One of the topics that I get more questions about than any other on this blog is finding an Invisalign dentist or orthodontist. My own search for an Invisalign dentist or orthodontist took visits to several providers before I was able to find someone that I liked that was willing and able to treat me.

One of the things that surprises me the most when I am asked this is that many people don’t understand the difference between a dentist and an orthodontist. The easiest way to explain it is to compare it to doctors. A dentist is the equivalent of a GP. They do general dentistry; sometimes this includes some orthodontics. In many countries they aren’t allowed to call themselves orthodontists but get around this by using the word “orthodontics” or similar in their advertising. By comparison an orthodontist is like a specialist doctor such as a cardiologist, except that they specialise in the movement of teeth. In most countries orthodontists have done substantial additional study at university (often several years) and generally do nothing but orthodontic work in their practices.

Invisalign is available through both dentists and orthodontists. Rather than having substantial orthodontic training, Invisalign providers are required to do an Invisalign course before they can offer Invisalign. It had never occurred to me to wonder exactly how extensive or otherwise this Invisalign training was.

Recently however, I was having a quick google to find some piece of Invisalign information or another and came across the following post from a dentist who is no longer offering Invisalign. To be honest, it terrified me.

As an avid reader of Invisalign forums I had known that Align (the makers of Invisalign) had been tightening up their systems to ensure that only more experienced providers of Invisalign kept offering it, but frankly what I read on the dentists blog terrified me.

For instance her assertion that:

“I graduated Temple dental in 2001 with little clue how to successfully and orthodontically move a tooth.Like most clinicians, I  learned little about orthodontics in dental school. Sure I bent some wires, took a gazillion alginates, uprighted some molars, and occasionally made an active or passive appliance. Requirements, however, were minimal and Ortho at Temple was always the ‘easy A.’”

must surely be a worry for people that are considering Invisalign through a general dentist.

Similarly I don’t know whether there is any truth in her statement:

“Invisalign approved nearly any case you sent. Even with unpredictable movements like extrusions, intrusions, rotations and difficult cases like open bites and cross-bites, Invisalign provided a successful clincheck. This of course was nonsense and after a few poor results, I quickly learned Invisalign’s limitations.”

but it certainly makes me glad that Align are tightening their policies. (incidentally, I wonder whether this blanket approval theory is still true; my orthodontist who is VERY experienced tells me that he gets cases refused regularly that he thinks he could treat)

All in all I think anyone who is interested in Invisalign should read this dentists post to make sure that they ask the right questions before choosing their provider.

As someone with a very complex case my preference for me is an orthodontist to do my treatment. However, I know that many, many people have had dentists do their Invisalign and they have done a fantastic job. The key to it seems to be that you absolutely have to ensure that your provider has experience of using Invisalign and lots of it. Fortunately the Invisalign website ranks providers according to the number of cases they have undertaken recently. Still, it never hurts to ask the question yourself. I saw one provider who had not finished a single Invisalign case but was happy to take on my very complex issue. I would also point out that I think it is important to ask not only how many cases have been treated but also whether any cases similar to yours have been completed and how successful the results were. Ask to see before and after pictures where possible as these will tell you whether you would have been happy with the treatment.

Also, I think when deciding who to go with that it’s important to not just base your decision on price. Certainly, if you have a very straightforward simple orthodontic issue you will probably find that you get a great result whoever does your treatment. If however you have anything more complex you really need to consider who will be the best person to treat you. I know that many patients ring around hoping to get the best price- who doesn’t want to pay as little as possible? In more complex cases though, I think it is also vital that you take into account whether the cheapest provider is actually the best one for you in experience terms. Of course, that isn’t to say that more expensive means more experience- I often found the reverse to be true. Rather I just mean that experience should be just as, if not more, important than price in complex cases.

A picture speaks a thousand words- you know the old cliche… so I thought I would confine this post mostly to pictures. These are photos of my teeth before I started treatment and after 28 sets of Invisalign braces. I have one more upper refinement before I have finished with this run and I have 6 more lowers before we attempt to move my stray tooth over. You can now see just how horrendous my upper crown looks (next to my front tooth on the left) having moved. Fortunately when my trays are in it hides it to a great extent… I will get it fixed as soon as I am otherwise happy with my upper arch.

It’s interesting looking at the pictures of my aligners themselves just how my upper arch has rounded out, and also how the bottom arch has moved forward on the right hand side, but not yet on the left (where we are making room for that stray tooth.)
Let me know if you have any comments. I will be returning to my orthodontist in a couple of weeks to discuss what else I would like done to my upper arch- any suggestions gratefully received!

It’s slow progress, but I think (and hope) it’s worth it!

I intended to follow the old English saying “start as you mean to go on” this year with my Invisalign Braces. So far, not so good.

In fact, not only did I pass midnight on New Year’s Eve without my braces in my mouth, I woke up with them on my bedside table on January the first. Not a great start.

This is actually a first for me. Although I am generally pretty poor in complying with the 22 hours a day Invisalign requirement (I average more like 20ish I think) I have never, ever left my aligners out overnight before! In fact, I’ve never even come close. Whilst I confess that I had consumed rather more alcohol than I might normally and that might have had something to do with it I am still amazed that I managed to go to bed and sleep the whole night (well, OK 1am to 9am!) without realising that something was missing. It took me less than 30 seconds to work out that my aligners weren’t in when I woke up, and a quick glance at my bedside table confirmed what I had suspected. Nonetheless despite my pounding head and the waves of nausea that let me know that I had drunk more than I have in many, many years I was still surprised that I had been drunk enough to forget my braces. I had thought that I was on autopilot these days when it comes to putting them in before bed. Obviously not!

I visited my orthodontist this week for my regular six weekly appointment and in a fit of raging guilt told him that I had a confession to make. He stood there, eyebrows raised expectantly with an expression I haven’t seen anybody wear since I left school, whilst I nervously weighed up whether or not to admit the whole sorry truth. However, I needn’t have worried. After admitting that I had left my braces out for a whole night he did nothing but snort, give a dismissive guffaw and tell me “That’s not a confession!” Apparently the girl in before me had left hers out for several days over Christmas and had to go back two aligners just to get them back in her mouth. So I picked the right time to confess I guess!

Despite me being so remiss all seems to be going reasonably well. I had 9 upper refinements (on top of my original 17 aligners) which consisted of 6 refinements and 3 over-corrections. I have now completed my first 6 refinements and I think there is still a little way to go before my teeth are absolutely finished on the top. My orthodontist told me that this is fairly standard; in fact most people who need refinements need to use the over-corrections. Over-corrections are given by Invisalign because those particular teeth proved stubborn to move the first time around and apparently they then usually remain resistant throughout treatment. For this reason he has told me to wear my next two upper over-corrections and he will then review my teeth again to see whether we are satisfied with the final positioning.

My bottom arch is now on aligner 26/34 and whilst I can see great progress my orthodontist is not convinced that there will be sufficient room after another 8 aligners to get my bottom wonky tooth (which you can see here on my clincheck) in to place. I am cautiously hopeful that he is wrong, but we shall see. If there isn’t enough room by number 34 we will have to do refinements (additional aligners) for the bottom row too. Funnily enough on my clincheck it always looked like there would be plenty of room long before the end and as my teeth seem to be tracking perfectly I am surprised that there isn’t. As my orthodontist has told me repeatedly the clincheck is only a guide, not gospel. Having read numerous other patients Invisalign stories I know that that is the truth. It seems that it doesn’t pay to get too wedded to the final result that the clincheck shows, it’s a useful estimate but nothing more.

There is no massive progress since the last Invisalign pictures that I posted ( you can see the highlights in the sidebar on the right) so I won’t post more now, but I’ll take more after these two over-correction uppers so you can give me your verdict on my upper arch. I think that I could do with a little more widening of my molars, but maybe the over-corrections will take care of that, we shall see. In the meantime I intend to try and make up for the misdemeanours of New Year’s Eve by being especially compliant in January. We shall see how long that lasts! At the very least I am happy that one year into treatment I am still loving my Invisalign.. Watch this space!

It occurred to me yesterday that it is almost exactly a year since I started wearing Invisalign and whilst I won’t be throwing the little plastic fellas a birthday party exactly, I thought it might be useful to reflect on how well the year has gone.

Firstly, have my teeth changed? Hell yes. When I look at that horrendous before picture in my right sidebar I’m not surprised that I never showed my teeth when I smiled. I’m actually just surprised that I left the house at all!
Not that I have perfect teeth now, in fact, I still have probably as long  to go again, if not longer. But I’m happy with that because I can see that things are moving in the right direction.
So to reflect on the good things to have come out of this whole process:

• My teeth look much, much better already. The thing that has made a particular difference in my opinion has been the widening of my upper arch. I knew that it needed to be done, I just didn’t know what a difference it would make.
• The tooth whitening. This made an enormous visual change to my smile and I plan to do some more when I am finished and all of my attachments are off. It was also a great boost at the start of the treatment. I can highly recommend the nitewhite that I used with my trays.
• My orthodontist is great, which is a huge relief. It was such a process to find a good orthodontist that I’m thrilled that it worked out so well.
• Wearing my Invisalign isn’t painful in any way. Of course, there is some pressure and tenderness at the beginning of some trays but there is no rubbing and chafing, no sores, nothing. I expected this to be much worse than it is. I’m not sure what I expected exactly, but I think it involved ucers, sores, waxes and many other horrors that I haven’t had to deal with.
• My oral hygiene has dramatically improved. I feel guilty now if I only floss three times a day. I hope this carries on after treatment at least to some extent. It’s also gratifying to actually be able to get the floss between my teeth, it used to be an exercise in physical force just to get the stuff between my teeth and out again without it breaking. These days I don’t even think about it.
• I just haven’t found wearing the things an ordeal. They aren’t that noticable, they aren’t that inconvenient, they just aren’t very difficult. Such minor inconvenience for such a great result seems a pretty happy balance to me.

Of course, not every aspect of Invisalign wearing is rosy … off the top of my head these are the things that I don’t like about my braces:

• I’m not as compliant in wearing my Invisalign I should be. I know that is my fault and not the fault of Invisalign but it still annoys me. Mainly it is just laziness and forgetfulness, less than admirable traits.  Still, it gives me something to add to my list of New Years Resolutions.
• I forgot to get my attachments removed before my upper refinements and then I forgot to ask my orthodontist why we didn’t remove them. Of course, there may well be a sound orthodontic reason for it, but I don’t know it so it annoys me!
• I keep losing the damn things. I’m sure if you’re a regular reader your pretty au fait with my inability to hold onto my Invisalign aligners, but honestly, in the next year I don’t want to go scrabbling through any more restaurant dustbins. Yes, it happened again last week. No, it wasn’t pretty.

On reflection there isn’t really anything that I would change about my Invisalign decision. Of course, I am yet to see the end result and that might change my feelings, but at what I assume to be about the halfway point I am thrilled with how things are going.

On a final note I just wanted to say thank you to the 65,000 of you (yes really) that have read this blog over the last year. Your comments, helpful suggestions and support have been much appreciated.

Merry Christmas and a Happy New Year! Keep smiling…

I know, I know, I’ve been a bit slow with the updates lately. I have no real excuse other than a serious bout of the flu. I’m in the southern hemisphere (i.e it’s summer here) and I have had both the swine flu and seasonal flu vaccinations (fortunately we have a large stockpile of swine flu vaccination here, it’s available free and on demand) but somehow I still managed to succumb to a 2 week bout of illness. Yuck. I managed to keep my aligners in for most of it, although there were a couple of days where I simply couldn’t function without a lozenge in my mouth as my throat was so raw and painful to swallow; so on those days I’m afraid I was a little remiss.
Fortunately I’m now back on form and back on track with my invisalign, so I promise I’ll try and update more regularly.

As you can see from the pictures there are no massive revelations at this point in my treatment, but things are slowly moving into place. I am now on 3/9 of my upper refinements and on 23/34 of my lower aligners.

As you can see from the first picture the movement of my crown has now caused a very ugly black line along my gumline next to the crown. Fortunately my aligners actually mask this to a great extent so it isn’t nearly so noticeable when they are in, but it is, nonetheless, a bit ugly. The profile view of that crown is improving (see third picture) but still isn’t nearly perfect as the front tooth still needs to move back into place a little more. I have six aligners to go, so we’ll see what happens. I’m still really looking forward to getting the crown replaced (although already having nightmares about the actual procedure!) I know that the cosmetic dentist also said that he needs to raise my gumline above that tooth, which I’m trying not to even think about at this point for fear of never going back to another dental appointment again. If you have had a gum raising procedure and can offer any kind words of encouragement, please, please do. Frankly, I’m terrified!

My upper refinements as mentioned in a previous post are focusing on two areas, my front right tooth that needs rotating and the molar that is too long and not in position on the left side (right side in these pictures). I was told that my nine refinements are really six aligners and three over-corrections; if my teeth look done after the first six trays we can stop. Something I have been wondering about is, what happens if one area looks perfect after six aligners and the other doesn’t? Do I have to over-correct one area to get a finished result on the other? I’ll ask my orthodontist at the next appointment and let you know.

My bottom arch isn’t looking too different from straight on but I am happy to report that a real gap is opening up inside my mouth for my stray tooth to move into (see my clincheck). I can also see that the bottom arch looks less “witchy” when viewed from the front. One of the things that I disliked so much about my teeth pre treatment is that the the bottom row were both very visible when I talked and also very pointed and crooked, giving me a look that could easily scare small children! (see my sidebar for the before pictures) This far into the treatment I am happy to report that they are becoming much more uniform and whilst not straight, will no longer qualify me for a walk on part in The Wizard of Oz.

As ever I would love to hear your comments on my treatment. Feel free to click on the “comments” link below and let me know your thoughts on how things are going.

http://myinvisalignblog.com/useful-links

I thought it might be interesting to keep a diary for a single day of my braces; how often I remove them, number of times I floss, brush etc. Of course, having written it I can see that it really isn’t that interesting at all- yes, my life really is this boring! However, it might be useful for people considering braces to see how often you have to remove them and it has also been useful to me, in showing me that I am really not achieving the twenty two hours a day. I would love to tell you that ordinarily I am much more compliant but the sad truth is I think this is probably fairly indicative of the amount of hours that I manage to wear these things. Must do better…..

• 6am Alarm, get up and shower. Braces stay in.
• 6.30 Go downstairs. Remove Invisalign and toss them on the kitchen bench on paper towel-yick! Have breakfast then spend 40 minutes chivvying children and brushing hair.
• 7.30 Children leave for school and husband and I grab a quick coffee on our back deck.
• 7.50 Brush teeth, floss and give braces quick clean before putting them back in. Yikes. 1 hr 20 minutes out. I think I would have convinced myself it was about 30 minutes if I hadn’t checked.
• 8.10 Check emails and do some work on my computer.
• 9.15 Get peckish and remember box of Cadbury’s Favourites in the pantry. Braces out and on the kitchen bench (new paper towel!)
• 10.15 Box of chocolates almost finished and braces still out. Realise and panic. Dash upstairs to brush/floss and put braces back in. Another hour. Whoops. Total time out so far 2hrs 20 minutes
• 10.40 Glass of water- Aligners can stay in.Yay!
• 12.20 Lunchtime. Sandwich, crackers and a banana. Eat it on my deck in front of my laptop. Brush, but don’t floss.
• 12.37 Aligners back in. Total time out so far 2 hrs 37 minutes
• 4.00 Arrive home from kids after school activities. Remove aligners and throw them on the kitchen bench. Grab a snack.
• 4.24 Realise aligners still out, swear loudly, do rudimentary brush and throw them back in. Total time out of mouth 3 hrs 1 minute. Gulp
• 5.54 Husband arrives home and serve dinner. Take aligners out- you guessed it, paper towel on the kitchen bench. Eat dinner fast as have to go out.
• 6.27 Brush and put aligners back in. Total time out. 3 hrs 35 minutes
• 9.00 Out watching Midsummer Nights Dream. Grab a glass of champagne in the interval. Hide in a corner of the room and remove my aligners. Put them in case in my handbag.
• 9.15 Queue for the toilets too long so can’t brush or would miss second act. Put aligners back in. Total time out of mouth 3 hrs 50 minutes.
• 10.45 At home. Take aligners out and put them in Steradent solution whilst I brush and floss.
• 10.52 Aligners back in. Go to Bed. Total time out of mouth during whole day. 3 hours 57 minutes.

As a quick summary what I can see is that I brushed 6 times during the day but only flossed 3 times. Whoops. That my aligners were in my mouth for 20 hours and 10 minutes. Just. Also that I really, really need to wear my aligners more. But you knew that already.