Monday, December 01, 2008

By AISHA SULTAN
ST. LOUIS POST-DISPATCH

last updated: January 21, 2008 06:00:43 AM

ST. LOUIS -- It's a seductive message for adults seeking a perfect smile: an easy, painless and invisible way to straighten teeth.

Christine Raye, 38, of Glendale, Mo., knew she wanted it the moment she saw the TV commercial four years ago. She's not alone.

Demand for Invisalign, a system of clear, changeable retainers, has boomed since it was introduced about nine years ago. In 2006, Align Technology, the Santa Clara-based maker of Invisalign, shipped to 26,000 doctors worldwide, nearly 17 percent more than the previous year.

More than half a million people have used the product, and about 46,000 doctors have taken the half-day training to become providers.

Dr. Jackie Demko says she had three to five Invisalign patients a year when she began offering the product eight years ago. Now, she is up to 100 cases a year.

But despite the widespread use and slick marketing, the way to flawless pearly whites can be filled with surprises.

Hundreds have shared their real-life experiences on a popular Invisalign forum on Bracesreview.com. Many don't learn about the details and common procedures involved with the computer-generated treatment until they've committed thousands of dollars to it.

While the company says its surveys show that 87 percent of respondents are extremely or very satisfied with their treatment, it also does not collect information about bad outcomes or failed cases.

After experiencing the process firsthand and hearing from other Invisalign users, here's the straight talk on getting straight teeth.

Most patients require little buttonlike attachments bonded to their teeth to hold the aligners in place or pull down or turn a tooth. The number of buttons may vary, and they may be added at various points of the treatment.

Raye, who is about six months into the treatment, recently had two attachments put on her front two teeth and asked if her dentist could add them after the holidays.

"They're weird, but they're still never going to be as bad as braces," she said.

First weeks are the hardest

After the first set of aligners is inserted, some patients are taken aback by the pain and pressure on their teeth.

"Everybody has some degree of discomfort," said orthodontist Robert Waxler. "You cannot move a tooth without getting sore."

Those who have had braces say the discomfort pales in comparison, but newbies may not be prepared. Some take a pain reliever before putting in a new pair of aligners.

Having a hunk of plastic in one's mouth can be a difficult adjustment. Hard plastic edges may dig into gums or the tongue, causing sore spots. Raye cut a jagged piece off with cuticle scissors, and others report using nail files to smooth rough edges. (The company recommends neither technique).

A few report feeling like their teeth are confined by the plastic trays.

For the first few days, patients speak with a noticeable lisp, which may recur with every new set of trays. Snugly fitting trays also can be challenging to remove until users perfect their technique. The trays must be worn constantly and are removed only for eating, drinking and brushing. One office staffer said a woman returned to the office shortly after getting her first set. She had been unable to take the aligners out and had not eaten for two days.

Tray removal also can get messy, with a trail of drool clinging to each aligner.

Those prone to headaches may have worse headache pain after getting new aligners.

Some mistakes can be costly

Wearing the aligners requires a serious commitment. Unless they are worn constantly, they won't work and may end up worsening a situation. If a tray gets lost or broken, doctors recommend wearing the previous set until a replacement is sent.

"If you don't wear anything, the teeth will drift," Waxler explained. "If you don't deal with it, and the teeth wander around, then nothing fits, then you're screwed."

The average length of treatment is about a year, but the doctor may order refinements, which can prolong the process. About half of Demko's cases take a bit longer than originally predicted.

"The computer image is a prediction, and the human body is not 100 percent predictable," Demko said.

Most patients don't shop around when starting treatment. Align Technology charges each provider the same lab fee -- about $1,500 for full treatment and $750 for shortened, express treatment for minor changes. Doctors' fees typically range from $3,000 to $5,000.

More than half of Invisalign providers are dentists, rather than orthodontists, who have specialized training.

"The price difference can come with different clinical skills," Demko explained, noting that a higher cost does not necessarily mean better treatment.

Schilling chose his provider based on recommendations from friends and family and is generally happy with the results, so far. He said he did not shop around because the orthodontist offered $500 off the price if he signed up the same day as the initial consultation.

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