Current results after arch expansion and Invisalign with attachments and bands - Okemos, MI

How I went about straitening my teeth with invisalign is a little different from most reviews that I have looked at. After searching the web A LOT I couldn't find anyone that had completed adult arch expansion before starting invisalign. So here is my story and pictures. I hope this helps someone make their orthodontic decisions easier because I could not be HAPPIER with how this turned out so far (and I'm not even close to being done!).

Why did I do what I did?

First, I will start by saying I highly recommend going to an orthodontic specialist and not a regular dentist, especially if you have sever crowding like I did/do. Because when it comes to making major decisions for fairly sever cases, you want to make sure you are solving the WHOLE problem, and not just picking and choosing what ortho work gets done.

Starting off, I had severe crowding. To say my mouth is "small" is an understatement. After doing measurements, we discovered I had the maxillary/mandibular arch expansion of a pre-teen...(I can't remember the measurements)...but basically that meant I could fit maybe two and a half fingers widths comfortably along my top arch. To say it another way, my tongue sometimes felt like it had no room! And because I had lived like this up until I was 23 (When I started), I didn't really think to much of it. But then I started having slight clicks develop. Turns out I was favoring chewing on one side because my teeth were angled in a more efficient way to chew on that side. All because my teeth were crowded. Further more, I'd always disliked my smile because it was like you could only see the first 4-5 teeth.They kind of angled out and blocked the view of my other teeth which made my overall smile look very small.

So when I talked to my ortho about invisalign he says "Yes! you would be a prime candidate case, BUT, give me time to work with you before invisalign and I can give you more than a straight smile." So I figured, if I'm pouring $5000 into an ortho treatment I might as well go all out and do it the right way and in a way that I would be happy with.

EXPANDER:

So we started with an arch expander on my top and bottom. The picture on here is of my bottom expander. You use a key to turn the spring every 3 days and this widens the expander. My top expander had 2 more sets of turn springs (one on left side and one on right) so that it moved the expander length wise.

This expander (like a rapid palatal expander) did two things. First, was to move my back molars back further. Since I still had wisdom teeth, these had to be removed first. Which is good, because they needed to be anyways since they were impacted and sideways. Once those were out the expander had room to push my back teeth further back and create room. Secondly, it was used to tip the teeth back outward and give the outward appearance of more teeth (not just 4-5). By tipping we also created more room. Phase 1 (moving teeth back) took 4 months and phase 2 (tipping) took about another 4 months. Admittadly, this was a long time to go through this. These expanders are hard to talk with in (especially with a top and bottom in!) and I wanted to start invisalign ASAP! But I'm happy that I did expand first, because I took progress pictures every month (highly recommend) and found some amazing differences in teeth straightness just from that! Granted, I went though an awkward phase in Oct-Dec when I developed a gap...

Side story... typically by adulthood your palate has fused close and is no longer readily available to expand (by rapid palatal expansion appliances). But, apparently I had some luck on my side and had some bone expansion up top...even if I did have a wacky smile for a while...

So I used an expander from May 2012 to Feb 2013 and then in March 2013 I got invisalign. I'm currently on tray 5 and absolutely LOVE my results thus far! And I can honestly say, I don't think I would be as happy had I not fixed my arches first. It's amazing how nice a broad smile can look when you started with a really small crowded one. Just a note for the pictures - in each one I'm smiling wide the same way! I'm not all of a sudden smiling "broader" because I'm happier, it's just that teeth are actually showing!

Now, Invisalign is a bit of a challenge for me just because I like to snack (healthy foods) throughout the day. And as you know, you have to brush/floss teeth and clean trays all the time. So far that's my biggest annoyance, but that's not that bad!

I am also wearing rubber bands to help with force generation and pull my upper teeth back so that they are jutting forward over my lower teeth so much. The bands are hardly noticeable and I've gotten used to them so I don't mind them at all. I will say that on the first day, my jaw was sore because I was getting used to the new forces. But after sleeping a whole night with them and getting used to them they no longer feel restricting.

I have many buttons (clear bumps to help align teeth) as well. I think 4 on top and 5 on bottom. They aren't too noticeable unless you are up close. My front right tooth has one if you look in the pictures. The first week with them was the hardest! I don't know why but it seemed about impossible to get the trays in and out with the buttons. But now, on tray 5, I don't have a problem. I don't think it's because I necessarily found a method either because I'm doing it the same way...It is just easier. I think because my teeth are more aligned so it helps.

My awesome orthodontist also threw in free teeth whitening. This is stuff that goes in your trays overnight and makes you look like a movie star when you wake up! It's truly amazing how much a little whitening can do for aesthetics.

Just to give a price rundown of total treatment:
$400 for arch expansion (custom molded palate expander for both arches - included all Dr. checkups and any replacements I needed were free. Which at one point my upper expander broke and I had to have it redone.)
$5200 for invisalign (includes entire treatment, with buttons/bands/checkups, and free whitening)

I thought I would post a picture showing my bands and how they work for me. Everyone that has bands will need them in different places. It all depends on where the Dr. decides the force needs to be.

For me on my left side I have a grey button on my bottom very back molar that the band hooks around and then it comes up and hooks on a cut out of the invisalign on my top incisor. My right hooks on a bottom button about 4 teeth from the center and hooks up on my top right incisor. Unless I'm smiling really wide they are barely noticeable because they go off to the side an back. Some people will have them right across the font teeth or closer to center where they are more noticeable.

The point of my bands are to pull my front teeth back so that the meet up with my lower teeth better. Because my left and right side need different adjustments (left needs pulled back more, while right needs pulled outward) the bands are in different locations to accommodate.

You can also kind of see my buttons. I actually have more than what I posted in my first update. I think 6 on top an 7 on bottom. I still haven't actually counted...most are on my back teeth.

Photos: How bands look when smiling and their locations

Well, after 3 months of Invisalign I’ve decided that I’m qualified to share my wisdom with others ;). (Technically I've been doing this whole ortho process for over a year now because taking care of my expanders required the same type of process)

Having bands attachments, IPR, etc. are a special kind of fun that comes with invisalign. Hopefully my experiences will help someone else.

Dealing with ATTACHMENTS:

1. They can be a pain in the rear
2. Outie - Luckily, this handy device known as an “Outie” (Sold on Amazon.com) was invented. Basically it’s like the picks the Dr. uses to pry things off your teeth. Now I haven’t used this myself as I’ve found my trays to come off easier with time, but many swear by this device. The reviews on Amazon are mixed, but it might be worth a try.
3. Coloring - My Dr. gave me teeth whitener to use in my trays and my attachments are not off colored by it (Yay!)
4. I drink coffee and tea regularly and my attachments aren’t discolored. HOWEVER, I also drink a lot of water in between to make sure my teeth are rinsed well.

Dealing with BANDS:

1. Ignore them – They are not too big of a deal. At least for me because they are pretty much out of the way. You will find yourself playing with them though. Stop if you can. You’ll just end up with sores on your tongue…
2. Change ~3x day - Change them when their elasticity wears out. I go about 5 hours depending on how much talking I’m doing. (Morning, lunch, afternoon, bed). If I’m teaching or in meetings a lot of the day I change them sooner sometimes.
3. Have some everywhere - Ask for a couple bags of the bands. Keep some in the car (out of sunlight so that they don’t become fragile), some at work, some at home, and some in a bag you take places.
4. Routine - If you forget to wear them a couple of times, not too big of a deal. Just put them on as soon as you remember and don’t “double up” trying to make up for last time. Little, if any, progress is lost from you not wearing them for a short time, so just get back into the daily routine.

Dealing with routine HYGEINE:

Most (All) of this has been said by others, but here’s my 2 cents.

1. Soak box - Invest in a denture/retainer cleaner box ($5 local stores). I have a yellow one and it does a few things. First, it provides a good (safe) place to soak. By safe I mean you aren’t just putting them in a cup only to have a friend, parents, disgruntled roommate toss it on accident. Also, It’s clearly identifiable and is easy to take to other peoples’ houses and not gross them out by using a cup for your teeth. They also come with a nice strainer so that you can easily rinse your trays.
2. Denture cleaner - Some (including Drs.) say not to use denture cleaner to clean your trays because it will make them cloudy. I use Efferdent and Equate’s version of Efferdent and I haven’t had a problem. I use this at night when I’m getting ready for bed and my trays are fresh and easier to clean.
3. Some type of denture cleaner (or the Invisalign brand cleaner) also helps if you have a lot of attachment sites on your trays. Those can get built up plaque and what not in them and can be difficult to get into with a big toothbrush. Having a cleaner to soak in is hand because it breaks all of that junk up and makes it easier to brush.
4. Travel brushes - Invest in a lot of travel tooth brushes. Their easy to keep in your pocket, bags, car, office, wherever, and you’ll never be without a toothbrush. And you will win the Cleanliest Mouth award from your friends and colleagues.
5. Cetaphil - Use a gentle soap cleanser to clean trays. I use Cetaphil and the great thing about it is that it doesn’t leave a taste behind. I can even use my toothbrush and immediately use it on my teeth afterwards and there’s no residue taste.
6. Brush, floss, swish, floss, etc.

Dealing with IPR:

1. The good - Honestly, IPR isn’t that bad. I had 2 back molars done at the beginning of my treatment and about half way through I will have another tooth done. The grinding wasn’t unbearable (even for someone with major “drill sound” issues) and I didn’t feel a thing.
2. The bad - However, food will get stuck in those spaces! And depending on where those spaces are it is a pain in the rear to get out! I had a back, top molar on each side done. They did about 1mm I think, but it seems to be a catch all because that is right where I chew! So having travel picks/floss comes in handy not only for flossing on the go but for having to pick out those spaces. Gross, I know, but it’s only until the spaces close (time varies by treatment).

MISCELLANEOUS:

1. Chewies - You were given Chewies for a reason. Use them. Trust me on this. Nothing is worse than getting part way through treatment and at your next checkup the Doc saying “You’re trays don’t fit right”. This has not happened to me, but it has to plenty of others because their trays weren’t all of the way on. Just a few seconds of chewing is sufficient. Make sure you get all of your teeth.
2. Pictures - Taking photos every time you switch trays is a great thing. Because when you think there are no results, the photos will usually show you something…even if it’s just the slightest movement in a not so visible tooth. It provides motivation to keep up the high maintenance hygiene and sometimes painful process.
3. Tracing – for those that haven’t taken pictures and want to see your progress a great thing to do is trace each aligner on paper and compare the movements.
4. Whitener – I was given whitener to put in my trays overnight. It’s a miracle product! Not sure how similar products are but after one use it was like a miracle. For mine I had to make sure my teeth and trays were dry and then I put some gel on each tooth indentation of the tray. In the morning make sure you brush trays well. Try to avoid getting it on gums. Depending on sensitivity it may burn a little if there is a large amount of gel setting on your gums all night. Use a Q-tip to go around the edge of the trays once they are back on your teeth to wipe off excess gel that squeezes out