Adventures in dentistry: Invisalign

For the past year and a half, I've been undergoing a six-month course in tooth-realignment. That's right. Eighteen months of a six month therapy. So let me explain...

Let me take you way back to tell you the whole story. In March of 2019, my weight had reached something in the neighbourhood of 330 lbs. I'd been trying everything for years to get that down again, but will power and the tide of biology conspired against me. Finally one morning at work, sitting there alone, I remembered the wife of a friend had had bariatric surgery and it had been literally transformational for her. And for the first time, I decided maybe I needed to give that a try. For what it's worth, I had the surgery not quite a year and a half ago, and I'm glad I did. So much has changed... including what I'm about to write about.

One thing led to another. Getting onto that program, which is a long process nearly a year from start to finish, meant that I had to see a cardiologist. He sent me to a sleep clinic. They told me I stopped breathing during sleep somewhere in the neighbourhood of 80 times an hour. Think about that. So, they recommended I get a CPAP machine to keep my airway open during sleep. I got it in November of 2019 and I've used it every night ever since. But one morning I woke up with a terrible ache in my jaw. I wondered if I'd fractured it. For days, I could barely chew. Back when I was in my 20s and I had my wisdom teeth extracted, my dentist advised me I should get braces because my teeth were badly misaligned and by the time I reached my 50s and 60s, I might start getting hairline cracks in my jaw. Well, this experience sobered me up to that, and so I started looking around for an affordable program.

I found Invisalign, which promised to do the job for somewhere around two grand; a lot less than other programs and with the added bonus that it was being done with transparent plastic rather than wires. So I went to see them, they showed me what they could do over 6 months, and I signed on.

The 18 pairs of aligners arrived in January, 2020. Here's how it works. You put a set it and, other than eating, leave them in all the time. You wear each set for a week, but every third set you wear for two weeks. So, 18 pairs comes out to 24 weeks, just about six months. Starting in mid-January, my therapy would have been completed around early July last year.

When I started out, my teeth were fairly crowded. I had buck teeth in the uppers (the left one out further than the right), with the outer incisors slightly tucked in behind the inner ones. My bottom teeth were worse. The two incisors on the right were pretty much okay, but the front left one was turned almost sideways, facing toward the left, and the outer left incisor was tucked in behind that one. Generally, you couldn't even see it. I looked like I had three bottom incisors because one was almost completely hidden behind another.

This is a picture of what my teeth looked like when I put my first aligners in. Please excuse the coffee stains. :)

Left is right and right is left here, of course. So, as you can see, only three incisors are visible along the bottom. There's an eyetooth there on the right (my left) that seems to be in its place. Space needed to be added there to move it forward. As well, on the top, you can see how the teeth overlap somewhat, almost like a poker hand. This is the mouth I've lived in since I was a tween.

Each Sunday night I would switch to the next set of aligners. They're tight, and they take a minute or two to seat properly using little tubes of plastic they call "chewies" that help you gently bite down and sit the aligners down over your teeth. Early on, they ached quite a bit for a day or so, but as the process went on, that really lessened. Maybe the therapy simply accustomed the teeth to moving as time went by. All I can tell you is, at some point, I stopped waking up Monday mornings still feeling it.

This was a fairly simple process at first. The first two or three sets were no problem. Then one Sunday night I found I was having a really rough time getting the aligners on; especially the bottom one. I was getting this pronounced wow in the inner arch, folding the plastic such that it formed a salient that poked at my tongue. I mean, I'm talking about something like a quarter of an inch here. It was very noticeable. I thought maybe my teeth weren't keeping up with the therapy, and I hoped they would catch up. In coping with that, I ended up getting an inexpensive Dremel tool to buff the wow and the edges of the aligners down (they can be fairly sharp). The aligners ship with a nail file for doing this, but I needed that Dremel to really get anywhere. It became a weekly thing for a while. Put in the aligners, let them deform, then Dremel the point down to a sort of inverted U gap behind my incisors.

About half way through the process, this was where we were at. You can see the bottom front left incisor has been turned to at least face more or less the same way as the others, and some room has been opened up in the hopes of bringing that outer one out from behind it. So, you know, decent progress...

The set and week is actually printed onto most of the sets I had, and at one point, around the start of June, I happened to look at them and I noticed the numbers for the upper aligners and the lower ones didn't match. The lower set I was wearing was several weeks in advance of where I was in the therapy. Well, that would explain why they hadn't fit and deformed so badly for some time. But the upper one was actually a couple of weeks behind where I'd gotten to... they were actually moving my teeth back where they'd been before!

Do I need to say I was livid? I got in touch with them and demanded they reassess my therapy. I told them I'd start putting the payments in escrow if I didn't get some action. I told them that, in my opinion, having a therapy that reversed the course of the treatment verged on malpractice. They sent me an impressions kit to make new molds of my teeth and advised me to keep wearing the current set at night so my teeth wouldn't start reverting to their old positions. I wore that set for about six weeks waiting for the new ones. They were pretty shagged out by the time the new ones arrived.

It was an entirely new set of 18 aligners. I was starting over again. This time I opened every set and checked the numbers, making sure they were in sequence and matching. They all were. I sealed each set in a sandwich bag and labeled it, and started over. This set arrived in August, which meant the new therapy would send in February. Now they were a lot easier to seat on Sunday nights and I pretty much stopped with the Dremel, not even bothering to buff off the edges unless they were particularly sharp.

You have to order retainers at some point, and just as I was about to do so, I broke one of the points of my lower left 12-year molar. I guess there'd been a crack there for a long time, because it broke while I was chewing bread. I went to the dentist who suggested I wait till the end of the Invisalign therapy to repair the gap, which was essentially just cosmetic, and to let Invisalign know they'd need more impressions to get the retainers right. So, that's what I did.

This is where my lower teeth were at just prior to the break in the back molar (it's the one with the white filling; the forward interior point is the one that would shortly break off). You can see that hidden incisor was really coming forward by then.

Fast forward to February. Filling is in and the point is reshaped. I get my impressions kit. Send it in. I'm doing this to get my retainers made. They send me back an email saying they'd received my request for a "touch-up" and were evaluating it. I nearly sent back an email saying, "Oh, no, I'm just ordering my retainers," but I stopped. Touch-up, you say...? Well, let's just keep our powder dry and out mouth shut till we hear back from them. If they want another thousand dollars, I'll just say "retainers, please". But if it's part of the therapy I'm already paying for, well...

As it turned out, it was, and they sent me another nine sets. So, another three months of tooth-straightening above and beyond the... oh, I can't even do the math anymore. This time, though, the numbers on the aligners were strictly Week 1, Week 2, Week 3/4, over and over. Each set of three was numbered exactly the same. I had to essentially trust them that they'd ordered them correctly. But in checking the first set against the last, I could see very clearly the progress between them, and so I sealed them all up again, labeled them, and got back to it.

So, that was late March. It's now mid-June, and last night, I put in what will almost certainly be the last of all those sets of aligners. I have to wear these another two weeks (at least), or however long it takes for the retainers to show up.

The last time they asked me to check in on my progress, a couple of weeks ago, this is where we were at...

Forgive the little red arrow; I drew that on there to show a friend which tooth had seemingly come out of nowhere in the past year or so. Yeah, that one is finally visible without you needing an angled dental mirror to see it.

It's been a long time, this "six month" therapy that's gone on for seventeen. But for all that, the results really are remarkable. I can't show you the original animations from last year anymore; they're long gone from the site—which is too bad, because those were profound. But I can show you what just these last three months represent...

It's been a long haul; a lot longer than I imagined. There were some real ups and downs at first, but aside from the original screw-up, I'd have to say that Invisalign has treated me with respect and addressed my concerns and, if I'm being honest, gone the extra mile for me. Would I recommend the process to friends I care about? Yes, I would. I don't imagine my experience with the misnumbered aligners was typical. Stuff happens. But when I told them about it, they made it right. I'm hoping that, aside from making me less ashamed when I smile, that maybe this will head off those "hairline cracks" warnings my dentist gave me 30 years ago.