How Invisalign Treatment Works

You’ve been looking around online for a way to straighten your teeth for some time now. You’ve researched all of the options and have settled on Invisalign being the best fit for straightening your teeth. Invisalign seems to tick all of the boxes for you, but you want to get some in depth information of how Invisalign actually works. This blog hopefully will give you an honest and detailed outline of how the Invisalign treatment works, including the process from beginning to end, and actually how the Invisalign system moves your teeth into a straighter smile.

What Is Invisalign?

Invisalign is a clear aligner system that is used to straighten a wide variety of crooked or spaced smiles. It uses a series of removable, clear, near invisible “aligners” or sometimes people refer to them as trays or retainers. Although, as we will see later, orthodontic retainers are something different. There is some debate amongst people as to how “invisible” these aligners actually are. Personally, I would never promise a patient that you will not be able to see them, as this just isn’t truthful. However the majority of people you come across will not notice anything about your smile. If you tell someone that the clear aligner is in, then likely they will notice them. Upon looking in the mirror for the first time, you will definitely notice your own Invisalign aligners though, so make sure you have realistic expectations of what Invisalign is going to look like.

There are a series of these aligners that are changed every 7-14 days depending on your case and the Invisalign doctor treating you. How many Invisalign aligners are necessary, depends very much on your case. I would say an average case at our Invisalign clinic in Fleet will range from 14 -30 aligners. This can be significantly more in a complex, comprehensive orthodontic case. Each aligner applies small pressure to certain teeth to move them, and once the small movement occurs, a new aligner with new forces and movements is fitted. These movements can be tipping teeth, rotating twisted teeth, closing gaps, pushing teeth up or pulling teeth down.

The Consultation

Before deciding on Invisalign as the treatment of choice for straightening your teeth, it is important that you have a comprehensive examination with an appropriately qualified Invisalign dentist. This is the only way you will know for sure if Invisalign is the best option in your individual case, or indeed if it is possible at all. Your Invisalign dentist should examine not only your teeth, but your gum health, your bite, your jaw joints, jaw muscles and facial profile. These can all have a huge impact on your treatment plan. Photographs are usually taken at the consultation.

At our clinic in Fleet, we use photographs to talk you through what we see in your mouth. We find that communicating with patients regarding dental issues is so much easier if you can see what we see. It is also important that x-rays are taken of any teeth that are to be moved. These will assess the health of the roots and surrounding bone. The last thing you would want is your Invisalign treatment causing damage to the teeth. Your Invisalign dentist should be able to show you some before and after examples of cases that they have treated with the system and don’t be embarrassed to ask the dentist what their experience is with the Invisalign system.

Usually following an Invisalign consultation, it should be possible to leave with a written estimate of costs that are to be expected during your treatment plan. Sometimes, for more complex treatment plans, the dentist will need to spend some time with your records and potentially get some specialist opinions before deciding on a final treatment plan. When you receive your treatment estimate, please ensure that there are no hidden extras and confirm what is included in the fees that have been quoted.

Impression Appointment

After you and your dentist have agreed on a treatment plan, the next stage is to get some impressions or commonly referred to as moulds. These are to obtain a three dimensional model of your teeth and jaws. The impressions involve a tray loaded with silicone putty impression material being seated over your teeth and being allowed to set. The impression will be in your mouth for around three minutes. For most people, this appointment is no trouble, however, if you have a bad gag reflex, you may find the impression appointment unpleasant. Some practices use 3d scanners, which remove the need for the putty impression.

Clincheck Appointment

Probably one of Invisalign’s most unique selling points, is the Clincheck simulation. Once the impressions are sent to Invisalign, they are 3d scanned in order to create a computer 3d model. The Invisalign technicians then assess the model and gradually move teeth around as per the instructions sent by the Invisalign dentist. This creates a 3d treatment plan called a Clincheck. The Clincheck is available for you to view and discussed with your dentist before treatment commences. It is even possible to make changes to the final outcome before the Invisalign aligners are manufactured. If you want to show your friends and family, it is possible for your dentist to send you a video of the Clincheck, so you can show people how the teeth are going to move during the treatment. At this point, it is also possible to find out how many aligners will be necessary, thus finding out roughly how long the treatment will take.

The Fitting Appointment

When your Invisalign aligners arrive, your dentist will arrange an appointment for them to be fitted. At this appointment, the first aligners will be inserted and checked for quality of fit. It is extremely important that the aligners fit perfectly. Once the fit is checked, the dentist will show you how to insert and remove the aligners and should check whilst you are in the surgery that you are able to do this. Don’t worry if you struggle to remove them at first. This quickly becomes much easier and you will soon be taking them out better than your dentist can! You will also be given an Invisalign case to keep your aligners safe, an instruction manual and a sample of some Invisalign aligner cleaning solution. In addition to this, at our clinic, we give some aligner “chewies”. These are some small, soft, rubbery rolls that are used to chew against when you insert your aligners. This action helps to properly seat the Invisalign aligner down onto your teeth.

At this appointment you may also have two other procedures, attachments and IPR. I will explain what these are in separate sections below.

Attachments

Invisalign attachments are small bumps of white filling material that are bonded to your teeth. The photograph above shows an example of some Invisalign attachments on the upper left teeth. They provide an area of the tooth for the aligner to grip. This aids in certain tooth movements such as rotations of teeth or pushing teeth up or down. I always use the analogy of a post in the ground in your garden. Imagine there is a post half buried in your garden and you try to rotate it in the ground. It would probably be quite difficult depending on how deep it is. Then imagine attaching a handle to the side of the post. As you can imagine, the chance of moving the post would be much higher. These attachments remain on the teeth for the duration of the treatment and are removed at the end. The attachments remain present on the teeth when the aligners are removed. Although tooth coloured, they are slightly visible. They appear as small, white lumps on the sides of the teeth. They are always necessary in all Invisalign cases, but not all teeth need them. The number of attachments varies depending on the case. Attachments cause no harm to the teeth.

IPR

IPR stands for “inter-proximal reduction”. This is the process of creating space in between the teeth, in order to gain room for crooked teeth to move into. This process involves removing small amounts of enamel from the area in between the teeth. Abrasive metal strips and rotating discs are used for this reduction. This is the part of Invisalign that creates most anxiety for patients. Yes, enamel must be removed, but it is not painful and does not cause any detrimental damage to the teeth. Teeth are not weaker or more susceptible to decay after this procedure, and this has been proved by plenty of research. Having IPR is by no means pleasant, as it can feel like a fair amount of pressure between your teeth. I describe it to my patients as having gritty, thick floss between your teeth. This is not the best experience, but certainly not painful. Local anaesthetic is not necessary for IPR, so there are no needles involved.

Sometimes the gaps that are made between the teeth are visible with the Invisalign aligners out of the mouth. However, they are very small. The largest gap we ever create is half of a millimetre.

Review appointments

All of the aligners are made at the start of treatment. However, your Invisalign dentist should only give you a few at a time. This is so that your dentist can review the progress of treatment at regular intervals. This is so important, as you may not be able to tell that a particular aligner is not fitting perfectly, whereas your dentist will and can fix fitting problems before they become too much of an issue. The number of aligners given to you per appointment depends on a few factors:

Your Invisalign dentist’s preferences.
Your individual treatment difficulty.
The stage of treatment that you are at.

Usually, at our Invisalign clinic in Fleet, we would give somewhere between 4-6 aligners at a time. A typical review appointment at our clinic consists of the following:

A chat about how you are getting on with treatment and addressing any concerns you may have.
Inspection of the fit of the current aligner that you are wearing.
A check on the progress of the movements of your teeth.
Some photographs to record the progress.
Fitting of the next aligner.
Any necessary IPR.
Giving you the next aligners.
Instructions of when to change the aligners.

The Final Invisalign Review

Once all of the aligners have been worn, your Invisalign dentist will arrange a final review appointment. At this appointment, the teeth will be assessed for how well they have aligned and checked against the predicted movements of the Clincheck simulation. You will be asked if you are happy with the alignment of the teeth and if there are any particular teeth that you would like moving further or differently. If the teeth require further movement, this is no problem. It is possible to make some refinement aligners to “fine tune” the alignment. If the treatment has gone well, any refinement needed is likely to be minimal.

The attachments are always removed at this appointment. If you require refinement, some further impressions or scans will be taken.

Invisalign and Retainers

All orthodontic or tooth straightening treatment requires retainers to keep the teeth from moving back. If there are no retainers, or retainers are not worn for long enough, the teeth will move back again. This is obviously not what you want, after spending all the time and money to get yourself a great straight smile.

There are two types of retainers:

Removable retainers.
Fixed wire retainers.

Removable retainers are most commonly plastic retainers that resemble Invisalign aligners very closely. These are called Essix retainers. Invisalign make their own brand of Essix retainers that are called Vivera retainers. These removable retainers are worn overnight only if used in combination with a wire retainer. However, if there is no wire retainer, these Essix retainers need to be worn full time, day and night, for at least the first three months after Invisalign treatment finishes. After this period, it is then possible to go down to night time only wear.

Fixed wire retainers are small, thin, metal wires bonded to the back of the front six teeth. A photograph of a fixed retainer is shown above. As they are behind the teeth, they are not visible. They can be used in combination with a removable retainer.

Our preferred “gold standard” retainer programme would be to have both the fixed and removable retainers. This gives us a “belt and braces” approach to keeping your teeth nicely aligned for the long term.

Unfortunately, retainers are forever. There is no safe time to remove wire retainers, or to stop wearing removable retainers. I can tell you that a large proportion of the patients we treat with Invisalign at our clinic in Fleet are patients who have had orthodontics when they were younger and not had an appropriate amount of time with retainers.

Long Term Follow Up of Invisalign

Once you have your straight teeth and your retainers in place, it is extremely important that you keep up regular examinations with either your Invisalign dentist or your regular dentist (these may be the same person!). Someone needs to be checking that the retainers are attached properly, that you are able to clean around them and that there has been no minor tooth movement since the treatment.

I hope that this blog has been helpful if you have been considering moving forward with Invisalign treatment. If you have any questions about Invisalign or teeth straightening in general, or if you would like to book a consultation, you can call us on 01252 614818, email us at info@ancellsfarmdentalclinic.com, or use the contact form https://ancellsfarmdentalclinic.com/contact/.

will.shaw 15.04.20 Dentistry, Orthodontics