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.