Metal Mouth Message Board

I’m about four months into my treatment and on tray 11 of 14U/21L and had my first regular dental checkup since starting. As I’ve become more familiar with Invisalign, I realize that my case is unusual for a number of reasons. Unlike most Invisalign patients, I started by checking out more conventional treatment plans as I had read that deep overbites required treatment with regular braces. Also, I didn’t like the idea of having to remove aligners every time I wanted to eat or drink, since I’m a bicyclist and also travel frequently. My ortho surprised me with this treatment plan after finding a resorbed tooth root and convinced me this was the way to go after explaining the problems, extra procedures/X-rays and costs to treat my case.

Aside from the very long seven weeks to get my aligners, most of my experiences so far have been positive. Initially the most important was near immediate relief from the pain caused by gum inflamation where my lower teeth were hitting. My upper tray covered the injured area and with my aligners in I could no longer bite into my gums. With this, I finally started to get sleep again as I’m not waking up if I should close my jaws. I also found that I can do a two week schedule per tray rather than the three I was initially told and my ortho has been very supportive in letting me try for the shorter period. The best news was from my recent dental appointment where I found my gum inflammation was totally gone and injuries from my lower teeth hitting them fully healed. I also had almost no bleeding from my cleaning, which was very unusual. It appears the gum irritation had been a problem for a while before I had symptoms.

At the halfway point, I’m starting to get some concerns. First, I’m finding out deep overbite treatment is new for Invisalign. This procedure is apparently very new (mentioned) as a future treatment method in the Journal of Clinical Orthodontics in a 2008 article. While I have made progress, I still have quite a ways to go with vertical correction and it doesn’t look like I’ll be finished in September when I finish tray 21L. I am aware that my ortho has spent a lot of time with Invisalign on my case. The general treatment plan is to intrude (push in) my front lowers, and then work on extruding my rear teeth, possibly using partial trays. Based on preliminary review of my case, my treatment time is expected to be 15 to 18 months. My treatment plan calls for regular braces if Invisalign results aren’t good enough, and after the tooth with the root problem is in position. My ortho is not an advanced Invisalign provider, but does have an advanced degree in orthodontics. I would feel more concerned about all of this if he wasn’t so good at explaining options and why I have had certain problems as well as telling in advance what problems I am going to experience. I’m going to be asking about the vertical correction concern at my next visit in May.

I haven’t seen anything like this elsewhere on this board, but would be curious if anyone else is having a unique experience with Invisalign – especially with vertical tooth movement, or if your ortho has recommended instead of regular braces without first being asked. It looks like Invisalign is working hard to expand their abilities to more complicated cases.

Thanks for the long post. I find your case interesting. My case sounds similar but may be not as bad.

We are trying intrude my front lower teeth and extrude my lower molars and 2nd premolar to bring my bite together. This was supposed to be happening during my current refinements (11U/11L + 3 possible overcorrection). I'm on #9 now and the teeth haven't extruded as much as they should have. I am supposed to get elastics on my next visit in 2 weeks to help pull these teeth up, so I see how that works.

Has your ortho mentioned using elastics with you?

John37, thanks for your response. Your case is very similar to mine and vertical extrusion of my rear teeth is a major concern to me. You are several months ahead of me in treatment and we are now trying to intrude my lowers.

My present treatment plan is to try to naturally extrude my rear molars and then if that doesn't work, use regular braces. I think Invisalign was a "last resort" option for my pre-existing condition.

I haven't had any mention of elastics yet, but both my age (59) and curved jaw probably will make natural extrusion difficult.

My last treatment (20 years ago) involved using strong elastics and a special appliance to pull my rear teeth up. This worked extremely well except there wasn't any good plan for vertical retention and my jaw muscles slowly pushed everything back. I had to wear the appliance at least 10 hrs/day and the elastics were almost like having my jaws wired shut when I had them in.

Did your ortho mention any special appliances with the elastics or are Invisalign trays being used? In my case the special appliance also kept my teeth from tipping while they were being extruded.

As for Invisalign with deep overbites, check the last paragraph of: http://www.jco-online.com/archive/artic ... clenum=687
From what I can tell, our treatment is very new to Invisalign as the comment was in 2008.

Hope you don't mind me joining in, despite not being able to answer your questions Wireless!

My understanding is that the molars intrude slightly whilst using Invisalign, so to extrude them must be difficult. My molars are no longer quite meeting (fraction of a millimetre) probably a result of clenching at night. This would suggest to me that if you are going to extrude them you are going to have to either stop the possibility of clenching and/or remove the part of the tray that covers the biting surface of the teeth.

I cannot remember whether I read here, or heard from my dentist that the molars should extrude back to their normal bite once I finish the process.

As for other vertical movement, I have a lateral incisor being extruded, and thus far it seems to be working. It is one of the teeth with an attachment and it is still fitting the tray okay. To keep it in place I will be having a permanent wire retainer - I don't know how else you could maintain the position of extruded teeth.

Wobblydeb, thanks for your info! My ortho is planning to cut off the portion of the trays covering my rear teeth as a first pass to get them to extrude. I'm not sure sure how much correction can result from intruding my front lowers. I need about 4 or 5 millimeters total, so I'm not sure what's practical. I don't want my treatment plan to drag on while trying things with minimal results.

This week has been interesting otherwise - I managed to deal with my aligners while having a snack on a 2 1/2 flight yesterday and am starting a new set of trays today while going to out of town meetings. This is a whole new subject!

@Wireless
I read that paragraph at the link you gave. I think this is what my dentist is trying to do. I have attachments on my lower 2nd premolars. The idea is to pull them up as the front teeth get pushed down. The attachments are supposed to give the aligner leverage--something to hold on to. The attachemtns on my 2nd premolars don't seem to stick out far enough on the bottom side. It's more like a wedge shape. I don't know if it's supposed to be like that, but it seems like the aligners don't grab it enough.
Check my clicncheck video:
http://www.4shared.com/file/75292575/da ... ide_2.html

Wobblydeb wrote: My understanding is that the molars intrude slightly whilst using Invisalign, so to extrude them must be difficult. My molars are no longer quite meeting (fraction of a millimetre) probably a result of clenching at night. This would suggest to me that if you are going to extrude them you are going to have to either stop the possibility of clenching and/or remove the part of the tray that covers the biting surface of the teeth.

I don't understand. If you are clenching with the aligners in, then there is a space all around, front teeth and back teeth. So when you take the aligners out your jaw will just close a little more and all the teeth would contact correctly.

Maybe I don't understand how teeth are supposed to fit together since mine have never fit together correctly in my entire life. I thought the front canines contact at the same time the molars do. But I guess as you clench harder, the canines flex a little allowing the molars to contact a little more?

Wobblydeb wrote:I cannot remember whether I read here, or heard from my dentist that the molars should extrude back to their normal bite once I finish the process.

As for other vertical movement, I have a lateral incisor being extruded, and thus far it seems to be working. It is one of the teeth with an attachment and it is still fitting the tray okay. To keep it in place I will be having a permanent wire retainer - I don't know how else you could maintain the position of extruded teeth.

Why would an extruded tooth go back if it wasn't in contact with the opposing teeth?

In may case, the back teeth don't even contact at all now. One wisdom tooth used to make contact with the upper molar, but I had all my wisdom teeth removed just before I started Invisalign.

John, you are correct - I think I hypothesised a step too far! This article is the one I have seen that explains the bite (and some common problems) pretty well.

http://www.dental--implants.com/bite_a ... sion.html

Perhaps my bite has changed with the movements in my canines... Hmmmm my premolars seem to be doing most of the protection work. My front teeth definitely don't meet as the uppers overlap the lowers reasonably correctly. (LOL..... except that HUGE crossbite of course!)

Still trying to find something that explains why I believe my molars will settle back after I've finished treatment. Might have to talk to my dentist again! My understanding is that teeth naturally erupt to fill gaps - and hence my molars will erupt again after treatment until they meet again. ......hopefully!

John37 and Wobblydeb, Thanks for all of your feedback and info. John37, I looked at your clincheck video and it looks like you are having some of the same vertical movements. It looks like you have other attachments also besides the wedged ones that were red. Mine are a little different - I have two large rectangular ones on each side of my lowers - one on each bicuspid. I don't have the lateral movement you have, but a much more severe overbite. before treatment, my lower teeth contact the gums behind my uppers.

Wobblydeb, I noticed there is a gap between my rear molars too when I take out my aligners. I expect this intrusion happens as there is more force on the molars when closing your jaws and there isn't any directly on the fronts. In my case, my ortho told me it was force on my back teeth and the shape of my jaw that caused my rear teeth to fully intrude again. Hopefully your teeth will go to a normal position shortly after treatment.

My ortho also mentioned bonded retainers when I finish. I'm not sure how this will be done on my rear teeth or if there are options. This sounds too much like "permanent braces".

I'm going to ask my ortho how the vertical correction is going at my next visit in May. I get the feeling this is going to take longer than 5 months!! I had happily noted on my calendar "finish with braces" two weeks after tray 21 even though I was told 18 months of treatment initially. It sounds like 42 weeks with Invisalign alone probably isn't going to fix the problem.

I'll take some pictures of my lower attachments and how my teeth line up over the weekend when I get back home and post.

Thanks again for all of your info!!! You have been really helpful!!

Wobblydeb, thanks for that article. I had read something like that before. This article explained it well.

I like that my front teeth are coming into position to allow proper canine guidance, but the back teeth still need to be moved into correct position. My smile looks better but it still feel weird when I smile since my muscles don't seem to relax correctly without my molars contacting. I think when all the teeth come together correctly certain muscles relax and it's easier to smile.

Wireless, my clincheck shows the attachments that are new for my refinements in red. The impressions were taken with my old attachments still on, so those show up white as if they were part of the teeth. On the lower right I have 3 attachments, canine plus both premolars (bicupids). On the lower left I have 2 attachments, canine plus 2nd premolar.

My back teeth haven't naturally extruded to fill the empty space in my bite. Before Invisalign the tips of the teeth may have been making just enough contact to keep them intruded. I had a crossbite. Even if the vertical spacing was correct, I'd still have a cross bite on my right side, so I'm hoping that gets fixed eventually with my next set of refinements.

Invisalign treatment with deep bites can be successful but there are a number of key points to address after reading this thread.

As mentioned, attachments are often placed on the premolars to use them as anchors while intruding the anterior teeth.

Posterior teeth tend to intrude with Invisalign due to the forces of occlusion. It is not uncommon for back teeth not to touch towards the end of treatment. As discussed, the trays can be sectioned to allow extrusion of those posterior teeth.

The JCO article referred to above shows vertical movement of the teeth, but this is simply due to tipping of teeth, rather than pure intrusion. Imagine bending your arm to 90 degrees at your side, and pushing your forearm further away from your body. Your hand is now being "intruded" relative to its previous position via this tipping method.

More complex are pure vertical movements that may require the use of auxiliaries such as buttons, elastics, and modifications to your aligner.

Invisalign moves teeth differently than traditional braces and therefore, the planning has to be approached that way. One of the best ways to ensure a great result is to seek an experienced Invisalign Provider.

Good luck!

Thank you for your comments Dr Tam. I think I have a better understanding now of what my ortho is doing. In my case, the Invisalign recommendation was a surprise that didn't come up until a resorbed tooth root was found in my records exam. My ortho explained the risks of treating this with regular braces and that too much pressure could cause loss of the tooth. His approach was to use Invisalign to carefully control movements of my upper arch. Otherwise, he told me I would require frequent X-rays to be sure there was no damage and wanted my regular dentist to monitor. At first, I thought he was being overly concerned until I did some internet research that confirmed what he was saying. I have an impinging deep overbite and didn't think I was an Invisalign candidate.

I was also told I may have to finish in regular braces if Invisalign doesn't provide the needed results. Since I was told about partial trays, but the extra treatments with elastics and buttons not mentioned. This is probably the point I will have to go regular braces to finish my lower arch.

At first I was told braces for 18 months, but found out I only had 21 trays (42 weeks) of Invisalign and assumed I would finish in a much shorter time. I now realize I probably jumped to a wrong conclusion and the longer estimate is more accurate.

I have a progress appointment in May and will be asking about my progress for vertical correction. Thanks to everyone for your comments!! I feel a lot better about my treatment plan now and what to expect.

I just had an ortho appointment for a regular check and to deal with a couple of problems. I did find out that my treatment plan is something very new for Invisalign. During the visit, I showed my ortho the Journal of Clinical Orthodontics (JCO) written in 2008 and mentioned deep overbite treatment as something in the future. He mentioned that JCO was a very good reference and that we were doing the procedure in the article. He didn't appear concerned and seemed to like it that I had done the research rather than being annoyed.

This does make me feel like a "guienea pig", but I also realize that I don't have options. Inflamed and receding gums behind my upper front teeth eliminated doing nothing as an option and a resorbed tooth root would may made treatment with regular braces much more difficult. If my problems had happened to someone a generation earlier, the solution would probably have been dentures.

Going in to my appointment, I was concerned that I may require refinements to continue treatment. My lower aligner was no longer gripping the attachments on my right side as one pre-molar hadn't rotated correctly. I also had an attachment on the back of an upper incisor with the resorbed root and pressure from my lowers pressing on it was making the tooth loose. My ortho simply filed off most of the attachment, then removed the attachment on my right premolar so it gripped again. To be sure there were no further problems, he "supersized" the attachment making it thicker than it was originally.

I also had an attachment break off and replaced on an upper pre-molar. The new one here is also more squared and larger than the original. As a result, I can no longer get either aligner out easily and have finally decided I need to get appliance hooks!

Since my treatment is a new Invisalign procedure, I'll try to keep this thread updated as I progress.