Starting 36 Sets of Invisalign

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I finished the first set of trays today. My teeth...

I finished the first set of trays today. My teeth hurt a bit during the first 3 or 4 days, then the pain subsided. I found the upper tray much more difficult to remove right from the beginning and it became even harder near the end of the two-week period.

As soon as I began wearing the trays, I noticed that there was a bit of play where the upper tray fits over the teeth. I could push the tray up about half a millimeter with my lower teeth and when released, the tray would move back down. At the end of the two week period this has not changed. I am not sure if the tray has done its work as I was under the impression that it is supposed to fit perfectly by the end of two weeks.

I did start wearing trays #2 last night. They do not seem to apply as much pressure on the teeth as did the first set of trays. The movement/slightly improper fit on the upper front teeth feels exactly the same.

I should have started with by saying that I am undergoing the treatment NOT for cosmetic reasons ...

I should have started by saying that I am undergoing the treatment NOT for cosmetic reasons but rather due to persistent health issues. I am experiencing frequent headaches, tension in facial muscles, and TMJ discomfort. I am also unable to mash most foods as my molars do not connect when my jaw is fully closed. I have sought help from my physician and my dentist. They referred me to a TMJ specialist who, in turn referred me to an orthodontist. I have had consults form three orthodontist before I finally decided to undergo a treatment proposed by a fourth ortho that I saww. The first three orthos suggested treatements that ranged from doing nothing to wearing a Gelb retainer. Neither of them were confident that they could alleviate my symptoms.

Here the analysis and treatment plan from my the orthodontist that is currently treating me with Invisalign:

Occlusal Analysis: Moderate Class II Division 2 Subdivision right malocclusion. There is 2mm of arch length deficiency in the maxillary arch and adequate arch length in the mandibular arch. The anterior overjet is 1mm and the anterior overbite is 90%. There is evidence ofn moderate incisal attrition combined with posterior erosion. Temoromandibular assessment reveals decreased translation on the left with closing and the patient report discomfort and tension on a daily basis.

Facial Evaluation: the patient has retrognathic, convex profile and an obtuse nasolabial angle, thin labial support and lower lip eversion. He has a good chin prominence and the deviates to the left. Upon smiling, the maxillary dental midline is 3mm righ tof the facial midline.

Radiographic Findings: The panoramic radiograph reveals the absence of the third mollars and the mandibular right second premolar. The maxillary right canine is vertically impacted.

Intraoral Findings: the patient's overall periodontal health is good. There is evidence of incisal attrition due to lack of posterior support and contact to sufficiently break down the food he eats.

Temporomandibular Joint Evaluation: the patient reports frequent headaches associated to the restricted movement of his mandible. He persistent tension in his jaw and facial muscles, particularly the masseters that is affecting his quality of life.

Treatment plan: Due to the face that the patient is unable to find orthodontic provider in his remote location and his quality of life so severely affected, his options to pursue a more ideal treatment plan consisting of exposing #13, mandibular advancement, and setting up for future restoration to replace his lost tooth structures, is not possible on along distance situation. However, his tempromandibular joint is experiencing discomfort due to the mandibular restriction, hence we will attempt to improve malocclusion and overbite with Invisalign. The space for #13 will match the contrlateral #23 and hem have #13 extracted and an implant placed in the future. The 3 unit fixed prosthesis in quadrant 4 in not ideal due to the overeruption of #16 and intrusi will be planned in the movements. The patient understands that this is a compromised treatment option; however it will improve his occlusion if worn well. We anticipate that the active treatment will be approximately 1.5-2 years to be followed by long-term retention. Throughout treatment, we will incorporate elastic wear with his aligners. While the patient is undergoing his orthodontic treatment, he should maintain his routine dental visits.

Trays #2 Completed - Aug 26 to Sept 9, 2015

Set 2 done and they went pretty much as good as I could have hoped. I did have a nasty sore on my gum for a few days, probably due to a scratch during tray removal it got irritated from frequent brushing and flossing but it has healed.

I am also resigned to live with linea alba (a white line of tissue) on the inside of my cheeks for the duration of the treatment. It seams that swallowing with the trays is causing a suction on the cheeks which develops this line. It does not hurt but I can feel its ridge along the whole length of my cheek with my tongue.

Iput in tray #3 last night. The small gap between the tray an the upper incisors that had with set #2 is still there with tray #3. I'll be asking my orthodontist if this is a concern.

Aligners #3 Completed - Sep 9-23, 2015

Slight Movement of Aligner on upper incisors

Explicit - Click to view

Third set of aligners have been completed uneventfully.

I emailed with my orthodontist and she reassured me that small gap and aligner movement is perfectly fine for the type of teeth movement she has designed.

Tray #6 Completed and my First Progress Check Appointment with my Orthodontist

I have completed six sets of trays now. Set #7 has been in for two days and I just had my first checkup since beginning the treatment. My orthodontist said that teeth are tracking well and that I can cut back from 14 days per tray to 9 or 10, if I wish. I was glad to hear that.

I definitely see a pattern now in how the teeth are moved. The first two days with new trays do the moving and I feel slight rawness during this time. Then the teeth settle down and the trays become easy to put in and remove.

I was glad to hear that I could cut back to 9 days per tray. This could reduce my treatment duration by almost 36%. However, I am about to start an extended travel trip (7 months) during which I will not have access to my orthodontist. I will need to have additional buttons installed at after I complete tray #27. It just so happens that I will be returning from my travels in time for try #28 if I stick to the 2-week routine.

Fourteen Month into Treatment

I am fourteen months into treatment and have a few updates. I took an extended trip to bicycle in Australian, Asia and Europe for seven months from February to August, 2016. During this time I had no orthodontist checkups so it was up to me to monitor progress and contact my ortho by email with concerns. Packing seven months of fragile aligner trays on a bicycle was a bit tricky, but I came up with a system that protected the trays and was not overly bulky.

Before the trip I wore each aligner for 10 days. During the trip I had to stretch this to 14 days per aligner because before tray 29 I needed a modification to attachments and I was not going to be back on time if I kept the 10-day routine.

Treatment during the trip progressed reasonably well, though I noticed each new aligner fit slightly less precisely on my upper front teeth (a gap was present and not closing at the end of the two week period). Upon return from my trip (end of aligner set #28) I went to my ortho and I got conformation that treatment is going well with the exception of the front upper teeth. It was time for a mid-course adjustment.

So, old aligners came off, new ones were put on and the aligner count started back from #1. I am currently on set #5 with about a year's worth to go).

Uncooperative Attachments on Crowned Teeth

I've recently had new attachments put on crowned teeth. One is on a porcelain crown another is on a gold crown. The ortho technician had a hard time getting the attachments to stay on. She had better success on the porcelain one than the gold but both were problematic. The one on the gold crown would come off immediately after being put on right there in the ortho chair. She used a special adhesive designed specifically for this scenario but had no success. She tried four times and then gave up. The attachment on the porcelain crown stayed on for a few hours but came off while I was having my first meal.

I live in a remote area and have to fly in (at large expense) for my appointments so I have been with two fewer attachments than ideal for a while. My next appointment is coming up and I am wondering if they will have come up with a method to make the attachments last.

Has anyone had attachments on crowns, especial gold crowns? Have you had issues with them? Do you know what adhesive works? My ortho was stumped.
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