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The buttons are called attachments and they are a vital part of the treatment. Without buttons your teeth will not move properly. Most patients get used to them very quickly and unless your trays are not in they should not be very visible.
Sometimes they can be avoided and sometimes they cannot. If you want a truly 100% invisble treatment option then find a dentist who is trained in lingual braces. Invisalign is a great treatment and most patients adapt to the buttons. The buttons are one of the drawbacks to the treatment. However the other benefits such as comfort, ability to remove the aligners outweigh the buttons.
To get the best results from Invisalign it is advisable to use the necessary attachments. Most patients get used to them very quickly, and your health care provider can make them as comfortable and invisible as possible. For my patients who refuse to have attachments put on (which is very rare), I tell them that we will not get the full correction as we would using the attachments. The alternative is traditional braces (or clear aesthetic braces, or lingual braces that go behind the teeth). None of these alternatives are as comfortable as Invisalign aligners with attachments.
Attachments are used to provide an extra grip for tooth movements that are known to be difficult to do with Invisalign. Some attachments are more "important" than others however so ask your doctor if they are all absolutely necessary. Sometimes slowing the treatment down allows treatment without attachments and other times the full movement is not expressed but everyone will still be happy...again, ask your doc!
It certainly sounds like you have a lot of trays but I have seen longer cases. I try to limit my cases to 30-35 trays as more means the case is very complicated. Your dentists may be pushing the limits of what invisalign can do. Speak to your dentist about your concerns.
Drs. Novak, Miyamoto-Shimali, and Waxler have given you wise counsel. ANY type of orthodontic treatment could result in loose or lost teeth if disease such as periodontal disease were present prior to orthodontics and not treated and managed to full health. No competent dentist or orthodontist...
It depends if you got Vivera Retainers or not. If you get Vivera your case is closed, if not then you should be able to do another refinement as long as it has not been 2 years since you case closed.
