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Orthodontist Ted Rothstein Invisalign Treatment Step-by Step (718) 852-1551)
Straight talk about crooked teeth (Neat film!)
When a would-be Invisalign patient from Grenada* (the Island of Spice: Nutmeg), West Indies called me this morning I was surprised and curious. She asked: Is it feasible for someone living in the Caribbean to start orthodontist treatment in the US and continue it in their country?
She explained that there was no orthodontist who offered Invisalign treatment on her Island. I wrote her back a lengthy email outlining the difficulties she would have to overcome in order for me to provide the service given a distance of 2109 miles between NYC and St. George's, Grenada, W.I. I concluded the letter by noting “Consider: Locating an Orthodontist who does Invisalign closer to you. http://www.invisalign.com/Pages/default.aspx "Find an Orthodontist” (“Choose country”)”
As a result of this conversation it occurred to me that would-be Invisalign orthodontic patients have little or no idea how the Invisalign service is actually provided so I composed a detailed outline visit-by-visit how the service is provided in my office.
INVISALIGN TREATMENT STEP-BY-STEP
Fee range: $4885- $7685
Initial Payment $1785-$2385
Discount for payment in full at start
Patient is provided with a consultation-exam which leads to the Diagnosis and Treatment plan.
Patient is advised whether or not Invisalign is a good solution to their smile/bite problem.
Dr. Rothstein will advice the patient whether or not teeth will require "slenderizing" (especially in cases of crowded teeth). SeeYouTube: "Interproximal Reduction".
He also explains the need for "Attachments", which are tooth-colored bits of plastic that are bonded added to the teeth to facilitate their movement in to their correct position: See YouTube: "Invisalign Attacments".
Fee is quoted and payment plans are arranged.
Initial payment is made.
Complete diagnostic (molds, X-rays of the jaws and head and photos) are made.
Dr. Rothstein then sands the edges of the upper and lower front when they are jagged/uneven.
A special mold of the upper and lower teeth is then made using a type of impression material called Poly-Vinyl-Silicone.
The patient is then asked to bite into a wafer of soft wax which will show the lab exactly how the upper and lower teeth come together--which helps the lab to know how the teeth should be moved.
Dr. Rothstein measures and analyzes the problem and writes a detailed prescription/description of the method that the lab should follow to complete the straightening of the teeth and transmits the information to the lab via the special software provided to Invisalign doctors.
The patients molds, X-rays are photos are mailed/transmitted to Invisalign as well.
THREE WEEKS LATER
The Lab sends Dr. Rothstein a "ClinChek" (See YouTube "Invisalign Clinchek"). And See a mini-version Clinchek of one of my patients
Clinchek is a look-like a three-dimensional "movie"/animation showing what each "aligner"/tray of the treatment series does to move the teeth into their desired position.
Typically a set of treatment aligners may number between 24 and-30 upper and the same number for the lower. More difficult cases can take upwards of forty aligners
To obtain the number of months treatment will take you divide the number of aligners by 2. (30 aligners means 15 months of treatment).
Dr. Rothstein reviews the Clinchek to see if the lab has followed his instructions. If they have not he sends back the ClinChek to the lab to correct the problems/errors they made.
If the Clinchek has met his treatment goals he brings the patient back to review the Clinchek with him,and encourages them to manipulate the mouse to view/play the animation in the endless arrangement of views offered by the Clinchek program. This is truly a "WOW" moment for the patient (for me as well).
Following this review with the patient, he authorizes the start offabrication (Click the "Accept" icon).
At this moment the company in Costa Rica begins fabrication of the complete set of treatment aligners.
When the patient is unable to return to the office to review the ClinChek we will send a "mini-version" Clincheck to the patient. (See above.)
About three weeks later the complete set of treatment aligners arrives at the office
Patient is given the first of the series of upper and lower aligners and is provided with instructions:
How to place them on the teeth and remove them.
How many hours to wear them (22/day).
How to clean them.
What to do with the ones that have been worn (return them).
Dr. Rothstein shows the patient what teeth will be getting "attachments" See YouTube: "Invisalign attachments" (typically 3-5 on the upper teeth and the same on the lower teeth).
Dr. Rothstein will also review what teeth the teeth that will require "slimming" (See YouTube: "Interproximal reduction") and the sequence of slimming. (For example: slim .3mm between the 8th and 9th teeth before the 4th aligner.
Two-three weeks later the upper and lower attachments are placed on the designated teeth
The patient is then given two-fours more sets of aligners with each set being worn 22 hours/day for 2-3 weeks.
Patient brings back all previously used aligners.
Patient is given 2-5 sets of new aligners.
LAST VISIT (When all the aligners in the set have been worn faithfully and the last aligner fits perfectly):
In theory if the correction is complete and satisfactory the attachments are removed.
Dr. Rothstein will make clear (Invisalign-like--but more durable-- retainers) that the patient must wear nights only for three years and then ONE NIGHT a week forever for the teeth to remain permanently straight.
LAST VISIT OPTION
if the correction is not deemed satisfactory, and the last aligner in the treatment series fits perfectly, Dr. Rothstein will order from the Invisalign lab a "Case Refinement", in which case, the lab will then send (at no additional charge) between four and ten additional aligners to detail the correction of any teeth still in requiring correction.
New photos of the teeth and face need to be taken.
If the correction is still not deemed correct still another "Case refinement" can be ordered.
Sometime for a variety of reasons the aligners stop fitting correctly (patient did not wear them correctly; aligner was constructed incorrectly, etc. etc.) When this occurs retainers are made to hold the teeth in place and new molds are made with the PolyVinylSilcone material and sent with a new prescription. They sometimes call this "Rebooting" the case. There is sometimes an additional fee.
SWITCHING TO CLEAR STANDARD BRACES TO FINALIZE DETAILS:
Occasionally patients may elect to have clear braces placed (at no additional cost) to correct any small errors that remain after the last of the set of treatment aligners has been used. This choice is made when it appears that the corrections needed to be made will be accomplished in 6-12 weeks. Patients might also choose this option when they know they can have the braces put on immediately rather that have to wait 3-4 weeks for the Invisalign lab to manufacture the "Case refinement" aligners. (See above LAST VISIT OPTION)
October 12, 2012
Rothstein DDS PhD
Specialist in Cosmetic Orthodontics and Invisalign
and Dentofacial Orthopedics: Adults & Children
Specialist in Orthodontic Jaw Wiring
American Association of Orthodontists--Life-active
35 Remsen St., Bklyn, NY 11201
7188521551 www.drted.com email@example.com
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