2nd round Impression

So, traveled all the way to London for my 3.50pm appointment. Waited at the lounge for a further 30 minutes again (last time was also a half an hour wait!) before seeing my dentist.

I think the impression wasn't taken properly on the 1st time round for my lower arch, that's why I'm back again. The friendly receptionist (I think she's the best receptionist that a dental practice can have!) assured me that I would be receiving my aligners around mid November, so can definitely bring the aligners back to Taiwan to show Mum & Dad! They'll be amazed to see Invisalign aligners- nearly invisible braces!!

In the surgery room, the desk is full of Invisalign boxes for different patients- I am sure there were like 30 boxes! Guess the dentist is fully booked with just Invisalign treatments. I am not surprised, coz with an amazing offer of just £1500 for the full treatment, one would be insane not to take it up! (Normal price is around £3000!!)

So just looking forward to seeing the clincheck, which will be available to view in the next 7-10 days!

False Alarm

I was really happy to see a missed call from the Clinic as I thought they finally got the clincheck back for me to look at... Unfortunately it's a call asking me to go back to take further impressions... ARGHHHHH!!! I guess I won't be receiving my aligners before the end of this year!

Oh well, new fresh start for 2009 heh?

Invisalign Express

Align Technology (company of Invisalign) also offers Invisalign Express. Well, at first glance, I thought Invisalign Express is a quicker and more painful treatment than Invisalign. However, after doing some readings, Invisalign Express = Invisalign Mini! Basically it's for people who require little movement, mild crowding and mild to no rotation. It is a great system for rebound cases of people who had braces before. Since it's designed for mild problems only, treatment time is generally less than six months. And with less than 10 aligners, obviously it's a lot cheaper than the normal full Invisalign treatment. Here is an useful comparison table

Another interesting Invisalign Video

Teeth Strengthening is An Investment, Girls!

I was talking to my friends and telling them the 'big news' that I am having my teeth strengthened, everyone looked so surprised and asked 'why, your teeth are fine!'. I then had to explain to them about my over-jet upper arch and overcrowded lower arch, they were like 'that's nothing, look at my teeth....' and said to me having teeth straightened is too expensive, especially when the correction is minor.

Everyone knows that 1st impression counts and teeth are clearly important in making an impression. When meeting an opposite sex, first 2 things you notice are eyes and smiles. I don't think I have an unattractive smile, in fact, I think my smile is actually one of my best assets. But since it's one of my best assets, I'd like to perfect this asset! And is it really that expensive? I really don't think so, coz it'll last me a lifetime! Think about it, if I divide the cost of my Invisalign by 25 years (assuming some of my teeth will fall off anyway when I am old), I am really only spending under £100 a year on my teeth. Compare that to the amount of money that I spend on clothes, makeup or skin care, the cost is really minimal! It's even less than buying an annual subscription of contact lenses! Now thinking back, why did I take this long to get this done!? I must have not been thinking straight! LOL

Still another week or two til I have my Clincheck! I can't wait!!

Invisalign = Slimmer me!

First of all, I have to admit that I have a sweet tooth and I love snacking! But I guess this habit of mine is going to disappear after my Invisalign treatment. Why? Because you have to take out the aligners to snack, brush your teeth PLUS the aligners before putting them back in. As much as I love snacking, I would rather save a few hours a day from performing oral hygiene.

Is Invisalign worth it?

On this website, it shows 81% of Invisalign users think it's worth the money! Yoohoo- that's a really positive result, particularly Invisalign is pretty pricy comparing to other orthodontic treatments. :) We all know that Invisalign is not as effective in straightening teeth in more severe cases than the traditional metal braces, it's the 'nearly invisible' braces that we're paying for, not really the end results. (although end result is really important too, still, who would want to wear metal braces when they're like in their 20s?) I mean, even when you're in your teens, just imagine your first kiss with a mouth of full metal braces is quite a horrible thought. My dentist told me that invisalign would only correct 80% of my problem- I think I'll be happy with that! :)

I've gone through some bad reviews, here are some of the considerations that the Invisalign website and your orthodontist/dentist would happen not to tell you:

1. More prone to cavities- read the user experience.
Basically your teeth are covered by the plastic aligners all the time during your treatment so the salivia no longer can act as a cleansing agent for your teeth and helps prevent decay.

This is quite an understandable concern, especially for me as I'm already prone to decay (I have 13 decays in my mouth already!) and the dentist says that during the treatment, one should not have decays as it'd change the structure of the teeth, which led to the aligners not being able to fit properly.

2. Filing and shaving teeth to make rooms
"To start off what they don't tell you is that they put these clear bumps on your teeth to hook the trays on, then they don't tell you that they file your teeth to make your teeth move faster. I did NOT want my teeth filed, especially my upper. I said ok to filing my lower, my ortho ended up filing HUGE gap inbetween my upper two teeth!!! He also filed one tooth smaller that the other - you can't fix that, it not like a bad haircut that will grow back. It was terrible."

"Also my bite shifted and became very uncomfortable! For some reason they felt it neccessary to literally FILE teeth in between to make room for the teeth to move as well as to adjust my bite. "

I was a bit scared when I read it- coz I know filing/shaving teeth is definitely not what I want!

3. Having "buttons"/"bumps" on your teeth
In order to have the invisalign plastic aligners, the dentists would attach these white (scratchy) buttons to your teeth to catch/secure the aligners. The 'buttons' are supposed to match with the colour of your teeth enamel so they don't really show up! But my dentist didn't mention anything about these 'buttons'?! Nor did the video!

I can't wait for my appointment so I can view the clincheck and ask my dentist all these questions on my head.
Maybe I should read all the positive reviews about invisalign to calm myself down!

Clinical Limitation of Invisalign

I found this article online- quite an interesting read:

Article from Canadian Dental Association, written by Xiem Phan, BSc, DDS and Paul H. Ling, DDS, MDS Ortho, MOrth, FDS, RCS

Clinical Limitation of Invisalign

Adult patients seeking orthodontic treatment are increasingly motivated by esthetic considerations. The majority of these patients reject wearing labial fixed appliances and are looking instead to more esthetic treatment options, including lingual orthodontics and Invisalign appliances. Since Align Technology introduced the Invisalign appliance in 1999 in an extensive public campaign, the appliance has gained tremendous attention from adult patients and dental professionals. The transparency of the Invisalign appliance enhances its esthetic appeal for those adult patients who are averse to wearing conventional labial fixed orthodontic appliances. Although guidelines about the types of malocclusions that this technique can treat exist, few clinical studies have assessed the effectiveness of the appliance. A few recent studies have outlined some of the limitations associated with this technique that clinicians should recognize early before choosing treatment options.

In 1945, Kesling1 introduced the tooth positioning appliance as a method of refining the final stage of orthodontic finishing after debanding. A positioner was a one-piece pliable rubber appliance fabricated on the idealized wax set-ups for patients whose basic treatment was complete. The practical advantage of the positioner lay in its ability to position the teeth artistically and to retain the alignment of the teeth achieved through basic treatment with conventional fixed appliances. Various minor tooth movements could be incorporated into the positioner. Kesling predicted that certain major tooth movements could also be accomplished with a series of positioners fabricated from sequential tooth movements on the set-up as the treatment progressed.

In 1971, Ponitz2 introduced a similar appliance called the “invisible retainer” made on a master model that prepositioned teeth with base-plate wax. He claimed that this appliance could produce limited tooth movement. Sheridan and others3 later developed a technique involving interproximal tooth reduction and progressive alignment using clear Essix appliances. This technique was based on Kesling’s proposal, but almost every tooth movement required a new model set-up and therefore a new set of impressions at almost every visit, making the technique excessively time-consuming.

In 1997 with the introduction of the Invisalign appliance, available to orthodontists in 1999, Align Technology made Kesling’s proposal much more practical. Instead of necessitating a new set-up for each new aligner, creation of an Invisalign appliance involves computer-aided-design and computer-aided-manufacturing (CAD-CAM) technology, combined with laboratory techniques, to fabricate a series of positioners (aligners) that can move teeth in small increments of about 0.25 to 0.3 mm.

What is the Invisalign Appliance?
The Invisalign appliance involves a series of aligners made from a transparent, thin (typically less than 1 mm) plastic material formed with CAD-CAM laboratory techniques. These aligners are similar to the splints that cover the clinical crowns and the marginal gingiva (Fig. 1). Each aligner is designed to move the teeth a maximum of about 0.25 to 0.3 mm over a 2-week period, and is worn in a specific sequence. The Invisalign appliance is currently recommended for adults and for adolescents with fully erupted permanent teeth who meet an acceptable standard of compliance. Excellent compliance is mandatory since the appliance has to be worn a minimum of 20 to 22 hours a day and each aligner should be worn 400 hours to be effective.


Current Technique
Fixed orthodontic appliances have been the backbone of orthodontic biomechanical technique. However, the reluctance to wear buccal braces because of their poor esthetic has been a driving force for the development of alternative treatment options for the adult population. Some current treatment options include Essix retainers, Trutain retainers, lingual orthodontics and Invisalign appliances.

Because of their removable nature, Essix retainers and Trutain retainers are indicated for mild nonskeletal malocclusions. Essix appliances have conventionally been used as anterior retainers from cuspid to cuspid. They are fabricated from vacuformed plastic sheets, and have a physical memory and flexibility that allows them to snap onto the anterior teeth, extending into gingival undercuts. With minor modification, Essix appliances can achieve small tooth movements, and serve as temporary
bridges and bite planes.

The Invisalign appliance alone is also generally indicated for mild nonskeletal malocclusions. It was successfully used by Boyd4 in conjunction with segmental fixed appliances, or with full fixed appliances used immediately before and after surgery for certain skeletal Class III malocclusions. Fixed lingual orthodontic appliances, on the other hand, can be used for complex malocclusions. Lingual orthodontics uses the same concept as conventional fixed braces, but with bracket placements on the lingual rather than the buccal surfaces of teeth. This approach improves the esthetic look of the appliance, but has been slow to gain popularity in North America because of insufficient training and knowledge of the technique.


Indications for the Invisalign A Appliance
Joffe5 suggested that the Invisalign appliance is most successful for treating mildly malaligned malocclusions (1 to 5 mm of crowding or spacing), deep overbite problems (e.g., Class II division 2 malocclusions) when the overbite can be reduced by intrusion or advancement of incisors, nonskeletally constricted arches that can be expanded with limited tipping of the teeth, and mild relapse after fixed-appliance therapy.
Conditions that can be difficult to treat with an Invisalign appliance or are contra-indicated altogether include:
• crowding and spacing over 5 mm
• skeletal anterior-posterior discrepancies of more than 2 mm (as measured by discrepancies in cuspid relationships)
• centric-relation and centric-occlusion discrepancies
• severely rotated teeth (more than 20 degrees)
• open bites (anterior and posterior) that need to be closed
• extrusion of teeth
• severely tipped teeth (more than 45 degrees)
• teeth with short clinical crowns
• arches with multiple missing teeth.

Use of the Invisalign appliance is relatively new for orthodontists and is still being developed. Currently, few clinical studies and case reports have assessed the effectiveness
of this technique. Although Align Technology has suggested guidelines for its appropriate use, clinicians have encountered numerous limitations when using the appliance.

Clinician Involvement
Although diagnostic preparation for treatment with the Invisalign appliance is similar to that for treatment with conventional fixed orthodontic appliances, clinicians play a more limited role during treatment with the Invisalign appliance. Preparation includes initial assessment, diagnosis, treatment planning and completion of pretreatment records (e.g., panoramic and lateral cephalometric radiographs, bite registration, photos and polyvinyl siloxane impressions), all of which must be sent to Align Technology in California where simulated virtual treatment is formulated by proprietary 3-dimensional CAD-CAM technology. Clinicians then download the virtual treatment set-up from the Internet to evaluate the proposed final positioning of the teeth. Clinicians can request modifications at this time, but once the aligners are made, they cannot alter the appliance during the treatment. As a consequence, clinicians must prospectively formulate a precise treatment plan. If the results are unsatisfactory,
clinicians may use auxiliary appliances (e.g., fixed braces) or contact Align Technology for adjustment and fabrication of new aligners.

Compliance
Since the Invisalign appliance is removable, patient motivation is critical to achieving the desired result. For the appliance to be effective, patients must wear it at least 22 hours a day. They may remove it only when eating; when drinking hot beverages that may cause warping or staining, or beverages that contain sugar; and when brushing and flossing. The transparency of this appliance may increase the likelihood of its being misplaced when it is removed. In their 1998 study comparing Essix and Hawley retainers, Lindaurer and Shoff6 found that one sixth of their patients lost their appliances; the majority of these losses were ascribable to the appliances being clear and removable. Aligners from the Invisalign appliance
have very similar properties to those of Essix appliances.

Extraction Cases
Patients having premolar extractions may not be suitable candidates for treatment with the Invisalign appliance because the appliance cannot keep the teeth upright during space closure (Fig. 2). Bonded restorative attachments on the buccal surfaces can assist in limited movements,but clinical results have suggested only partial effectiveness.5 Bollen and others7 reported excessive tipping around premolar extraction sites. They found that only 29% of those with 2 or more premolars extracted were able to complete space closure with the initial aligners; none completed the overall treatment. Miller and others,8 in their case study of lower-incisor extraction, found similar excessive tipping around extraction sites using panoramic radiographs.

Anterior Open Bites
Treatment of anterior open bites with the Invisalign appliance has had limited success. A few authors have reported difficulty achieving ideal occlusion during treatment of cases of anterior open bite. After retreatment of anterior crowding and open-bite relapse with the Invisalign appliance, Womack and others9 found that the position of the maxillary central incisors was superior to that of the canines and posterior teeth. Although they noted anterior extrusion, it was not enough to achieve ideal overbite. In their 2003 randomized clinical trial, Clements and others10 reported similar limitations; they found no significant improvement in anterior open bite after treatment.

Overbite
Although Joffe5 suggested that deep overbite problems can be corrected with the Invisalign appliance, others have provided evidence to the contrary. Kamatovic,11 in a retrospective study, concluded that the Invisalign appliance did not correct overbite relationships. The peer assessment rating (PAR) index was below 40%.

Occlusion
Many authors have suggested that removable appliances have limited potential to correct buccal malocclusions. The lack of interarch mechanics may explain this limitation. In 2003, Clements and others10 demonstrated that correcting buccal occlusions with appliances similar to the Invisalign appliance was least successful; for some patients, their buccal occlusions were worse after treatment. Djeu and others12 found that fixed appliances were superior to the Invisalign appliance for treating buccolingual crown inclinations, occlusal contacts, occlusal relationships, and overjet. Only 20.9% of their patients treated with the Invisalign appliance met the predetermined passing standard, compared with the 47% of those who had fixed appliances. In addition, Kamatovic11 found that the Invisalign appliance in general did not reduce the PAR index and concluded that the appliance did not correct buccal segment (antero-posterior and transverse) relationships. Vlaskalic and Boyd13 also concluded that conventional fixed appliances could achieve better occlusal outcomes than the Invisalign appliance.

Posterior Dental Intrusion
Because of the thickness of the Invisalign appliance, intrusion of posterior teeth is often observed. Compensating for such intrusion must be accomplished in the retention period when the teeth are allowed to erupt freely into occlusion. Womack and others9 claimed that intrusion could occur from 0.25 mm up to 0.5 mm. This degree of intrusion was also confirmed by Boyd and coworkers in their 200014 and 200213 studies.

Tooth Movement
Because it is a removable appliance, the Invisalign appliance has very limited control over precise tooth movements. Root paralleling during space closure after extraction, tooth uprighting, significant tooth rotations and tooth extrusion have been inconsistently successful. Bollen and others6 indicated that the Invisalign appliance
yielded the most predictable results with tipping movements.

Intermaxillary Appliances
The Invisalign appliance, because it is removable, wraps around the teeth, which can inhibit the use of interarch mechanics (e.g., Class II and Class III elastics). Some clinicians have suggested using elastics on buttons bonded to the buccal surfaces as adjuncts to tooth movement, but retention of the appliance when wearing these elastics may be compromised.

Treatment Time
The clinician’s treatment time can be lengthened because of the additional time required for documentation during Invisalign case preparation. The treatment plan must include the sequential movements for every tooth from the beginning to the end of treatment. If changes are needed after treatment starts, significant additional time and documentation are required to modify the treatment plan. In addition, the lag time between formulating a treatment plan and inserting the appliance can be up to 2 months. This lag time can cause further delays if the dental changes are significant because of the additional time needed for planning and documenting the treatment again, in addition to the extra waiting period required to make new aligners. In their 2002 case study, Womack and others9 described severe limitations that prevented their completion of a patient’s mandibular alignment because of the delay between planning the virtual treatment and the delivery of the appliance.

Conclusion
The Invisalign appliance may be a treatment option for simple malocclusions, as Joffe5 suggests, but it has some limitations. Achieving similar results to those of more conventional fixed appliances may be difficult. The use of the Invisalign appliance in combination with fixed appliances has been explored to reduce the time needed to wear fixed appliances, but may result in considerably higher professional fees overall. Conversely, theInvisalign appliance can provide an excellent esthetic during treatment, ease of use, comfort of wear, and superior oral hygiene. Additional research and refinement of the design should allow further development of this worthwhile treatment.

Tips on wearing Invisalign

I've been doing loads of research on Invisalign so thought that I'd share on the tips of wearing your Invisalign:


1. Make sure you are putting on the correct set of aligners. Each aligner is marked with your patient number, aligner stage number and a “U” for upper and “L” for lower.
2. When aligners are first received, the aligners should be rinsed thoroughly with water.
3. Insert the LOWER aligner first, then the upper.
4. Gently push the aligners over your front teeth first, then push the tops of aligners to the left and right molars by using your fingertips.
5. When removing, also use your fingertips, but to lift your aligners off your molars first before lifting them off your front teeth.
6. Wear your aligners at all times, except when eating, drinking, brushing and flossing – about 22 hours of wear per day. Drinking pure water with aligner is fine.
7. Swap to a new stage of aligners every 2 weeks. Aligner stages SHOULD NOT be skipped or accelerated. If your Aligner is lost or broken, please contact your Invisalign® accredited orthodontist or dentist immediately.

I really can't wait for my aligners to arrive- still erm 7 weeks to go! How I wish time can just pass on a blink of an eye.

What is Invisalign

I found this video on the invisalign website. It's quite an useful video to watch as a patient (not sure why it's on the dentist side of the website!) as it goes through all the stages of the treatment; from treatment plan to 3D computer model to Clincheck to aligner manufacturing to final results! It's a really interesting video as you can see how the aligners are being made.

History background of Invisalign
Invisalign technology was founded in 1997 and has treated (and still growing daily!) 500,000 patients. The aligners are made of clear medical grade plastic that is nearly invisible when worn.

Invisalign vs traditional braces
Invisalign aligners are practically clear. No one may even notice that you’re wearing these virtually invisible “braces,” making Invisalign a seamless fit with your lifestyle and day-to-day interactions with others.

Invisalign is removable. Unlike braces, you have the flexibility to eat and drink what you want during treatment by simply removing the aligners. And you can also remove the aligners to brush and floss as you normally would for fresh breath and good oral hygiene.

Unlike braces, there are no metal brackets or wires with the Invisalign system that could cause irritation to your mouth. Plus since your office visits during treatment don’t involve metal or wire adjustments, you’ll likely spend less time in the doctor's chair.

And finally, Invisalign allows you to view your virtual results and treatment plan before you start so you can see how your straight teeth will look when your treatment is complete.

Invisalign vs ClearStep
I've been trying to find some information about the comparison between two products- but it seems quite difficult even with the almighty Google! I guess it's because ClearStep is only being sold in the UK and according to some dentists, the success rate is higher with Invisalign than Clearstep! That's why Clearstep is a lot cheaper- I guess you get what you pay!

On Clearstep's website it says:
ClearStep and Invisalign® are both part of the invisible orthodontics category, so there are similarities between the two products and they are used to treat similar types of cases. However, one of the key difference between the two systems is the appearance of the ClearStep aligner. ClearStep positioners are smooth and have no ridges, making them more hygienic and very easy to clean.

So perhaps it's because ClearStep has no ridges, which makes them less effective?

Oh well, I've chosen Invisalign now- so lets just conclude here that Invisalign is the best! :)

Invisalign- is it as good as it seems?

After starting to dig around and learn more about Invisalign, there are two worrying aspects about invisalign:
1. Reproximation: teeth shaving?

I read it somewhere that for overcrowding teeth, in order to make room, the dentist tend to lean toward shaving tiny bit off each of several teeth... erm?! W.H.A.T? But I guess it's not going to happen to me coz my dentist hasn't mentioned anything and my impression has been taken already.

2. Discolouring of tooth (K says it's really rare, but hey it might happen to me right?)

I watched Kahlil's youtube video and one of his front tooth discoloured during the procedure!


Maybe I'm just being paranoid...

Invisalign- I can't wait to wear my nearly invisible braces!

So, YES, I am going to be wearing braces in 8 weeks! I am probably NOT the only person in the world who gets sooo excited about wearing braces! K says that I'll just be happy for the 1st day seeing the 24 sets of aligners and once I put them on, I'll be in too much pain to smile!

The clinic that I chose is a really nice dental practice in London. Everyone seems to be really professional. The receptionists are really friendly and knowledgeable and the dentist has a platinum elite status in Invisalign and has done over 500 cases in the last 3 years, so I know I am in good hands.

After making the payment (thanks, K!), I was taken to have my x ray done to check whether I have any obvious/potential dental decays. Apparently once the aligners are made, you can't change your tooth structure or they won't fit properly and having fillings would change the tooth structure! Going to be brushing my teeth vigorously for the next few months!

Then, I realised that today was going to be the day where they take my 'before' mug shot! I wish I was reminded earlier so I can at least put some makeup and wear some pretty clothes... Oh well, I guess the effect would only be more phenomenal when I look all nice and dressed up for my 'after' shot.

Oh, and the moulds, they didn't take long to do- I thought it was going to be ages (from the distant memory of my childhood), but less than 10 minutes they're done and dusted. There were some tiny bits of left on my teeth though and it was hard to wash them off with just rinsing! (I would have brought my toothbrush if I knew!) The moulds then get sent to Invisalign where the CAD models of my teeth will be made! So in 3 weeks time, I am going to the the clinic again to check out what my teeth would look like when the treatment is completed, yes the final finish product!! The dentist predicted the treatment would last for 12 months which means that I'd get 24 sets of lower and upper trays, and change trays every 2 weeks. FUN FUN FUN!

I am so excited although I know it's not going to be painless journey... but...no pain, no gain, huh?

Invisalign - Dental Clinic in London

I've been wanting to do something to my buck teeth for ages-

Back in primary school, I did wear a retainer. I remember that I kept on misreplacing it & looking for it- there was even one occasion where a friend helped me to find it in the school's rubbish bin. (not class bin, school bin, so imagine the size of the bin for a school of 12,000 pupils! no joke) Eventually the retainer broke in half - but the orthodontist (probably didn't want to make another retainer for me) told me that my teeth were fine, so that was the end of my treatment.

Then I came to England- because all the orthodontic treatments were free for people under the age of 16, so I went to see an orthodontist again... But the orthodontist said that I had a lovely smile so unless I really want to wear braces, there is not much need to get my teeth done! I guess I was flattered by the comment (even though it's from a very old man!) so decided not to go ahead with it. I guess that's one of my biggest regrets in life!

So I've lived with my teeth and my 'lovely' smile for 28 years now... so why change? Well I guess I am just vain! :) Plus I've been looking at so many dental websites and before & after cases... which make me want to do something to myself too! In addition, there are a few clinics that are doing free consultations and the invisalign treatment for apparently only £1,500! (don't know whether they're any catches!?!) I called up today but was told there was no available slot in August but they're thinking of extending the deal into September... So the lady is going to give me a call on Monday to see whether they can book me in for the special deal! :D Fingers CROSSED.

Can't go wrong with one of the biggest clinics in the UK, plus it's on Harley Street right? K bear was saying that I might look worse after the treatment... LOL