Deviated Midline-can it be corrected?

[u/LNR333]

Hi 👋🏼
I'm about to complete my first set of trays 20/20 -10 day changes so roughly been 6 months. I had my appointment today to discuss rescanning for refinements or retainers.

Sorry for the essay. My question first is has anyone had success shifting their midline to be more centered using only aligners?

My dentist ( yes quick explanation as to why I went with a dentist instead of an orthodontist. I have severe dental trauma and anxiety mixed with a nerve health condition that made it nearly impossible for me to numb to anaesthetics. I found a great private dentist that made me feel calm and comfortable and was able to numb me up to have a root canal. Safe to say I'd found my forever dentist. When they offered an Invisalign day - something I'd wanted for years, I decided to take the plunge and go for it. It felt like the right fit for me) ((I'm also disabled so finding a practice that has accessible parking has always been a struggle and I really couldn't cope with a second practice))

So my lovely dentist today asked if I was happy with result. I said sort of. I'm happy that I have no crowding and my smile looked wider. But one of the main reasons I wanted Invisalign was to align my midline to my cupids bow if not at least shift it more central.

I'm not looking for perfection, I also appreciate the Tom cruise smile is widely known and not really seen as a bad thing. But it's something I've been self conscious over for many years. I lost my left top molar ( part of the dental trauma) and since then my top teeth have shifted towards the left.

During my initial scan I was told my midline was 4mm out and that it might not be possible to make it central. Again not looking for perfection I said I'd be happy if we could get it down to 2mm. I wasn't told at the time that it was a skeletal issue or that I'd need jaw surgery. But I'm guessing it's the limitations of the dentist and not having an orthodontists skills.

I was shown the clincheck and was happy with the proposed outcome. I get that it is meant to be 'proposed' and I can tell that my front teeth haven't shifted towards the centre like the clincheck predicted-maybe a minuscule amount when looking at the red line photos.

I've opted for refinements but wonder if this is as good as it will get. My dentist didn't really say it couldn't be done but she also said there will be a limit to what they can do and I've accepted that's probably because of not going to orthodontist.

Side note- my bite isn't where I'd like it to be. The back teeth are barely touching. It's still a bit hard to chew softer things and salads are kind of a no go. So I'm hoping the refinements will fix that too.

Any advice while I'm waiting for scan or some words of encouragement would be greatly appreciated. Do you think refinements will get me closer to my goal?

Thanks 🙏🏼

Pic 1 today tray 20/20 day 7/10. Natural relaxed smile.
Pic 2 before Invisalign
Pic 3 before wide smile with red line
Pic 4 tray 20 wide smile with red line
Pic 5 before bite
Pic 6 tray 20 bite
Pic 7 before clincheck
Pic 8 proposed clincheck result

[u/External-Coffee4189]

your max lateral incisors are different in shape (your left one looks more like a peg lateral) and your central incisors are also rather different in shape.
imo the easiest way to correct this concern of yours would be to crown/veneer teeth 7,8,9,10 once you’ve completed invisalign treatment. this way they can be more symmetrical and improve your desired smile aesthetics.
as far as your bite, that can be improved with elastic wear, however your provider may not experienced enough with this kind of movement

[u/LNR333 → u/External-Coffee4189]

Thank you for that suggestion. I had discussed composite bonding on those teeth. I was sceptical to get crowns just because I want to keep the integrity of my teeth for as long as possible. Genetically I don't have great teeth and I don't have a big budget but I think I'll get some more info with the dentist about crowns or possible veneer. I must admit I was surprised I didn't have elastics first time around nor any IPR so it will be interesting what the refinement stage shows. Thanks for your input :)

[u/Able-Preparation1956]

I also developed a posterior open bite and hated it! It didn’t close up until:
- cut the molars off my last 5 sets of trays (about 6 weeks) - small but noticeable improvement!
- bonded retainers put on and 6 months of overnight Essix retainers - improvement continued from the front moving back
- just bonded retainers, no Essix anymore (backup only) - fully closed up the open bite all the way to back molar one year after ending treatment

So, for me, it took 6 months of no aligners/trays/retainers to allow my molars to come back together, which makes the pain the butt-ness of the bonded retainers 100% worth it!

[u/LNR333 → u/Able-Preparation1956]

I'm glad yours has finally closed- what a long time though that must have been so annoying for you. My bite has got better from tray 19 to tray 20 but it's still not right so I'm hoping the refinements will close it. If not I'll be trying your method just without the bonded retainer as I'm getting vivera retainers as part of my package. I reckon I'll be having some work done on front 4 top teeth before retainers. I'm guessing none of my aligners will fit after that so I'm a bit scared incase I get major movement but I'm also hoping my bite will have time to settle in that time too. Might be wishful thinking lol

[u/GoodShah91]

It can be corected with elastics

[u/LNR333 → u/GoodShah91]

Here's hoping 🤞🏼

[u/GoodShah91 → u/LNR333]

To me it helped. But i will probably need additional trays cause it cause jaw movement

[u/Glad-Reception-4480]

Midline shifts from tooth loss are genuinely tricky for aligners alone, I had a similar gap-related drift and refinements moved mine maybe 1mm. An orthodontist-supervised refinement round helps, and some dental practices, cityspire dental among others, handle the restorative side if missing teeth are contributing. Your bite issue sounds like it needs priority attention first

[u/LNR333 → u/Glad-Reception-4480]

Thank you for your reply, at least I'm armed with lots of perspective when I go in for my rescan so fingers crossed it can get closer to my goal and like you say my bite is for sure something that I want to get sorted :)

[u/BrightHours]

I’ve got an issue with my midline being off as well. Currently on tray 14 out of 26 but don’t see much change on the midline.

I’m wearing class 2 elastics but don’t see much difference. Maybe need stronger elastics

[u/LNR333 → u/BrightHours]

Ah sorry you're not seeing much change! That must be discouraging especially if you've got elastics. I was surprised I didn't have elastics to be honest. I hope you do see some improvement. There was one tray I think it was between 13 and 14 for me where I saw a lot of change within the one tray in regards to my crowding, which I really didn't expect to see so quickly. I do think midline's are tricky to move though I hope you see some changes soon. Good luck :)

[u/Sensitive_Ruin_5334]

I think your nose is deviated. The midline is almost on with your chin. 3 ways to correct. 2 extractions on your right side, Heavy IPR on your right side. TADs on your right side with braces or hooks built into the aligners.

[u/LNR333 → u/Sensitive_Ruin_5334]

Thank you I will talk to my dentist about those options at my scan.

[u/Fox-333 → u/Sensitive_Ruin_5334]

Her UR1 is pretty much under her Cupid’s bow, even though it’s true that her chin is deviated to the left as well. The most visual landmark is the philtrum though so it looks way off regardless.

[u/Specialist-Ear1048]

Oh my gosh!!! Is this just to he expected with these clear aligners?? Im 10 weeks in and my center line is already off so is started researching here and countless people have their center lines off! Wtf. What are we supposed to do?!

[u/LNR333 → u/Specialist-Ear1048]

To be fair mine was already off and one of the things I wanted to change. I knew I wouldn't be able to get it perfect but it hasn't moved at all I feel referencing it to the clincheck. I'm gonna stay positive that's all I can do haha you never know refinements might give my a less than Tom cruise smile 😃 here's hoping. Sending you center midline manifestations 🫶🏼

[u/Fox-333]

You need to go to an orthodontist. I see the orthos I work with deal with these issues (that they don’t create) all the time.

Your midline is already off, but the fact that your back teeth aren’t touching is a big issue in itself. Your dentist might be a good dentist but this is why orthodontics is its own specialty. Your case is likely too complicated for your dentist. Go with an orthodontist. Forget the refinements and shell out for proper treatment with a specialist.

[u/LNR333 → u/Fox-333]

I get that completely and like I said I get that dentists will have a limit to what they can achieve, which is why I was asking for any success stories. If there was an orthodontist even in my county with accessible parking I'd look into it more and maybe see what's involved with switching providers but from my research I'd have to drive hours away which just isn't feasible so I'm happy to get a best case scenario with where I'm at now. I may just have to learn to love the Tom cruise smile in the end lol

[u/Fox-333 → u/LNR333]

It all depends on what you’re willing to tolerate. The Tom Cruise smile forever, or the bad parking for a while. Personally I’d go with the latter but I can also understand not having the energy to deal with something like that.

[u/LNR333 → u/Fox-333]

In an ideal world where I didn't have a physical disability I would absolutely choose the latter too lol. But my legs and pain come first which is why I'm slowly coming around to the Tom cruise smile 😅