Todd Dickerson, DDS

Assuming the aligner is tight from movement teeth moving, you should not change yet. Pain, pressure and fit are used to evaluate when to change. You can decrease the pain and pressure as well as accelerate tooth movement with OrthoPulse.  Visit our website or look up OrthoPulse to learn about the technology. I assume you are being treated by an orthodontist. You can possibly get an orthopulse unit from a dentist, but most orthodontist haven't seen these yet, so it's pretty much a guarantee a general dentist will have never heard of photobiomodulation.

Assuming you could see your upper teeth prior to braces more than you can now, the treatment most likely intruded the upper anteriors to get the bite in a good position. Hard to tell if there was a better way to do this, but usually we try to increase the smile arc and these flat smiles can be due to bracket positioning. Ask your orthodontist about the smile arc and flatness. Honestly, if a general dentist did your treatment, you are better off asking an orthodontist to correct this for you. Make sure to ask about smile arch in particular.

Yep, broaden the arch. See an orthodontist and they will help you and evaluate the other parameters. Invisalign will work, although you will see the change more slowly. Maybe even consider 6 months of braces if you can endure it, and then fine tune with Invisalign. We also use OrthoPulse on all of our adult patients to accelerate treatment and expect most to be done in about a year under our OP protocol. Dr. D

It's really tough to tell from the angle of the photo, but:

-I suspect you can be treated nonextraction because of how narrow your upper archform appears in what is visible. If you want to decrease the fullness of you lips, extraction is probably the solution. In these optional cases,we often wait 6 months and revisit that question. Dr. D

You can have the wisdom teeth removed any time during treatment. I would recommend starting the straightening and then removing wisdom during or after treatment since the orthodontics is going to take  the longest and removal can be done at anytime during treatment. Dr. D

Yes, that's quite a while to have braces, but you should seek additional help. Your bite is not visible in the photos, but I suspect it can be improved and maybe even help your tmj issues. We treat a lot of patients nonsurgically that were told surgery was the only option, so I suspect you may be able to find the same where ever you may live. 

Yes, Invisalign or other aligners will move your teeth to an ideal position, as will braces. Remember, Invisalign is simply a brand name for one of the clear plastic removable aligner companies. It is simply the best known. At the time of this writing, Invisalign is the best clear plastic aligner available in the US, but that may change as there are other good alternatives entering the market. The key is the provider, however, not the product, don't let a massive amount of marketing money confuse you.

Brackets are often placed high to improve the smile arc. This is totally normal and usually gives you a more natural looking finish and smile.