Q. Is it safe to order aligners online and use them to correct my smile?

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Hello,

Welcome to icliniq.com.

It is not advisable to get any changes done by any appliances without the supervision or guidance of a certified orthodontist. Please make sure you are getting your treatment progress monitored. Thank you.

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Regarding follow up:

Please share your intra-oral pictures of teeth in normal and smiling pose and a profile photo,

please share the treatment plan they have made for you.

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Hi,

Welcome back to icliniq.com.

I went through the data you shared (attachments removed to protect the patient's identity). I would like to enlist specific points that concern me regarding the company's plan. Indeed, they enhance your smile by closing the midline diastema (space between front teeth) and aligning them into a smile curve. However, the plan is not fully efficient and, more importantly, not stable. To elaborate, if you end up in an unstable occlusion after your smile correction, teeth and the surrounding tissues tend to go back to previous occlusal positions causing a relapse. This means, whatever efforts were made to correct the occlusion will be an utter waste. Please note that some minimal post-orthodontic settlement occurs in every case where teeth and surrounding tissues adjust to the newer positions, even after ending on a stable occlusion. But the difference is so minimal (microscopic) that it is not visible to the naked eye. However, suppose you end on unstable relations, as shown on your final smile positions. In that case, relapse will occur during settlement, and all of your efforts will not be worth it. Midlines are an essential aspect of smile enhancement. 1) The plan is not to end your occlusion with matching midlines between upper and lower front teeth. To a layman, upto 2 mm of midline discrepancy is not noticeable, but when you are undergoing treatment, you should be given a proper matching midline to get the best of your smile. Rotated teeth are one of the most frequent causes of relapse. Few teeth from the posterior (premolars) are not entirely de-rotated to settle into a good occlusion. Both upper and lower premolars need to be completely de-rotated. Further posterior teeth (molars and premolars) are supposed to settle in a cusp-fossa relation. (Cusp of upper molar sits in the groove of the lower molar). This is important as cusp-fossa relation is the stable occlusion, and deviation from this relation causes relapse, which will result in your teeth again losing the alignment and becoming irregular. The second molars are not included in the treatment protocol. These teeth might put pressure on the front ones, eventually disrupting the achieved results. Kindly ask them to have them also into the treatment plan. So, kindly ask them for the changes enlisted and demand a new plan. I hope this helps. Thank you.

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# Hi Jim.. Greetings of the day.!

I went through your new scans and have seen significant improvement on the occlusion and smile, which the company is providing now.

1. The midlines matching: Your new scans midlines are still not matching 100%. As previously mentioned, it won't be noticable to layman so easily but you can still opt for a better midline match. If its not possible by the company, you can still go ahead with the current scans and if required, you can go for esthetic corrections using composite restorations.

2. Rotated premolars: As previously mentioned about rotated premolars, new scans show that posterior teeth have been de-rotated and now settle in better and stable position as compared to old scans. You can go ahead with the revised scans for de-rotation.

3. Posterior occlusion settlement: The pre molars and molars are still not settling in cusp-fossa relation as expected. You can get a revised plan for the same. Although sometimes, after the end of the treatment, they do settle out. (Post orthodontic treatment settling)

4. Inclusion of 2nd molars: They have still not included 2nd molars in their plan. However, it can be avoided if facing difficulty in its inclusion. But there might be chances of some degree of relapse later on, minimal though.

Overall, there has been an improvement in the revised treatment plan and you will get better smile and results as compared to version 1. But you do have an option of getting still better results.

Please note: Not all the results mentioned in the plan are achieved. There is some amount of results lost (About 5%, which varies from company to company) due to thickness of the material and virtual-to-real environment conditions and response. So it is always advisable to get the most in treatment plan so that result loss in real world is minimal.

Retention of the results is a very important aspect and kindly do not neglect it.

Do reach out for further queries/clarifications/guidance.

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Regarding follow up:

Kindly share the final positions of the new scans (version 3) in all aspects. (Front, top, bottom, right left), avoiding the mid and initial positions.

# Hi Jim.! Greetings of the day.

Yes, these scan results look better and stable as compared to your current status.
Results should be pleasing and smile, definitely enhanced.
I feel you can go ahead with the plan.

Once you start your treatment, ask the team for a mid treatment scan and refinements can be done at that particular point (if required) to enhance the treatment efficiency. There is always an option to revise the finished results on real time basis.
Kindly ask for mid treatment scans and planning.

If you are satisfied with the mid treatment scan results, you can go ahead with it. Otherwise, you can modify it at that point as well.

Note: As mentioned earlier, do not forget to take complete details of retainers as well, which is an important aspect of treatment.

Should you require any advice / instructions / suggestions, kindly reach out.
Drop a feedback as well (once you are satisfied with all your queries) for better assessment and enhancement of answers for future use.

Regards

# Hi Jim.. Hope you are doing well.

The pics you shared aren't very clear but it does give me an idea that your gums are inflammed and swollen. (Gingivitis - as it is known)

Do not worry regarding the same. It is a reversible condition and following certain instructions will relieve it and gums will return to normal state.

1. As mentioned, do salt water rinses 4-5 times a day.

2. Brush twice daily, but make sure you are not doing hard brushing, but a gentle one to clean any deposits and food remnants from the teeth.

3. You can take vitamin C oral supplements for about 15 days (once daily)

4. Practice flossing daily

5. You can opt for cetrimide gum astringent for 10 days.

Apply a pea sized astringent from your finger tip and massage all over your gums after brushing and leave it for 10-15 mins. (Do not eat or rinse during this period)

Then, simply rinse whole mouth with water and resume your activities.

These should reduce the inflammation.

Do reach out for further information/clarifications.

Have a nice day and weekend.

Regards

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Same symptoms doesn’t mean you have the same problem. Consult a doctor now!

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