners usually disappear within a few days.

INJURY FROM APPLIANCES

Appliances are designed to have a maximum amount of strength and a minimum amount of injury potential. Nevertheless, accidents can occur. It is also possible for a patient to swallow or inhale parts of the appliance or our instruments. The gums, cheeks and lips may be scratched or irritated by the aligner occasionally. Tender teeth should be expected after switching to the next aligner in the series. The period of tenderness or sensitivity varies with each patient.

UNEXPECTED TOOTH PROBLEMS

Occasionally, a tooth becomes tightly bound (ankylosed) to its surrounding bone. It may not be possible to move that tooth at all. A change in the plan of treatment may be necessary if a tooth ankyloses.

ENAMEL WEAR

A tooth's surface (enamel) is a crystalline structure and like other crystals, it can have undetected defects and fracture lines within it. Enamel may also wear when a patient grinds their teeth excessively.

ORAL SURGERY

Sometimes tooth removal or orthognathic(jaw) surgery is necessary in conjunction with orthodontic treatment, especially to correct crowding or severe jaw imbalances. We will recommend these procedures only if it improves the prospects for successful treatment. Risks involved with treatment and anesthesia should be discussed with the patient's general dentist or oral surgeon before making a decision to proceed with this procedure.

TOBACCO USE

Tobacco use places orthodontic patients at greater risk of cancer and periodontal (gum) disease. Tobacco reduces blood flow to the mouth tissues at a time when good blood flow is needed for tooth movement. We recommend that all tobacco users enroll in smoking cessation classes given by the American Cancer Society, the Tobacco Intervention Network or the Anne Arundel Co. Department of Health.

GENERAL MEDICAL CONDITIONS

General medical conditions can affect orthodontic treatment. You should advise your orthodontist of any medical conditions you have or any changes in these medical conditions occurring during treatment.

ROOT RESORPTION

Orthodontic forces initiate a cellular response in the supporting tissues surrounding the roots of the teeth. It is this cellular response that allows the teeth to move. Sometimes, this response becomes confused resulting in damage to the ends of the roots of the teeth. Usually this effect is mild and does not compromise the teeth. However, sometimes this root resorption can be extensive and may then endanger the teeth if periodontal (bone and gum) support is lost at some future time. Some patients are prone to this happening, some are not. Because it is not possible to predict which teeth might be affected, we may want to take progress x-rays of a patient's teeth during the treatment process to evaluate whether root resorption is occurring.

SUCCESS OF THE TREATMENT

We intend to do everything possible to provide the very best treatment result. However, we cannot guarantee that the proposed treatment will be successful to a patient's complete satisfaction. Individual patient differences create the possibility of incomplete or unstable results. Selective retreatment at additional fees may be necessary despite the very best of care. Occasionally a limited period of braces may be recommended to achieve an optimal result.

STABILITY OF THE FINAL RESULT

The tooth positions achieved at the end of treatment may not be perfectly stable. The retainers that a patient wears, will enhance the stability of the final result, but even diligent wear of the retainers may not keep a patient's teeth exactly as they were at treatment's end. The teeth and jaw structures are a dynamic system that constantly change throughout one's lifetime. Orthodontic treatment does not make a patient immune to this process. Maturational changes that occur after active orthodontic treatment may alter the quality of the end result. Ongoing wear of the retainers will minimize changes. If a patient decides to stop wearing their retainers at some point, their teeth may change. Some of the original problem may re-emerge. The most vulnerable teeth are those in the lower front. A lifetime commitment to retainers may be necessary.

POSSIBLE ALTERNATIVES

Include but are not limited to: no treatment, extraction versus treatment without extraction, orthognathic (jaw) surgery versus treatment without surgery, conventional brace, prosthetic (artificial tooth replacement) and compromise solutions.

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You may schedule an orthodontic appointment with Dr. William Trepp in his Pasadena, MD office by calling 410.696.4624 or in his Clinton, MD office by calling 301.868.6200. Written inquiries should be mailed to: 3020 Mountain RD, Pasadena, MD 21122, USA or 8918 Woodyard RD, Clinton, MD 20735, USA