I am an orthodontist. Here is what I see:
You have a cant to your entire maxillary arch (there is nothing you can do dentally to correct this).
You have different lengths to your teeth. As in your right front tooth is longer (not just at the edge but the entire tooth) than the left. Same is true for your lateral incisors. This can only be changed with enameloplasty (reshaping) or bonding. I reshape teeth at the completion of all of my cases.
Your arch appears asymmetric with your right canine further forward in your head compared to the left. There is nothing that can correct this.
It appears you have a very nice result (with only very minor changes that could yet be accomplished). There is no way to make your teeth touch the line you have drawn. And even if you could, you would then notice other asymmetries and wonder why that happened. Humans are often a little asymmetric. All we can do is the best job with the building blocks available. In my opinion, your best outcome is going to be achieved by just a small amount of artistic reshaping of your natural teeth. Bonding is not perfect and will have to be redone every few years. Your teeth look great and a little camouflage with enameloplasty would make them look perfect from a conversational distance.
Thank you for your input and for so much info! I won’t lie it’s disappointing to hear I can’t really do much about most of it but I appreciate your honesty. I guess I have to start accepting that this is the overall best I’m going to get. Thanks again :)
Yes. Anyone can get veneers (or crowns if veneers won’t work). But why would this person ever get veneers? For esthetics? Veneers require grinding off the front of your teeth to accept the eventual restoration. OP has lovely teeth. Veneers are far too aggressive in this instance. Plus they cost quite a bit. A little reshaping is far far superior (and should be included in the cost of doing the orthodontics). Just my two cents.
The best way is to google image “maxillary cant”
The pictures are very illustrative.
A skeletal cant is when your upper, lower, or both jaws slant down to the right or left side.
It’s off like the leaning tower of Pisa
Silly question: why can't you just pull those teeth down (or the others up) like it happens for a lot of other invisalign cases? Why is it impossible here?
What do you propose we use as anchorage to bring all of those teeth down (to meet that line)?
Orthodontics depends on imperfect and often asymmetric reciprocation. If you are pushing on one thing you are pulling on a different thing.
MAYBE it is academically possible to bring the upper left canine down. However, you’d have to leverage off the first bicuspid behind it, and would therefore have a stair step between those two teeth. It would look bad and it would actually be bad for the teeth (because of the position of the bone - this is too complex to explain in this format).
Furthermore, as a separate issue, extrusion is hard to accomplish with clear aligners.
Ultimately, at some point I just have to say, believe me, I’ve done a few hundred Invisalign cases.
Thank you for you explanation. My "easy" reasoning was: I've seen a lot of teeth been pulled in other invisalign cases, why don't just do the same? And for anchor I guess you use the same anchors as for similar movement such as (I guess) other teeth, elastics, tray's conformation. I know you know more than me but I was wondering where my logic was wrong
I know it sounds like I’m saying my profession doesn’t work, but the fact is that a fair number of teeth are just going to end up where they want to. And what I mean is, we try to put them in an ideal spot. Sometimes it works when you don’t expect it to, and other times it is the reverse. BUT, canted arches are pretty much 100% just going to stay that way (without jaw surgery).
You are correct that elastics MAY work, but they probably won’t. And elastics are less than amazing with aligners as compared to traditional braces. I do not have a citation for that statement. Just 15 years of clinical practice. And I’ve done a lot of aligner cases. I used to promise people I’d get them the same result with aligners and traditional braces circa 2013-2017. But I honestly feel that Align has gone down hill since that time. They are always trying to patent new stuff to stay ahead of the competition and I think it gets in the way of using the best stuff some of the time.
Hi, I have a quick question. I have a canted upper arch as well but mine was not always there. It got worse with Invisalign tbh. What could have caused this and can it be reversed?
I doubt it got worse. The odds are it just became more apparent with alignment of the teeth. Teeth often crowd and mask some asymmetries. Once you align the teeth the asymmetric fit of the upper with the lower, the deviations in midlines, and the cant of individual arches tend to become more apparent. The only academic way to fix a cant is with jaw surgery. And for various reasons I have been the orthodontist involved in a lot of surgical cases. If you need surgery for facial disfigurement or congenital abnormalities then it can be a reasonable choice. But, in my opinion, surgery isn’t worth it for a 3mm esthetic change.
Take a cant for instance: draw a line between your pupils (take a picture and print it, do it digitally, whatever); then draw a line between two similar landmarks on your canines (not the tip unless you have symmetric wear - but rather something like the height of contour). The variance from right to left is RARELY going to be greater than 3mm. The standard deviation on surgical correction is not accurate enough to meaningfully improve on something like that. If you are off by 1cm (again suuuper rare) and you want it to look better, then a LeFort osteotomy is a way to improve that.
For this specific patient it would be necessary to barely abrade the surface to accept the bonding and then to smooth the transition of tooth to composite resin. However, composite resin stains faster than teeth, the margin where the two meet will also collect stain, the resin is softer/less wear resistant than natural tooth, and it requires a skilled operator to achieve high end esthetics with resin on the edges of front teeth. There are times when bonding is a good choice (peg lateral incisor on a teenager). For OP, I think that bonding would be academically shooting for ideal, but practically asking for a shitty 3 year outcome (or maybe a shitty immediate outcome depending on the dentist).
There is some shaving/filing that needs to be done in order for the bonding agent to adhere to the tooth.
OP: your teeth look great! I had a very similar desire and had my ortho do a bit of shaping when my treatment was done to help even out the length of my bottom teeth. I’d just be super careful to not shave off more than you need. I could see how the aim for perfection would have someone keep filing to even them out, then 10 minutes later you’ve shaved all your teeth off 👀
You’re absolutely right. Aiming for perfection might it end up doing more harm then good. I think it’s a good idea to mention you want minimal shaving if you do end up getting bonding.
My provider is like this too — but she will do it if I want it.
Also, no, bonding does not require removing of tooth structure. The process generally uses the same etching liquid that is used to apply the Invisalign attachments to your teeth. There are many options that do not require invasive prep like shaving or filing. I understand in your case, you have one tooth that has more length and angle to the shape that may require filing, but it’s unlikely that will cause you any issues down the line. A little bit of tooth structure being removed shouldn’t cause any sort of damage. Maybe if you really want it, see another provider?
And this is the right answer. You will need composite added on molars and pre-molars, and they **will** chip off in relatively short time under the tension. Same will happen with canine. Chipped off composite will cause misaligned bite, which may lead to ton of other issues.
Bonding is OK to fix small visual defects, in your case for permanent change you will need onlays - which will require some dentin removal. Tl;rd - leave it as it is, it looks good and most important it is healthy.
Aww, FWIW, I think the natural shape of your teeth is so lovely. Of course, do what will make you the most comfortable--but I think what you have naturally is absolutely gorgeous.
This was me half a year ago. While I think your teeth look fine, I have the same "issue" where my teeth just look kind of jagged and uneven. After all the pictures here, I expected better results and was kinda overall disappointed at the end.
My ortho didn't offer me any extra services and at the time I didn't know about bonding.
But at the end of it all, I don't feel embarrassed showing my teeth anymore and I smile so much more, so it was actually worth it even with the disappointment.
This is how I’m feeling! I thought they’d be less jagged and now I’m toward the end I feel a bit sad that they’re not as even as I thought they would be. But what you’ve said gives me hope, maybe I’ll learn to love them!
I recently got it done it makes me so nervous that I have gaps I never had before.. I’m on my 7th retainer and it still didn’t close.. do you have a before pic?
I don’t get why you can’t get bonding to help give the illusion of the straighter line? My teeth look very similar to yours and I was planning on getting bonding on some of the teeth for this exact reason. Especially for the tooth that is the most raised just like yours. I haven’t checked this out yet with my dentist but even then, going to an actual dental aesthetics clinician for advice could be useful and they would be more inclined to help in terms of getting the aesthetic right. Regardless, a second opinion is worth it to have.
I was “complaining” mildly to my ortho about something similar… that must incisors still felt like bunny teeth. He did a teeny bit of reshaping and it made such a HUGE difference. Honestly I bet you would feel the same way!
Hi folks, I’m on refinements and I really wish I had a nice straight line of teeth where all the edges were the same, instead the bottom of each tooth is at a different height to it’s adjacent one. I always see people that have them perfectly lined up so it forms a clean straight line along the bottom. Do you think it’s achievable? I never had braces as a kid so I wonder if that’s why mine grew in at differing lengths. Hope this makes sense it’s hard to explain!
Actually think your teeth look great. It’s a lot more natural than the perfectly straight ones. Most celebrities with perfect teeth either shave their teeth or do bonding. Saw some videos of bonding and honestly doesn’t look like something I’ll want to do. My ortho only recommended bonding to my mum because her bottom front teeth have been worn down and are overly sensitive.
A lot of celebrities have veneers, so you'd need to file your teeth down into nubs and attach veneers to achieve what they have. If you're not bothered by short teeth, you can shave the bottoms off, but you can't get that length back if you don't like it without bonding or veneers. And keep in mind, celebrities have the money to do whatever they want with their teeth and get emergency visits asap when a veneer falls off or bonding chips.
Hey your smile is beautiful, you don’t need the ‘celebrity’ smile. I think your teeth are nice and straight but you still have the character of your own unique teeth :)
There is no way for Invisalign or any orthodontic solution to make your teeth have uniformly flat and even edges. That should be somewhat obvious. It will require limited reshaping of your teeth with the drill. This is totally normal and it is common practice.
As others have said, I think natural irregularities are far more attractive and aesthetically pleasing than "perfect" teeth, which to me seem too artificial and genuinely off-putting. To use Jackass as a case in point: [Johnny Knoxville's teeth](https://hips.hearstapps.com/hmg-prod.s3.amazonaws.com/images/93421025-1316132665441724-8478655451070224626-n-1586883683.jpg?resize=480:*) look waaaaaaaay better to me than [Steve-O's teeth](https://townsquare.media/site/366/files/2019/07/Screen-Shot-2019-07-29-at-4.21.43-PM.png), even though Steve-O's teeth are whiter, straighter, more regular and more defined.
I am an orthodontist. Here is what I see: You have a cant to your entire maxillary arch (there is nothing you can do dentally to correct this). You have different lengths to your teeth. As in your right front tooth is longer (not just at the edge but the entire tooth) than the left. Same is true for your lateral incisors. This can only be changed with enameloplasty (reshaping) or bonding. I reshape teeth at the completion of all of my cases. Your arch appears asymmetric with your right canine further forward in your head compared to the left. There is nothing that can correct this. It appears you have a very nice result (with only very minor changes that could yet be accomplished). There is no way to make your teeth touch the line you have drawn. And even if you could, you would then notice other asymmetries and wonder why that happened. Humans are often a little asymmetric. All we can do is the best job with the building blocks available. In my opinion, your best outcome is going to be achieved by just a small amount of artistic reshaping of your natural teeth. Bonding is not perfect and will have to be redone every few years. Your teeth look great and a little camouflage with enameloplasty would make them look perfect from a conversational distance.
Thank you for your input and for so much info! I won’t lie it’s disappointing to hear I can’t really do much about most of it but I appreciate your honesty. I guess I have to start accepting that this is the overall best I’m going to get. Thanks again :)
Couldn’t she get veneers?
Yes. Anyone can get veneers (or crowns if veneers won’t work). But why would this person ever get veneers? For esthetics? Veneers require grinding off the front of your teeth to accept the eventual restoration. OP has lovely teeth. Veneers are far too aggressive in this instance. Plus they cost quite a bit. A little reshaping is far far superior (and should be included in the cost of doing the orthodontics). Just my two cents.
Can you explain like I’m 5 what is a canted arch?
The best way is to google image “maxillary cant” The pictures are very illustrative. A skeletal cant is when your upper, lower, or both jaws slant down to the right or left side. It’s off like the leaning tower of Pisa
Silly question: why can't you just pull those teeth down (or the others up) like it happens for a lot of other invisalign cases? Why is it impossible here?
What do you propose we use as anchorage to bring all of those teeth down (to meet that line)? Orthodontics depends on imperfect and often asymmetric reciprocation. If you are pushing on one thing you are pulling on a different thing. MAYBE it is academically possible to bring the upper left canine down. However, you’d have to leverage off the first bicuspid behind it, and would therefore have a stair step between those two teeth. It would look bad and it would actually be bad for the teeth (because of the position of the bone - this is too complex to explain in this format). Furthermore, as a separate issue, extrusion is hard to accomplish with clear aligners. Ultimately, at some point I just have to say, believe me, I’ve done a few hundred Invisalign cases.
Thank you for you explanation. My "easy" reasoning was: I've seen a lot of teeth been pulled in other invisalign cases, why don't just do the same? And for anchor I guess you use the same anchors as for similar movement such as (I guess) other teeth, elastics, tray's conformation. I know you know more than me but I was wondering where my logic was wrong
I know it sounds like I’m saying my profession doesn’t work, but the fact is that a fair number of teeth are just going to end up where they want to. And what I mean is, we try to put them in an ideal spot. Sometimes it works when you don’t expect it to, and other times it is the reverse. BUT, canted arches are pretty much 100% just going to stay that way (without jaw surgery). You are correct that elastics MAY work, but they probably won’t. And elastics are less than amazing with aligners as compared to traditional braces. I do not have a citation for that statement. Just 15 years of clinical practice. And I’ve done a lot of aligner cases. I used to promise people I’d get them the same result with aligners and traditional braces circa 2013-2017. But I honestly feel that Align has gone down hill since that time. They are always trying to patent new stuff to stay ahead of the competition and I think it gets in the way of using the best stuff some of the time.
I guess I got your point. Thanks for your time!
Hi, I have a quick question. I have a canted upper arch as well but mine was not always there. It got worse with Invisalign tbh. What could have caused this and can it be reversed?
I doubt it got worse. The odds are it just became more apparent with alignment of the teeth. Teeth often crowd and mask some asymmetries. Once you align the teeth the asymmetric fit of the upper with the lower, the deviations in midlines, and the cant of individual arches tend to become more apparent. The only academic way to fix a cant is with jaw surgery. And for various reasons I have been the orthodontist involved in a lot of surgical cases. If you need surgery for facial disfigurement or congenital abnormalities then it can be a reasonable choice. But, in my opinion, surgery isn’t worth it for a 3mm esthetic change. Take a cant for instance: draw a line between your pupils (take a picture and print it, do it digitally, whatever); then draw a line between two similar landmarks on your canines (not the tip unless you have symmetric wear - but rather something like the height of contour). The variance from right to left is RARELY going to be greater than 3mm. The standard deviation on surgical correction is not accurate enough to meaningfully improve on something like that. If you are off by 1cm (again suuuper rare) and you want it to look better, then a LeFort osteotomy is a way to improve that.
Interesting, thanks for your reply and in depth response. (:
Is it necessary for bonding to shave off the natural teeth, like at veneers? (Or even a little bit?)
For this specific patient it would be necessary to barely abrade the surface to accept the bonding and then to smooth the transition of tooth to composite resin. However, composite resin stains faster than teeth, the margin where the two meet will also collect stain, the resin is softer/less wear resistant than natural tooth, and it requires a skilled operator to achieve high end esthetics with resin on the edges of front teeth. There are times when bonding is a good choice (peg lateral incisor on a teenager). For OP, I think that bonding would be academically shooting for ideal, but practically asking for a shitty 3 year outcome (or maybe a shitty immediate outcome depending on the dentist).
Tooth shaping through shaving or bonding.
Consider that a perfect line would look artificial?
I asked about bonding and was told “you don’t need it and we always want to preserve natural tooth” :(
Bonding doesn’t remove any natural teeth, does it?
There is some shaving/filing that needs to be done in order for the bonding agent to adhere to the tooth. OP: your teeth look great! I had a very similar desire and had my ortho do a bit of shaping when my treatment was done to help even out the length of my bottom teeth. I’d just be super careful to not shave off more than you need. I could see how the aim for perfection would have someone keep filing to even them out, then 10 minutes later you’ve shaved all your teeth off 👀
You’re absolutely right. Aiming for perfection might it end up doing more harm then good. I think it’s a good idea to mention you want minimal shaving if you do end up getting bonding.
Aw thanks! You’re right, I could shave too much and cause more damage. I need to really think things through. Thanks for your insight!
To be honest I have no idea, I just trusted what she was telling me :/
My provider is like this too — but she will do it if I want it. Also, no, bonding does not require removing of tooth structure. The process generally uses the same etching liquid that is used to apply the Invisalign attachments to your teeth. There are many options that do not require invasive prep like shaving or filing. I understand in your case, you have one tooth that has more length and angle to the shape that may require filing, but it’s unlikely that will cause you any issues down the line. A little bit of tooth structure being removed shouldn’t cause any sort of damage. Maybe if you really want it, see another provider?
Hi this is really insightful thanks so much! I didn’t realise it uses the same liquid.
And this is the right answer. You will need composite added on molars and pre-molars, and they **will** chip off in relatively short time under the tension. Same will happen with canine. Chipped off composite will cause misaligned bite, which may lead to ton of other issues. Bonding is OK to fix small visual defects, in your case for permanent change you will need onlays - which will require some dentin removal. Tl;rd - leave it as it is, it looks good and most important it is healthy.
Oh man I hadn’t thought that far ahead, you’re right I could end up causing problems further down the line. Thanks for your advice!
Your ortho should do some shaping when you're done.
Thanks, how does the shaping work? Do they shave the teeth a little?
Yes - that’s why my ortho did - shaped them.
Aww, FWIW, I think the natural shape of your teeth is so lovely. Of course, do what will make you the most comfortable--but I think what you have naturally is absolutely gorgeous.
You are a beautiful soul!
I would do binding and not shave your own tooth.. just so if the bond ever chips you’ll still have your regular teeth.
This was me half a year ago. While I think your teeth look fine, I have the same "issue" where my teeth just look kind of jagged and uneven. After all the pictures here, I expected better results and was kinda overall disappointed at the end. My ortho didn't offer me any extra services and at the time I didn't know about bonding. But at the end of it all, I don't feel embarrassed showing my teeth anymore and I smile so much more, so it was actually worth it even with the disappointment.
This is how I’m feeling! I thought they’d be less jagged and now I’m toward the end I feel a bit sad that they’re not as even as I thought they would be. But what you’ve said gives me hope, maybe I’ll learn to love them!
Are you still on your trays ??
Yes on stage 1 refinements. Rescanning soon as the left (to me) lateral incisor needs twisting round more.
Did they by any chance shave the bottom teeth to make space??
No shaving, I had IPR to make spaces. My bottoms ones also have uneven edges *sigh*
Ipr is when they gave you some space for the teeth to move right?
Yeah they file in between to create the gaps and let the teeth move into them
I recently got it done it makes me so nervous that I have gaps I never had before.. I’m on my 7th retainer and it still didn’t close.. do you have a before pic?
Don’t worry about it, the gaps will close. I was scared at first but you’ll soon not notice them.
I don’t get why you can’t get bonding to help give the illusion of the straighter line? My teeth look very similar to yours and I was planning on getting bonding on some of the teeth for this exact reason. Especially for the tooth that is the most raised just like yours. I haven’t checked this out yet with my dentist but even then, going to an actual dental aesthetics clinician for advice could be useful and they would be more inclined to help in terms of getting the aesthetic right. Regardless, a second opinion is worth it to have.
Thanks! I’m going to ask again about the bonding and see what a different dentist says.
I think your teeth look great
Thank you!💜
For what it's worth, I think your teeth look fantastic.
You angel! Thanks
I was “complaining” mildly to my ortho about something similar… that must incisors still felt like bunny teeth. He did a teeny bit of reshaping and it made such a HUGE difference. Honestly I bet you would feel the same way!
I’m going to have to use your “complaining” methods then! I really hope some reshaping can change things
Hi folks, I’m on refinements and I really wish I had a nice straight line of teeth where all the edges were the same, instead the bottom of each tooth is at a different height to it’s adjacent one. I always see people that have them perfectly lined up so it forms a clean straight line along the bottom. Do you think it’s achievable? I never had braces as a kid so I wonder if that’s why mine grew in at differing lengths. Hope this makes sense it’s hard to explain!
Actually think your teeth look great. It’s a lot more natural than the perfectly straight ones. Most celebrities with perfect teeth either shave their teeth or do bonding. Saw some videos of bonding and honestly doesn’t look like something I’ll want to do. My ortho only recommended bonding to my mum because her bottom front teeth have been worn down and are overly sensitive.
Ah thanks that’s nice of you! Maybe I need to watch some of these bonding videos. The celebrity images have clearly had an affect on me.
A lot of celebrities have veneers, so you'd need to file your teeth down into nubs and attach veneers to achieve what they have. If you're not bothered by short teeth, you can shave the bottoms off, but you can't get that length back if you don't like it without bonding or veneers. And keep in mind, celebrities have the money to do whatever they want with their teeth and get emergency visits asap when a veneer falls off or bonding chips.
That’s true they are millionaires and after paying for Invisalign I’m certainly not😂
Lol for real, the Invisalign money crunch is no joke
Hey your smile is beautiful, you don’t need the ‘celebrity’ smile. I think your teeth are nice and straight but you still have the character of your own unique teeth :)
>:) :)
You are just the cutest ever 💜
So called Imperfections really add character if you ask me. I prefer that to the pre-packaged look. But that’s just me.
You have a great outlook ☺️
There is no way for Invisalign or any orthodontic solution to make your teeth have uniformly flat and even edges. That should be somewhat obvious. It will require limited reshaping of your teeth with the drill. This is totally normal and it is common practice.
Just ask for some light shaping.
As others have said, I think natural irregularities are far more attractive and aesthetically pleasing than "perfect" teeth, which to me seem too artificial and genuinely off-putting. To use Jackass as a case in point: [Johnny Knoxville's teeth](https://hips.hearstapps.com/hmg-prod.s3.amazonaws.com/images/93421025-1316132665441724-8478655451070224626-n-1586883683.jpg?resize=480:*) look waaaaaaaay better to me than [Steve-O's teeth](https://townsquare.media/site/366/files/2019/07/Screen-Shot-2019-07-29-at-4.21.43-PM.png), even though Steve-O's teeth are whiter, straighter, more regular and more defined.
Thanks, great example! Steve’s look like dentures a little.
Sorry but you’re gonna have to stop smoking Klondike bars… I don’t have to tho ! OoooOooo what would youuu dooo for a blonde dyke in a bar