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”. H
mmm. 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.