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Solution for a Drastically Crooked Tooth

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I want to improve my smile, but I have a unique situation with a front tooth. It is very crooked and part of it is even behind the other tooth. Other than that, my teeth are pretty stained. I’ve had one dentist suggest braces. I asked him about Invisalign, which I keep hearing so much about, but he said that only works on the easy, ideal cases. Another dentist suggested pulling the tooth and putting a fake one there. Is one of those options better than another? Or maybe there is another option altogether?

Andrea

Dear Andrea,

Invisalign Aligner

Wow! I’m shocked at some of the “professional” advice you have been getting. It is as if they have not kept up with the developments in their profession at all. Whatever you do, don’t pull the crooked tooth. If I understand you correctly, there is nothing wrong with your tooth, it is healthy. Why pull a healthy tooth?  Then, what would you replace it with? A dental implant is the best replacement, but if there is not adequate space there for a new tooth, you would need to open the space up with orthodontics. Whoever suggested that, really did not think this through.

While braces would work, Invisalign may still be an option for you. In its early days, Invisalign could only handle the least complicated cases. Since then, Invisalign has grown up. It can handle most cases. I would go see an Invisalign dentist and let them evaluate your case.

You mentioned that your teeth were stained. Invisalign has an additional benefit of being able to double as teeth whitening trays. Just like the bleaching trays that are made for your bite, aligners are fit to your bite with the intention of gently moving them into the next corrective position. Your dentist can provide you with teeth whitening gel. this will allow you to straighten and whiten your teeth at the same time.

This blog is brought to you San Antonio Cosmetic Dentist Dr. Imam.

Dental Flipper to Make Teeth Look Straight

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I have some crooked teeth that stick out a bit but feel I am too old for braces. I recently heard about this thing that is a dental flipper that fits over your teeth and makes them look straight. Would that work for someone like me?

Samantha

Dear Samantha,

I think you may have a dental flipper confused with something called Snap-on Smile. A dental flipper is a false tooth that is used to fill in an empty space. Snap-on Smile will fit over your teeth and make them look straight. They aren’t as attractive as something like porcelain veneers. Most people use them temporarily for something like a photo shoot or a special occasion.

One thing to be aware of is that because they fit over your teeth they will be a bit bulky. As your teeth already stick out a bit, that will make them look even more forward than they do already.

Invisalign Aligner

I know you said you feel you are too old for braces, but has anyone mentioned Invisalign to you. Instead of the traditional metal wires and brackets that braces use, Invisalign uses clear aligners. An example of Invisalign is pictured directly above. These are not only much more comfortable than traditional braces, but they will work in about half the time. Plus, they truly are invisible, even at a conversational distance.

They have an additional benefit as well. The aligners they use can double as teeth whitening trays. This will allow you to straighten and whiten your teeth at the same time. It is like getting a mini smile makeover.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.

Invisalign and Missing Teeth

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I have a missing lower bicuspid and all my teeth are crooked because I didn’t have braces when I was younger. I feel I am too old for regular braces and would like to do Invisalign, but don’t know if they work when you have a missing tooth. I’d like a pretty smile and am hoping to have enough money left over when I’m done to get my teeth whitened as well.

Lisa

Dear Lisa,

Invisalign works fine with missing teeth. You will find that more dentists will be comfortable using them this way than an orthodontist. This is because orthodontists were trained to work with metal wires and brackets and Invisalign is much different.

As for the missing bicuspid, you may or may not need to replace it. That will depend on the rest of your bite. If you do, a dental implant will be the best replacement. What I’m going to recommend you do is see a few dentists who do Invisalign and then ask them what they’d recommend, giving you a few perspectives on the best course of action. Without seeing your x-rays I don’t want to give a recommendation on the missing tooth.

Invisalign and Teeth Whitening

As for getting that pretty smile you want, Invisalign has a wonderful side benefit. The aligners can double as teeth whitening trays. This will allow you to straighten and whiten your teeth simultaneously. This will save you a significant amount of money.

All you will need to whiten your teeth is for your dentist to provide you with the whitening gel, saving you money on needing to have custom trays made. By the time you are finished with your treatment, you will have both a straight and white smile.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam. Learn about our digital smile design.

After Invisalign?

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I’m at the very end of my Invisalign treatment and need to move to another city. Do I just finish these aligners and am done or do I need to find another Invisalign dentist?

Angelique

Dear Angelique,

Ivnisalign aligners

Invisalign Aligners

In most cases, by the time you are at the end of your Invisalign treatment you don’t need to find another dentist. The exception being if your teeth were a tad ornery and your dentist had to do some special interventions to keep you on track. It doesn’t sound like that is your case.

Often, after any type of orthodontic treatment, the patient needs to wear a retainer for a time to ensure the teeth are able to retain their new position. The good news is, you may not even need to see a dentist about that. Your last pair of aligners can double as a retainer if handled properly.

Using Invisalign as a Retainer

  • Start by wearing them all the time for a month.
  • When that is done, wear them only at night for two months.
  • Start wearing them every other night, while doing the movement test. *see below
  • After a month or so, try backing off to every few nights, again being careful to do the movement test
  • Go to once a week.
  • Eventually, try once a month, then backing off completely.

The Movement test

While using the aligners as a retainer, it is important to periodically check that your teeth haven’t shifted positions. You do this by noticing if the retainers have gotten a little harder to put in. If they’re not going on easily, you may need to back up to the previous step, wearing them more often, then try again.

This is a great time for you to add a little brightness to your smile as well. Because the aligners are custom fit to your bite, they can double as teeth whitening trays. Ask your new dentist to provide you with some teeth whitening gel you can wear in your aligners. This will allow you to whiten while keeping your teeth straight.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.

Inexpensive Smile Makeovers

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I went to a well-known cosmetic dentist in my area to get a smile makeover. What I really wanted are whiter, straighter teeth, and maybe add some length to them. The price was far too high. Is there a way to get an inexpensive smile makeover or do they only come pricey?

Mariella

Dear Mariella,

Ivnisalign aligners

Invisalign Aligners

We all want that beautiful, Hollywood smile. Though, those often come at Hollywood prices. One thing I would caution you against is trying to find a dentist who will do your smile makeover cheaply, especially if you are getting something like porcelain veneers. You will end up disappointed with the results. If you want a stunning smile, you need to use the expert cosmetic dentists who can give you gorgeous results. That doesn’t mean you can’t improve your smile without the cost of porcelain veneers.

Inexpensive Ways to Improve Your Smile

The quickest, most inexpensive way to improve your smile is with teeth whitening. It quickly makes your smile look years younger.

If you’re wanting to straighten your teeth, especially as an adult, I recommend Invisalign. Some people call them invisible braces. This is because they use clear aligners instead of metal wires and brackets. They can straighten your teeth without anyone even knowing, even at a conversational distance.

One lovely side benefit of Invisalign is it allows you to do both at once, at a fraction of the cost. The clear aligners are custom-fitted to your bite. This also allows them to double as teeth whitening trays. By the time your Invisalign treatment is over, you will have both straight and brilliantly white teeth.

This will give you a significant improvement to your smile at just a fraction of the cost. If you still want porcelain veneers after that, I recommend saving up to do it right.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam. Ask about our Digital Smile Design.

Three Major Dangers of Smile Direct Club

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Most dentists have had patients ask questions about Smile Direct Club. If you’ve read independent reviews, you’ve seen the reams of pages of horror stories. I’m going to share the three biggest dangers to patients.

Because of these, I wouldn’t be surprised if they ended up in the courts soon— if they haven’t already.

Smile Direct Club

No Pre-Exam

Before any orthodontic treatment takes place it is imperative, for the safety of the patient, that a full examination takes place, including x-rays. Just some of the things it is important to check for are:

  • Periodontal Disease
  • Decay
  • TMJ Problems

If you have undiagnosed periodontal disease, you risk losing your teeth by shifting them around. One reviewer said, “I returned my aligners within the return and refund date. My mouth bled and I got a migraine from one night. They ended up saying I owe them money.” [source: Better Business Bureau]. Bleeding gums are a classic sign of gum disease.

Without those exams, there is no way for you to know what types of problems are brewing beneath the service. It could destroy your teeth and even your jaw.

On this topic, when it comes to providing the aligners, the impressions made of your teeth are of the utmost importance. They have to have no bubbles, tears, or defects. Yet, this company will send you a do it yourself impression kit to do at home.

No Follow-Up

There are any number of complications which can develop during any orthodontic treatment. For instance, teeth don’t always move the way they are supposed to. With Smile Direct, you just keep putting in your aligners and things go from bad to worse. You need a treatment plan which includes the care of a dentist so there are proactive steps taken as an issue pops up.

Spacing Issues

Most orthodontic issues are a result of crowding. This means for your smile to be beautifully straightened, space has to be made for the teeth to fit in their proper positioning. Sometimes that is done by removing pre-molars. Other times, when you don’t need a ton of spece, some shaving of the teeth is all that is necessary. This is something that has to be done carefully by a skilled dentist.

Invisalign: Your Safer Alternative

If you want to invisibly straighten your teeth in a way where you can have peace of mind and the expertise of a real dentist that the treatment is moving along properly then I would recommend Invisalign. It has a very high patient satisfaction rate with patients.

It also has another hidden benefit. The aligners can double as teeth whitening trays. This will allow you to straighten and whiten your teeth at the same time, giving you the essence of a mini smile makeover.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.

Her Tooth Gap May Be a Sign She’s Losing Her Teeth

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I had braces as a child because of bucked teeth from sucking my thumb. My teeth had been fine until this year when I started developing this tooth gap. I want to get it fixed with either Invisalign or porcelain veneers, but my dentist said I can’t because of periodontal disease. Why would that matter? It’s my gums not my teeth.

Sunny

Dear Sunny,

Ivnisalign aligners

Invisalign Aligners

Periodontal disease is serious. Once your teeth start shifting, as yours have, means they’ve already lost about half of their bone support and are now loose. If you don’t get your gum disease under control you are going to lose them. I want you to see a periodontist as soon as possible and see if your teeth can be saved at this point. Hopefully, they can.

Neither porcelain veneers nor orthodontics will be useful to you at this point. Any additional pressure on your teeth will only cause you to lose them faster.

After Your Gum Disease is Under Control

Once you get your gum disease healed, then is the time to look for solutions to the appearance-related issues. For a tooth gap, you have three options.

Dental Bonding

You could close in the gap with dental bonding. A great cosmetic dentist can use a composite resin to fill in the gap in a way that looks completely natural. The size of the gap will determine if this is a good option for you.

Invisalign

This can close the gap naturally. It is sometimes called invisible braces because it can straighten your teeth without any one knowing.

Porcelain Veneers

If you are looking for a dramatic change in your smile, like a total smile makeover, then this would be the treatment of choice. Porcelain veneers can change the shape, size, and color of your teeth all at once. However, be careful. It takes an artistic cosmetic dentist. Make sure you check out their smile gallery to ensure they get beautiful results.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.

Invisalign or Candid?

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I often see ads for clear aligners like Invisalign offers but sent through the mail instead. I’ve always thought they were scammy because you don’t know who’s actually looking over your photos and if they even have real dentists on staff. I recently heard about a company called Candid, which says theirs is better because they only have board-certified orthodontists on staff. Plus, they say they can bill insurance. I’ve held off because the price tag of in-office orthodontics is a bit out of reach for me. Is Candid a safe alternative?

Thanks,

Nicole

Dear Nicole,

A woman placing Invisalign aligners on her teeth

Invisalign and Candid Offer Similar Aligners

If you’re looking at the treatment in its purest form, both companies make clear orthodontic aligners. Invisalign has been in the game since 1997 and has invested millions into development and has patented concepts and materials. Candid has been in business since 2017.

Insurance Companies Take Issue with Candid

Remote dentistry is an emerging science and there’s certainly benefit to it, especially when someone can’t get to a dentist and is struggling with a major issue like a toothache. However, it’s only recently that the ADA even created a code for teledentistry, making it all but impossible to bill for remote services. Further adding to the issues, many policies specifically state that treatment must be performed in a dental office and by an in-network dentist. It’s not surprising the Candid company has a ton of BBB complaints related to insurance.

Something else to consider is companies can maintain a good BBB rating by following up with complaints, even if the customer never gets a resolution. For example, Candid’s website currently states, “Many people have dental insurance, and some of those policies cover adult orthodontics (including Candid’s aligners). While coverage can vary dramatically, many plans reimburse 50% of the treatment cost, with up to $1000 reimbursed.” It goes on to say, “Before you know it, you’ll receive a reimbursement check in the mail without lifting a finger.”

This is the messaging people see. You actually have to dig into the site more to find notes like, “We can’t say on a case-by-case basis whether or not you’ll be reimbursed,” or suggestions that you should talk to your own insurance company first. Of course, the company can use these disclaimers as fodder when people complain they weren’t covered, which is enough to satisfy the agency.

Candid Has Been Dropping the Ball with Follow-Ups

At the time of publishing this, there were 41 complaints lodged against the company. That’s pretty intense for a company that’s only been in business two years. One of the other primary complaints is that people having issues with their treatment reach out to the company and never hear back. Yikes. Obviously, a local dentist could have the same problem, but at least you can go down to the office and talk to them in person. It’s a bit harder to get a resolution when you can’t visit a business in person.

Orthodontics Requires Monitoring

While it may be true that lots of people never have a single blip throughout their treatment, issues can arise. Sometimes teeth become traumatized during the shift or things don’t move right. Addressing these problems right away is essential. Failure to do so can genuinely result in losing teeth.

Invisalign vs Candid: Which is Best?

The biggest draw for people interested in Candid is the cost savings. You might save some cash if you don’t have to pay for visits to the dentist during treatment, so Candid is cheaper in some cases. The real question is whether you’re willing to bet your teeth on it. Is the additional risk worth the savings?

A Hidden Benefit of Invisalign

Most patients realize being under the care of a dentist during treatment is a benefit, but did you know you can whiten your teeth while simultaneously straightening them with Invisalign. Their aligners can double as teeth whitening trays. Your dentist simply needs to provide you with a tube of whitening gel to use in the aligners. Together, it is like having a mini smile makeover.

This blog is sponsored by San Antonio Dentist Dr. Imam.

Lumineers for a Tooth Gap? NO!

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I went to see my dentist about fixing a large tooth gap I have. It’s about 8mm wide right smack in the middle of my smile. It has been a source of embarrassment for most of my life. I told him (my dentist) that I am too old for braces. He suggested Lumineers. I was excited until he quoted me the price. While I am the one who limited him to no braces, is there any other treatment possibility? If not, I’ll suck it up and do it.

Kevin

Dear Kevin,

Ivnisalign aligners

Invisalign Aligners

Wow, I’m glad you wrote before moving forward with this. First, let’s talk about the size of that gap. Normally, a tooth gap would be fixed using some dental bonding. However, 8 mm is a large enough gap to fit an entire tooth in the space. That would not look natural at all.

Even with porcelain veneers, it would take an expert cosmetic dentist to pull this off and make it look natural. I can tell you already your dentist is not an expert cosmetic dentist by the brand of porcelain veneers he recommended.

Lumineers are heavily marketed to inexperienced cosmetic dentists as being easy to place because they tell the dentists they’re thin enough to be placed without any tooth preparation. While this can work sometimes, in most cases it ends up looking bulky. Not to mention, there is a LOT more to making a beautiful smile than tooth preparation.

I’m going to suggest you do Invisalign. I know you don’t want braces. I’m going on the assumption that is because of the metal wires and brackets. With Invisalign, no one will even know you are straightening your teeth. Invisalign uses clear aligners, which makes it invisible even at a conversational distance.

If you are deadset even against using clear aligners, then you will need to go the porcelain veneers route. However, be very careful about who you have do this. I wouldn’t go to the dentist who suggested Lumineers. You want someone who has invested a lot of time and training in cosmetic work. I’d be certain, at the very least, to look at their smile gallery to see if you like the work they do. You want to be blown away with the results they get.

You also want to be sure you get final approval. He (or she) should agree to use a temporary try-in paste. You’ll want to look at them in various lightings and decide if you love them or not. I don’t mean like them. I mean love them. If you don’t, your dentist needs to send them back to the lab and try again. He should be willing to do this until you are completely thrilled.

If they don’t agree to those terms, move on to someone else for the cosmetic work.

This blog is brought to you by San Antonio Dentist Dr. Imam. Ask about our Digital Smile Design.

Does Smile Care Club Work?

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I have been saving up for Invisalign, but saw an advertisement on Facebook for Smile Care Club. As I looked into it, it appears I could save quite a bit of money going this route. Does it work? I figured, because I live across the country from you and could never actually be a patient, you’d give me a straight answer.

Paul

Dear Paul,

Ivnisalign aligners

Invisalign Aligners

I have looked at this before as a matter of professional interest. Smile Care Club is essentially a “DIY” Invisalign knock-off company. It is significantly cheaper. The bulk of the reason for that is you don’t have the regular care and supervision of a dentist during treatment. Plus, it switches aligners every three weeks instead of every two.

Does it work? It looks like it can if you’re an ideal candidate and nothing goes wrong during the procedure. Here are some considerations before making your final decision.

Considerations before Choosing Smile Care Club

You send an impression and photos to the dentist. I do not feel these are enough of a diagnostic to know whether or not a patient has gum disease. If you do and go forward with treatment, it will aggravate the situation and could cause you to lose teeth. However, if you’re sure your gums are in top shape, that won’t be a problem.

There are a couple of other big concerns I have:

  • Shaving Teeth

In cases where patients have crowding to deal with, one solution is shaving the sides of the teeth. This is a very tricky procedure, that even the best cosmetic dentists have to be extraordinarily careful to maintain the proper shape of the teeth while removing the right amount of enamel. They’ll likely send you to one of their contracted dentists to do this. It’s just a simple way for a local dentist to bring in some extra cases. However, this dentist isn’t personally invested in your case because you’re not technically his patient. I’m not sure how careful he or she will be.

  • Tooth Rotation

Sometimes teeth have to be rotated during the procedure. With Invisalign, you’re under the continual care of a dentist who has a vested interest in the outcome. During your checkups for treatment, he or she is able to evaluate whether or not the tooth is rotating as it should. Without those checkups, that will get missed and the outcome will not be what you’d hope for.

Bottom line. It’s a gamble, but can work. You’ll just have to determine how much of a risk-taker you are.

This blog is brought to you by San Antonio Cosmetic Dentist Dr. Imam.