Month: March 2018

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What Fresh Hell is This?

By Sue Seboda, Dental Part 17

When I decided enough was enough, the world was a sunny place.  I only had to wear my trays at night.  Happiness.  All was good until I had the first major meal without the trays.  My incisor on the right side scraped against the lower tooth creating a most unpleasant fingernails on blackboard sensation.  Plus my back teeth did not come together properly.  Eating was very uncomfortable.  I gave it a few days and then called both the orthodontist and periodontist and said that my bite may look good, but it is not good.  Back to the drawing board we went.

The orthodontist had explained before that my back teeth may need to settle after completing Invisalign.  Didn’t pay a lot of attention to that.  I got it now.  Here is the deal in very simplified terms. The jaw is essentially a hinge.  When biting, the top and bottom teeth come together.  Now insert a piece of plastic over your teeth (Invisalign).  With the additional thickness near the hinge, the front teeth do not come together as before.  This was subtle and unnoticeable to me.  The teeth (having supernatural powers imho) then adjust naturally so all the teeth come together again when chewing.  In other words, the back teeth recede a bit.  

When the plastic is removed, sometimes the incisors have too much contact and the back teeth have none.  This is called a posterior open bite as shown above (wish my gums looked like this).  For minor situations, the rear teeth will correct on their own.  For dramatic cases, further action such as rubber bands pulling the back teeth together may be required.  If still in Invisalign some orthos will cut off the back portion of the tray.  There are different opinions as to what causes a posterior open bite during Invisalign but the above appears to be the prevalent one. 

To encourage the teeth to settle, rather than wearing a plastic retainer at night covering all the teeth, a Hawley retainer was recommended.  The dental term for these retainers is “vertically permissive”.  Hmmm.  What else do they allow?? The orthodontist filled my mouth with that nasty stuff to create an impression of the teeth and roof of my mouth.  A couple of weeks later, I put the retainers in and looked at my very good and intuitive orthodontist with eyes that emphatically said, “no f*&$king way I can do these”.  With no other verbal communication, she said I can trim them.  Yes PLEASE.  She cut away the plastic covering the roof of my mouth.  After wearing them a day or two, I prefer the Hawley retainer over the plastic.  Since a retainer must be worn at night indefinitely, finding what works best for you is important.  Ultimately, I will have a permanent retainer on the bottom teeth plus a bite adjustment.  More on that to come…

Takeaways:

  • Invisalign sometimes results in a posterior open bite. In many cases this will correct on its own over time.  The chance for a posterior open bite increases when eating while wearing the trays as is done with Wilckodontics (another reason braces might be preferable when doing Wilcko).
  • When completing orthodontic work, wearing a retainer at night is necessary. There are options.  One may work better for you than another.  Ask questions.
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Holding Patterns and Other Unpleasantries

Dental Part 16

Holding patterns are not my favorite thing.  I am a moving forward kind of gal. So I was disturbed to learn that the second set of trays would take almost a month to arrive.  I offered any amount of money to expedite the trays.  Nope, not possible.  The orthodontist made hard plastic retainers to hold my teeth in place and I wore them night and day. 

Aside from adding a month to the overall time in orthodontics, this month is critical if having Wilckodontics.  Recall that a tremendous benefit of the Wilcko bone graft is that for 4-5 months teeth move very quickly when orthodontic forces are applied.  For example, instead of spending two years in braces, one would be finished in 6 months.  Since I completed the first 38 trays in 3 ½ months, I wasted the final month of fast moving time waiting for the second set of trays.  This is a huge downside of Invisalign when doing Wilckodontics.

The refinement included 16 trays and lasted 3 months, almost as long as the first 38 trays.  The photos below are trays 1 and 16 for the bottom and top .  Unfortunately, my teeth once again did not follow directions.  While there was notable progress, I did not achieve all of the expected movement and a third set of trays was recommended.  

What to do???  The primary goal was to fix my bite which would curtail bone loss and give a chance to hang on to my own teeth.  The periodontist was confident he could perfect my bite without additional Invisalign.  Therefore the third set of trays would be a purely aesthetic effort.  I ultimately decided against it.  Why?  Instincts.  For the second time, my teeth started to firm up and my instincts were screaming that loosening them for a third time could have unknown and unpleasant consequences.  Not sure science supports this fear, but it was too strong to ignore. 

For those considering Wilckodontics, this paragraph is for you.  I strongly suggest discussing the pros and cons of braces vs Invisalign.  As horrible as they are, braces may be preferable since they provide a more constant force on the teeth and a higher level of control.  If a tooth goes walkabout, the braces can be adjusted immediately rather than waiting a month for a new set of trays.  This is a highly individual decision and there are many factors that influence the choice including things that have nothing to do with your teeth like your travel schedule.  For example, if you have braces and your teeth don’t follow directions, the braces need to be adjusted immediately.  Things go real bad if not, so its best to be consistently near the ortho office.  Find a good orthodontist who will dig into this with you.  And if your orthodontist is unfamiliar with Wilckodontics, find another.

Takeaways:

  • Several rounds of Invisalign may be required to achieve goals. Understand the worst-case scenario before starting.
  • The gap between scanning for and receiving the next set of trays could be as long as a month. Add this into the overall time calculation.
  • Review the type of movement required, ie. lateral, vertical, rotational and ask which appliance is better suited for that type of movement, braces or Invisalign.
  • Do a thorough comparison between braces and Invisalign if considering Wilckodontics. In this one instance, vanity may have to take a back seat. The driving factor should be which appliance will manage the required orthodontic movement in the shortest time period.

 

 

 

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The Back Foot Comes Forward

Dental Part 15

Remember dating?  The early days were all smiles and perfection with the well-turned, best foot forward.  But as always, that back foot inches into view and we are reminded that nobody is perfect.  Bummer.  Turns out Invisalign is not perfect either.  So let’s have a look at the “back foot” so well informed decisions can be made. 

The orthodontist will explain prior to starting Invisalign that a “refinement” period may be required.  A refinement is more appropriately described as another set of trays because your teeth did not follow instructions during the first set.  Requiring a refinement is reasonably common and becomes more so when the desired orthodontic movement is complex.  Since I had tremendous success for the first few months, it appeared that I would have only a minor refinement period.

Unfortunately, the wheels came off in the last few weeks when my front tooth dropped down.  In addition other teeth did not move vertically or rotationally as expected. On the positive side, the lateral movement was excellent.  Without lateral movement, there would have been no room to sort out overcrowding, the main problem with my bite. 

Because the trays still fit very well on the back teeth, it was agreed that the best course of action was to finish the set, complete the lateral movement and then tidy up the vertical and rotational issues in a second set of trays.  Would post the photo of my teeth but it is simply too unattractive in that selfie, horse teeth sort of way.  This photo with the retainer on gives an idea of what happened to the front tooth.

Here is Invisalign’s “back foot” #1 and #2:

  • Moving teeth can be an unpredictable business. It does not matter if you have the best orthodontist (I do), once your teeth loosen up and start moving, they may move the wrong way or get stubborn and stop moving.  Everyone’s teeth loosen during Invisalign.  They loosen exponentially when doing Wilckodontics so I suspect that the possibility of teeth going walk about is higher.
  • Invisalign may have trouble “finishing” when notable rotational and vertical movement is necessary and it could take several sets of trays to achieve the desired result.

So let’s look at how the second set of trays went…