Using Invisalign to treat a dental phobic who wants braces

A dental phobic is a person afraid of anything to do with dentists. These phobics are happy to brush and floss but fail to attend for dental treatment for fear of needles and also the drilling procedure.

Case presentation

The following is a case of a young 19 year old female who as a needle phobic had avoided vaccinations, dental injections and had even bit her last dentist on the finger.
She presented with her mom in desperate need of orthodontic treatment.

Naturally she had not accepted dental extractions and fixed orthodontics as a teenager but was now keen to be able to smile.


She was an attractive young girl who did not like to smile.
After careful consideration of her dislike of dentistry and for not losing a finger I examined her and found her suitable for Invisalign treatment.

The patient was a mild class 2 dental and on a class 1 skeletal base

UR3 was half class 2/ UL3 was class 1 leading to a proclined UR1

Centrelines were acceptable

Oral hygiene needed improving

I wanted to reduce the amount of dental procedures for her so I decided:

  • No extractions
  • No interproximal reduction
  • Attachments were delayed for 6 months
  • Upper arch space was created by distalising the molars
  • Lower arch space was created by arch expansion
  • The distalisation of the molars is only possible if the third molars are missing or oven unerupted
  • There were 35 upper and 17 lower aligners


I saw the patient every 6-8 weeks with no problems or tantrums.

At aligner 11 after molar distalisation, the premolars are then distalised allowing the anteriors to start correction.
At the end of the treatment of 18 months I was so happy that we agreed to remove the attachments and then take impressions for retainers.


Unfortunately the dental phobic had spent the last year on Google and had become obsessed with her teeth. She wanted them even straighter and had asked for a second opinion.
Another dentist not knowing how nervous she had been recommended further anterior correction, which would have involved IPR.

She came back to the surgery and started shaking and crying in front of me. I was annoyed as I had already ordered the retainers and this precluded further refinement.

So I was surprised by her change of heart as I had thought that she would be happy just having them straighter. But I was wrong as she wanted the straightest.

I agreed to pay for Invisalign Lite (14 aligners) and she agreed to pay for new retainers.
The upside was that she did refer her mother for Invisalign as well.

The refinements were 7 aligners in total and again no IPR.
She then did not attend for over 15 months and decided to treat herself with the aligners.

After that period the patient attended wanting even more retraction of the UR1, but I refused to bend to her wishes. I commented that she was non- compliant and that if she wanted more work then she should see that other dentist.

After 45 minutes of deliberation and mediation with her mother she agreed to retainers and only after I had contoured the incisal edges of at least 8 anterior teeth.


The patient did have a soft tissue triangular space between 1/1 but that could only be reduced with
aggressive IPR.

The final alignment actually looked worse than the refinement but this was because the patient never attended for reviews.

Invisalign when used to its full potential allows the dentist and patient to benefit from full spacecreation and minimal IPR.

When treatment planning involves the patient then Invisalign can convert the dental phobic into a fully committed dental patient.

Orthodontic referrals can be forwarded to
Dr R Kumar is conducting national seminars on removable orthodontics and Invisalign certification and enquiries can be forwarded to


Leave a Reply