Seattle orthodontist patients’ guide to Invisalign

Does Invisalign work?

Yes, but the answer is complicated. Invisalign is a custom orthodontic appliance that is innovative and technically sophisticated. This appliance can be a powerful tool in well trained experienced hands

Invisalign is a commercial product that is marketed directly to the public. This marketing leads many patients to believe that any orthodontic problem can be treated using Invisalign. Invisalign technology is also heavily marketed to both orthodontists and general dentists under the mistaken belief that the computer-programed used to generate Invisalign treatment is sufficiently sophisticated to produce satisfactory orthodontic treatment results without significant doctor modification. This has not proven to be true and there are a number of reasons why:

– The Invisalign’s computerized setup considers only position of the dentition without reference to bone and gums that support the teeth. These supporting tissues are critical in determining whether or not a particular orthodontic treatment plan is achievable and whether the treatment outcome will be stable over time. Another words many Invisalign treatments fail because the treatment plan was not biologically plausible from the outset.

– the mechanics of the Invisalign system, i.e. the capacity for, and application of, force, are quite distinct from the edgewise/bracket-and-wire system; therefore, to effectively utilize Invisalign, the practitioner, whether orthodontist or general/aesthetic dentist, must make a significant educational investment in the use of this tool.

– a further complication for the non-orthodontist is that the ability to determine the relative complexity of an orthodontic case and then determine a plausible treatment plan for those cases that are complex. These clinical skills are developed not only through education as a general/aesthetic dentist but additionally through two to three years of postdoctoral education in orthodontics. To be sure there are general dentists who are capable of utilizing Invisalign responsibly and who are quick to refer those cases that present with complicating factors to an experienced orthodontic specialist.

The question remains, “Does Invisalign work?” The answer is “YES” when used by an clinician who is both experienced in the specific biomechanics associated with Invisalign treatment and who has the diagnostic ability to recognize appropriate patients where the invisalign custom appliance is indicated, Invisalign is a very effective and reliable orthodontic treatment option.

Does Invisalign only work in certain cases?

The short answer is yes. Invisalign aligners are one of several tools that an orthodontist may use to move teeth. Other orthodontic options are, traditional stock braces, custom preprogrammed braces placed both behind the teeth (such as Invisalign) and custom braces on the outside of the teeth (for example SureSmile). Each of these orthodontic appliances have advantages and disadvantages. Certain tooth movements are not accomplished effectively by Invisalign aligners. In such cases, these difficult movements may be accomplished using limited braces (often, on a few teeth for a brief period), resulting in a case that can then be successfully completed with Invisalign. By integrating modalities, experienced orthodontists are able to treat a wide variety of cases with Invisalign and achieve ideal results.

Why use Invisalign?

Invisalign aligners are very thin, clear, removable, and intimately approximated to the teeth; they are extremely “aesthetic” compared to traditional or even clear braces. They are less costly, sometimes significantly so, than lingual braces (braces on the inner aspect of the teeth) and avoid the associated issues of speech impediment and discomfort to the tongue.

Are there advantages of using Invisalign other than it is more esthetic?

No. In certain cases the use of Invisalign presents a clinical advantage, such as 1) when enhanced control of teeth is required—Invisalign is quite effective in creating space of exact size, e.g. where precise widths are needed for post-orthodontic restorations; 2) when braces would not remain on the teeth well (e.g. patients with numerous crowns or veneers, patients with abnormal tooth enamel); 3) when access for particular dental procedures such as dental restorations during the course of treatments; 4) when indications of root resorption necessitate the isolation of certain teeth: Invisalign is able to accomplish this whereas braces cannot do so; 5) When we wish to isolate some of the teeth and NOT move them. It is not uncommon that the orthodontist does not want to disturb the fit of the back teeth when aligning the front teeth. This is particularly difficult with conventional braces and is an indication for the use of a custom orthodontic appliance such as Invisalign or Incognito braces.

Does Invisalign cost more than braces?

Fees structures vary across the country. In some regions, such as our own, Invisalign is priced similarly to fixed appliance/traditional treatment.

Does Invisalign treatment take longer than braces?

No, if the doctor is experienced in orthodontic treatment with custom aligners and the treatment plan is appropriate for the Invisalign appliance, the treatment duration can actually be shorter than conventional braces.

What is involved in initiating Invisalign treatment?

Each patient, regardless of treatment type, should receive a comprehensive examination of his or her facial structures (hard and soft tissue), teeth and dental alignment, jaw joint (temporomandibular joint), periodontal structures (hard and soft tissue), and a meaningful discussion covering his or her goals for treatment and other salient issues. Invisalign patients will have diagnostic records taken including a digital intraoral scan (which will later be used to create aligners). These records are sent to Aligntech (the parent company of Invisalign) with an initial prescription provided by the orthodontist. The Aligntech technicians use software to formulate a preliminary treatment plan involving a “path” toward the prescription of desired tooth alignment. The number of stages (or aligners) will vary depending upon the extent of tooth movement required. The software used for this preliminary treatment plan cannot, however, determine what is clinically realistic or advisable; therefore, it is imperative that this treatment plan be modified by an orthodontist who is experienced in both diagnostics and Invisalign biomechanics. (The preliminary treatment plan would commonly lead to treatment failure if implemented without modification: this is why we recommend that Invisalign treatment be sought from a qualified practitioner. Once the orthodontist has sufficiently modified the treatment plan, he or she will approve the plan and the construction of aligners will commence. Because we use an intraoral scanner to produce the initial 3D digital model of the teeth and electronically transmit it the Aligntech in our Seattle office, the aligners usually arrive two to three weeks after the taking of diagnostic records.

What happens when I receive the Invisalign aligners?

At the first appointment, the aligners will be checked to confirm fit and you will be instructed on their placement and removal. The rate of change from one aligner to the next will also be discussed. This is an exciting appointment.

What will I notice once I begin wearing the aligners?

First, you may be surprised at how difficult it is to see the aligners once on and how closely they fit to the teeth (the fit will become even closer as your teeth adjust to the aligners). You will probably note a mild increase in salivation because your mouth senses something new and assumes it is food; this phenomenon usually lasts one to two days. As you speak while wearing the aligners, we advise that attention be brought to any changes in your speech; if such changes occur, we recommend practicing those sounds that require adaptation. Speech adaptation usually takes one to two days, as well.

Is Invisalign treatment painful?

The perception of discomfort or pain varies widely among individuals, but, given that orthodontic tooth movement requires some amount of force to elicit a biological response, at least some initial discomfort will be experienced. Invisalign aligners, however, cannot generate the heavy force of the traditional braces of past generations. Patients who are seeking retreatment with Invisalign tend to report less discomfort as compared to earlier, traditional treatment. However, there is likely to be an initial period of low-level discomfort around the teeth when the dentition goes from unperturbed to orthodontically mobile. Once the Invisalign orthodontic process begins, however, this discomfort lessens.

How many hours per day are the Invisalign aligners to be worn?

The ideal amount is 22+ hours per day. Typically, patients remove the aligners to eat, clean their teeth, clean the aligners, and to speak or perform in special situations. They should be worn at all other times, including sleep. It is ideal to reduce the number of times the aligners are removed each day; we have strategies for those who like to snack or sip throughout the day.

Does Invisalign treatment involve anything that is attached to your teeth?

At some point in treatment, most patients are provided with small, tooth-colored attachments that have very specific shapes and are positioned precisely at certain spots on designated teeth. These attachments will correspond to similarly shaped forms in the aligners to allow specific force vectors to be delivered to each tooth to bring about precise patterns of orchestrated tooth movements through space and time. In addition, auxiliaries such as bonded buttons or hooks may be used in concert with the aligners to allow the use of other force-generating units, such as elastics.

What if I have crowns, bonding, or veneers?

In general, Invisalign is better suited for those patients with significant dental work of this type because these restorations present a more difficult bonding surface than the natural tooth, whereas Invisalign aligners work equally well with restored and unrestored teeth.

What if I have bridges or implants?

If fixed teeth exist, such as implants or ankylosed teeth (teeth that have fused to the bone, usually after trauma), these teeth must be considered in the overall treatment plan whether that treatment involves Invisalign or braces. If, in the final result, these teeth can remain in the present position, they can be extremely helpful “anchors” from which to move other teeth. If these teeth would ideally be repositioned, the decision must be made whether or not to do so. In the case of bridges that need repositioning, the abutment teeth can be moved individually after the pontic(s) are removed. (Pontics are the false teeth that connect the abutment teeth.)

Should I have a dental check-up before Invisalign?

Yes. It is important that dental issues such as decay, gum disease, infection, tartar build-up or any procedure that would necessitate altering the shape of any tooth be completed before your aligners are fabricated. A very intimate fit of the aligners results in the most efficient and effective transfer of orthodontic forces and, therefore, the most ideal orthodontic result. In addition, the dental check-up allows your dentist and orthodontist to collaborate in planning your overall long-term treatment relative to aesthetics, function, and health.

Can I wear the aligners just at night for more weeks and get an ideal result?

No. The orthodontic process is a biologic reaction to the presence of force; therefore, when the stimulus of force is removed, aspects of the biologic (and orthodontic) process begin to reverse. To complicate matters, different teeth will move and revert at different rates. This means that each tooth will shift to a different stage in treatment and no single aligner will fit all of the teeth as well as it should. If this “non-tracking” is caught early on, extremely consistent wear of the best-fitting aligner can recapture the dentition. If the situation has gone too far, rescanning is necessary to create a new treatment plan and set of aligners; this lengthens treatment and, at some point, an additional fee will be charged by Aligntech and the orthodontic office. The best advice is to commit to the recommended level of aligner wear 22+ hours per day. (If this seems unlikely, a viable alternative is to consider the use of clear brackets and enamel-colored wire. The convenience of such a choice includes having no loose parts to misplace and ease of maintenance [the appliance itself is cleaned when brushing the teeth and is not removed and repositioned, necessitating brushing, upon eating]. Once the initial period of adjustment has occurred, this appliance protocol is typically found to be very satisfactory.)

Is Invisalign for adults only?

No. In fact, teenagers often make the best patients. The biologic facts that, compared with adults, teens have more active bone metabolism, more facial growth, and active tooth eruption means that their dentition is quite malleable. This makes the teenager an excellent candidate for Invisalign (except in such cases that Invisalign is not diagnostically recommended). In assessing the appropriateness of Invisalign for a teen, one must consider both the orthodontic situation and the patient’s level of dedication and commitment to achieving treatment goals. Many teens are highly motivated, responsible, and willing. For this type of teen, Invisalign is not only more aesthetic and convenient, it allows for better oral hygiene and less interference with daily activities (e.g. athletics, playing certain musical instruments, eating specific foods) and usually a shorter treatment length. For the peace of mind of parents, in our practice it is made clear to the teen that we are committed and obligated to the best orthodontic result possible. Therefore, if aligner wear is insufficient, the treatment will revert to traditional braces (at no extra cost to the parents). While this type of motivation is not needed for the adult patient, it can be very helpful in solidifying the teen’s commitment to consistent wear and hygiene.

Dr. Riolo has had the opportunity to successfully treat over five thousand patients with various orthodontic appliances. Riolo Orthodontics has been recognised as a “Center for Excellence” by 3M Unitek due to Dr Riolo experience utilizing the Incognito custom lingual bracket system. Riolo Orthodontics is also a Preferred Provider of Invisalign. Riolo Orthodontics uses the newest technologies, including advanced 3D imaging, digital models created using intra oral scanning, advanced bonding procedures and both traditional and custom orthodontic appliances. Dr Riolo is a Board Certified Orthodontist by the American Board of Orthodontics and teaches part time at the University of Washington Department of Orthodontics.