Friday, June 14, 2013

About 3 weeks ago, Beverly started Invisalign treatment.  We have discussed her orthodontic treatment many times in the past, but she wasn’t a great candidate for braces because of the complexity of her malocclusion.  Treating her to an ideal position with braces would require either extraction of two teeth and completely changing her facial appearance-not for the better-or bringing her lower jaw forward with jaw surgery, also making a less-than-desirable change in facial appearance.  We finally took some impressions, had them scanned, and then played with the tooth positions on a 3-D computer model.  Using Invisalign aligners (a new one every two weeks as calculated  by the computer model) and a combination of “slenderizing”some teeth and wearing rubber bands from the top aligner in front to the bottom aligner in back to shift upper teeth back and lower teeth forward, we can straighten out her teeth, intrude the upper front teeth so that she has more teeth and less gums in her smile, and shift the upper teeth back so the front teeth don’t stick out and she will, for the first time in her life, be able to bite with her front teeth.  Beverly is maximally, almost neurotically, compliant.  I have to be careful what instructions I give her because she will follow them to the letter.  This is actually what we want with Invisalign patients (22 hour-a-day wear), but aligner kisses just aren’t the same.  She is also the most physically sensitive person I have ever treated, so I hear about every discomfort she suffers.  In this regard, I guess it’s a rare opportunity for me to be able to observe, first hand, Invisalign treatment day-by-day.  You might say I’m living with aligners vicariously. Her plan is a long one, with 41 projected aligners, but she is already thinking of how she might be able to shorten the treatment.  In fact, because her compliance is so good, she will probably be able to wear them for 10 days each instead of 2 weeks, which will cut months off of her treatment.  There is also an less common procedure that she wants to try.  When bone receives a traumatic injury, in order to repair itself, the remodeling rate of the bone doubles.  This is called the Regional Acceleratory Phenomenon (RAP).  By controlling the remodeling rate of the bone, you can control the speed with which you can move teeth.  A procedure called corticision involves causing localized trauma to the bone between teeth that are actively moving and thereby accelerating the remodeling rate and the tooth movement.  My wife is about the last person I would have expected to want a scalpel blade forced into the bone between her teeth under local anesthesia, but the fact that she does shows how eager she is to move the treatment along. And it’s unlikely she will sue me, so it’s a win-win.