Tag: Invisalign

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The Dentists are Coming

By Sue Seboda, Dental Part 19

During my own dental saga, I began to notice a good number of women in my age group considering Invisalign.  Let’s call us the over 50 gals.  A friend of mine, who had just started Invisalign, wondered aloud if they were coming after us. Yup, I reckon they are. 

It’s not just us.  Align, the company who owns the Invisalign system, is on the hunt for market share wherever they can find it and doing a brilliant job.  They are a billion dollar a year public company with approximately 80% of the clear aligner market.  They have a big bottom line to feed and shareholders to keep happy.  Absolutely nothing wrong with that.  But there can be unintended consequences if a company’s emphasis is weighted more heavily on the bottom line and less on the ultimate end user, the patient.  And if that is the case with Align, the patient must be vigilant.

Align markets directly to the end user (patients) and the providers (dentists and orthodontists).  Very smart.  Build demand from the bottom up especially in a dental industry that is probably slow to change.  They market to teens and their moms.  Good idea.  They have simplified orthodontics so dentists with minimal training can handle patient cases. Also very smart.  This increases the number of providers which will ultimately increase the number of end users, fattening up that bottom line nicely.  Therein lies the rub.  And why patients in general and the over 50 gals in particular need to be careful. Let’s dig in.

On https://www.invisalign.com, plug-in your own zip to find a doctor.  I did this using a 5 mile radius and came up with 29 providers, 22 of which were dentists and 7 orthodontists.  Interesting…  Note there is a rating system from VIP down to bronze based on the number of Invisalign cases each provider has handled. The more cases, the higher and more visible the provider.  Great information for the public, right?  Yeesss, but…  Also providers pay Align a lab fee for each Invisalign patient.  The more patients, the lower the fee.  Sounds logical?  Yeesss, but…  Also Align has attempted to set quotas for providers but so far has failed I believe.  Hmmm…  Because we humans are incentive driven to the max, these incentives do wonders for Align’s bottom line.

You know what is coming.  The potential downside for patients:

  • Incentives may encourage general dentists with only a superficial understanding of orthodontics to manage Invisalign cases that should be referred to an orthodontist.
  • To get numbers up, providers will tap into undersold markets such as us over 50 gals. This is fine with a provider who understands the complexities of orthodontics at this age.  It could be disastrous otherwise.
  • Incentives may also result in a provider recommending Invisalign when another orthodontic appliance may be more appropriate.
  • Providers with little experience may be unable to properly navigate the side effects of Invisalign.

Stay with me a bit more, especially the over 50 gals.  I am all in favor of orthodontics and Invisalign at any age.  And, yes, there are general dentists who have an in-depth knowledge of orthodontics.  But as compartmentalized as the dental field is, I seriously question whether the typical general dentist falls into this category.  So what’s my problem with hiring any ole dentist to manage your orthodontics?  It’s simple, SHIT HAPPENS.  As we discovered, moving teeth can be an unpredictable business.  I want a top notch orthodontist and periodontist who know a lot about tooth movement, bone loss and a healthy bite to AVOID shit happening and who know what to do when it does (it will).

 

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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…

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My Teeth Love Italy

Dental Part 12

Usually guests bring presents for the bride and groom but Susan and Chris were the ultimate gift givers when they chose Italy for their nuptials. Nothing quite like the exchange of vows within the embrace of magical Italy.

The traditional Hotel Terme Rosapepe, located near Contursi, has been in Susan Rosapepe’s family for decades. This area is famous for natural mineral pools and the Hotel Terme Rosapepe is the crown jewel. I love mineral baths and was delighted to discover this journey would include hours of soaking time. The hotel is pleasing, in a gorgeous setting, comfortable and well off the American tourist route so prices are quite moderate.

After a long day of travel, I arrived Wednesday evening (without green teeth I might add). It was clear immediately there would be no time for jet lag. After a quick refresh, we were all firmly ensconced in lovely Italian wine and conversation followed by a leisurely meal. Italian wine is good, inexpensive and continuously present but even better one can drink a lot of it, remain coherent and have no hangover. How is this possible? We can send people to the moon but we can’t figure that out here?

It is a good thing the wine has a lower alcohol content because happy hour starts at the normal time but dinner is very late, typically already in bed late. The second day I joined a couple of Susan’s friends and Susan for a hair appointment in the nearby small town of Oliveto. We had lunch in a lovely spot and because I was starving and had no idea when my next meal would be, ordered the carne mista without any consideration of how it would actually get into my stomach. Unfortunately much of the meat was too tough to handle due to my current dental state. The rose, however, was lovely.

 Predictably dinner was delayed until after 10:00 and the first two courses where pasta. Normally I don’t eat gluten free pasta but I wolfed it down. The main course was veal stuffed with spinach. You got it, too tough to manage. Spinach was good.  

Friday the bride and groom took the group to a gorgeous winery. I loved every second of this trip including the bus ride with wheels a foot from the cliff. We wine tasted to our hearts content while enjoying stunning views and noshing on cured meats and cheeses. I desperately wanted to load my plate but good manners dictated otherwise . We returned to the hotel late afternoon and met on the gorgeous patio for yes more wine and yet another superb sunset. New friends invited me to join them at a nearby seafood restaurant and we arrived at 9:30. The restaurant was empty so I assumed perhaps not everyone eats late but to our amazement the place was full by 10:30.

My hunger is now something to be reckoned with. At this point, even the wine is not helping. But to my delight copious quantities of food start to flow, sardines, grilled octopus, calamari followed by mussels and pasta. It was fantastic and I ate with abandon. My friends spoke Italian and their friends only Italian. Some quick conversation passed back and forth with fingers pointing between me and my constantly full plate. Our hosts were curious how I could be thin considering the amount of food I was stuffing in my mouth.  The burning question was if I had a thyroid problem. I laughed and kept eating. Impossible to explain.

The wedding was the following day and as one could predict, many of us were moving slow. Luckily the magic pools awaited. Susan explained how to create a mask from the pockets of mud and viola, no more tired faces. After a relaxing day we gathered for an early evening ceremony conducted by the mayor of Contursi. Absolutely beautiful. And in due course, a full Italian meal began to unfold. It was truly a wonderful night. Thank you Susan and Chris.    

 

 

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Flapping in the Breeze

Dental Part 10

Two weeks after Wilcko surgery, I went back to the orthodontist to switch to the third set of trays.  I entered the office repeating 50 times, no loud outbursts, no loud outbursts. We changed the trays with some difficulty but without incident and was provided trays for the next 10 days. I felt like a reluctant bird being pushed out of the nest. My first solo tray change came two days later and yes my finger slipped again into my gum, yes there was inappropriate language as if that would help get the trays in. Then deep breaths and the aahaa moment when I understood the purpose of the “chewy”, a small cylindrical rubberish thing one bites to ensure the trays are seated fully. Add this to the invisalign survival kit.

Fast forward to 4 weeks after surgery and the world has brightened considerably. Transitions have improved and will continue to do so as the teeth become less jumbled. Teeth are moving at warp speed and the last stitches came out today.  Fair warning, a few weeks after Wilcko surgery some of the teeth feel like they are flapping in the breeze. Teeth are not actually as loose as they seem but the support of the trays is much appreciated. I laugh when considering the extensive debate regarding daily tray time. Don’t waste a minute on this since the very last thing you will want to do is remove the trays. And, at least for now, eating without the trays is unthinkable. I guess that steak will have to wait. But as inducement, the longer the delay, the better the wine.  It will be worth the wait.  

So tomorrow is a big day. Taking this show on the road. Are you ready Italy???

PS.  Talk to your doc about when to use the chewy. If the tray is not aligned correctly it could cause problems to use the chewy to help install the tray. Also my sister took the photo of the baby bird. Excellent photographer.

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A Bad Thing Happens

Dental Part 8

Nine days after surgery and all is going well. Feeling confident, popping the trays in and out, eating solid food although nothing too crunchy or hard to chew. In hindsight it reminds me of a ski lesson many years ago. I was learning fast, feeling good, ready to get to the next level. At the bottom of the slope, preening in all my glory, I noticed another student skiing out of control straight for me. Maybe I wasn’t so great after all. Worse, she crouched down just before impact. I yelled don’t bend down but it was too late, she came in fast and low. I was propelled into the air, landed flat out leaving my skis exactly where they were.  What a great photo that would have been.

Back to teeth. The orthodontist office is one big open area with 4 dental chairs. Doctors and nurses tend to patients in soft, calm voices creating a serene ambiance. On this day all the chairs were occupied by young kids with mothers perched nearby and of course me, not a kid. We are ready to put in my second set of trays. As you may have guessed there was substantial difficulty even for the doc. So I am attempting to force the tray on my lower teeth and my finger slips and digs into my tender, Frankenstein gums. Yes, the F bomb came out of my mouth, vigorously you might say.  It was not my finest moment. Of course I stood in the no longer serene room and apologized to all the young moms.

Which led me to another observation. Am I the oldest patient they have fitted with invisalign? There was a long pause before answering the question in the negative.

 

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Zombies

Dental Part 7

Soooo, let’s get to the question you have been dying to ask. How do you look after surgery? Not bad at first but the swelling kicked in on Wednesday and peaked Friday. Fair warning, these photos do not grasp the extent of the swelling but perhaps this story will paint an accurate picture. Earl was away for the weekend and when he returned on Sunday the swelling was almost gone. He duly noted that and then told me that I had looked like an old lady who lost her teeth. Hot.

I thought I had escaped any real bruising but no I was sadly mistaken. On Friday, two bruises popped and started draining down my face. Peak blackness was Sunday but those babies lingered through the following weekend. Come up with a good story. People either stare or ask. I like the “askers”. What I needed was some black lipstick to complete the look but alas my black lipstick was in Key West where such things are needed.

To sum up, swelling gone in a week and bruising gone in two.  Not a bad tradeoff to reduce the time in braces/invisalign by more than half.  The first selfie above was the day after surgery, the second was 3 days after and the selfie with the zombie base makeup was at 6 days.  And for comparison, the nonselfie photo was taken just before all this started.  My vanity demanded inclusion of a normal photo.

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A Girls Gotta Eat

Dental Part 6

Sleep is your friend. Do a lot of it. Also, before surgery, set up a nest in the living room so you can comfortably lounge and binge watch a series your significant other has no interest in.  Rest, be kind to yourself and keep the talking to a minimum.  For some of us that is a challenge.

Advance planning on the food front is essential especially for those who clock in multiple hours a day snacking and dining. The periodontist will recommend soft food. Pull the long ignored vitamix out of the closet unless you find days of yogurt and protein shakes satisfying. I started with foods like soups; blended vegetables with almond milk and protein powder; yogurt with hemp, peanut butter, fruit and walnuts. But before long I got really hungry. Drastic measures were called for and I did something that just feels wrong.  I added meat to the blender. Cook a sweet potato, sauté shiitake mushrooms with a bit of ginger and put all this in the blender with flavored bone broth, a good source of protein.  Add chicken, hit blend and do not look at the mess that is created.
By the fifth day, I was ready to sauté veges with eggs, lots of eggs. It was wonderful. And yes, there was also ice cream.

During this initial period, the invisalign trays are only removed for cleaning once per day. On Thursday (surgery Tuesday) I went back in to have an area restitched and  could not to remove the trays at all plus rinsing vigorously (great word) was verboten. Could only gently swish the hydrogen peroxide. Friday I went back since another stitch pulled at which point he  removed the trays for cleaning.  Yuck.

Btw if a stitch comes loose, it is typically in the lower front gum. It is not uncommon and other than the novocain shot, restitching does not hurt. Therefore, as much as you may not want to do it, have a look see in your mouth after surgery and call the doc if anything concerns you. Truly, looking at blended meat is far worse.

 

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Don’t Believe Everything You Read Online

Dental Part 5

I appreciate the irony of that statement. But really, do not go online and start reading what others say the day before your surgery. That is a sure fire way to ramp up anxiety to previously undiscovered heights. Plus my imagination went a little crazy with the idea that I would not be completely under during the surgery. The periodontist said I would be able to hear, respond and talk but would not remember anything. That sounds a little like being conscious, a totally unacceptable state when having bone grafts.

They provide a happy pill the night before surgery to aid in sleep and something similar to take an hour before your appointment time. Not a fan of painkillers and all their friends but I slept and was a bit looped by the time I arrived that morning, a good thing. And it was true, the last thing I remember is the novocain shots and the next thing I remember is an angelic voice quietly saying open more, turn your head, open a bit more. This was at the end of the 2 ½ hr surgery. As I started to come to, they put ice packs on my face. Note to self, when on anesthesia do not attempt to discuss the relative merits or lack thereof of putting ice on swelling. I think all I could manage was, “no ice, no ice”.

Earl picked me up and I honestly have limited recall of the drive home. Of course I wanted a photo immediately after the surgery for this article and to Earl’s amazement, I was sitting in the car taking a selfie. I have no memory of this. As you can see I was not dripping in blood or any other horrible state your imagination might conjure when considering dental surgery. I do have to work on selfie skills however. Why did selfies ever get popular? They are horrible.

And I needed food. Luckily Earl helped with that too. It was a bit of a challenge getting that soup actually in my mouth and staying there.

Here is the amazing thing. While uncomfortable, I experienced no pain. I was giddy with relief. Consider this statement on another periodontist’s website: “The pain after Wilckodontics can be rather pronounced, but everyone’s pain threshold and experience is different. With that in mind, patients who undergo Wilckodontics may notice major issues with pain even if they bite or chew soft food items. It’s for this reason that patients should take all pain relievers as recommended in the early days and weeks after surgery and that they follow their post-surgical instructions to the letter.” Does she moonlight for the drug companies I wonder? At my first follow-up, I told the periodontist that I had no pain and he said all his patients say the same thing, discomfort yes, pain no. Two questions and an observation come to mind. Who would you hire? Why don’t more people do this? And I have been spelling Wilckodontics wrong.