Will DIY orthodontics make or break your smile?

Some will want to frame the following thoughts as an attack, or a move to protect my profession from an invasive competitor. This is simply not the case. Read on, and you’ll see I’m really looking out for my patients; attempting to ensure they get what they desire out of an orthodontic treatment.

Smile Direct Club is a company with a product intended to help the general population cut out the middle man and treat themselves to straighter teeth. There’s a desire for all kinds of DIY instructions, many available across the internet, and dentistry is no exception. Smile Direct offers an imitation of the Invisalign aligner treatment. As you may know, Invisalign uses a series of plastic, elastic aligners, in a specifically designed sequence, to push your teeth in tiny increments over time. This is what dentists have been doing with metal braces for a great many years, and with aligners for several decades. Even in the hands of professionals, plastic aligners aren’t able to move the teeth nearly as completely or accurately as the good old-fashioned brackets and arch wires, or you would have seen metal hardware disappear by now. Aligners are popular because they’re pretty, the teeth remain cleansable, and they’re less hurtful. And they’re trendy too. But what happens when you put such tools in the hands of amateurs?

There is a good reason dentists invest, in most cases, 8 years of their lives getting dental degrees and licenses to practice. There’s a lot to know about oral health, and the specialty of moving teeth is no exception. There are opportunities to damage yourself in ways you can’t undo. But in the case of DIY orthodontic treatment, specifically with aligners, you’re more likely to end up with a result that simply doesn’t satisfy. Let me share an example.

I treated one young man with conventional braces a number of years ago. We got a great result, and the family was pleased. Upon completion of braces, our patients are given clear instructions about how their teeth may become crooked again if they fail to wear retainers. Retention is a life-long task if teeth are to remain straight, and my patients hear me preach that fact. As frequently happens, this young man let the retainers slide, and his teeth shifted. He was embarrassed, and as he entered his 20’s, decided that the Smile Direct product sounded like a good way to get his teeth straight again, without having to face me, (his words). I’m sure there was a cost factor in play as well. He worked with the company to treat himself over time, but despite his efforts and investment, he failed to get the results he had hoped for. At a recent cleaning, he asked if I could help him get a better result with the gadgets afforded him, and I agreed to help, if he would let me share his experience and a few photos.

As Smile Direct treatment begins, the fit of every single aligner is predicated on a perfect set of models, which is nearly impossible for an amateur to capture. So, from the start, aligner effectiveness is compromised and two solid objects cannot occupy the same space at the same time. Take a look at the photo below and see how one of the front teeth is clearly boxed out of a smooth arch.

DIY aligner setups can’t prevent such collisions, and even with the experience I have, there is no way to get past such an impasse without reshaping one or more teeth, or re-engaging the company for additional attention, and their attention generally costs money. In this case, we’ve elected to reshape the teeth as subtly as possible. Can you see the shape differences below?

His front teeth will almost certainly require some additional “slenderizing” before they can bump past one another into a smooth arch form. We’re taking it a couple weeks at a time, meaning we’re counting on the aligners he has to continue to move his teeth as new space is created. Create too much space, and you’d never get the teeth to touch. It’s tricky! I’m not sure most could accomplish this by themselves, by looking in the mirror. Here’s what you’re looking for:

So crowding can be difficult to resolve. How about spacing?

Spacing cases do seem to yield more satisfying DIY results. But again, there are potential complications. You must not forget that the upper teeth and the lower teeth must cooperate. Getting teeth positioned in smooth arches would be much easier if the uppers and lowers never had to meet. Collisions between upper and lower front teeth can cause upper spaces to be impossible to close. If you manage to tug your uppers together, you may “cage the lowers”, creating heavy bite forces on just a few front teeth, and those few can suffer wear very rapidly. There are just so many things that can go wrong. I believe the supervision that you get when a professional takes responsibility for your case is worth something. But ultimately, I’m of the opinion that citizens should be allowed to utilize such techniques at their own risk. Folks don’t need dentists like me telling them what they can or cannot do. And maybe less-than-perfect results are OK. Just approach this with your eyes wide open to the pitfalls of a DIY treatment. Know that a great result might be a real possibility. But so is a very poor result, potential injury, and a great deal of frustration, not to mention loss of funds. You may even find yourself asking your dentist for help!

I can guarantee there will be people who read this and say they had a great experience. I trust you’ll contact me to disagree. Don’t be angry if you disagree. Perhaps the folks with success stories haven’t needed my services. I wish everyone who tried Smile Direct Club got a great result. I’ve only shared because I care, and want you to know what I’m seeing in my office.

Best wishes for fantastic smiles! #SVDGsmiles