Are You in It to Win It?
Dr. Pfister goes over an Invisalign treatment plan with a patient.
July is always a special month for me…
As a kid, school was so far away that nobody talked about it. July is the anniversary of my office opening in Medina. It is also the anniversary of our relationship with Invisalign, to create well-functioning occlusions and killer smiles, without the use of conventional braces.
We were the first to use Invisalign in Medina back in 2008…
But by 2012, we terminated our usage of plastic to move teeth due to failure to produce the goals we had set for patients. Polymers, at that time, were just too weak to move teeth. Disappointing sure, but it was groundbreaking for the industry. The seed had been planted to find an alternative to bands and wires.
Roll the clock ahead 6 years…
New research on tooth-moving dynamics, new polymers, and better imaging meant hitting on realistic goals with Invisalign. In 2018, we were back in the saddle with new software and predictability not seen before in the world of tooth-moving. By the time Covid hit, I was contemplating converting my entire practice from braces to polymer aligners with Invisalign, as several of my friends in Ohio already had.
But over the last year, there have been ripples that have surfaced on a relatively smooth Invisalign treatment protocol that had not been seen up to this point. Part of this is due, in part, to the much larger patient population in my practice and throughout the U.S. using Invisalign as their treatment of choice, when compared to the past.
Let’s look at these situations or ripples that need to be addressed before an individual decides on the best treatment modality for his or her bite correction and smile production.
Over the last year, dentistry has been working overtime to reduce the pandemic backlog of patients’ needs. All offices are super busy throughout the United States. Knowing this, there has been an upsurge of commercials and advertisements for Invisalign-like systems that have interesting instructions and protocols for tooth-movement. Some say “just wear at night”; others say “wear several times a week”. And there are various combinations and permutations that play on a patient’s desire to have straight teeth without a lot of self-involvement.
After 37 years of chasing teeth around jaws, I can tell you pretty unequivocally, there are basic biological rules that must be followed to move a tooth and, once moved, to be retained in that specific position!
Violate the rules and take shortcuts and the tooth will return to its pre-treated crooked, but comfortable, position. Trust me, most orthodontists, somewhere in their careers, have shortened the time to get braces off for proms, weddings, pick-an-emotional-event, and later down the road had to put braces back on. Or, patients had to wear retainers full-time for a longer period of time due to not abiding by tooth and bone biology!
Let’s look at how Invisalign views treatment success and tooth-bone biology.
Invisalign sets the parameters of wearing their aligners at 21 or more hours-a-day, seven-days-a-week. The aligners can be taken out (but don’t need to be) when eating; and they can be cleaned several times a day. New trays are replaced every one-to-two weeks, depending on the treatment demands. That’s it! Initially, it looks very simple and, with most cases, it is…
But as the complexity of the case increases, so does the number of trays needed. It is not unusual for a difficult adult case to need 40 trays initially and another 20 trays to tweak and detail for that ultimate smile. Run the numbers, 60 trays… average 10 days a tray… almost two years of wearing aligners. But to be fair, if this were a brace case, it may go three or more years of wires and brackets irritating the cheeks, lips, and gums!
For the record, I love Invisalign. No allergic gum tissue swellings, no decalcified teeth due to plaque buildup, perfect ability for oral hygiene to be maintained throughout treatment, quicker treatment time… all of these are tremendous benefits that I feel far outweigh the inconvenience of daily aligner removal. But that personal feeling is not shared by some of my patients and so I truly believe braces will never disappear.
In the last three weeks, I have had at least four adolescent patients (three girls and one boy) who were perfect Invisalign candidates say to me, “I don’t trust myself to cooperate at the level you need me to!” I even had an adult female patient (who would also have been a perfect Invisalign candidate) say, “I bought a tread machine and I never got on it and I buy exercise books and never read them. Dr. Pfister, I need you to move my teeth with braces without a lot of my cooperation!” I loved the honesty, but it broke my heart because aligners could have gotten the job done quicker and cleaner!
So where do I feel Invisalign therapy is going?
Back in the day, when brackets replaced the band that went all the way around your tooth, everyone said bands were antiques and would become extinct. Bands are still here for patients with porcelain crowns or a ton of silver filling material when a bracket fails to adhere.
I’m now doing hybrid cases, where one jaw is treated with either Invisalign or braces and the opposing arch is treated with the other therapy. This allows me to get the best advantage of both systems with minimal aligner time and maximizes the cooperation factor.
Invisalign will never fully take over the world or my practice, but for those who want it and are willing to put the time in, its return on investment, ROI, is biblical!
Invisalign is here to stay in one form or another. What it does well, it does very well and that can’t be swept under the proverbial treatment rug! Personally, I feel Invisalign is like exercise - the toughest step is the initial step (to start) and the next crossroads is six months into treatment when patients ask themselves, “Can I stick with it?” This is where you look inside yourself and ask “Who am I?” The answer will change your life!
The title for this blog comes from Randy Jackson. When he was a judge on American Idol, he would say this in reference to a contestant who just perfectly nailed a song! “In It to Win It” should be all of our tag line for our journey through life, remembering, you only get out of it, what you put into it.
And, in the case of achieving one’s best smile, embracing the therapy that’s best for you is where the win is at.
Wishing you that perfect smile,
- Dr. Pfister