Phase 1 Complete; on to refinements

Finished the last of my 23 upper and lower aligners. Orthodontist says there are a couple of teeth he would like to move a bit more. He also said that it looks like some of the upper incisors needing to come down more are not likely to move much - that type of movement is generally tough for Invisalign, and with my veneers it makes it even more difficult. He said he will try, but not to expect much; that new veneers will make everything look great (though I am not looking forward to the expense of all new veneers).

Meanwhile, he ground off my attachments and took new impressions for refinements. He expect 5-10 aligners for round 2, followed by retainers which he will make in-office. They also took new photos. Will post when available.

The last aligners feel strange without attachments - there is no "click" to know they are properly placed, and they are much easier to remove. He told me to wear the aligners only at night until the refinements are in - he is hoping some of the teeth in the back will "settle in" - with Invisalign the aligner prevents full contact of the teeth, so they need time without aligners to get into final positions.

The FDA and Invisalign

The recent activity between the FDA and Align Technology is concerning. Seems the makers of Invisalign have been neglecting to report side effects reported to them by patients and dental professionals. This is an FDA requirement for makers of medical devices.

This was a concern of mine going in...I have sensitivities to many chemicals, and Invisalign aligners are essentially plastic gadgets you leave in your mouth nearly full time for a year or more. I also read that the aligners are sprayed with a disinfectant before leaving the factory; the disinfectant could also cause reactions.

What should we all be doing about it? First, keep an eye out for side effects like swelling, sore throats, itching lips or gums. Keep you orthodontist in the loop, and don't be afraid to report to the company or FDA. I also take the precaution of thoroughly cleaning fresh aligners before inserting them. This means soaking in Dentasoak (which I love [unpaid endorsement]) for 15 minutes, then brushing with a toothbrush and a little low abrasive toothpaste, then a good rinsing in warm water. Seems to take away the "plasticy" taste and odor of new aligners.

Another month; On my soapbox...

October has come and gone. Using my aligners as a Halloween candy defense - the longer I keep them in, the less candy I will eat.

Had an ortho appointment earlier in the week. I am on set 19 of 22. We started to talk about end plans. One lateral incisor and one canine are not tracking/moving as well as the rest of my teeth. My ortho felt that I might not need refinements since my 4 upper incisors have veneers and any remaining cosmetic issues could be dealt with through new veneers. My feeling is to do the refinements and get as much tooth movement as we can, and rely less on the talent of the dentist making the veneers, though I do expect to have to replace at least two of them (if not all). Ortho did not object to my preference,and said to plan for new impressions at my next visit when I will have completed the final set of aligners. He thinks any course of refinement will be half or less the time of my original treatment.

This conversation puts me back on my soapbox. Whether for Invisalign or for any medical treatment, it is incumbent upon us as patients and consumers to play an active role in our treatment, from selecting a doc, to reviewing treatment options, to assessing progress, to deciding an end game. We simply can't sit back and let someone else make decisions for us. A medical professional brings specialized knowledge and expertise to the table, but should be treated as part of your health care team, with you as the leader, quarterback, manager, or whatever other euphemism you prefer. Only you know what you will consider a treatment success or failure. Your expectations are hopefully shaped by the advice of your experts, but ultimately only you will decide if you are happy.

For Invisalign, you should all become armchair experts, as I have. When I had LASIK, I became an expert in laser eye surgery. Be educated, be assertive (but polite), and if the doc needs to be God and can't deal with this, find a new doc.

Been a while...

Wow - it's been a while since my last post. Guess I haven't had much to say. I am on set 17 of 22 now. Set 16 was particularly painful, and my usual tricks of Sensodyne, starting a set right before bed, and minimizing "out time" during the first few days did not work. I was away on business for a few days, so I kept that set in for an extra 2 days. Set 17 went in much easier, and has been much less uncomfortable.

Had an ortho checkup last week. Things still look good, though an upper lateral incisor and cuspid are not tracking as well as the rest of my mouth. Doc was not concerned. He expects in most of his Invisalign patients a course of refinements about half as long as the original course - so for me that would be another 11 or 12 aligners. In addition, he thought part of the correction could be achieved through new veneers, since my upper incisors already have veneers, and it is looking like I will need to replace them after treatment is complete. I am not so happy with that suggestion - good veneers are quite expensive. My current veneers are adequate, not spectacular, but the dentist who did them gave me a price I couldn't refuse.

Vacation time

I decided to stick to the program and swap out my aligners on the second night of vacation. This set went in easily, but I was definitely feeling it the next couple of days, even with liberal use of Sensodyne toothpaste. Not that it slowed my vacation eating any - so much for the Invisalign diet - breakfast buffets, ice cream treats, and other goodies were there the entire week.

Progress continues, though during the last sets my teeth looked so good, this set is one of those "transitional/my teeth don't look right" sets. As before, patience is necessary - I'm sure in a set or two things will look good again. I continue to have concern that a couple of teeth are not tracking well, though my ortho says everything looks great. I still expect that I will need some refinements. I will be glad when the whole process is over, but will deal with extra weeks of refinements - the whole process overall has not been bad, so what are a few extra aligners?

Lucky 13

Set 12 went off without a hitch. Had a good ortho checkup; everything continues to go as planned. He gave me 4 sets of aligners and an appointment in 8 weeks - my longest stretch between appointments (he actually asked me if I wanted 3 or 4 sets).

Set 13 is still tight 8 days into the set - I think this is the longest time I have noticed tightness. I have been using the chewies every time I insert the aligners (recommended by Dr. Jason Tam of Markham Orthodontics, who is a frequent poster on the Invisalign boards and has some great informational videos on youtube). Maybe the aligners are just seating better than before so I am feeling it longer.

For my increase in chewie use, I ordered some mint-flavored chewies. They don't taste bad, and it gives a little bit of a feeling of chewing gum, which I miss since I began treatment in February. I will again float the idea of making the aligners mint flavored - might be nice to have a hint of minty freshness all day.

I am back to the vacation dilemma I had in March. We are going away starting Monday, which is the day I would normally switch to the next set of aligners. I took an extra week back then, and also an extra week in July when I was sick, so I am reluctant to extend my treatment yet another week. I will make a final decision over the weekend.

Minor delay

Was flat on my back sick as a dog for nearly 5 days last week. Well, ordinarily illness would not be an issue, but multiple sessions of cookie tossing are not conducive to aligner wearing, and they were out for much of those days.

So I wore set 11 for an extra week, and am now wearing set 12. They went in fairly easily, but as I slacked off on the Sensodyne toothpaste again, I am feeling some soreness the past 2 days. The only other change is that I am using the aligner "chewies" more frequently, to ensure the aligners seat well and I get maximum movement for this aligner.

Halfway point

How could I have missed the fact that I am now at the halfway point? Now, when I say halfway, I mean that I am on set 11 of 22 upper and lower aligners; but I know quite well that this is just the initial treatment. There could be a whole new set of refinements when I hit the magic 22. Even so, I am quite pleased to be at the 50% mark - things have gone well, I have not had much trouble adjusting to Invisalign, and hope the rest goes as well.

On another note, while checking into a hotel yesterday, the bell hop said "can I ask you a personal question?" I said "fire away" and he said "does your insurance cover Invisalign?" I told him that my insurance covers about one-third of the $6600 price tag. I also said that I was surprised he could tell I was wearing the aligners - nobody has ever said anything before, and as I noted in an earlier posting, my wife and even orthodontist don't even notice. Anyway, he said he went through 2 sets of braces - once as a teen and again in his 20s, and he feels his teeth have shifted again. Funny, they looked movie star perfect to me...

Long time, no post

Wow - over 3 weeks without a post. Things have been so quiet that there was nothing to say.

While the time was uneventful, I was a bit lax with aligner set #10. I left them out for longer than I should have for a few days last week - one afternoon for a barbecue, one night from before dinner until bedtime, etc... I know some people feel it is OK to slack off near the end of a set of aligners, but I decided to extend my wear until yesterday, 2 days extra, so I would get enough hours for that set (supposed to be 280 to 300 hours per set).

#11 went in tightly, and my teeth are sore all over my mouth. The last few weeks were nearly discomfort-free, so I slacked off on Sensodyne as well, but I am going to use it at least twice a day for the next few days. It really does help with the discomfort.

Good checkup

Ortho checkup this morning went very well. As in the past, everything looks good; my teeth are tracking the aligners and moving nicely. The bone loss issue from my dentist seems to be a non-issue - my ortho says that (1) it would take 6 to 9 months for bone loss to result from invisalign, and (2) the panex panoramic x-ray he took looks fine - there is no evidence of bone loss.

I asked about refinements, but he said it was too early to tell. I also asked about IPR (interproximal reductions - filing small spaces between certain teeth to allow for movement), and he said that he planned the case to have no IPR, which I am glad to hear.

I was given 3 more sets of aligners, and sent on my way for another 7 weeks.

Number 9 Number 9

Breezed right through aligner set 8 and into set #9. This set went in much more easily than the last 2 sets - there was no struggle to get them in, and minimal discomfort. I do find that the trick I used to remove the lower aligner doesn't work anymore, so I had to find a new spot in the back to use a nail and remove it.

Orthodontist appointment next week. Still need to look at the bone loss issue seen by my dentist. Fingers crossed that it is nothing.

Meanwhile, I continue to see real changes in my smile and bite, though the temporary misalignment on the left side molars remains annoying.

Dental checkup

Had my first dental checkup since starting Invisalign. While generally a positive checkup, as expected, there was more tartar around my teeth than usual. As much as I brush, floss and rinse, there is no escaping that having aligners covering my teeth 22 hours a day creates an environment conducive to dental problems. I suspect many Invisalign wearers end up with cavities or gum issues in the short term.

More concerning is that the dentist said he saw some possible bone loss on a molar. He said this was not unexpected due to the combination of my age (42) plus orthodontic treatment. He suggested I get a panoramic x-ray from my orthodontist and see if I need to see a periodontist - might need some bone filler. This is discouraging - I brush and floss and fluoride rinse diligently, and began taking calcium supplements when I began treatment. Not sure what else I could have dome to prevent this.

Will discuss further after my next ortho appointment in 3 weeks.

Bite is off

Really starting to notice the changes to my bite. This is a hopeful sign, but I am finding it more difficult to chew my food this week. The teeth on one side of my mouth don't come together well for chewing. I know this is temporary, as we move the upper teeth outward, but it is annoying - it seems like I am only semi-chewing everything, or favoring the other side of my mouth. We'll see where we are in a few weeks - it's not like I'm starving...

Lucky 7

I don't know why I continue to be surprised that a new aligner means pressure and discomfort for a couple of days... #7 went in last night without too much trouble - top was very snug - I used a "chewie" to help seat it, and chomped on it for a while to be sure the aligner was in well.

Yesterday I saw a friend whom I had apparently not seen in person for about 3 months. I immediately noticed he was wearing Invisalign, pointed to mine, and we chatted. Odd that his aligners were so noticeable to me - not sure if I am just more aware of Invisalign and am apt to notice another patient, or that his really were more visible than I think mine are.

He is on aligner 7 of 10 (I wonder if he is doing Invisalign Lite), and says he has been sick of it for some time and wants it over already. While I understand the hassles of Invisalign, I have found the whole process to be not so bad - especially since we must remind ourselves that we are moving our teeth, which are normally anchored into our jaws... That being said, I would certainly prefer my friend's 10 sets to my 22!

My friend and I have both benefited from the "Invisalign diet". I am down 25 lbs., and plan to continue to lose; Invisalign makes it that much harder to snack or graze, since I am always anxious to brush my teeth and get the aligners back in. My biggest snacking time is evening; I have found that by brushing, swishing with fluoride rinse, and popping in my aligners I am much less like to overindulge in snacking. If the urge to snack after dinner is great, sometimes I will force myself to brush and put in the aligners to stave off a snack attack.

Good checkup

Had an orthodontist checkup this morning. He looked in my mouth for a few seconds, said everything looked good, asked me how things were going, and gave me 3 more sets of aligners. I am glad all is well, but sort of wish he had to do a little more work to justify the huge fees I am paying for Invisalign.

I recounted to the doc something from the other day - I was in the men's room brushing my teeth and aligners after lunch, when another fellow walked in, popped out his aligners and brushed as well. He said he was at nearly the 2 year mark with invisalign, and still had another 6 months to go. His ortho had originally told him the whole job would be less than 1 year.

My ortho said that it all comes down to case selection; that Invisalign does some things better than others, and that an Invisalign job should never take more than 1 year. If it is longer, then the patient was not a good candidate for Invisalign, and the ortho should not have taken the case.

If the above is true, then maybe I should reconsider the first paragraph above - that my ortho's case selection and initial setup of my Invisalign case (molds, ClinCheck planning, etc.) were where my money was spent, and that a good job then paved the way for uneventful checkups and a hopefully successful, under 1 year long, case. Like having a good architect design your building from the outset.

Still hurting

This is something new - it's Wednesday and my teeth are still quite sore from the Sunday new set of aligners.

My teeth are hurting all over my mouth. There is a lot of movement going on in this set, front and back, top and bottom. I can feel the upper arch widening where I thought I had the biggest issue pre-treatment. Also, there are small indentations in the upper aligner near the gumline for two upper incisors, called "power ridges". I can't get attachments on my upper incisors because all 4 teeth have veneers.

I have been using Sensodyne more frequently - I generally use only at night, but have been using it mornings as well. Other than that I am just dealing with the discomfort.

Set #6

The last 2 weeks have gone smoothly. I did have a couple of lazy days where I wore the aligners for fewer hours than ideal (18 or 19 hours instead of 20-22). Though I started set #5 on a Saturday, I decided to wear the aligners for an extra day and not switch out until Sunday night, so I would be closer to 300 hours of wear for the set.

The new set is very snug, even after wearing them overnight. Getting the upper aligner in last night was a bit of a challenge, and I ended up biting on a chewie for an hour after insertion to help the aligner sit properly.

The gap between my front teeth is even bigger now, but the ClinCheck shows it closing up again with the next 3 sets of aligners, so I am not worried yet.

My ClinCheck movie

Here is my ClinCheck movie My ClinCheck.  I have read that ClinCheck shows the ideal movement, and that actual movement may vary, sometimes significantly, from the graphic.  I guess that is why so many cases need refinements (new impressions plus a small number of new aligners) after completion of the initial treatment. 

Worse before better

I knew it was coming because I saw it on the ClinCheck, but I am still not happy that a small gap is developing between my top front teeth.  (ClinCheck is a computer graphic provided by Invisalign showing how they expect your teeth to move through the course of treatment.)

Fortunately the gap is not visible when the aligners are in.  If things go according to plan, the gap will close by aligner # 12 (I am on set #5 now).  I am assuming that it is necessary as my top teeth are moved laterally (sideways) to get my midlines to match up.

Back from vacation

Home this evening, very glad I kept the old aligners in.  I had them in and out several times a day the whole week, for eating, swimming, did I mention eating?  Good thing we did an enormous amount of walking every day as well.

Decided to pop in the new set after dinner to ease some of the guilt of the vacation delay.  Surprisingly, I had none of the trouble getting them in as I had last time.  They are certainly snug, and a bit uncomfortable, but they went right in.  Only issue this time was that the bottom aligner was rubbing my gums in the back, behind the second lower molar (wisdom teeth out 20 years ago).  I removed the bottom aligner, saw where the aligner was rubbing the gums, and used the "finishing" side of a nail file to remove some aligner material and hopfully make it more comfortable.  After a couple of tries, filing, washing, and reinserting, I think I fixed it.

By the way, I see the number of hits on this blog has been growing.  I'd love to see some comments... just say hi, or why you are reading, crack wise, or impart some of your own wisdom.  And thanks for reading!

Vacation day 1

So I am that certain holding off on the new set of aligners was the correct decision - first day of vacation and I had the aligners in and out so many times that I'm not quite sure how many hours they were actually in.  Fortunately I had 2 compliant weeks already, so the third week is cake...

Vacation decision

Thanks to some helpful comments on the Invisalign bulletin boards, I have decided to keep my trays in for an extra week while I am on vacation.  Why?  (1) who wants to deal with the discomfort of new trays on vacation? (2) vacation time means less compliance with the 22 hour rule (3) no swimming with aligners in your mouth (4) will only be a 5 day delay - from Monday to Saturday, and then I can be extra compliant with the new trays.

Hooray for the bedtime trick

The bedtime trick worked again.  After inserting the new aligners last night with some difficulty, I went right to bed.  This morning the aligners were snug, but came right out, and reinsertion after breakfast and brushing was no problem.  Now, I still feel the pressure, a lot more than at the end of the previous aligners, but it is not painful and there should be no issue with going about my regular routines.  And since I'm eating low carb, I don't have to worry about biting into crusty bread or crunchy carrots, which I am certain would be quite uncomfortable the next couple of days.

Set 4 is in...barely

Ready for aligner set #4.  Almost ready for bed.  Teeth brushed and flossed and fluoride rinsed.  Now to put in the new aligners.  Let's start with the lower.  First try - won't go in, second try, they click in - victory!  Super tight.  Now the upper.  First try - not even close; second try - right side clicks in, but left and front not working.  Now to try a little more muscle - right, lllleeeeefffttt...click, push front up as far as I can without really forcing it...  I guess it is in.  Ouch.  Now to try a chewie for a few minutes to get it to seat better in the front.  Then some tylenol and bed.  Hope the morning is better.

Why two weeks?

I read somewhere that Invisalign recommends wearing each set of aligners for 250 to 300 hours - hence, the 2 week schedule (called "activation time").  The closer to 300 hours, the better.  I think at some point many folks were swapping aligners after only 1 week, and results were not as good.

I'm just an armchair orthodontist, but I suspect that teeth move in the first week and stabilize the second, so they are more ready to move when the aligners are swapped.  That would explain the pressure in week one, and relative looseness in week two, especially near the end as I am now.  It is tempting to swap early, but I will wait out the full two weeks and swap on Monday night.  Conventional braces are generally tightened only once a month, so Invisalign may move the teeth more efficiently.

On the additional benefits front, the Invisalign diet continues.  I am using the aligners as a very good excuse not to snack.  I have combined this with a low carb approach, and am down 15 lbs. in 4 weeks.

Now that's better...

A week into the third set of aligners and the tightness has finally waned.  I was surprised it took so long, but with my teeth being pushed, pulled and torqued, I suppose it takes a while for movement.  I find I am still playing with the aligners with my tongue; it feels like flavorless gum attached to my teeth. 

***Hmmm - I wonder if they could impregnate mint flavoring into the aligners so they always taste good?***

I've been thinking ahead to my vacation at the end of the month.  I am scheduled to change aligners early in the vacation week.  I'm wondering whether I should keep the old aligners in for an extra week for vacation comfort.  I am leaning toward "lumping it" and keeping to my schedule.  Why torture myself?   The discomfort is not really that bad, it will keep me from stuffing my face the entire vacation (the Invisalign Diet is still in full force and effect), and I want the whole Invisalign process over as soon as possible. 

I don't really expect my entire course of treatment to be over in 44 weeks:
-my ortho said up front that I should expect refinements, bringing me up to about 1 year
-I have veneers on my top 4 incisors (front teeth) which may need to be replaced once treatment is over.  This will mean new molds, the wait for the aligners, and possible setbacks...

Still tight

Just a quick check-in.  I have been wearing the 3rd set of aligners since Monday night, and they are still quite tight.  The first two sets were not nearly as tight after 3 nights.  Hope this means more progress...

Better this morning

Well, the overnight trick was successful.  This morning I was able to remove the aligners pretty easily.  They are still quite tight, and I feel the pressure, but not nearly as bad as last night. 

I suppose I should be glad I am feeling it - kind of like sore muscles the day after a good workout - how else will my teeth move where they are supposed to go?

Ouch!

Note to self:  Never say out loud that the aligners are comfortable and hardly hurt.  Just put in set #3.  They are much tighter than the first 2 sets.  I could barely get them in, they hurt immediately, and I spent the last 10 minutes biting on a "chewie" (a small foam cylinder) to be sure the aligners are seated properly.  Here's hoping that the overnight trick works its magic.

"I see you're not wearing the aligners now"

Had my 4 week visit with my ortho.  Funny thing - he said "I see you're not wearing the aligners now" when he greeted me, but I was.  That is how invisible the aligners can be.  He asked me to show him my teeth, and remarked that my aligners looked very clean. 

(Unpaid endorsement - I use Dentasoak every morning, and brush the aligners with a regular toothbrush and water after meals, so they do stay pretty clean and fresh.)

So he checked the fit of my 2nd set - a bit loose, and very easy to remove, after a full 2 weeks of wear.  He said everything looked good, and that my teeth were moving according to plan.  Since I was very compliant with wearing the aligners, he gave me 4 new sets of aligners (an 8 week supply), and scheduled a follow up visit in 8 weeks.

I told him I planned to put in the new set at night, so removal would be easier after a night's sleep.  He said he hears that a lot, and is recommending this practice to many of his patients.

 

Cruising along and the Invisalign Diet

At the outset of this blog I thought there would be much to say, but three weeks along my Invisalign experience has been remarkably uneventful.  While I am conscious of the aligners and tend to "play" with them with my tongue, they are not particularly intrusive or bothersome.  Insertion and removal have become a quick process.  While I hope that the next 41 weeks are as easy, I am sure there will be some bumps along the way.  My biggest concern is that one of the veneers on the top front teeth will come off or break, causing a slow down in my progress, possible new molds, etc...

On the plus side, I planned to use my Invisalign time as an excuse to begin a diet.  I figured (1) my mouth would hurt and I wouldn't feel like eating, or at least would eat softer food, and (2) at the very least I could cut way back on snacks since you can't eat with the aligners in your mouth, and removing them, though easier than I thought, is still an impediment to constant snacking.

I definitely did decrease snacking the first two weeks, and in the third week began a modified South Beach low carb diet.  And have lost 7 pounds without too much effort.  Nice!  Even if I go back to my less healthy higher carb diet, I think I will continue to take advantage of the "no eating while the aligners are in" rule, which can only help me lose a few more.

Not so bad

The new aligners at night gambit paid off.  The aligners came right out in the AM, no hassle and no pain.  Aligners still feel a bit snug, but they are coming out relatively easily.

Week 2 ends

Finished out the second week.  Aligners are fitting much looser than the first few days. I would even say they are comfortable.  My teeth have shifted - there is more space between the teeth for flossing, and my bite sits differently.  Nice to see some early progress.

Decided to put in the second set of aligners tonight; I figured it would be easier to remove them in the morning.  Still not looking forward to removing them in the AM - it may be a bit uncomfortable or painful.  New set is very tight - how soon I forgot how tight set 1 was 2 weeks ago.

So this is me...

At first glance, my before smile looks pretty good.  No teeth sticking out in odd directions, or large spaces.  But a look at the closups shows the issues I want corrected - misalignment in front and sides, slight open bite.

Initial photo - right

Initial photo - left

Initial photo - front

Moving along

Week 2 is almost over.  My teeth have definitely moved already, and the aligners are much looser than in the first few days.  The top comes out quite easily, and the bottom easier than before, though the attachments on one side seem to stick, which means that removal still hurts a bit. 

Reasons

So why am I going through this at my age? At first glance my teeth look don't look bad at all largely thanks to veneers on the upper incisors (lower teeth look OK to begin with). However, my bite is off - I have a slight open bite, the midline of my front teeth is off, and the back teeth don't mesh, meaning chewing and biting are just not right.

Both orthos I consulted said they were surprised I did not have TMJ (jaw) pain, and I would probably develop pain in the future. It would be nice to have an improved smile and actually be able to bite and chew properly.

My insurance will cover a good piece of the fees, and I am hoping the whole process will be less than 1 year. I have 22 upper and lower aligners, bringing me to 44 weeks, plus the possibility of refinements, so I should be on target.

First day

First visit after impressions was to have attachments attached, and to install the first aligners. Attachments was a fairly easy process - tooth surface is prepared (maybe an acid etch?), the material is placed in an aligner, then the aligner is inserted and a special light device is used to harden the material. I have 1 upper attachment and 5 lower.

Since the aligners went in with the attachments, I was done. The doc gave me 2 cases, the second set of aligners, and some "chewies", and told me to leave the aligners in for a couple of hours. After that, I was to remove them for meals and brushing.

Wish I had been given the chance to practice insertion and removal of the aligners. At lunchtime I removed the upper fairly easily, but the lower was a bitch. Felt like I was pulling my teeth out by the roots. Finally worked it out, but 2 of the attachments came out with the aligner. D'oh!

Welcome

So my adventure in Invisalign begins. Consulted with a couple of orthodontists in November, waited until January so my flexible spending account would kick in, and went to my chosen ortho to begin the process the first week of January.