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Getting Started with Invisalign®


If you’re interested in getting on your way to a new smile without the use of metal, ceramic, or lingual braces, you will have to visit a certified Invisalign® dentist or orthodontist for a consultation. Many consultations are complimentary, but the scope of the examination will vary by location and office.

Typically, the doctor will take a look in your mouth and discuss some of the problems and solutions to your malocclusion. The cost, duration, and treatment may be discussed as well. Proper diagnosis and treatment planning requires photos, a cephalometric X-ray, and full-mouth series or panoramic X-ray, but these may not be included in the complimentary assessment.


PVS Impressions (previous method of Invisalign records)


If you’re ready to go ahead with treatment, a series of polyvinyl siloxane impressions (PVS) and bite registration will be taken. These impressions create an exact imprint of your teeth to help formulate your treatment. The future impressions are likely to be replaced by digital scanning or 3D X-ray imaging.

All records are sent overnight to Align Technology in California, from where they are forwarded to Juarez, Mexico, for scanning a 3D model of your teeth. The digital record is emailed to Costa Rica where technicians (not dentists or orthodontists) create a simulation of the way your teeth will move (ClinCheck®).

It is your doctor’s responsibility to ensure the movements provided by Align technicians are biologically and physically possible in your mouth.


Often, several modifications and edits of tooth movement are required. When satisfied, your doctor will accept the simulation and begin the process of aligner fabrication in Mexico.

Unfortunately, many inexperienced doctors do not recognize improper or impossible movements and accept treatment because the video simulation produces a good result. This is one of the most common reasons for failed Invisalign treatment.

Remember that the ability of your doctor to show you a ClinCheck that produces a nice end result does little to ensure that you will achieve the desired results.


iTero™ Digital Invisalign Tooth Scanner


In the past, PVS impressions were the only way to send 3D information to Align Technologies. In the spring of 2011, Align bought the technology of the iOC scanner, which allows an instant 3D capture of the teeth. It is a non-X-ray scan and offers several advantages, including increased accuracy and comfort.

Now there is no need to worry about gagging, messy materials, or inaccurate impressions. It is truly an amazing technology, but currently, the cost of a single scanner is about the cost of a nice car. Therefore, this service may not be available, except from some of the higher-volume Invisalign doctors in North America.

Several different models of scanners have come out over the past several years, but yield the same accuracy in the detail of the scan.


Initial insert


Treatment generally begins with your first sets of aligners, attachments, and instructions on their wear and care. It usually takes between 4 and 8 weeks for your doctor to plan your treatment and get your aligners into the office.

Please note that you may experience the following when you begin treatment:

  • Transient lisp until accustomed to the aligners
  • Teeth may develop some soreness associated with tooth movement
  • Bite may feel weird or different
  • Some adjustment period to the aligner
  • Adaptation of teeth to the aligner may not be ideal to start

On the positive side, patients often receive compliments that their teeth look shinier and straighter even when they’ve just started treatment, due to the smooth contours of the aligner.

We always ask you to keep your previous aligner in case you lose your current one. Sometimes, it is okay to switch into the next aligner with some extended wear time. We ask that you call the office to determine what is best.

Visits usually occur about every 3 to 5 months, depending on the stage of your treatment.


Attachments and IPR

These are two facets of Invisalign that are not mentioned on the Invisalign website or by many doctors. However, they are extremely important components of proper Invisalign care.

IPR (Interproximal reduction) is also known as filing, grinding, slenderization, and enameloplasty. Whatever the name, it refers to the reduction of tooth enamel from the interproximal surfaces of the teeth to create sufficient space for tooth movement and/or to aid in the removal of “black triangles” at the gumline.

Patients are often concerned about this part of treatment increasing sensitivity, leading to cavities, being painful, or leaving gaps. It is a completely safe method to reduce anywhere from 0.2mm-0.6mm without concern when performed properly as shown by decades upon decades of study.


IPR is often achieved using a diamond-plated wheel, bur, or strip. The method will be determined by the doctor and based upon amount and location desired. Sometimes IPR is done prior to impressions, while other times it is done as treatment progresses.

Don’t be concerned if you feel the bur, disc, or strip at the gum level, or you see a bit of blood. Proper IPR requires reduction all the way to the gum level to avoid ledges that may create traps for plaque and make it difficult to floss. Improper reduction may not allow proper tooth movement and delay the progress of treatment.

Attachments are virtually invisible bumps that help move the teeth and grab the aligners. They are bonded temporarily on the selected teeth through the use of a white filling material. An attachment template that is made of a more flexible material than the aligner, with wells for placement of the resin, aids the doctor, hygienist, or assistant in placement. Note that attachments are often placed at the initial insert visit.


Some patients may experience the loss of Invisalign attachments. This is an uncommon occurrence with experienced offices, but it can occur because of:

  • Improper bonding technique and isolation
  • Inadequate movement of the teeth during the first two aligners, due to poor compliance or improper treatment planning
  • Improper removal of the aligner

If you’re concerned with how attachments look, consider that they are much less visible than braces. Currently, there are attachments in various shapes and sizes to aid in rotations, extrusions, intrusions, bodily movement, and to anchor units of teeth against another. The judicious use and placement of these attachments are critical to more advanced treatment. Most people, other than you, won’t even notice that you have attachments, especially when the aligners are in (which they should be ... 22 hours per day!).

Note that the addition of attachments to the teeth may make aligners more difficult to remove. Don’t worry: This will get easier with practice and as the teeth settle into the aligner. Various types of instruments are available to help you remove your aligners as well.


Additional Aligners (formerly mid-course correction/refinement)

Sometimes the teeth don’t move exactly as prescribed in the ClinCheck. If this occurs in the middle of the course of aligners, a new impression may be taken to “reboot” your treatment. This is known as mid-course correction.

In North America, one mid-course correction is included in the lab fee for providers, given that it is not due to a change in treatment plan or dental work, such as fillings, crowns, etc. However, whether or not your treatment includes this will depend on the agreement with your doctor.

Refinement would be the equivalent of detailed finishing with braces treatment. It should not be viewed as a failure of treatment, but rather as a part of the process, if required. After the first course of trays, there may be slight movements that need to be achieved.

At this point, new impressions can be taken, and a new course of trays can be used to help with the remaining movements. Note that in North America, up to three refinements are included in the lab for providers, but what is included in your treatment fee is going to vary from office to office.

In mid 2015, Align changed refinement and mid-course correction to “additional aligners,” to allow providers up to five years of aligners to help complete a patient’s treatment. Again, the number of revisions or aligners you are provided will depend on your contract with your office.


Removing Attachments

This is a relatively simple procedure that is usually performed before impressions are taken for refinement/mid-course correction, or at the end of treatment. It simply involves the removal of resin that was bonded to the teeth.

No anaesthesia is required, and there is no pain involved in this procedure. Some patients may experience some sensitivity if there is gingival recession or root exposure present.

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Just like any other orthodontic treatment, the use of retainers is required to maintain tooth movement with Invisalign. There are many types of retainers, including fixed wires on the inside of the teeth, removable acrylic, and wired retainers, as well as Invisalign-type retainers. Generally, you will be asked to wear the removable retainers full time for a certain duration followed by indefinite periodic nightly wear. Patients commonly ask how long they should wear retainers for; the best answer is “as long as you want your teeth to stay straight!”

At MCO Orthodontics, nearly all of our patients opt for clear essix retainers. They are used all day and night for a period of time, followed by just at night. We fabricate these retainers in our lab, with quick turn-around time for our patients. With our Retainer Warranty program, it’s easy to maintain the results of your treatment at MCO Orthodontics!


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