The waiting is the hardest part: Part III

When I last updated this blog, I had three weeks to go and then I would have a re-scan to correct a couple teeth that had gotten off track. I wasn't sure what to expect as far as how much time this would add to my treatment plan, but boy did I get a shock yesterday when I had my visit. SEVENTEEN more aligners to go now. They also added SEVEN rubber band buttons to the two that I already had, so I now have NINE metal pieces in my mouth. They had taken all the clear attachments off my upper teeth at the last visit when they scanned me, and now they have added ten of those to the top, and an additional couple on the bottom.

I am disheartened. I really had only anticipated maybe another 4-5 weeks. An extra 4 months is just crazy. Honestly my teeth look pretty good now, I just didn't think there was that much work to be done yet.

The main thing they seem to be focusing on is my bite. They told me that moving the teeth is the easy part, but getting them all to line up together on the top and bottom is tricky. This is why I have so many more buttons. They are really going to focus on dialing in my bite by utilizing elastics. At times I will be wearing 4 rubber bands at once.

Again, I am impressed with their commitment to making sure that I am happy with the end results. But man am I bumming right now with how far I have to go.

Just 3 weeks to go. But....

I have three more aligners to complete my treatment. However, I've already been told that after that they'll do a re-scan and send to Inivisalign to start a new series to correct some uncooperative teeth. The same tooth that has always given me trouble is way off course, as is one of my front upper teeth. The attachment came off that one, and the orthodontist decided to not bother to replace it since we'll be re-booting my treatment plan anyway. I have no idea how much longer this will mean the process will take, but I wouldn't think it would be too much. Anyway, I'm just glad they're adamant about making sure that the end result is one that I'll be happy with.

This is a good time to discuss how my habits have changed over time. I'm no longer quite as worried about adhering to a strict 22 hours per day policy. Usually, I have them out for at least two hours just in the morning while I have breakfast and sip a couple cups of coffee. Some days I forget to use the Acceledent. When I go to a restaurant, rather than brushing and all that, I usually just kind of rinse with water and pop them back in after eating and then brush when I get to a more convenient location. In short, I've gotten used to the whole thing and don't freak out over details quite so much anymore. I'm really comfortable with them now. But I still can't wait until it's over.

Regular Appointment

Well I went to the orthodontist yesterday, and all went well. He wasn't concerned about the movement of the teeth that I talked about in my last post. He made some room for my bottom teeth by shaving in between them in several spots.

He said he is happy with my jaw movement and that I can go to only wearing the elastics half of the time. Crazy thing is, I'm very used to them and it feels weird without them in. I put them back in before I left the office and left them in for rest of the day. I took them off at night. I think that's what I'll do for awhile until I get used to the idea of an unrestricted jaw during the waking hours.

I forget to point out that I lost an attachment on the bottom, but it doesn't seem to be causing any trouble so it can wait until my next visit.

Can You Eat With Invisalign In?

I was just talking to a new coworker who noticed my Invisalign and said that he just completed his treatment less than a year ago. He said that his treatment course was 27 months long! Then he told me that after about a year he just started eating with them in! He said he couldn't chew or bite off things like meat, but anything on the softer side he would leave them in for. He said it was actually easier because all you have to do is rinse them off when you're done. I am just baffled. I once tried to eat a martini olive with them in and couldn't bring myself to do it. I cannot imagine doing this!

Can You Use Mouthwash With Invisalign?

I love to use mouthwash. I usually keep a bottle in my drawer at work and use it throughout the day. Since I've gotten my braces though, I haven't. The brushing makes up for it, but sometimes I still feel like I could use a cleanse.

I don't know why, but I just always assumed that using mouthwash with Invisalign would be a bad idea. No one told me not to, but I guess I just figured that the green might stain or at least get trapped in there temporarily and look weird. But I tried it the other day, and it's fine. I just rinse with water when I'm done, and it works great.

Will We Need Another Reboot?

I have a regular visit tomorrow, and I have concerns about another tooth. It's the opposite one as before, and it seems to not be coming down. This one did not get a new attachment when my new aligners came in, and I think it probably should have. You can see it here in the center with the large gap between the tooth and the bottom of the aligner:

In fact, the same tooth that had been giving me trouble before seems to not be tracking so well again. Have a look:

Not as bad as before, but still concerning. Keep in mind that this is the very first day with this particular aligner, and some space is normal. I even have been wearing the aligners for a little longer than a week before changing to the next one to try to correct any issues, but it doesn't seem to matter.

One thing I have taken away from this experience is that if we have to change treatment plans again and get all new aligners, I will INSIST that all attachment be removed and new ones installed.

The Reboot

Three weeks after my visit they finally called to tell me that my new aligners were in. However, the doctor was out of town that week so I couldn't get in until a full month after we had ordered them. It was longer than expected, but still quicker than the old way. But here's the thing with wearing the same trays for 4 weeks: it's gross. They turned yellow. I soaked them in peroxide. I soaked them in Efferdent. I soaked them in peroxide and Efferdent together, which made a nice bubbly mess, but left them still disgusting. I do not ever want to have to wear them for that long that again.

The big question I've been wondering while waiting was how far out this whole episode with the tooth that wasn't tracking would set my treatment plan back. I was on tray 16 of 44, so 28 to go. My new set has 21 total. So even though I lost a month waiting, I'm still going to finish 3 weeks ahead of schedule. Can anyone explain that to me? How exactly did having to adjust for an uncooperative tooth shorten my overall treatment? Makes no sense to me, but I'm not complaining.

At the visit, they had to adjust some attachments for the new aligners. The two on my front upper teeth came off (though they told me that they would be going back on later) using basically a dremel tool. They added two to my lower teeth towards the back one side. I can't quite figure that out, either. You would think since the bottom were doing fine that the same course of treatment would apply.

The assistant that was working on me clearly did not want to do any more messing with the attachments than necessary. I specifically asked her if the attachment on my trouble tooth needed to be changed, and she said no. After she was done, the doctor came around to examine me and pointed out that all the attachments on my bottom front teeth were a different shape and size and needed to be changed. So back in she went, ground them off and re-applied them with the new mold. Another inspection from the doctor, and I was done.

Except I wasn't.

After I got home, the first time I took the tray out and looked in a mirror I realized that the attachment on the tooth that had been giving me problems did not line up with the notch in the tray. At all. It was in a different spot, and was a different shape and size. I was very frustrated. If it was any other tooth, I would not have been so worried. But since it was the tooth that caused us to have to completely redo my whole treatment plan, I thought that we had better get it right.

I called and asked to speak to the orthodontist himself. I explained what I saw and he agreed that it should be redone. He said to come on over and they would get me in right away, which they did. When I walked in, the assistant that worked on me the day before gave me a funny look and said, "What are YOU doing here?" It was kind of awkward, but she fixed me up and now I don't have to worry about it.

Two days later, an attachment fell off a bottom tooth. I'm going to just keep an eye on it and have them fix it at my next regular appointment.

OH! One more thing...   Since they removed the attachments on my front two upper teeth, I got to see if the whitening I've done permeated the attachment. It did! There is not a darker color where the attachment was, they are evenly white. NICE!

The Waiting is the Hardest Part, Part II

It's been two weeks and one day since I was at the Orthodontist and they told me that we would have to get an all new treatment plan to correct for one insubordinate tooth. They said the new trays would be there in about a week and a half. Meanwhile, I am to stay on the set of trays I was already on. In other words, we're making no progress while we wait. When my new trays come in, I find out how many sets I will have. I was on set 16 of 44, I can only imagine that the overall treatment plan will be longer, plus add in the down time while we're waiting. The anticipation is once again killing me.

Can You Bleach Your Teeth With Invisalign?

Time to reveal more of my sordid dental past. When I was a kid, my teeth were horribly stained and yellow. They not only had an overall yellow-ish tint, but had splotches of darker yellow peppered throughout. I'm not sure what caused it. I don't think that I had worse dental health than most children, especially after observing my kid's habits (we found out that when my oldest son was away at camp, he found it best to just wait to brush his teeth until someone would comment on his breath). It got so bad that my parents agreed to let me get bleach trays from the dentist. But like most things, we did it only half-way and just got an upper tray. I'm sure my parents thought that I would be a typical irresponsible middle-schooler and lose the things anyway, so they only paid for one.

What I remember actually making the most difference was the scrubbing the dentist gave me before the treatment. To prepare my teeth, he sort of just got in there and ground on them with some rotary instrument. After that, they looked much better and frankly the treatment could have stopped right there. But I got my tray, and my gel. I was to wear it all day and keep the tray filled, which was tough to do because the gel was flavored and it's hard not to suck it out. But I tried, and my upper teeth did get noticeably whiter than my bottoms. And then I lost it. Of course. I blamed the cat.

Now that I'm wearing similar trays 22 hours a day, I got to thinking that maybe I could try the whitening process again. Nowadays my teeth aren't terribly yellow, but I do find myself jealous of other's white smiles sometimes. I also do still have an interesting stain on one of my front teeth that sometimes seems more pronounced than others. I'm sure no one else notices it, but I do. So I looked up on some info on using whitening gel in Invisalign trays. I didn't find any clear answers as to whether this was a good idea or not. Some said that it's pointless because you'll end up with dark patches where the attachments were. They also point out that the Invisalign aligners fit much tighter than whitening trays, and they insist that the gel will just be forced out when they snap in anyway. Others insist that it's a great time to do it since you're already wearing the trays, and the bleaching actually permeates the enamel and whitens the teeth beneath the attachments. Everyone recommends consulting your orthodontist first. I didn't.

I am NOT recommending this, I'm just sharing my experience. I found some whitening gel on the internet one night and just decided to go for it. I won't tell you where I got it or what brand it is or how much it was, but let's just say that it's readily available and is surprisingly cheap. I keep calling it bleach out of habit, but it's actually carbamide peroxide, whatever that is.

First I remove the trays and dry them. Then I carefully place the gel across the front of the aligners, making sure to coat the entire surface and remove any excess. (the first time I made the mistake of using too much). Then I dry my teeth with a paper towel and insert the trays. I then wipe any excess off my gums with the paper towel. It is supposedly mint flavored, but tastes like medicine. If the gel sits on your gums too long, it burns. While I have them in I try not to suck the gel out, and limit swallowing. Dabbing the paper towel around my mouth every now and then helps. It's an unpleasant process. The instructions say to leave it in for 30-60 minutes and repeat as needed. I did it once a day for roughly a week, and have done it a few times since then to refresh. It has made a noticeable difference.

So can you bleach your teeth while using Invisalign? Even though I am, I'm still not sure.

What Happens When Invisalign Doesn't Work?

As I discussed in my last post, one of my teeth is not cooperating. Here is the culprit:

As you can see, it's just not moving with the rest of them, and now the attachment on that tooth no longer lines up with the notch on the tray at all, so it's pretty much hopeless that it's going to fall back into the program.

So today I went to the orthodontist for my regular appointment, and discussed it with him. He noticed it right off, of course. Basically the only way to correct it is to toss the rest of my trays and start over with a new plan from the computers at Invisalign beginning with this point in time. I was assured that this will not result in any extra costs for me. I can only guess that this will add time to my overall treatment plan, but we won't know until my new trays arrive. Luckily, that shouldn't be too long from now because my orthodontist has a new toy.

Rather than make molds like they did the first time, the office now has a machine that skips that step and creates the computerized 3D images right on the spot. This means no more mailing the physical molds to California and waiting 4-6 weeks for them to send the trays. Instead the file will be sent electronically, and I will have my new trays in a little over a week. The machine even does a preliminary treatment overview and shows you exactly how your teeth will look when done. Really cool. Here's the machine with the rough model of my teeth before it did all its processing:

The process involves a technician simply taking that wand and going over and over your teeth with it until a complete image is generated. She had some trouble with mine, mainly because the machine is new and I was only the third person she'd ever used it on, but also because it was very difficult to get the wide wand all the way to the back of my mouth to get my still-present wisdom teeth. It was very uncomfortable, and someone with a very active gag reflex would have certainly had a hard time tolerating it. But nonetheless even with the complications the whole process took about 20 minutes. If 20 minutes of being uncomfortable can save me 5 weeks of waiting time, I'm all for it.

Other than that, the visit went well. I'm to continue to wear the tray that I'm on until my new ones arrive. He was pleased with the way that the elastics (rubber bands) have been moving my lower jaw back. I was pleased that they had a fix for my wayward tooth, and that it won't cost me any more money.

Week 15 Update

Things are still going along remarkably uneventfully. However, I do have one concern that I will bring up with my orthodontist at my next appointment later this week. One of my more crooked teeth is obviously not behaving the way it's supposed to. You can see it in this picture:

It's the one on top just to the right of the large one in the center. You can see that it doesn't fill out the bottom of the tray, because it's not moving like it's supposed to. The attachment on the tooth no longer comes anywhere near the notch on the tray. This means that the flat part of the tray is actually being pressed out by the attachment, distorting the tray and affecting how it lays on the next tooth. I took this picture more than a week ago, I can tell that it's even worse now with the next tray in. That tooth is not moving.

I'm not sure what they do when things don't go as planned. All the trays are made for the whole process already. If it's bad enough do they start over with new molds? Or do they just ride the process out and then make extra corrections at the end somehow? I guess I'll find out soon.

Movement!

I think I understand the strategy now. It seems like my teeth are spacing out quite a bit. The plan must be that they get spaced out first so there's room, and THEN they start turning/straightening. The gaps between my teeth are huge. I can tell becauseand I'm getting food stuck in places I never have before, and because the floss just glides between them without even touching sometimes. Next time I'm at the orthodontist I will confirm this by watching my progression video again. Maybe they'll let me video it so I can share!

Regular dentist visit today

Today I had my first regular dentist visit since getting my braces.

Now, a little strange background on this. When I was a youngster, I of course went to the dentist regularly, and regularly had cavities that would need filling. I think four or five altogether. But then as a young adult, I stopped going. You see, I missed an appointment (due to being a lazy teenager that refused to get out of bed), and somehow I was under the impression that when I did go in, I would have to pay for both appointments, which seemed unjust to me. Where I got this idea, if it was true, and why I was even concerned when I wasn't paying my own medical bills yet anyway is all a mystery. But rather than suffer this grave injustice, I didn't go back. For 20 years.

Time just got away from me I guess. And I've had zero issues with my teeth. I've been very lucky. But my family recently found a great dentist, and I knew I was way overdue. So finally, a little over a year ago, I went to the dentist. We did x-rays, cleaning, the whole deal. No issues. I was worried sick that they would tell me that I had to have my wisdom teeth removed, but no. Everything was fine. The hygienist said I had some plaque buildup, but no worse than anyone else that gets regular checkups. They were all just completely amazed that I really hadn't hadn't been to the dentist for 20 years, and had no complications.

When I checked out, she asked if I wanted to schedule an appointment for my next cleaning in six months, and I laughed and said, "No, I'll see you in twenty years."

But then the braces thing happened, and I know that I should get regular cleanings at least while I have Invisalign because the trays trap things in them and actually promote plaque forming. So only a little over one year later, I found myself back at the dentist.

They wanted to do x-rays, but I declined and she was very polite about not pressuring me. It's not that I mind doing them, it's just that it seems unnecessary at this point for any reason other than to help pay for their machine. That's not meant as a dig against dentists, or a suggestion for other people to follow. It's just how I feel about my particular situation. I don't get my car aligned unless it's pulling or shows unusual tire wear, either.

Anyway, the visit went very well. The hygienist scraped my teeth with the pokey thing, and ran that icky paste over them, and it was all done. She was shocked at how many "buttons" we're on my teeth, and I told her that it was indeed an office record. Then the dentist came in and was just as flabbergasted. "You've even got metal ones! That's very unusual." Yes, yes, I know office record-holder here.

My appointment

So literally nothing happened at this appointment. I was expecting more teeth-filing, but no. He said that won't happen until sometime around 25 weeks. All he did was ask how things were going, and do a quick visual exam. No x-rays, no nothin. They gave me more trays and told me they'd see me in another couple months.

9 Weeks Update

I have now had my Invisalign braces for nine whole weeks! I am fully used to them now, to the point that I don't notice them anymore throughout the day. In fact, sometimes I sit down to eat and then remember that I need to take them out. I am also used to the routine, and it no longer seems like a hassle to me.

But I cannot yet say that I notice any difference in my smile. In fact, my wife and I closely examined my first set of trays next to my eighth set and could tell no difference. It's no big deal, but I would just have thought that 20% of the way through the process I would have noticeable changes. The only thing I notice is that when I floss, the floss breezes through some spaces where it used to hang up. Oh ya, and when they're out my bite does feel different, with my teeth lining up in new ways.

Pain is minimal. I still wouldn't dream of biting into an apple, but other than that it's fine. I've started drinking coffee again, I just take them out when I do. I haven't noticed any staining on my attachments.

I have an orthodontist appointment tomorrow. Somehow we ended up with one extra week between appointments than I had trays, so I kind of stretched out the last three by a couple extras days to make up for it. I wish I had known this earlier, because I would have used that extra time in the beginning when pain was more of an issue. I'm sure tomorrow they will be cutting more spaces between my teeth. So on to the next phase!

Acceledent Review

What is it?

Acceledent is a device that speeds up the movement of teeth by gently vibrating them. It is a technology first employed in healing bone fractures. It basically makes the jaw bone more forgiving of dragging teeth through them. The device is designed to be used for just 20 minutes per day, and cuts the time needed to straighten teeth in half. 

Does it work?

First, let me state that I am not qualified to answer this question from a clinical standpoint. I can only offer my personal experience as anecdotal evidence. Strictly from a practical standpoint, I have to answer that yes, it does work. It cuts the time in half because without Acceledent my orthodontist would only let me change out my trays every two weeks, and with it I get to change them every week. So yes, it absolutely cut my time in half. But that doesn't really answer the question of if it works, does it? In other words, could I have changed my trays every week anyway? I don't know. I can't find out, and neither can you because responsible orthodontists everywhere only give you enough trays to last between scheduled appointments, so you can't try to speed the process up on your own. I tend to be skeptical in nature, and I just have a tough time believing that it really makes that much of a dramatic difference, but what do I know about osteopathy? For me it was a simple economic decision to use it. My time is scarce and has value, and so does my money. To me it was worth the extra monetary investment to save the time. Which leads us nicely to my next topic...

What does it cost?

I paid $800 extra to add Acceledent to my treatment plan. I have read where people have paid way more than that, mostly when it first came out. I have also read where other people have paid about half that. You are buying the device from your Orthodontist, and I think the price mostly depends on office policies and what kind of volume the office does with Acceledent. 

I have said before that when you hold it in your hand, it in no way seems like it should cost hundreds of dollars. It feels like about a 20 dollar unit with a 60 dollar carrying case (that you'll never ever use). But think of it this way: You're not just paying for the unit, you're paying for the research that went into it, like a college textbook. Hope that makes you feel better. 

You shouldn't (and probably can't) simply buy a used unit to save money. First, you'll need a new mouthpiece for sure not only because they are fitted, but also because ewwww don't use someone else's mouthpiece. And secondly, it is a regulated medical device only for use under an Orthodontist's supervision. You can't even buy a new one from Acceledent directly, you have to buy one from your Orthodontist, and you absolutely shouldn't buy one used. I have even heard (unconfirmed) that the device is timed to stop working after one entire treatment regiment, to prevent a second user. I don't know if that's true or not, but it would be pretty crummy if it was as I could see one family getting more than one use out of it. But at any rate with that being the rumor, I wouldn't risk it. Plus your Orthodontist probably won't allow treatment administered unless you've purchased the device from his or her office anyway. 

What's it like to use?

I have to say, it's no big deal. I thought it would be kind of a pain in the butt to have to use the thing every day, but it's actually become a part of the day that I look forward to. It feels kinda good. It charges by USB, so I keep it in the center console of my truck and it charges as needed every day when I drive to work. I have about a 25 minute commute, so on the way home I use the device. This routine works perfectly for me, and doesn't interfere with my schedule at all.

My Orthodontist told me that I could break up the 20 minutes throughout the day if I wanted to. But this is directly contradictory to the instructions, so I've been doing it all at once. It's a smart unit, and flips on and off at the halfway point so you know where you are in the process. After the 20 minutes, it shuts itself off, so you don't have to time it yourself. If you have to shut it off in the middle of a treatment, when you turn it back on it picks up where it left off. It's got some nice tech to it. 

When I first started using it, I was quite concerned that it wasn't hitting all my teeth. Because of my underbite, my back teeth hit the flat mouthpiece first, and my front do not touch it at all when in that position. In the beginning I was biting down on it quite hard to get all of them to touch it. But when you do that, it no longer vibrates. You see, there's two parts: the mouthpiece and the actual unit. If you clamp down hard on the mouthpiece, the unit vibrates but the mouthpiece doesn't. It's when you loosen up that the mouthpiece really begins to quake. When I spoke to my Orthodontist about this, he seemed unconcerned and advised me just to do the best I can, offering no real helpful advice. The instructions are not much help either. I've read other places that it only really needs three points of contact to work its magic, but have no idea if that's true or not. So what I do is just kind of shift it around while I'm using it, attempting to give all my teeth a chance. I guess it's working (see second section).

To sum up...

If you can swing the extra bucks, get Acceledent. It cuts the time in half, it's not inconvenient, and it feels kinda good when you use it. 

So Are Invisalign Braces Really Invisible?

In a word...yes.

As I've said before, this was not a huge concern for me when choosing braces. In fact I was all prepared to have traditional braces put on. The orthodontist recommended Invisalign because of the level of accuracy that Invisalign offers. But they certainly do also offer a much lower-profile option when it comes to teeth straightening.

So far, I don't think that anyone has noticed my braces yet. On the contrary, when I point them out to people, they still can't see them and don't understand what I'm talking about. To me, they look fairly obvious, but apparently to others they really are invisible.

Now, I do have rubber bands that connect my back top teeth to my lower front teeth to try to correct my underbite. Those you can see if I have my mouth wide open, like if I'm yawning or laughing. But again, I don't think that anyone has noticed them either, unless I point them out.

Keep in mind, my job entails me giving presentations to clients that are sitting directly across the desk from me. They are literally less than three feet away, and I have yet to have anyone that seems to notice.

Or maybe they're just being polite.