Refinement Nightmare

Just as I had feared last May, I now realize that I may have chosen the wrong Invisalign provider to take over my treatment.  I had a gut instinct and didn’t follow it, and because of that, I am now at the mercy of my doctor and doctor’s assistants.

I’ll start by saying that personality-wise… I like all the girls with whom I interact with during my appointments, including my doctor.  I enjoy the small talk and the comfortable atmosphere, but when it comes to my money and time, it ain’t show friends, it’s show business.  That may sound stupid, but really it’s not.  I pay someone top dollar for their expertise and services and in return, I receive subpar performance.  I often imagine tearing up individual $1 bills and letting them float away with the wind as I stand there with a mouth full of crooked teeth.

I may have written that last bit out of anger and it also may have been a slight exaggeration, however I do, in a way,feel as if I’m being hosed here.

When I went in for my initial consultation, we discussed my concerns about my teeth and I told her about my rotated upper right cuspid (that big pointy tooth).  I brought up refinements and though we did discuss them, it was never brought to my attention that they were definitely not included in their plan.  Stupid me for assuming that, like my previous provider and most others, they would include a set of refinements in their plan. Rather than using this smoke and mirrors technique to lure in new patients (briefly covering the topic but not being specific), I  think they should’ve been just a little more up-front and verbal about what is and isn’t included.  Or perhaps offer a bulleted list?  I’m a smart person and don’t need things spoon-fed to me, however when delving into something like orthodontics –a subject in which patients shouldn’t be expected to know everything about– things should be made very clear.  At that point in my treatment, I truly thought that refinements went hand-in-hand with the Invisalign process.  But instead, it was like ordering a Big Mac combo in the drive-thru, getting home, and realizing that your burger is nothing but dry meat and two buns; they left off all the fixings because that particular McDonalds only has a 50% customer base who actually needs those things on their burger.

At least throw it out there in the beginning as an optional service to add on if need be.  Perhaps on that bulleted list?  And now that I think of this, I’m a little bit concerned about retention.  Like the refinements, we discussed retainers in the initial consult but I never checked if this was included.  This is something I will ask next time… and you better believe how fired up I’m going to be if I find that it’s an additional cost.

So now that my rant is over, I’ll explain how everything went down.  It’s been several months since I’ve last posted and though a lot of that time has been me twiddling my thumbs, waiting for new trays, quite a bit has  happened.

I left off when I was finishing up #19.  Around set #16, I began to notice a slight space between the top of my aligner and my gum line above my right lateral incisor and the canine next to it. As time went on, I noticed a similar amount of space ‘growing’ on the other side as well.

Just before switching to set #18, I addressed my concerns to my orthodontist. My theory was that my bite wasn’t opening quite like my first orthodontist had planned… meaning my top front teeth were not moving up into my jaw with the help of the virtual bite turbos located on the back of my top aligners.

Adding to complications, my top right canine is severely rotated and during my initial consultation, my first orthodontist informed me that we might have trouble moving that tooth.

Anyway, my current doctor’s response to my theory was that things were “looking fine”, according to the screenshot printout from my ClinCheck file (single upper arch occlusal view, not front so the lack of intrusion wasn’t visible), and that sometimes trays have less plastic covering teeth than other trays do, and mine happened to “probably have less plastic” to cover those specific teeth.  I suggested taking new impressions for a mid-course correction and was told that she’d have to consult with a colleague and get back with me, but most likely I was just going to finish up and we’d correct whatever needed to be fixed in refinements. I suppose I was pretty put off by her lack of concern because I felt that I had a real, legitimate problem… and later I learned that I really did.  And there was never a follow up. She never called me back.

Fast forward about a month and a half.  My trays became more and more of a nuisance.  They definitely weren’t fitting:  They seesawed over my front two bunny teeth and protruded over my rotated canine and lateral incisor which created extremely visible spit bubbles and gave me an attractive lisp.  Here are pictures of me wearing upper #21.  Keep in mind that #23 is the aligner that I had to wear around for two months while I waited for new trays, and looked far worse than this one.

Screen shot 2013-01-14 at 12.02.40 PM Screen shot 2013-01-14 at 12.03.45 PM

Luckily, I had an appointment that week that I had scheduled a while back otherwise it might’ve been several more weeks before they could fit me in- that particular office is only open on Tuesdays and the appointments slots fill up quick… another downfall if you need shit done, like, yesterday.  My orthodontist seemed hurried when she came to my chair.  I reminded her about what we had discussed before, and the problems I was having that I concluded were getting worse.  Surprisingly she agreed with me, but even more surprisingly, she insisted that I just finish out all 27 of my aligners (what??) even though I was only on #23.  That’s when I decided to put my foot down.

I reiterated the fact that my aligner clearly wasn’t fitting correctly and that it was progressively getting worse and suggested/kindly demanded we do something to fix it… i.e. mid-course correction (since I was under the assumption that when my multi-thousand-dollar treatment wasn’t going as planned, we should have things corrected). I was told that since I am nearing the end of my treatment, that I wouldn’t qualify for a mid-course correction and that we would have to just move straight into refinements if I wanted anything done.  Really?? No wonder I was brushed off a month and a half ago! She asked if that was what I wanted and I said, “Well… um, yes, I do want my teeth fixed.” She smiled, kindly said okay, and walked off. That’s when their money lady came up and asked me to sign the paper stating that I would pay the $399 fee for my refinement. Cue the vinyl record abruptly stopping, because that’s what I heard.  And I’m sure I looked like an idiot sitting there in a child’s dental chair with my stupid blue dentist bib and a dumbfounded stare painted over my face.  That’s when she informed me that refinements aren’t included in their plans because they’re not common enough to be a necessity; only 50% of their patients actually need them.  The word ‘pissed’ doesn’t do my mood at that moment any justice but what options did I have?  I signed the paper and the fun began.

Remember, I had 14 attachments.  It took two people two whole hours to jack-hammer them off my teeth.  The surfaces where the bonding had been were still rough and a couple places on my gums were bleeding; it was by far the most uncomfortable time I’ve ever spent in a dental chair.  I’ve never had attachments removed before, so this may be the norm… I’m not sure, but what I do know is that it sucked.  Then it was time for the impressions which also seemed to be extremely challenging for them.  It took five attempts which I was okay with because, as I told the girl, “I just want it done right the first time so we don’t have to do this again.”  Frustrated and gagged out, I left.  After a few moments of driving, I realized that my doctor didn’t even ask my thoughts on what I might want changed.  When I got home, I called up to the office and they suggested that I email the orthodontist with my concerns.  This was great because I’d be able to tell her everything I wanted without getting sidetracked.  She immediately responded and apologized profusely about the lack of time she spent with me, etc., which I truly appreciated because she also explained to me her reasoning for being in such a hurry.  After several positive email exchanges, I was confident in my orthodontist again.

One month later, I received a voicemail from a very cheery receptionist stating that there “must’ve been a discrepancy in one of my impressions” and that they’d need me to come in “sometime next week or the following week” to redo them. They want to “get a jump-start” on my refinement process.  I immediately felt my face grow hot and my temples began to pulsate; I saw red.  Here is a close representation of me while I was standing in the scarf aisle at Old Navy:


Really.  That was me.

That was the moment I realized I had at least another month to wear my busted up aligners.  The aligners that fit like store-bought whitening trays.  In fact, I could remove both trays with my tongue!  I called back and insisted that they find an open slot for the following Tuesday… I refused to wait any longer than that.  I showed up to my appointment and I didn’t even have to wait in the waiting room before they called me back (I think they expected me to come in looking like my portrait above).  It took two people–that’s four hands– and five more gag-inducing impressions to get it right.  Being in my tenth week of pregnancy definitely didn’t help in the gag department.  When they were finished, I had to ask for a paper towel to wipe away my new green and purple beard.  That shit was seriously smeared all over the bottom half of my face.

Three weeks later, I received an email from my orthodontist asking me to okay my new ClinCheck video and everything looked fantastic except for some minor changes I wanted corrected in my lower teeth (black triangles).  After a couple more email exchanges, my aligners were sent to production.  11 upper and 7 lower.  Several weeks later, I received another voicemail from the same cheery receptionist asking if she could schedule me sometime “in the next few weeks” because my new aligners were in.  AAAAHHHHH  Don’t they know that I don’t want to wait more weeks??  Again, I called back and somehow, they fit me in the following Tuesday.  My new aligners fit snuggly and I’m quite happy… aside for my new power ridges on all my front upper teeth.  Whatev.  I just want to get this show on the road!

Anyway, just for reference, here are some recent photos of one of my previous aligners compared to one of my new ones.  Notice on the new one (right, bottom) how far my teeth still needed to move up in order to fit correctly!