Too slow for invisalign? 8 minus 7 = missing attachment

At the beginning of October, when I was removing my trays (tray 1) for the first time a few hours after the attachments where made I counted my attachments: 7!

The technician had told me that I had 2 attachments on the right upper canine. They where there, great!

Two days ago (tray 3) I looked at the bubbles with my trays on: an 8th bubble, a second flat one on the upper left canine below the bigger one.

Today (!) I looked at my upper left canine: there is one attachment, the entire front of the tooth is covered with glue but no second flat attachment.

Had it ever been there? Had it broken off at the very first removal of the trays? Whatever! I have been missing it stupidly unaware since the beginning of the treatment. I just hope that as it is only the second one on the tooth it is not too bad. Anyway, my ortho had said that I should only bother to replace any missing attachment at the next scheduled date (up to 8 to 10 weeks(!) whereas the technician had said to come in and have it replaced asap).

I am fed up with my airhead right now.

Millenia reply
I don’t have an answer for you but now I’m going to count my attachments next time my trays are out. I hadn’t even thought of it before now.

Milonga reply
AAAAAAAAAAAAAAAAAAAAh! I have just called the ortho. She said that 3-4 days without the attachment could be ok but 10 days is definitely too long! (I had asked if I could only come on the 22nd of November as I already have an appointment scheduled with my daughter on that day). My next check-up would be on the 11th of December. The ortho’s office is quite far away from me.

She said that I should come in asap – which is Monday morning (12th). Maybe that is why I have always felt the tightness so much in front and not around my supposedly moving molars.

Whatever. Panick does not help anymore. The attachment will have been missing for 6 weeks! :-( The technician either forgot to do it well or I have torn it apart right away. Anyway, I (!) forgot to check if all my bubbles were filled with buttons.

No wonder my trays were generally easy to remove :-)

Milonga reply
Yes, that is a good idea! This 8th attachment should be very small and flat but with the trays on it is quite easy to spot that this one bubble looks different than the others. The filled bubbles are so much more apparent. The empty bubble looks "transparent". Sounds so simple and obvious but for me… it is not! :-o

I told the ortho’s assistant that it has probably been missing from the very first day onward.

One positive aspect: at least it is supposedly the last day of tray number 3. So, it will probably not make it too tight. And if it feels awkward then I will just discuss with ortho and keep it a little longer until it feels right to switch.

Random reply
oh wow. I think the important thing is were the canines supposed to be moving during these trays? If they were not, I kind of think the missing attachment probably hasn’t had an effect. I guess they will be able to tell you all of that when you go in. Hopefully all is still well. A good reminder for all of us to count our attachments (it will take me forever lol).

Milonga reply
The ortho’s technician said that if it is on the trays, it is necessary. But who knows? My ortho would probably say something different. Maybe this tiny attachment only comes into play later on. They cannot put on/remove attachments just for the trays where they play their special roles (except holding the trays on to the teeth altogether) – So, I am curious to feel the difference with my missing link :-) on Monday.

Yes, good idea to check if all our white sheep are still there. :-)

And now (!) I think I would see it clearer. It is easiest to check with the trays on. If the bubble is well visible, everything is ok. Maybe that applies to all the bubbles and not just mine.

Random reply
Well the reason for the attachments is that the trays can use those to rotate and move the teeth right. So in theory, I am assuming, that if you had all the other attachments on, the trays were quite likely fitting tightly enough to do what they needed to on the molars. As long as that particular tooth didnt need to be rotated or moved, the lack of pressure on that particular tooth I would imagine, would not have a significant impact on the back teeth. Just what I am thinking.

Milonga reply
So, this morning I had my missing/broken attachment replaced. The ortho told me that it looks as if it had broken off. I must have ripped it off right after it was put on as I have never counted it in my initial counting that I did the very first time taking the trays off.

She etched right on the glue, fixed it and shaved some excess stuff off and – on went the trays: tight like on day one of the same tray!!!!

The same technician that had warned me never to change trays quicker that every 14 days told me, that after 2-3 days it should be fine and ready to be replaced! Ha!

Well maybe I’ll think about it differently tomorrow but this attachment definitely makes a huge difference on all upper front teeth and up to upper teeth number 5 on this side.

As it has never been there I guess I should be lucky that the tray fits and that there is not even pain. Just the "normal" feeling of tightness of a fresh tray.

Lesson learnt: always check if all attachments are still there in ther initial volume and shape.

I was very pleased that they did not need to touch the other attachment on the same canine.

I was also very pleased that they did not have to shave off the glue before the etching as I am so aftraid of even more sensitive teeth.

The first meal was also weird. The upper jaw feels very much like at the begin of each tray: all teeth off.

It will definitely delay my schedule. I would have switched tonight. But I am happy that it did not do more harm as I had missed this attachment for 6 weeks. Thank goodness, the big action happens currently on the molars.

Definitely more space already between left lower teeth five and six, and this is just from putting them in a more upright position.

So here comes my advice: Keep checking your attachments! :-) … if your not already doing it :-)

Random reply
Glad all is well Milonga!

Milonga reply
Yes, thanks! I figure that a delay of 14 days is nothing in relation to my more than 2,5 years of total time :-)

I had another paranoid thought (typical for me, now I have a new focus: my attachments!): on the trays, the formerly missing attachment seemed like the smallest one. Now in my mouth, it is one of the biggest! So, my question: why are the other ones so small? Are small parts missing, has the technician messed up their volume? Is there a way to check from the look with the trays on, if the bubbles are correctly filled?

If a fifth of a millimeter is so important, than the size of the attachment is very important aswell – I have felt that today.

What about the precision?

I am going to be a pain in the neck about that topic at my next regular visit in December.

Before that, I thought about PLAY-DOH! :-) I might take some from my kids, fill a former set of trays with it around all the attachments, and then compare the play-doh attachments with my actual ones! HAHAHAHAHAHAHA! (I am getting really weird now :-)

And I am going to remember that tray number 3 with the non-removable chewing gum will have been in my mouth for an extended period. HIHIHIHIHI!

Good night everyone!

Random reply
oh?? You are delayed by 14 days? I totally didnt catch that from your other post, I thought just a few days of delay?

About the attachments. I youtubed that and watched them do it, and it was interesting cause when they did it to me originally I had no idea what they were doing in retrospect lol. At this point, I am sad to say that only two months later, I barely even remember them putting on the attachments! But I guess they put these starter fake trays on you, and they put this liquid I think composite material (I think the same thing they use to make a white filling) squish the tray over that, squish out excess composite material, then use that special light to harden it all, so my guess, is that its probably a pretty accurate process. You are hilarious with the play dough idea Milonga!! I love the way your brain works! My attachments are all different shapes and sizes. I figure it has to do with the different rotations they want to do. I have a very pointy large one on a tooth that is barely expected to move, and two puny tiny ones on a tooth that needs significant movement. Shrug. I figure they know what they are doing though :-P

oh hey! what did the ortho say about the gum???

Christina Marie reply
The attachments can be all different shapes and sizes. They are all preplaced and shaped in the trays when they put them on, so I’m sure they’re just how they’re supposed to be.
I have some that are tiny and barely noticeable and the a couple that are WAY bigger, but luckily out of view for the most part. I now have a couple of teeth with two attachments since they switched everything up on me last week. It just depends on what their purpose on your tooth is. On my front tooth, the root isn’t moving correctly and making my tooth crooked. There is an attachment in the top corner and one in the opposite bottom corner to straighten this out. I FREAKED OUT when they put these on last week because it was on my front tooth, but they are really small and barely visible now. :)

Milonga reply
Oh, I will definitely lose a lot more time than just a few days. From my feeling today I will have a delay of 14 days. It is very tight and reminds me of a normal "new" tray. But it’s ok as long as I don’t have any pain. So that kind of makes it 69 trays – :-) I hope I won’t other substantial delays.

I would be interested in an overview on the shape, size and positioning of attachments and their respective teeth movements. I love those details. :-) Does it existe somewhere on the internet?

I have also most attachments on the teeth that don’t need to make interesting movements. The canines seem to be a favorite anchor point.

The attachments hold in place AND permit special movements, don’t they?

Are ther epeople without attachments during the entire treatment period? And if yes, why? Is movement possible without attachment? HA! A philosophical question that can be applied to life itself! ;-) Just kidding and getting carried away.

Random reply
I am not at all confident about this, but I THINK I may have read that originally invisalign did not have attachments. I think I read that this was why it was originally only used for very mild cases. Attachments were added as a way to be able to take more complex cases. I am sure that teeth movement can take place even without attachments, as I have 8 teeth with no attachments on them, and those teeth are still expected to have movements. However I think if you really want to pull a tooth sideways or whatnot, it probably needs an attachment, or at the very least, a big gap between other teeth.

That really sucks Milonga about the 14 days, however, the good news is that you caught it in the early stages, much better than needing a mid course correction later on.

Hmm…. I found this article that has some pretty interesting information in it. I looked it over quickly. It really shows me how complicated all of this is and how well trained our orthos must need to be to properly move our teeth, WOW! check it out!…ate_103009.pdf

Milonga reply
Thank you Random!!! Although a lot of it is much too difficult to absorb this is very interesting.

What struck me most is 1) the wear of the attachment material! (The file is from 3 yrs ago and Invisalign is working on it – I hope that the orthos use the best material available) and 2) on this one slide there is this example of an IPR Region depth of 0.5 mm! My ortho told me something about 0.15 mm max per tooth. Maybe I understood the info on the file in a wrong way- I think 0.15 mm is already a lot – (for someone with so little enamel) and I hope that this 0.5 example will never applied to me. 0.5 mm just appears to be a lot to me for anybody’s teeth.

But all those wonderful words I do not understand: force combined with momentum and distance between center of resistance and center of rotation.

And all these different shapes of the attachments: great stuff – and then the shapes get partialy worn off after only 18 weeks :-)

I bet that Invisalign in 10 years is so much more effective than today. I am glad I did not get it 10 years ago, when I first laid eyes upon it.

I just felt that the difference now with this attachment on is incredible. All my upper front teeth just feel enormously bent (moved) and there is a lot going on there at the moment. Well, that is how it should be so I am in fact very lucky I caught this missing one now.

W1ngz reply
That was a really interesting read. and proved to me just how much of my high school physics that I’ve forgotten… moments of force and rotation used to make so much sense to me!

What strikes me after reading all of that, is another thread (the one about veneers) where the doc said to just ‘leave the attachment off’. I’d be running away madly in search of another ortho if I were given that advice.