See Dr Wesley’s Invisalign Journey Episode 9: Refinements. Refinements are a natural part of aligner therapy. I think that people often see the number of aligners and assume that they are done when they reach the last aligner. Orthodontist are well trained at assessing the types of movements that required to achieve your ideal results. When you are in a consultation, listen closely! They will often give you an estimated length of treatment. I find too often that I will estimate 18-24 months but the patient will think that they are done in 36 weeks (9 months)because they have 36 aligners (you change an aligner each week on average).
Moving teeth on a computer screen is much different then moving them in a human body. As you know, there no two humans that are alike. Keeping this in mind, you can imagine that there are several variables that effect the way your body responds to orthodontics. We make every attempt possible to predict and accommodate for this but there will always be a degree of variability. There is also the compliance factor where the patients ability to wear the aligners according to the orthodontist recommendations effect the results as well. For all of these reasons, we say that you should never expect to be done after the first set of aligners. Finishing treatment in one set of aligners is like a hole in one in golf. It happens sometimes when the stars are aligned, the patient is diligent about their aligner wear, and their body is just suited for the tooth movements but it is not the norm. You should always expect at least 2-3 refinements. This means you may have 3 or more sets of aligners. For example, you may have 39 aligners on your first set that get you close to your result. On your second set you may have 26. Then you may only have 5-10 on your next few sets. The number of aligners in successive sets typically is less but not always.
What to expect during your refinement
When we do a refinement; we will take a new intraoral scan, new photos, and often times a new x-ray. We send these in, it usually takes 4-5 weeks to have your new set of aligners returned. Just like the initial set-up, I spend a lot of time assessing every tooth movement and designing your aligners. Once they are designed and shipped we will see you for your refinement delivery. At the refinement delivery you can expect that a few attachments will be removed and a few new ones will be bonded to your teeth. I work to minimize the amount of attachments that we need to replace by careful planning. I will not however, compromise any desired outcome at the expense of laziness. This is why we may have to remove and add several attachments at this visit.
Think about braces. You come in every 6-8 weeks and your wire is changed out or an adjustment is made to your wire. When your body does not respond to the desired tooth movements, it is easy to adjust your wire at your next visit and redirect the course of your treatment. In contrast, we try to plan your entire treatment from start to finish when we design your aligners. When your teeth do not move the way that they move on the computer then an adjustment needs to be made. Therefore, you can think of your refinements as a wire adjustment. There are many advantages to aligner therapy. One is that you can go 12 weeks or more without having to come see your orthodontist. The drawback is that when an adjustment it needed, it is more involved and takes a little more time to shift gears when you have aligners than it does with braces. This is not necessarily a bad thing. Just understand that refinements are a normal part of aligners.
Gerald W. Wesley, DDS, MS