Dr H's New Practice

One of the elastic attachments falls off. I have it replaced by my dentist in London. Dr H says he will replace the elastic attachments with tougher ones on my next visit. It takes quite a while to get to Dr H's new surgery as it is in the north-west of the city and one of my favourite apartments to stay at is in the south-east. He is really pleased with my progress.

We have a moment when it becomes clear noone knows where aligners sets 11 through 30. Dr H thinks I have them because he thinks he has taken everything from the old surgery. He calls the old surgery and they say they don't have them. But I know that's where they must be because I don't have them and neither does Dr H. If they have been lost, it will be very expensive to
replace them. Fortunately, Dr H emails me a few days later to say he has found them at the old surgery and has couriered over three sets.

Third Visit

I am now on my fourth set of aligners with no real problem other than one of the ledge-like attachments has fallen off. I do not recall this happening so I have probably swallowed it. Dr H's assistant refixes the attachment. Then Dr H drops a small bombshell - he is leaving the practice and starting up his own. He asks if I want to transfer my case to his new practice. I am happy to do so, even if I have not been given a lot of choice.

Another small piece of drama - to accommodate the attachment, small apertures have to be made to the aligners. Previously, Dr H has down this with a dental implement. On returning home, I realise he has forgotten to do this to the new sets. I let him know by email and he agrees to let me have a go myself. I am very nervous doing this, but it turns out nail scissors can be just as effective as othodontic appliances and I am pretty proud of the result.

Second Set

Three weeks after my first visit I return to Budapest for a check-up. Dr H is pleased with my progress and fits half of the other attachments. These really increase the pressure on the teeth. The aligners now go on with a real snap - like a cell door swinging shut, says Dr H. We move onto the secons set of aligners.

As an added bonus, I get to go to the Sziget festival. Radiohead are playing on Saturday and I buy a napijégy (dayticket) from the jégyiroda (ticket agency) near the dentist's for 6000 forints. I hop in a taxi mid-afternoon out to the festival site, wander around for a few hours and see Radiohead play an excellent set in a reasonably uncrowded setting. The festival program says the open-air midnight screening of "Fehér Tenyér" will have English subtitles. The first long scene doesn't have much dialogue so it's only about twenty minutes in that it becomes clear that it won't. Only slightly disappointed, I leave and join the short queue for taxis back into town. A day like this would be impossible in London.

Wearing My First Aligners

Wearing the aligners is quite hard work. I was surprised how sensitive the mouth is to foreign objects. I found the inside of cheeks were irritated by the attachments although this passed in a week or so. I can only wear the aligners for a few hours at a time and I often wake halfway through the night wanting to take them out. The aligners fit so well that getting them off is quite difficult. My first attempt took about ten minutes in front of a mirror, but I rapidly got better at it.

Fitting My First Aligners

I have come back to Budapest in the middle of a heatwave. The flat I have rented for the weekend just off Ráday Utca is roasting hot and does not have air conditioning or even an electric fan. I insist they provide a fan which arrives on the first evening. By closing the shutters during the day and opening them at night, I can make the flat habitable. I go for a swim at the Alfred Hajos swimming pool on Margit Island in the middle of the Danube, but the beautiful outdoor pool is being used the shoot the movie "Children of Glory" so I have to swim indoors.

At Dr H's surgery, he fits the first set of aligners. They snap very tightly around my teeth and, since each tooth is having forces applied to it, they create a fairly strange sensation. Slightly painful - a bit like being punched softly in the mouth - but the feeling does fades. He takes the aligners off to fix the elastic attachments. When we fix the elastic bands which apply the force for the first time, one of the attachments pings off and has to be reattached. While my teeth are getting used to this rough treatment, I am allowed to wear the aligners only ten hours a day and we leave the other attachments for the next session.

By Monday, the weather has turned ultra hot and humid, to the point that it is making me feel really quite ill so I decide to phone for a taxi and leave for the airport early after lunch. This turns out to be a good idea because as I drive out of town a biblical storm breaks flooding the roads and the metro, and making taxis very hard to come by.

On the plane home, I learn a useful lesson about aligners. I take them out to eat dinner. When the plane lands, I realise one is missing. I frantically search my hand luggage and the area around my seat until I get told I have to leave the plane. I am thinking how I am going to explain this to Dr H and get as far as the train platform when I realise I am also missing my laptop, which I have left on the plane while unpacking my hand luggage. I go back to the terminal and ask, rather without hope, if the laptop was handed in. It was, and half an hour later it is given to me along with a sick-bag containing the aligner. A small miracle, but a lesson to be a lot more careful with aligners, especially if they are the only set you have.

Dancing Teeth

Dr H has emailed me his proposed treatment plan. The part that I can understand best is the video clip of how the teeth will move around the mouth. Some teeth have to move to create space for others to be straightened. The final stage looks good - well-spaced straight teeth. To make this happen, he also plans other attachments. Some are small ledges stuck to the side of the tooth which give the aligners extra purchase. Others are small knobs on the teeth which will hold elastic bands which apply extra forces on the teeth. The aligner will also stick out behind the upper front teeth to form a small platform the lower front teeth will rest on, which will help close the overbite.I have agreed the plan so now the thirty or so sets of aligners have to be made in California which will take a couple of months.

Fogfehérités

I have decided that years of coffee, red wine and tobacco have darkened my teeth a shade or two and I should try teeth whitening. I return to the surgery on the Monday to see Dr K, who explains the he does not really approve of teeth whitening but if I must, there are two options. Laser whitening, where the bleaching gel is activated by an intense laser light and home whitening, where the bleaching gel is worn overnight inside a gum shield for several days. Laser whitening is quick but more expensive. I feel quite strongly that I don't want unnaturally bright teeth - I feel over-obvious attempts to conceal the aging process don't make you look good, they just make you look like someone who has problems coping with reality. I decide to go with the home whitening system so that I can stop when I feel my teeth are the right shade.

I think Hungarian is a beautiful language and "fogfehérités" is an example of why. It means literally tooth whitening, but the string of simple, equal syllables has real poetry to me. Anyway, the experience was interesting enough to justify a short diversion. As Dr K explained it to me, whitening involves bleaching the outer layer of the tooth, which temporarily dehydrates the tooth and makes it more porous. As the tooth rehydrates and closes up, it naturally darkens a shade, but you should avoid coloured food and drink for two weeks after bleaching as these will stain the teeth much more quickly. I was given a gum shield and four tubes of bleaching gel to take home.

The gel is quite difficult to apply to the inside of the gum shield because it is so viscous but it becomes easier with practice. I applied half a tube of gel each night and could see a small lightening each morning. What I had not expected was how much the gel made my teeth ache - a fairly dull constant ache that was quite hard to bear. I also found it hard to stay away from coffee and red wine for two weeks. I found myself feeling self-conscious about drinking white wine with friends when it's not my usual drink. In future, I will leave tooth whitening until we have a heatwave. I am not sure if the pain and the need to avoid coffee etc are side effects of laser lightening as well or not. Anyway, I was interested to see if any of my friends passed comment on my whiter teeth - they didn't, but a couple asked if I had been to a tanning salon - I hadn't, so it must have made me look a little bit more like George Clooney.

X-Rays and Impressions

The first step in a course of Invisalign treatment is to take lots of X-rays and impressions of the teeth. These are then sent to Invisalign HQ in California where they do a 3D simulation of how the teeth will move around the mouth. Once the orthodontist agrees the treatment plan, many sets of aligners are made. Each set is slightly different to the last and is to be worn for 20 hours a day for two/three weeks before moving on to the next set. They are made of plastic rather than steel, but because they put pressure on the whole tooth, rather than just through one point of contact, they can be as effective as steel braces.

I fly to Budapest on Friday morning for an afternoon appointment with Dr H. I have several X-rays taken - a couple of involve staying still inside a machine for 45 seconds. The machine is too small for me so I have to crouch over and try not to move - very uncomfortable. The worst part though is taking the impressions. This involves biting hard into a quick-setting foul-tasting plastic gel. It's really important to cover all the teeth and not get any air bubbles so this takes several tries. Eventually Dr H is happy and I am released into the spring sunsine.I get a call over the weekend from Dr H to ask me to come back in Monday to retake one of the impressions as he is not happy with it. Fortunately I am booked in on Monday lunchtime for teeth whitening so this is not a problem.

Swapping emails with Dr H

I have been thinking about Dr H's advice. I really respect the fact that he has not pushed Invisalign even though he knows it is the only course of treatment that would make sense to travel to Budapest for (reasons given below). I am just about to resign myself to lingual braces in London when Dr H gets in touch to say he has been to an Invisalign conference in New York where new treatment protocols were introduced which makes it possible to treat me using Invisalign. I am delighted with this news. He proposes that the treatment will last just over a year and quotes a price of just under 5,000 euros. This is quite a lot less than I was quoted for treatment in London, but it will involve at least ten trips to Budapest. I love visiting Budapest so if I think of this as the same price as London with lots of breaks in Budapest thrown in, it makes sense. If you were thinking of having Invisalign in Budapest solely to save money, I don't think it would work. I also rate Dr H more highly since he seemed to give a lot more thought to what was possible than the London orthodontist I saw.

My First Trip To Budapest

I book a cheap flight to Budapest on SkyEurope (unfortunately no longer flying the London-Budapest route) on Friday and arrive just after a snowstorm. I find the surgery just off Déak Tér where the three metro lines intersect and meet Dr H for the first time. He examines my teeth and takes photos and goes away and thinks for a bit. When he returns, he gives me the disappointing news that he doesn't think Invisalign is a suitable method for my teeth because opening the overbite and straightening the teeth is too big a job. He recommends lingual braces which I had decided I really didn't want - because they seem harder to wear and because they require more frequent check-ups and emergency repairs. I really can't commit to coming to Budapest every five weeks at the moment and it would certainly work out more expensive than having the work done in London.

Hungarian Orthodontists

I have looked at websites of orthodontists in Budapest and emailed a couple about Invisalign treatment. My concerns are that the quality of treatment should be as good as I would get in the UK and that there should not be a language barrier. The fact that Invisalign is an American company who work with the orthodontist to form the treatment plan and that they make the aligners themselves is reassuring.
The most sensible reply comes back from an orthodontist at a clinic in the centre of town. I have explained to him that an orthodontist in the UK has recommended Invisalign. I suggest we meet on a Friday and, provided I am a suitable case for treatment, they take the X-rays and impressions needed to make the aligners on the Monday. Before I go, I have to see my own dentist to make sure the teeth and gums are in good health and to have any fillings done before the aligners are made as fillings can change the shape of the teeth.