Invisalign Refinements: It’s Not Over Yet

This past December, I finished my initial course of Invisalign treatment. Overall, I am very pleased with the results so far, it’s just that the initial course of treatment didn’t get my teeth all the way to straight.

But that’s okay. I knew it was likely I would need refinements because I did lots of research before deciding to do Invisalign, and my orthodontist kept me informed of that possibility all along the way. I’ve come this far, after all, and I didn’t want to stop short of my teeth getting as straight as possible. And why would I? As I’ve blogged before, Invisalign has become such a regular and unobtrusive part of my lifestyle that I honestly don’t care how long it takes. I’ve invested this much time and money into my teeth, why wouldn’t I want to keep going?

After 24 Refinement TraysFor this reason, I advise anyone undergoing Invisalign to make sure that refinements are included in your originally quoted price. My orthodontist is an Elite Invisalign provider, and I suspect such is the norm among Elite providers, but I did read in my original research that some doctors charge extra for refinements. Ask about refinements during your initial consultation, and if your doctor charges for them, go someplace else. Chances are you’ll need them and you don’t want to get this far and get stuck paying additional fees to complete your treatment.

Refinements are fundamentally a new course of treatment. When I went in for my December appointment, they removed my attachments and took new impressions of my teeth as they were so far. I actually sort of complained that they were removing my attachments, but my doctor explained that I might need a different scheme of attachments for the next round.

And boy did I! Apparently it’s all the rage to have double attachments, now. Maybe it was all along, and I just didn’t get them the first time. The reasoning behind the double attachments is supposedly that two smaller attachments can move the teeth more effectively while being less visible.

Before InvisalignGood thing, because when I showed up for my new attachments and first set of refinements, I discovered that I would have two teeth with double attachments, one of them being my right front tooth! Aside from the fact that they were initially pitched too far inward, my front teeth have always been my straightest teeth, as far as I can tell. Add to that, I DID NOT end up with attachments on my lateral incisors (the teeth on either side of the front teeth), which were the very teeth that were most misbehaved during my original treatment!

Since I’ve been happy with my treatment so far, I decided to go with it and accept the attachments the way they were (also, my mouth was already propped open with dental gear and my teeth prepped when the doctor walked in to put on my attachments). I did ask, once the attachments were on, why I didn’t get any on the lateral incisors, and he said that apparently the Invisalign computer thought my teeth would move well enough without them… an answer that didn’t exactly make me feel like he was really taking charge of my treatment… but then said if the incisors weren’t moving properly, we’d re-order refinements with attachments there.

Six Months Into TreatmentWhatever… as I said, I’m in this for as long as it takes, and I was anxious to get started on my new course of refinements. At first, the lateral incisors were fitting snug in the new aligners, and then inevitably they fell behind, but not by much. There were stages in my initial course of treatment when the laterals were so far behind that I could feel the air trying to force through the gaps in my aligners when I spoke loudly in busy group classes.

Overall, I like the refinement stage better than the initial course. My orthodontist had me changing the aligners once a week for refinements instead of every two weeks and the changes were so incremental that any pain or discomfort was negligible. Changing every week somehow makes me feel like I’m making more efficient progress!

I continue to go about my life with Invisalign just like I did before. When people ask me about what it’s like to wear them, I often describe the experience of wearing Invisalign to the experience of wearing shoes. When you’re going about your day in a comfortable pair of shoes, you don’t spend much time thinking about the fact that you have shoes on or consciously aware of the fact that you have shoes on, but when you stop and think about about it, you can feel your shoes. Now if they’re uncomfortable, new and not-yet-broken in, you are thinking about them and irritated by them (like a new set of aligners with rough edges you haven’t had a chance to file down yet), but a comfortable pair of shoes isn’t going to register in the front of your brain as you wear them, likewise your aligners won’t either.

One Year Into TreatmentFor the most part, I go about my days not thinking about the Invisalign and with people not noticing them. My work environment is one where most of my colleagues and regular students already know about my Invisalign, but we do get a steady stream of new folks in the door. Rarely someone will notice them, but I just explain that I have Invisalign, and it doesn’t bother me at all for them to know it. So what if I have braces? The main drawback of people “knowing” you have braces is the sophomoric or nerdy “metal mouth” look. I have the braces of the future; it’s like Star Trek, right? Some people who have known me and worked with me this whole time are surprised when they only just find out. I happened to mention it to one of my students, and it turned out he had had Invisalign himself, and that he had even been an Invisalign pioneer, one of the first people to get them back in the late nineties. I still can’t figure out if he never noticed them, or was just too polite to comment (he’s that sort, the kind who says “excuse my language” when he exclaims “bloody!”).

We had a professional dance champion and dancing coach in the studio a couple months ago who also is undergoing Invisalign. She outed me immediately (not that I cared about being outed) to my first student of the day. He noticed them for the first time and was surprised he hadn’t noticed them sooner. He spent at least one lesson kind of staring at my braces, but since then he only occasionally comments on them, sometimes to ask if I even have them on because he can’t see them. It was interesting working with the coach that day because I got to hear some of her experiences with having Invisalign. She says to my one student, referring to her and me, “We have Invisalign, that’s why we lisp.” I blinked and didn’t say anything, but frankly I don’t think I lisp at all. Maybe I’m living in a fantasy world, but I honestly can’t sense a lisp on any words I say, except maybe the word “lisp”! Occasionally when I’m tired or a little inebriated, I sense a greater tendency to mess up my words when the aligners are in, but when I’m enunciating as normal and not speaking lazy, I don’t think I have any sort of lisp. Friends, feel free to disabuse me of this notion. The coach also asked me about my aligners and whether they get stained by the end of the time I have them in. I told her it depends on how much coffee I drink. With the refinement stage, honestly, I care about stains not at all. With the aligners in and out in one week, it’s not an issue at all.

Two Years Into TreatmentThe coach also wondered if I get dry mouth while I’m teaching. I wasn’t able to answer her fully because my next students just walked in, but the answer is no… and due an apparently peculiar phenomenon that it doesn’t appear she has experienced. Over the course of time I’ve been wearing my Invisalign, my mouth has come to produce excess saliva. As a result, I don’t notice a difference when the aligners are in, but I definitely notice when they are out. I assume my mouth will go back to normal once treatment is over, but for now, I have saliva to spare.

Another thing I experienced for the first time this round was a set of over-correction aligners. The last three sets were marked as over-correction. My orthodontist didn’t really explain over-correction in detail, only to say that I didn’t really have to wear them, but gave them to me anyhow. I looked it up online, out of curiosity and found that over-correction is much as it sounds… the aligners actually target your more troublesome teeth to move them further than perfect. Rotate them a little more than ideal with the knowledge that once the attachments are off and treatment is done, these teeth will revert at least a little. This strategy makes perfect sense to me, and I’m actually comforted by the thought that Invisalign has built in this protection against tooth reversion, but perhaps unsurprisingly, many folks online are FREAKED OUT by the prospect of over-correction and very upset when their orthodontists tell them about it. Now, I have to admit that the over-correction aligners were harder to get in. I had to put them in after wearing my old set for at least a half hour (I usually put a new set in after I eat dinner), and then it did take some pushing of the new set into place, and sometimes much chewing of Aligner Chewies to get them settled to the point where they wouldn’t pop out on one side or the other. The over-correction did hurt more than the rest of the refinement aligners, but no more than the average aligner in the initial treatment. Once again, internet Invisalign patients seem to be freaking out for nothing.

My refinement course of treatment was 24 aligners, and I just finished last week. While I continue to be happy with my results, they aren’t perfect just yet. My orthodontist offered that if time were an issue we could fix them up within a few weeks with clear traditional braces, but what’s another six months or so? One of our students who has done Invisalign in the past, got talked into six weeks of clear traditional braces by her doctor and hated them. I told him just not to be stingy with the attachments (I actually said please put some on my laterals!) and he resolved to make the next round of refinements, however long they take, finish the job. At this point they look great with my aligners in, and they just need a few more tweaks to look just as great with the aligners out. If I had known when I started that it would take at least a year longer than the orthodontist first quoted me, I might have been concerned, but now that I’m in the midst of it, time is no issue. It’s hard to imagine my life without Invisalign.

On to the next round!