Bump in the road

It was going so smoothly - the final 2 sets of aligners, though a bit painful, came and went, and I was officially done with active treatment.

Ortho and I decided upon Essix retainers made in the office rather than either Invisalign Vivera retainers or fixed retainers behind the teeth. While he prefers fixed, I was not happy about the difficulties with flossing that fixed retainers cause.

Molds were taken, top mold was no good but bottom was fine for pick up. It fit OK, and they took new upper molds.

Pickup day came, and I was asked to insert the new upper retainer. I said it felt tight to go in, assistant said it was supposed to be tight, and so I pushed it in. And promptly cracked off 3 of my 4 veneers. I think a couple of the kids in the other chairs learned a new word, and it wasn't "Fudge."

To say I was angry was an understatement. I had decided to keep my old veneers for another year before incurring the significant expense of new veneers, and now the choice had been made for me. Now, they weren't perfect, but they looked OK, and as they lasted through 18 months of Invisalign aligners there was no good reason they should have cracked off, except the possibility that the retainer had been made incorrectly.

Ortho denied any responsibility, but it seems to me that (1) when I removed my aligner in the morning, everything was fine, as it had been for 400 prior mornings with Invisalign, and (2) suddenly they break off when I switch to an office made retainer, that (3) the ortho and the retainer he made are at least partly to blame. I asked him to consider what he would be willing to pay toward new veneers, and he again denied any responsibility (like a dry cleaner who is never responsible when your shirt comes back with a hole...).

Will leave it for now while I go through the process of getting new veneers, but I am reserving my right to my day in court if ortho doesn't come up with something.

So ortho walked me next door to the cosmetic dentist, who took some molds and photos, put in some pretty nice looking temporary bonded front teeth, and sent me on my way until next week. I am looking at $6500 - $7000 + for new veneers. Ouch!

The Home Stretch

Finishing set 13+ shortly; only 1 set to go. The over-correction (noted by the "+" sign) has been a bit uncomfortable. Over a week into this set, and my teeth still hurt. I haven't helped things much - have been leaving them out more than I would like, so I will keep them in a few more days before moving on to my last set.

I am really ready for treatment to be over. Still not sure about fixed versus removable retainers, but I am fairly sure I will keep my existing veneers for a while more. They still look decent, and I am in no rush for such a big expense.

Experiment

The first 2 sets of refinements have been really easy - little discomfort, even the first day or two, and after a week they feel, maybe not loose, but they certainly go in and out really easily. So I am going to experiment by moving on to the next set at day 11 instead of the full 14 days. Now this is not a real experiment - my orthodontist gave me the option - but I have worn every past aligner for at least 2 weeks, and sometimes longer. If this is successful, the remaining refinements will go that much faster. I'm not counting on it, but it would be nice to be through with treatment already. The weeks I spent wearing aligners only at night (while I waited for the refinements to come in) were quite pleasant. It was good to feel my real teeth all day, and my bite began to settle in.

Refinements are In

Refinements are in. I was surprised to learn that there are 14 upper and lower aligners - was expecting 10 to 12. Two positive developments - (1) No attachments. The aligners go on and off so much more easily, and removal was far less painful this first day; (2)My ortho said that some of his patients change aligners after 1 1/2 weeks instead of two full weeks. He left it up to me whether to attempt to accelerate the process. I am unsure - while I would like to have the process over faster, the materials I have read suggest that 2 weeks is ideal.

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.