Wrong tooth extracted

[u/CMWH11338822]

TLDR:: general dentist extracted tooth 26 but was supposed to extract 25. Aligners have both 25 & 26 in them but 26 has an attachment. I’m on tray 2 & looking ahead to tray 6 it looks like tooth 26 is being brought forward as if it’s still there & tooth 25 is disappearing like it’s not there. Tried to explain to orthodontist but he said trays look good. Is he right or should I be concerned?

Hey everyone, I’m totally new to Invisalign & looking for input from anyone who understands how the trays are manufactured & mapped or may have experienced something similar.

I have substantial crowding of my lower front teeth with tooth 26 most noticeably misaligned & sitting back behind the others. My scan showed that treatment could be done without an extraction & it could bring 26 forward & make room for it but my ortho strongly felt an extraction was needed. 26 was the obvious choice but we ultimately decided on 25 because of some gum loss & sensitivity & felt it would be better to get rid of a tooth that was likely going to be a problem anyway. So I was referred out, had the extraction done & when I got home & took the gauze out I saw the dentist extracted 26. But again I was referred for 25.

Fast forward to when I got my trays, all of the teeth are on the tray which the ortho said was for cosmetic reasons even though I was a little disappointed because I preferred the small gap from the extraction vs a sometimes noticeable crooked tooth I’ve been trying to hide since it came in.

Anyway, two assistants worked on me that day & as did the orthodontist who showed me how the teeth were going to shift & the final tray (through the plastic baggy) showing me how even though I’d only have the 3 front teeth it wouldn’t be noticeable & he sent me home with my first 6 trays with instructions to schedule the next appointment on my last tray which will be in December.

I am now on my second tray & I just do not feel like this is right. It’s not sitting like my top. It sounds like I have something in my mouth when I talk. It’s fraying & digging into my gums & tongue. I can see spit bubbles around the top of the aligners on my front teeth but they aren’t going down to the gum line or even close on one of them. It’s like the extracted tooth is completely messing up how it’s sitting. Plus while it was painful for my tongue & gums, it has not hurt my bottom teeth at all. While my top teeth were pretty painful the first 2 days.

When making the aligners does the orthodontist have to specify if a tooth is going to be extracted & if so, provide the CORRECT one? I just feel like the teeth would have to shift differently to close a gap vs pull a tooth forward?

I did call the orthodontist & he brought me in immediately the next morning when the office was closed. Which is another issue—they are only in the office in my town 1 day a week & I am having surgery in 2 weeks & don’t know how long the recovery will be so that gives me 2 Mondays to get this resolved if needed. He looked in my mouth & told me they were seated beautifully & explained how to file the sharp edges. & on Monday when I took my son to his appointment he asked me how they were feeling & told me to bring them in if they still didn’t fit right. But I just don’t know what fit right means? Or is supposed to feel like? And I clench my teeth horribly so I honestly believe I could make anything “sit beautifully” on my back teeth which is what he was looking at.

Since then I just pulled out all the aligners & compared the shift that is going to happen & a) tooth 26 which is not in my mouth has an attachment on it & b) from what I can tell it looks like the track is to bring 26 forward, it almost looks like it’s turning 25 sideways & then it just disappears so I’m assuming that’s because the aligner thinks 25 is extracted so is viewing it as a gap?

Am I misunderstanding how this works? The orthodontist is so sweet. & he has 40 years of experience & knows his stuff. But he’s old & is forgetful & does misunderstand things sometimes. I’m not questioning that he knows how to do his job, but I’m questioning if he is going by memory on something that he’s not remembering correctly? We did discuss the wrong tooth being pulled & he said he knew & normally he’d be upset but since he just needed any tooth to come out, it didn’t matter. But does it? I really don’t want to question him AGAIN, if I’m just misunderstanding how orthodontia in general works. But I’m extra concerned because tooth 25 isn’t as stable as the rest of my teeth & I don’t want it being treated as if it’s not there.

Any guidance, suggestions, reality checks, explanations, what is/isn’t normal would be really appreciated.

[u/Potatoskins937492]

If you were supposed to get tooth 25 out and still have it, your aligners would be made for that tooth to NOT be there, which means yes what you're seeing is the aligners assuming that tooth isn't there because that was the plan. They aren't going to move that tooth correctly because it shouldn't exist.

If you got tooth 26 out instead, that means the aligners are trying to move a tooth into position that doesn't exist.

If it were braces, you could probably substitute one tooth for the other (I don't know, I'm not a doctor) and continue on without changing course much because you're altering it in the moment, but with aligners they're pre-planned, you can't just decide to change the plan if they've been printed. So yes, the aligners are made for each tooth to move in specific ways and extractions need to be accounted for correctly.

If I were you, I'd show him where 25 no longer exists in your aligners because it's not supposed to exist in your mouth. Then show him that 26 is is supposed to move into place, but that tooth no longer exists. Focus on one, then the other. He should be able to understand this without the aligners to show him, but you'll have to physically show him on the aligners that those teeth can't do what the aligners are planned for.

I don't usually chuck older people into the bin just because they're older, but he's showing signs of aging and in this case it can be dangerous because you can't grow back teeth. (Edit: this was a turn of phrase and when I reread it I realized it looked rude because I didn't finish my thought. I meant it like how a lot of people will immediately dismiss someone who's older, but I don't like that, it shouldn't discount someone from being able to do something, but in this case it does look like he may be deteriorating a bit.)

You need to insist on a rescan. Stop moving forward in the aligners until you have the right ones. Your math is mathing, you're correct (because anyone, even a doctor, knows you can't move what doesn't exist). It'll just halt your progress. You may have to wait until after your surgery which is disappointing, but you don't want to take risks with your teeth.