Starting my Invisalign Journey

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*Treatment results may vary

My dentist as a teenager said my teeth would be...

My dentist as a teenager said my teeth would be "fine" and it wasn't until I was 17 years old that he referred me to see an orthodontist. At that time I was recommended to have four extractions, surgery for retrognathic mandible and traditional braces. Due to a variety of reasons me/my family declined at that point.

I have been quite self conscious of my teeth since then, and am now 28 years old. I finally did some research about Invisalign. After contemplating it for a few months and reading some reviews, I went for an orthodontic consult.

My issues include:
Angle Class 2, divison 2, subdivison left
Overbite 50%
Overjet 5mm
Moderate crowding maxillary arch, 6mm
Mild crowding mandibular arch, 4mm
Skeletal class 2, retrognathic mandible

The orthodontist felt I am indeed an Invisalign candidate. I may need up to 2 years of treatment and will require class II elastics to distalize the posterior maxillary teeth throughout the treatment. I will need extraction of 1.8 and 2.8 (upper wisdom teeth) to make room for this correction.

January 27th - I went for moulds and records. They did 2 sets of molds, a Panorex, cephalic X-ray and digital photograms. I will start my treatment Feb 27th, and have my upper wisdom teeth extracted sometime in March. My orthodontist prefers my extraction to occur after I start my 1st set of aligners, to take advantage of the inflammation / healing process to start the movement of the upper teeth distally (instead of waiting weeks to months after to start Invisalign).

I am a bit hesitant as to how obvious my Invisalign will be (given the elastics and attachments, likely on my front teeth), but I hope they will be a bit less noticeable than traditional braces. One of my main concerns is that I look quite young for my age. I work in health care and find my "youthful" look can make patients a bit less trusting of me.

Any tips and advice is much appreciated!

Day 1 Invisalign

Well yesterday (February 27th) was Invisalign day!

At my appointment the assistant explained a bit about Invisalign and I practiced taking them on and off. Without attachments? Easy! She then placed my attachments which was no problem or discomfort. I have a total of 10 upper and 10 lower - four of my teeth have two attachments on them. Once the attachments were on, getting the aligners on and off required more force but not much of a problem.

The orthodontist took a look to confirm she was happy with the attachment placement and aligner fit and then showed me my ClinCheck video. I will have 39 aligners (although the bottom teeth move into place within the first ~15-20 aligners I believe) plus potential refinements. Essentially, the front teeth (my biggest problem) will not move until tray 16/17, as they are distalizing all my other teeth first in order to make room. So it will be awhile before I can see progress on my smile itself. The lower front teeth will move almost immediately, though. I am getting my wisdom teeth extracted March 14th (before tray 2) and I will have my next follow-up appointment in 6 weeks, prior to tray 4, when I will start my elastics.

I had dinner and put in my trays - my first thought? Wow, this is tight! I tried to practice speaking as I had a bit of a lisp, which didn't seem to resolve. I attempted to sleep but had major insomnia - not because of pain, I think just because of my mouth feeling different. In the morning, my teeth were a bit sore but I was able to eat breakfast (oatmeal) without a problem. By lunch and mid-day, a bit more sore, but not enough to require analgesics. There are a few sharp areas that I have filed down that have irritated my tongue, so it's a bit tender as well. A few of my teeth have bite tenderness but again, nothing severe and not like a "tooth ache" per se.

My lisp actually felt worse this morning - potentially because of fatigue and a bit more soreness, so I am still hoping it will resolve. I actually feel like people were noticing the change in my voice more than the aligners at work - nobody said anything and nobody stared. Although I have two small attachments on one of my front teeth, that actually isn't the most noticeable. The canine attachments (both upper and lower) are a lot more noticeable when I speak.

Tray 1 Week 1

I survived my first week of Invisalign! Surprisingly, it went better than expected. The discomfort was fairly mild and I didn't have any sore areas as I filed down the edges the first day. My lisp is mostly gone as long as I keep hydrated. I even survived a holiday week travelling and bringing my toothbrush etc everywhere.

Unfortunately 4 of my bottom attachments which were on two crowns fell off (however, I still have 6 and the trays fit tightly) which I will be getting them replaced this week.

I am also getting Acceledent! I am excited, the cost will be $1000 but if it cuts my treatment time down it is definitely worth it.

Attachments Replaced, Acceledent, Tray 2 and Wisdom teeth extraction

Lots to update on! I went back and my attachments on my lower teeth replaced. It was fine except for a bit of a problem with glue stuck between the teeth afterwards that they had to drill out.

My Acceledent also arrived! I was charged $1000 Canadian, no tax, which I think is quite reasonable. I have seen between $1200-$1400 on RealSelf, so I suspect my orthodontist sold it to me "at cost". I will be now changing my trays every week, after I re-start Tray 2 when I am healed from my wisdom teeth extraction. This could mean I finish my 38 remaining aligners by the end of 2014! Definitely worth every penny for the accelerated treatment.

I will heading back in ~2 weeks, after Tray 3, to start my elastics. Of course, I am not thrilled to be getting them, but I understand they are important component of my treatment. In addition, I now don't particularly care if other people notice my Invisalign, although nobody has mentioned anything. I have now noticed people who have metal braces that I never knew did in the past -- it just goes to show how little others notice/care about other people's teeth. I hope that can be reassuring for others!

I put in Tray 2 last night and it was tight as expected, but not much discomfort. This morning I had my four (three impacted) wisdom teeth removed under IV conscious sedation. It was fine, but my mouth is quite sore and I am unable to take in anything besides liquids. My ortho suggested I could try to put in Tray 2 after 24 hours, but my oral surgeon suggested waiting at least 48-72 hours as there may be significant edema still at that point. As of now my aligners definitely couldn't go in, as it hurts to open my mouth wide enough to eat yogurt.

Once they are in I will then start the Acceledent, and do 7 days in Tray 2 starting from that day. I am hoping it won't be terribly painful when I put it back in, but I suppose I could go back to Tray 1 if absolutely required.

Tray 3 and Elastics

The switch from Tray 2 to Tray 3 was easy, except for some issues with the aligner not fitting completely tightly over my lower right 2nd molar (the tray can move up/down 1-2mm). I emailed my orthodontist, who wasn't concerned as this tooth has minimal movement. A few days later, I also noticed the the upper aligner also can move up/down ever so slightly over the upper left 2nd molar.

Today I went in and they are happy with the progress so far. I had one stubborn attachment replaced again (over a crown) and had the metal buttons added to my lower 2nd molars for anchoring my elastics. My elastics are in and so far, so good. I find placing them inside the upper hooks before inserting the aligner makes it straightforward.

As for visibility of the elastics? I would actually say it's on par with the visibility of the attachments themselves. When I am speaking normally, you can't see them really - only if I smile widely or if you are up very close. And I am happy to have them in order to correct my class 2 / div 2 malocclusion and prevent flaring of the anterior teeth. I am wearing them full-time, likely for the duration of my treatment (though I wasn't given an exact time, yet, but was told at least until my molars and premolars move into position.) I will be back again in 6 weeks and have received Trays 4-9. I took a peek at them -n o movement for the front uppers yet, but I am pleased to see my lowers will be much straighter by Tray 9 and my molars will continue to distalize.

Overall, this tray has caused minimal discomfort and the Acceledent is going well. I have started using it right before bed, as I find it really "seats" the aligners down tightly.

Elastic button off

Unfortunately, the metal elastic button which was bonded to my 2nd molar gold crown, came off while eating and I will have to go get it replaced before restarting my elastic wear. So frustrating! I had already noticed some soreness in my upper and lower molars with the elastic wear - a sign they were doing something.

I find it hard to manage all these appointments around my work schedule, although luckily the office does stay open late on Thursdays (until 7PM). Between going here, my regular dentist and my oral surgeon I must have been to the dentist 20 times in the past few months - my co-workers must think I am crazy! Anyone else?

Tray 7

After I had my metal elastic button re-bonded to my 2nd molar gold crown, it fell off again! This time it lasted four days but I woke up with it having fallen off. At that appointment, my orthodontist said she would re-design the trays if it came off again.

She redesigned my lower trays to have the hooks as cutouts within the aligner similar to my upper trays ("precision cuts") and added two regular attachments to the 1st lower molars to prevent the trays from lifting off at the back due to the cutouts.

I have the new lower trays today and so far, they are okay, despite a bit more difficulty in hooking on the elastics than before. I haven't had a "pinging off" problem so far, so hopefully that won't be an issue.

As for teeth movement, no visible differences on the upper front teeth as expected, as only my 2nd molars have moved - they seem to be moving on track as with each tray the space between 1st and 2nd molar is bigger. My lower teeth are noticeably (to me) more straight as well. I am still changing weekly and the Acceledent is also going well - they are snug for the first day or so with the new tray but no problems getting them on. Definitely glad I have the Acceledent! There has been only mild bite tenderness for the first two days or so with each tray.

Tray 17

It's been awhile since my last update! The precision cuts work great with elastics for me with no problems at all with them bending or the elastics popping off. I am continuing to use acceledent and change my trays weekly. Travelling in China was a bit of a challenge with access to clean water and found I couldn't brush my teeth until the end of the day back at the hotel. I have been compliant with wearing my aligners 22 hours a day with the elastics on all the time - they don't particularly bother me.

As you can see from the photo, my bottom teeth are almost done and are much straighter. I saw my ortho last week who gave me up to tray 28. Tray 17 was the first tray where my non-molars are moving which is exciting. I haven't posted a photo of the upper as all the movement has been moving my molars back first to make room for my other teeth.

Tray 22

Not much new to report except that I finally am seeing some movement in my central incisors. My bottom teeth are also quite loose but have almost moved into position.

Tray 32

Well it's been awhile since my last update!
A few things to report:

1) I had a porcelain crown fracture after less than 2 years of my root canal. It may have been due to movement from invisalign changing my bite and causing undue pressure. We are waiting until Invisalign is complete to repair it, but thankfully, my dentist is excellent and replacing it free of charge. 

2) I have a new cavity that requires a filling. If you look on my photos without Invisalgin, you will see there is brown staining between my two front teeth. There was substantial overlap between those teeth before, and due to the concavity of the filling, it apparently appears brown. I will be having these replaced as well. 

3) I have switched to a stronger elastic on my left and a weaker elastic on right to account for the malalignment which persists. 

4) I will need revision trays, the number is unknown but given that I am using Acceledent I should be able to switch every 4 days, according to my orthodontist. 

5) I have a "black hole" or gap between the top of my two front teeth that I hope will be fixed with IPR/revisions. Only 4 more trays to go with my first Invisalign course and I could NOT be happier. There has already been substantial improvement and I am finally happy to show my teeth when smiling!

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