Marlon Moldez, DMD, MSc, PhD

Did the pain start after inserting the new tray? IF so, your teeth are not quite ready for the next tray, you may need to go back to the previous tray to allow gentle tooth movement to take place for more days. If the pain is due to pressure from the new tray, the pain should subside the moment you step back to the previous tray. If not you need to identify what makes the sharp pain worse. A sharp pain (that does not get better after going back to previous tray) from chewing, cold/hot or sweet food means a lot of things: dental cavity, fracture or infection (root infection or gingivitis) and require immediate attention. It is also possible that as a result of tooth movement, you develop heavy contacts between your upper and lower teeth when biting or eating. If this is the case, you need to avoid clenching your teeth and biting hard. Keep your teeth apart with lips closed. The only time your teeth should meet is when your are swallowing or chewing otherwise, keep them apart to allow healing. You will surely get better.

get well soon.

dr moldez

To quantify the changes resulting from braces or Invisalign treatment, a measurement comparison between baseline records (pictures, models, x-rays) of your jaws, teeth and facial profile with new freshly taken similar records. Obviously, tooth repositioning due to Invisalign or braces that changes the bite is reversible and to some degree can reverse the changes in the facial profile. However, it is important to understand that not all facial changes during orthodontic therapy are due to the treatment. Consulting your orthodontist is advisable.

It is difficult to assess your facial profile in your picture. However, I dare guess that  you have pleasing facial balance, however your overjet is significant such that your jaw function is affected (speech, biting, etc). 

Correct diagnosis is very important to answer your question. First we need to know the cause of large overjet. A mild to moderate overjet due to dental imbalance can be corrected with extraction of upper 1st premolars to resolve both crowding and overjet. Your orthodontist can attain these goals with either invisalign or braces. However, it is important to realize that moving your front teeth may adversely affect your facial balance. It is important that the planned orthodontic treatment will improve and not disfigure your already pleasing facial profile.

Another possible reason for your overjet is small lower jaw. A severe overjet due to severe jaw discrepancy will require a surgical correction to attain facial balance and good function. Be cautious in proceeding with braces or invisalign correction when there is underlying severe skeletal imbalance since the outcome is usually poor for both function and facial esthetics. Again, correct diagnosis is important for a great orthodontic/Invisalign outcome. Please consult your orthodontist.

All the best,
Dr. Marlon Moldez

Invisalign trays delivers light pressure on ligaments, vessels and tissues surrounding your teeth. Thus, fluid is squeezed out, tissues are compressed. This cascade of events happens immediately within seconds of tray insertion. Within minutes of insertion, inflammatory mediators are activated, hence pain is felt. 2 days after, the cells that remove (osteoclast) and deposit (osteoblasts) bone around your teeth are activated, thus tooth mobility/movement occurs in the following days. You should allow 14 days before you go on to the next tray to allow bone remodelling to take place. Insertion of a new tray before remodelling is complete will cause undermining resorption and excessive tooth mobility and pain.

Interproximal reduction (IPR) is required to create space to move teeth into for alignment. It also increases tooth contact areas that helps in stability after braces. Your enamel around your teeth is about 2-3mm. The ideal IPR removes 0.25 to .5mm of enamel and is within safe limits.

Best regards,
Dr. Marlon Moldez

To answer your question, let me start with the two main goals of orthodontics: establishing pleasing facial balance and functional occlusion/bite that promote health and longevity of temporomandibular joints and related structures-teeth, gums, bone,muscles, etc. In order to attain these goals, an accurate diagnosis is required. In your case, it is apparent that your lower jaw is larger than normal and adversely affects your facial proportion/balance and TMJ function. This is called dysfunction due to skeletal deformity. Cephalometric analysis is required to determine the severity of your skeletal disharmony. The greater the degree of discrepancy the greater the need for surgical intervention. Your orthodontist can properly advise you whether Invisalign alone or in conjunction with surgery is feasible. If you do Invisalign only, your orthodontist will require extraction of the lower first premolars and move your lower front teeth toward the back. The adverse effect of this procedure is deterioration of facial balance and dysfunction depending on the severity of skeletal disharmony. The best option is to align your teeth within the limits of your upper and lower jaws with invisalign or braces then do orthognathic surgery to set align jaws normally to establish facial balance, optimal dental relationship or bite and normal TMJ function. Due to possible underlying skeletal disharmony, your best option is to consult your orthodontist for possible orthodontics with braces or invisalign in conjunction with corrective surgery
Best regards, 
Dr. Marlon Moldez