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Jeff,

I saw your comments on another board saying that you think Invisalign is revolutionizing orthodontics. I'm curious as to why you believe this is so. I've been "Invisalign certified" for about 3 years IIRC and I've found that the system has certain limitations. Have you finished many cases yet? I haven't done too many cases, since I only reserve it for patients with limited orthodontic needs (Class I or mild Class II/III tendency, mild crowding or spacing, normal to slightly deep or slightly insufficient overbite, no crossbites, etc.). I also offer it as one alternative to patients who may have comprehensive orthodontic needs, but only wish to straighten the front teeth, as long as they understand the risks of incomplete correction of their malocclusion.

I ALWAYS tell my patients that if Invisalign does not correct the problem to the patient's satisfaction, then we may have to put braces on their teeth after attempting Invisalign mechanics. I've had to do this a couple of times.

I would love for Invisalign to be capable of treating complex malocclusions, and maybe someday it will. I receive regular updates from Align, with suggestions on how to overcome some of the limitations inherent to the system. I've noticed, though, that many of these solutions involve attaching what amounts to traditional fixed appliances to the teeth and/or using rubber bands, etc. (IOW, just the things the Invisalign patient was paying extra to avoid). As of now, I see Invisalign as playing a niche role in my practice. I find that traditional fixed appliances are still necessary in the majority of my patients.

One last point: as you mentioned, the lab costs for Invisalign are extremely high. I find that many patients who could be treated effectively with Invisalign could also be treated with other, much less expensive, removable appliances (one example that comes to mind is an Essix retainer, which is essentially the same thing as an Invisalign aligner but without the gee-whiz effect of using the computer to simulate tooth movement). When I offer these options to patients at a fraction of the Invisalign fee, they usually choose the less expensive alternative.

Your comments regarding Invisalign being amazing and revolutionary lead me to believe that your experience with the system has differed substantially from mine. I'd love to hear your input on how you deal with the seeming limitations of Invisalign. I know that my patients would be well served if I could offer them an esthetic, removable, and, above all, effective system for correction of malocclusion.

Thanks,
Jason
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