Mid-Course Correction

[Wireless]

I went in for a check this week after trays 14 of 14U / 21L. My upper arch looked almost perfect with the exception of one tooth that is very slightly off. During the visit, my ortho looked closely at my lowers and the position of my attachments and decided they aren't tracking correctly. My lower attachments are to rotate my pre-molars and also to intrude my lower front teeth to correct a severe deep bite. He decided to do a mid-course correction, which involves taking new molds and other adjustments.

My ortho wanted to re-do all of my attachments in the process, so he ground off the seven I had - no fun!!! It took about fifteen minutes to get them all off. Afterwards, he took new molds.

I now have to wear trays 14 for several weeks until my new aligners come in. I was told 4 to 6 weeks, but from my earlier experience this will probably be 7 to 8 weeks. I was also told that I may have more than the 7 remaining trays I had to this point. It looks like all of this will add 4 to 6 months to my treatment plan. Although this is quite a bit longer than the date for my original 21 trays, its still less than the 18 months in braces I was told with my original consultation.

While this is a setback, I can see some change in correction of my deep overbite already although it is small. I've been very concerned that Invisalign wouldn't work well for my case based in info I had read prior to starting treatment. I am encouraged to see positive results, considering from what I can tell Invisalign techniques for my problem are probably only a year old.

I finally got the nerve to ask about the overbite corrections and my ortho told me it was going to be a slow process. He also noted it was a very difficult thing to treat in adults because pressure from jaw muscles pushes teeth vertically back to the original position. He noted I will have to wear retainers at night indefinitely to avoid another relapse.

I also found out that I will have more attachments on my lower teeth once treatment is resumed (six instead of four). It looks like Invisalign is leaning towards more attachments as this technique expands to treat more complex cases. My ortho also told me I would need to have appliance hooks to get the lower tray out due to the extra attachments.

So far there has been no mention of fixed braces. I hope I will be able to finish without them and a total treatment time of 14 to 16 months.

[DrJasonKTam]

If the teeth are not tracking with the aligners it is best to stop and "reboot" using mid-course correction. This will actually save you time in treatment in the end. Attachments that are not fitting properly into the aligners will actually cause unwanted movement, generally pushing the teeth lingually.

Good luck!

[Wireless]

Dr. Tam,

Thanks for your comments!! I have really appreciated your participation on this board as well as the comments from others.

I appreciate the re-assurance that this is routine change in treatment. Up to this point I could tell I would need more vertical correction than the seven remaining trays would accomplish.

With the attachments removed from the rear of my lateral incisors, I have been able to see more vertical improvement than what I thought had taken place.

Initially, I was very concerned with my doctor's recommendation that I go with Invisalign due to problems found in my records review. Everything I had read suggested I was not a candidate and that Invisalign was not good at treating deep bites. At this point, I see enough progress that I am feeling very reassured.

My doctor has also been terrific at explaining everything and hasn't minded my worrysome questions. He's been really good at trying to get me through one more (and hopefully final!) treatment. I'm not sure if Invisalign gives extra support to doctors working on more difficult cases, but so far my doctor seems to be on top of any problems I have experienced.

[Wireless]

I've resumed treatment after a six week break to get new aligners for a mid-course correction. I now have eight attachments instead of seven, and the ones on my first premolars are now horizontal rectangles instead of vertical. I assume this works better for intruding front incisors than the vertical ones, where my teeth weren't tracking correctly. The bad news is these are on my uppers and lowers, making it difficult to get out both trays.

I did do a search on "Invisalign Attachment Protocol" and found there were some changes to Invisalign procedures this past spring. I hope this is all helpful in making future progress.

Before the mid-course correction, I had made it to tray 14 of 14U/ 21L, so I was surprised to find out I now have 8U / 17L to go (total of 22U / 31L) increasing my schedule from 11 months to 17. My ortho didn't make any mention of fixed braces and noted he needed to do more intrusion. Originally I was told 18 months in braces, so I'm probably on schedule if I don't need refinements.

If there was one thing I could change in all of this, it would have been to have caught the relapse when a six month treatment would have fixed the problem. My ortho repeated that my problem was one of the most difficult to treat and maintain correction and was not surprised the previous correction didn't hold up, as extruding rear teeth for a deep bite usually ends up with them being pushed back into their sockets from jaw pressure. I'm not sure how this would have been tracked or resolved 20 years ago. At this point, my retreatment is going to take just as long as it would for a new patient.

My consolation here is that I am ahead of my non-ortho friends in some cases. One just had gum surgery and a tooth extraction to address TMJ problems and bone loss. Another lost a tooth from his dental bridge on a business trip - its bad when you loose teeth you don't have!!

[myhollywoodsmile]

Glad you are getting it sorted out Wireless. I am about to finish my Uppers but will definitely need refinements as I suspected from several sets ago. At this point I am not even thinking about a finish date. That way I can't be disappointed!