Attachment Removal

Just thought I’d share some interesting information I found covering the topic of attachment removal.  I had a pretty yucky experience several months back when I had all 14 of my attachments removed for new impressions– It took two people two hours to remove most of the composite material that was on my teeth.  Over the years, I’ve had cavities filled, a gingivectomy at the age of 9, and all of my wisdom teeth pulled with nothing more than just a few shots of novocaine (or whatever it is they use these days). Hell, my dentist was practically straddling me for better leverage.  In other words, I’m experienced when it comes to the dental chair… and I will say this: my attachment removal episode was by far the most uncomfortable.  Maybe it’s just because I hate things vibrating on my teeth.

Just FYI, out of all the stuff I’ve read online, it seems that I’m the only one with such a bad experience.  Don’t let what I say about attachment removal deter you from getting Invisalign.  Chances are high that you’ll have an attachment removal experience that won’t even come close to mine.  I just like to bitch and this is my personal venue.

So, after I was finished up with my first round of refinements, I reluctantly asked my orthodontist if we could remove my attachments to take an impression for a new, bubble-free aligner to tie me over until my upper teeth were complete.  I figured the good would outweigh the bad and she was game!  I was so scared to go into that appointment with memories of the last one still haunting me… I was expecting the worst.  Surprisingly, the same lady removed them and it was the complete opposite of what happened the first time!  It took maybe ten minutes and was hardly uncomfortable at all.  She looked at me like I was an idiot after the third time I said three different variations of, “Wow, that was painless!”

I was to return the following week to pick up my new aligner/retainer.  Immediately following that appointment and all following seven days, I did a bunch of reading and realized why the attachment removal process is so tedious.  A dental bur in the wrong hands can straight up fuck your teeth up for life.

Anyway, here are a few interesting links:

http://www.dentalaegis.com/cced/2009/12/practical-applications-removal-of-invisalign-retention-attachments-a-new-minimally-invasive-method

http://www.dentalaegis.com/cced/2009/12/practical-applications-removal-of-invisalign-retention-attachments-a-new-minimally-invasive-method

http://www.dentaleconomics.com/articles/print/volume-93/issue-7/departments/common-sense-dentistry/to-etch-or-not-to-etch.html

As I mentioned, there was still a ton of gunk remaining on my teeth.  When I went back the following week, I asked a different person to remove what was remaining.  She tried for a while but stopped when I accidentally showed discomfort.  She told me that I’d probably have to get my dentist to finish up the job if I wanted it all off because “they’d have better tools to get close to my gum line.”  My first thought was, “Whew… Thank god, no more grinding.” and then, “WTF.  My dentist??!”

So I went home and a few days later, I made a video

I will say that when I went back last week to have the rest of my upper attachments removed, they did just about the same job as the other previous two, in much less time of course.  I was okay with it though, because my favorite assistant lady also has Invisalign… and has a painfully high number of trays… like 67 or something like that (I call her my favorite because she’s funny and makes slightly tacky and inappropriate commentary which is right up my alley).  She and I both agreed that since I would be getting more attachments within the next month, that it might be pointless to go through the discomfort of getting everything smooth.  I get it.  Even though my teeth feel like they’re constantly covered in disgusting plaque, I’m sorta okay with it as long as they do the awesome polishing she promised would happen in the end.

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Are you wearing whitening things on your teeth?

tl;dr- My aligners look stupid.  My teeth are still crooked and they’re moving at the speed of erosion.  Basically, their future is looking bleak.

Part 1

“Are you wearing whitening things on your teeth?”

Yep.  That was my neighbor’s question for me last week.  Seriously.  I was loading some stuff into my trunk when I heard my name.  He was walking over to chat (I’ve learned that chatting is what retired people like to do) so I smiled.  Mid-sentence, he stopped and asked me if I was wearing whitening “things” on my teeth.  He’d apparently seen a commercial on ‘the television’ about those.

C'mon.

C’mon.

Am I wearing whitening trays?  No.  Just my regular ill-fitting aligners.  And I’ve actually had this complex for a while now… thinking that my aligners look like whitening trays.  Thanks neighbor.  These stupid things get more beautiful as the weeks go by.  Nothing screams “hot babe” like spit bubbles accumulating in and around my whitening things.  Not like I’m trying to look hot these days… I’m 32 weeks prego and feel like a whale.  Guess it could be worse.  I could have a mustache, cankles, and diabetes.  At least I can still wear my regular jeans fastened with a hair tie through the button hole.

The old hair tie trick at 29 weeks

I’m currently in the beginning stages of hating my Invisalign treatment, and no, it isn’t because of the Invisalign product, it is because I am truly convinced my provider didn’t put a whole lot of thought into my high-dollar refinement.  Or maybe she did… I really don’t know what goes on at her office.  What I do know is that this same tracking issue is happening all over again and my trays fit like shit.  And she’s perfectly happy with it, just as she was last time.  Overall though, if a year and a half ago someone were to show me a picture of my teeth as they are today and say, “If you could spend the next 18 months of your life in plastic aligners and have these slightly crooked teeth, at no cost to you, would you be happy with the results?”  My answer would be an enthusiastic hell yeah.  My beef today is that this crap ain’t cheap and I expect nothing less than what I was told I’d get for $6,000.  That’s roughly £3,900 for all you folks across the pond.  And the check-writin’ ain’t over yet either.  Think: RETAINERS.

I guess I should start from the beginning.  Sometimes I forget what I have and haven’t written in my blog mainly because I spend a lot of time in the Invisalign forum on bracesreview.com.  I do my bitching there instead of here where it really should be.  I know I have a lot of readers from that site so forgive me if you’re one of those folks and you notice that what I’ve written here is repetitive;  I’m fat and lazy and I don’t feel like rewording all the junk I’ve written over there.  Copy and Paste are my friends.

interproximal ledge

It’s been a while since I’ve last written.  I left off where I was pissed about my orthodontist’s hacksaw job to my front teeth (corner shaved from one tooth and interproximal ledge cut into the adjacent incisor) but happy at the same time that my aligners started off fitting snug and awesome.  In my mind, I was going places.  My teeth were going to be fixed!!  Not so fast, dumb girl…

To sum up my current situation, I probably wouldn’t suffocate if the only oxygen I could receive was through the new gaps in my lower teeth.  Don’t ask me how I know that.  Also, I can still blow spit bubbles through that jagged little space though I’ve been “finished” for several weeks now, and I’ve got two aligners remaining on the top until my teeth are supposed to be perfect… and in reality, they’re no where near being finished.  If you recall, back in my post titled “Refinement Nightmare,” I posted pictures of my poorly-fitting aligners back from my first round.  Here is the comparison:

Refinement Comparison

Looking at this picture makes me feel nothing short of deflated.  It wasn’t until I finished putting this comparison together in photoshop ten minutes ago that I realized the complete lack of visible difference from the front view in a period of five months, and to be honest, it stirs up several emotions.  Anger being the most dominant followed closely by hopelessness.

Invisalign can be tough and is definitely not for everyone.  I thought that for it to be successful, it required complete dedication and 100% patient compliance which in my case, relied heavily on (and still does) being able to see progress.  People with braces are just along for the crappy ride. Invisalign patients are technically driving their ride, meaning that if they want to derail and GTFO, they can.. and many do.

I’ve given all the compliance and dedication required, along with a lot of my money and time, but it’s just not panning out like I envisioned.  Though my lower arch has shifted into a better position during this refinement, I’m still left with an orthodontist-caused interproximal ledge that will unfortunately need to be corrected with more IPR which requires more enamel permanently shaved away, and more months of the constant, dreary maintenance routine.  To put it bluntly, this shit is growing old.  For once, I wouldn’t mind going to a restaurant, not worrying about removing spitty aligners, enjoying a carefree meal, and then driving home only to park my ass on the couch and watch mindless reality tv with my man and my gray cat… without being a slave to my floss and toothbrush. Don’t get me wrong… I understand that these are the things that I signed up for, it’s just that now, there’s no end in sight.  No light at the end of the tunnel.  Plus, I’m fixing to hatch a small baby human.  Those things are time consuming.  And as Sweet Brown says, “Ain’t nobody got time for that!”

Part 2

I guess now that I’ve gone off on one of my typical rants, I can move forward and expand on why I am where I am in my treatment.  For reference, I am currently on the first day of refinement tray 10 of 11 on my upper arch, and I “completed” my lowers a while back on #7.

A couple days into refinement tray #5, I had once again noticed that my teeth were beginning to track similar to how they were during my initial phase.  This time I didn’t lollygag.  I brought it to my orthodontist’s attention immediately and not surprisingly, she had the same nonchalant attitude as she did the first time.  She brushed it off and told me that my top middle incisors weren’t intruding at the time because, at that point in my treatment, she was intruding my lower incisors.  What tha..?!!  Her uneasy demeanor lead me to believe that she literally had just made that up.  Plus, it really just didn’t make sense.  Sooo my aligners are not fitting on top because of something completely unrelated?  That’s like saying my brakes on my car are squealing because I’m late on changing my oil.  Anyway, I took a mental note to wait a few weeks and request my lower ClinCheck, which I did receive. I’ll post it further down.  I didn’t continue on this topic though because it’s hard to argue with someone who’s studied this subject for an eternity.

She's got at least seven on me.

She’s got at least seven on me.

So, wearing a crooked bib a blank stare, I left it at that.

ClinCheck Review Time!

This is my lower arch (duh).  Notice how there is zero “intrusion” like she told me.  This was even confirmed by a second orthodontist.

The next two are my very first ClinCheck movies.  Though we had to cut this round short for refinement, I still love seeing my teeth transform… and for what it’s worth, I almost got exactly what was predicted out of the lowers in the first round.

Some would say, after seeing this ClinCheck, that my teeth weren’t that bad to begin with… but if you examine these two pictures taken before my treatment, it is clear how a deep bite such as mine can affect someone’s appearance.  Especially if you’ve got a gummy smile like I do.

bunny teeth

bunny teeth

My teeth today:

problem teeth

Below is the same ClinCheck, only from the left side.

And then below is my first refinement ClinCheck from both sides.  Notice the intrusion of my upper incisors.  When I’m bitching about my trays not fitting because of the upper incisors not intruding like they should, this is what I mean.  Doesn’t it seem like this particular movement was the main PURPOSE of my $400 refinement, though??  To be fair, there might also be some extrusion from my posterior teeth as well.  I’m not sure.

If you’ve been reading all my drivel, you more than likely recall me going on and on about bite ramps… I mainly brought this topic up in my Invisalign forum but I do have one blog post dedicated to them.  These are bite ramps:

Bite Ramps

Bite Ramps

The main purpose of bite ramps in Invisalign aligners is to open up a deep bite (a deep bite is different from an overjet but they often come packaged nicely together).  Obviously, mine was pretty bad, but from the beginning of treatment up until around tray 19, it had opened up significantly.  Here’s a short video to help you understand what bite ramps are for:  https://www.youtube.com/watch?v=FdyPdSJt00k

Like I said, the intrusion movement was going great, however it finally slowed down to a standstill once there was no longer any force coming from my incessant jaw clenching.  I.e. In the first part of treatment, my molars did not touch.  The only contact my upper and lower jaw had was at those four bite ramps.  But after months of biting down (leading to the complete destruction of the bubbles by the end of every two weeks), my upper incisors were forced up into my gums.  My problems arose when my molars could finally make contact and pressure was evenly distributed amongst all of my teeth.  The bite ramps were still present in the same location on every subsequent aligner.  I figured there was a reason for this so no questions were asked until I knew something was up.  That’s when I was given the ultimatum:  Either love it up or pay for a $400 refinement.  I guess that’s about how it went.

When I finally received my first set of refinement trays, I was more than a little concerned that my bite ramps were in the exact same position.  I was under the impression that these would be moved into a new location to encourage more upward movement… after all, it was the main reason I agreed to pay $400 more!

Along with the tracking issue, I expressed my great concern over her IPR job between my two lower incisors.  She suggested that I continue wearing my aligners (suprise su-fucking-prise!!!) and to return back in six weeks to see if things looked any better.  Though she skated around the idea that my two incisors were now deformed by her hand, she did agree to fix my lower teeth. She immediately went to her filing strip drawer and pulled out several different-sized IPR strips.  I balked at that and questioned what her plans were.  She wanted to “just smooth over the small area on the other tooth”.  HELL NO.  I still had a gaping canyon for christ’s sake.  Of course, with me being the total pussy that I am, I was nice about declining.  I kindly told her that I was uncomfortable with the more-IPR idea.  She pulled out a different, more paper-like strip and asked, “How about this one?  I’ve got to try and smooth this spot out.”  I folded and let her go at my mouth again.  After a few minutes of light sanding, she stopped.  If you take a gander at that interproximal ledge picture further above, you’ll see that no amount of light sanding would fix that monstrosity.  Anyway, she had her assistant pencil in for the upcoming appointment:  attachment removal and impressions for a mid-course correction for the lower.  She then told me that if my top teeth were getting worse, we’d just do the whole shebang.  I asked if this mid-course correction would count against my two refinements and she assured me that it wouldn’t.  I skipped out of the office in a better mood.  At least she offered a solution and I was content with that.  I still don’t understand how she doesn’t think my aligners are fitting poorly.  This picture is straight from this link on Align Tech’s website: http://www.aligntechinstitute.com/files/ATEArchive/pdf/ate_091611_MonitoringAndFinishing.pdf

Poor Aligner Fit

Poor Aligner Fit

They could basically replace the bottom picture with mine and it would go perfectly.  But alas, I have zero ground to stand on since orthodontia isn’t my craft.  I really can’t argue.

So, weeks passed and as predicted, my aligners continued to fit worse.  At least I was getting that free mid-course correction, right?!  Wrong.

I showed up for my appointment and chatted with the receptionist.  I sometimes feel bad for writing all this stuff because everyone there really is nice… but I have to continuously remind myself that ‘nice’ doesn’t straighten teeth.  Anyway, they called me back and had me wait in the kiddie chair, fully reclined.  All hopes of using body language to express my displeasure in treatment floated right out the window.

So I waited to speak with my orthodontist as I had planned (I regret not insisting that we take the conversation out of the reclined chair, and into her office). She briefly listened to my concerns about the aligners not fitting while smiling and nodding like she always does, and once I was done, she turned to her assistant and in a nutshell said, “Okay, I need two new attachments on the upper lateral incisors to pull those teeth down–” of course in more professional jargon.  I had to stop her mid-sentence and remind her that that wasn’t the issue at all and that there should be no need for anything to be pulled down. My clincheck projected the upper central incisors moving up and they’re not moving up. She replied, “..oh.” (seriously) and didn’t even bother to check whatever paperwork that was with my box. She hurried to the back and returned immediately with a laminated “smile chart” that displayed a diagram of an 8.5 by 11 inch-sized “aesthetically pleasing smile”.  She described to me how in orthodontia these days, orthodontists no longer like to make every top tooth even, straight across because it gives off an “I’ve had braces” look. I told her, “That’s fine if we can’t move these teeth up. I’m now at the point to where I just want my crooked teeth to be straight. That is all I want, and I don’t think that might be happening now since, once again, my aligners aren’t fitting properly.”  She then pulled out my last four remaining aligner bags and closely examined the upper 11 of 11. She bent over closer to me and pointed with her tool at how straight the rotated teeth were going to be if I just give it time and keep wearing this series of aligners. In my head I was thinking, “SURE, and the same tray also has my upper incisors shoved up into my gums as per the original plan.” Reluctantly, I said okay thinking that I could come back in a few weeks if things continued to get worse.

If my facts are correct, I do believe that Invisalign gives providers up to a year after the end of the first round to complete refinements.  Given this time frame and taking into consideration the length of time (one month) it takes to send of impressions and receive new trays, I figured I’d be better off just holding out and seeing what these aligners would do.

I am now on tray 10 and my teeth are exactly how I not-so-enthusiastically anticipated them to be.

Maybe if I’m not so lazy tomorrow, I’ll take some new pictures.  I’m tired of writing and I’m sure, if you’ve made it down this far, you’re probably tired of reading too.  So here, I sign out.

UPDATE:

Photos taken 5/12/13

right left

And then the scary one:

lower

Oh, and just so yall know… that gap on the left side…?  Yeah, that’s new.