People always say, you get what you pay for....
BUT, with Invisalign, it can be a different story! HONEST!
A dentist offers cheaper Invisalign treatment doesn't necessary mean he is less experienced than others. In fact, he can be the most experienced Invisalign dentist but still offers one of the cheapest Invisalign treatments! You must be wondering why? This is because Invisalign offers dentists an option that they can bulk buy Invisalign at a hugely discounted price - so more Invisalign cases a dentist does, the cheaper it costs the dentist to buy! So a dentist who is willing to commit a lot of cases a year can easily undercut (in price) those who aren't prepared to commit! Depends on how many cases that a dentist wish to commit to a year, they can become a silver, gold, platinum accredited Invisalign dentist, so a Platinum dentist tends to be able to offer lower prices than those dentists who are not accredited!
However, when you go for your appointments, don't just look at all these colourful accreditation system. Ask the dentists how long they have been practising Invisalign and how many cases they have done to get a better understanding of how experienced they are! :-)
Showing posts with label Invisalign Review. Show all posts
Showing posts with label Invisalign Review. Show all posts
Tuesday, April 07, 2009
Tuesday, September 16, 2008
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!
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!
Monday, September 15, 2008
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.
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.
Saturday, September 13, 2008
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! :)
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! :)
Friday, September 12, 2008
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...
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