I first started researching Invisalign in September 2012 and put it out of my mind for a while and instead focused on paying off my car. Still, I had plenty of time to think about it and prepared a list of questions in advance of my appointment. I would recommend anyone considering treatment do this before their consultation. Mine are grouped below and include answers and my musings.
1. With Itero (Invisalign's proprietary tooth scanning technology), is the treatment planning/development process really done completely without impressions?
Another practice I explored that had Itero still used impressions and, since I was trying to avoid impressions, this was a priority for me. I also learned that the impression process and material had improved a lot since my last experience in the mid-1990s so it doesn't sound nearly as terrifying. (Terrifying = drippy and gag and vomit inducing.) But, this office does use Itero for all Invisalign treatment. I won't have to have impressions unless I lose or break a retainer. They make the replacement retainers in-house in 24 hours. I'm looking into ordering an extra set at the end of treatment to delay the need for impressions, even if the technology and patient experience has improved.
Since my last post, I made an appointment for my scans. It's scheduled for June 12.
2. What percentage of patients need refinements? Is there an additional cost? What if something happens to my teeth during treatment?
I learned about 25% of patients need refinements or additional trays after the initial treatment is completed. These may be due to things the doctor and/or the patient want to address when the initial course of treatment is complete. Up to three sets of refinements are included in the treatment cost.
If something changes in my teeth (cavity, chipped tooth, etc.) a mid-course revision can be done. The coordinator that I was meeting with didn't think there was a charge for this but she wasn't entirely sure. Fingers crossed I don't need to find out.
(This may vary by practice and Invisalign system. That is, I am doing the full adult Invisalign but Invisalign Express and Invisalign Teen have different features and prices.
3. Are there recommended strategies for preventing decay?
I found some complaints on the web about people that ended up with cavities during/because of treatment. Many people seem to think excellent oral hygiene habits (brushing and flossing after every meal/snack) are the key but others maintained that they did this and still had cavities. This practice prescribes an oral fluoride rinse to be done each day to prevent decay and strengthen teeth. I'm not due for my next cleaning and exam until November which hopefully will be four months after I start Invisalign treatment, but I'm thinking about going every four months during treatment after that so if I do have issues with decay, they are caught and addressed early!
The daily hygiene routine that the coordinator described didn't seem that intense, but I am planning to brush my teeth after all food and floss daily for sure and maybe floss even more often.
4. Tell me about attachments and filing.
I was informed that I may need attachments (no idea how many) and might have IPR (interproximal reduction, or a slight reduction of my some of my teeth) done. This was actually addressed/mentioned without me asking, but it was on my list of questions. As I've been researching Invisalign, I discovered many patients were not informed about this at the outset of treatment. And, the Invisalign website really doesn't address this. Both sound less than pleasant, but I understand the reasons for both. IPR is used as an alternative to extraction when there is crowding. The orthodontist thought I might need this on a few teeth but also said its possible I won't. I am hoping if I do need attachments, it won't be on a lot of teeth.
I was also warned about two other things I hadn't uncovered in my research. One is that some people have teeth that are fused to the jaw bone and don't move. This is rare - this orthodontist has only encountered it a few times - but can affect treatment/results when one tooth insists on remaining firmly entrenched. The other is "dark triangles." These occur between teeth at the gum line when the teeth move but the gum doesn't "fall" because it's been caught there so long. Teeth will be straight but patients may be disappointed in this less-than-perfect result.
The coordinator also noted that sometimes the orthodontist recommends a periodontal evaluation before treatment begins. He checked my gums with a probe but didn't recommend this for me. (My pocket depths at my dentist appointment last month were all less than 3 which means my gums are in good shape overall with no signs of active periodontal disease.)
5. What is the retention advice? Which retainers are used? Are they included in the cost of treatment? How much are extras?
The orthodontist told me I would wear retainers at night forever. Initially, the wear would be daily but eventually, I could wear them just a few nights a week as long as there are not fit issues. He uses plastic retainers, at least for Invisalign patients. These are similar to the Invisalign trays. One pair is included in the cost of treatment. They can make replacement retainers in their on-site lab within 24 hours, following impressions. The cost is $150 each, $300 pair.
6. Will my teeth be shaped at the end of treatment?
My teeth may be shaped at the end of treatment. This didn't happen at the end of my first course of orthodontic treatment and I still have mamalons on mine. I guess I'll cross this bridge when I come to it.
7. Are there ways to "catch up" on missed hours, like on Thanksgiving?
This practice recommends wear of the aligners a minimum of 20 hours per day. The coordinator I met with said that they recognize there may be special occasions that prevent this from happening but not every day is a special day. She made it clear the aligners won't fit and problems will occur if I slack in wearing them. She also described how a typical day would work with eating, brushing, etc. and 20 hours per day seemed very doable.
8. Would traditional braces be a better option for me?
I added this question midway through my consultation appointment after learning impressions were better now and that I had some serious issues. The orthodontist stated very strongly that he felt that Invisalign was the best option to address my problems becaus of the way the aligners act on the teeth. His bachelors degree is in engineering and that's pretty cool to me because, to me at least, orthodontics is tooth engineering.
9. How often are appointments?
I was told appointments would be about every three months. This was even less infrequent than I expected.
10. What is the cost? What types of financing are available?
The cost for this treatment is just shy of $6000. I am fortunate that my dental insurance will cover $1500. I was presented two payment options: full with a 5% discount or $1000 down and a 20-month payment plan. The monthly payments are a little less than my cheapest car payment (which was $199/month) and a little more than my monthly cell phone bill ($110). This a reimbursable expense for most flexible spending accounts. While I didn't plan for this in 2014, I will for 2015.
The cost is $1000 more than what my dentist's office quoted me in late 2012, but I feel better paying for the expertise of an orthodontist.
