Update

I realise it's been nearly two years since my last post, so I apologize to my regular readers. It's been a busy time with a lot of changes (most good) for me. I'm nearly at the end of my treatment. We agreed to make a course correction a while ago, so the last ten sets of aligners were remade. I'm now on the final set of aligners which I've been wearing for a few months mainly because I feel the elastics are still moving the teeth around a lot.

I hadn't looked at the "before" photos for a while so I was once again really shocked to see what a mess my teeth were. If my orthodontist takes some "after" photos I will post them, but my teeth are now straight and regularly spaced and the overbite is much reduced. Maybe the lower left canine has been a bit stubborn which pushes the lower jaw to the right, but really they are so much better than how they used to be.

I feel there are two long-term dental health benefits of all this. One is that it is much easier to floss now my teeth are regularly spaced. And I realise that I wasn't flossing regularly before because of that. The second is that I realise that it is hard work to get used to foreign objects in your gum so I am really determined to do everything I can to look after my teeth and avoid false teeth in the future.

Well I should be back for what might be my final visit in September. Watch this space.

Off topic : Be there or be square

I've got a bit bored of the guys over at Pestiside not using all the lovely stories I keep sending them in favour of endless reviews of burgers, so I am going to post them here instead even though they won't be about my teeth.

HUNGARY TO HOST FOURTH RUBIK'S CUBE WORLD CHAMPIONSHIP
2007-09-20 11:27 (New York)
Budapest (dpa) - Some 25 years after the first ever Rubik's Cube World Championship the fourth such tournament will be held in Budapest this October, organizers said on Thursday.

More than 300 people from 32 different countries are expected to attend the tournament, where they will compete in variety of different categories including solving the cube blindfolded or with one hand. The Rubik's cube - in its standard form a multicoloured cube with nine tiles on each side that must be rotated to make all six sides the same colour - was invented in 1974 by Hungarian Erno Rubik, but did not become popular until the early 1980s. Over 100 million cubes were sold between 1980 and 1982 as kids and adults everywhere became obsessed with solving the puzzle. The craze was so intense that in 1981 a book on how to solve the cube, written by 12-year-old Patrick Bossert, sold over 1.5 million copies.

The United States is expected to send some 39 competitors to vie with 50 from Hungary and 22 from Japan for a total of 20,000 euros (20,168 dollars) in prize money. (You might want to double-check that exchange rate, bucko.) Competitors from Lithuania, Indonesia and Mexico are also expected to make the journey. The current fastest time on record is 9.86 seconds, set by France's Thibaut Jacquinot in the second round of the 2007 Spanish Open.

My "before" photos

I have been meaning for some time to post the photos my ortho took of my teeth before treatment back in Jan 2006 and I have finally got around to it! I will admit I find these photos pretty scary to look at now because my teeth look so much more regular now.

Quick aside: Finally Google acknowledges my existence. This blog is the number one hit when you search for "Budapest Invisalign blog", number two when you search for "Budapest Invisalign" and somewhere on page two for "Invisalign blog". Woohoo!

Anywhere enjoy the horror show :o)

A Small Step Forward

Part of my Invisalign plan since day one was the small ledge behind my front upper teeth. This was created by four bulges in the upper aligner behind the four upper front teeth and the idea was that the lower teeth would sit on the ledge and take pressure to move down rather than backwards and so close the overbite. The problem was that it always felt more comfortable to close my jaws more completely with the lower teeth further back and higher up, so that's what happened, especially at night. But now my teeth have moved around enough that it actually feels more comfortable to rest the lower teeth on the ledge. So I hope that this will speed up the closing of the overbite by putting more downward pressure on the lower front teeth, but also by changing the extension and angle of the interarch elastics to pull the lower molars up.

Otherwise I am not sure how things are going. Some mornings the problem teeth look to be fitting well into the alingers, other mornings I can see clear gaps between the teeth and the aligner. I had no idea teeth could move around so much on a day-to-day basis. Or maybe I am becoming obsessed with my teeth and am imagining it!

Steady as She Goes

So I am back from a beautiful weekend in Budapest. Great weather, great company, stayed in my favorite apartment on Lónyay Utca just a block from the funky restaurant/bar zone of Ráday Utca. Had such a good time that I wasn't too bothered about losing my mobile, which I either dropped or had stolen while waiting for a friend's delayed train at Keleti Station.

Anyway Dr H was fairly pleased with my teeth. The upper premolar problem teeth seem to be moving now with the strong elastic chains. The lower premolars are still a problem and Dr H warned me that we are on thin ice. As long as it possible to get the aligners on, we are OK, but if they fall out of plan too far, we are going to either have to make a mid-term correction (making a new course of aligners) or switching to metal braces (eek!). This warning did focus my mind and I think I have found a strategy which I think is working very well and that I would like to share with my readers. If the aligners stop fitting a tooth snugly, the forces they apply are reduced which means the tooth is likely to drift even further out of plan. My problem is that there is a gap of a few millimetres between the problem premolars and the aligner. My solution is to put a knuckle in between my premolars and bite as hard as I can stand. This keeps the aligners snug around the teeth, applying maximum force, and I think it's had quite a visible effect in just a few days. So I remain optimistic that Dr H will have a nice surprise at our next appointment in early September.

Close shave

Not much to report other than that I had a couple of very uncomfortable hours when I thought I had lost aligner set 17 - probably in the car park of a restaurant in northeast Umbria. If you recall, set 16 got thrown away by mistake on a flight to Tokyo. At the time, sets 15 and 18 were both hundreds of miles away so I thought I was facing several days without aligners. Since I had already learnt at New Year just how quickly teeth can relapse when not wearing aligners, I thought I was in big trouble with Dr H. Anyway, I was majorly relieved to find them on the floor under the kitchen table.

I am a real pro at getting the new elastics on now - it takes about 2 minutes compared to the 30 minutes on the first attempt back in May.

Slow Progress

Two weeks into the new regime. The new attachments no longer irritate the inside of my mouth and I can get the elastics on in just a few minutes. I cannot see whether the premolars have moved as planned - but I can certainly feel strong pressure on them. I think I am going to have to bite the bullet and start wearing the upper aligners during office hours, even if they give me a slight - but noticeable - lisp. A small panic when I realise Dr H has not given me enough elastics to last until our next appointment in July. He says he will post some from Budapest. I am on holiday next week with a friend who knows I wear the aligners, so I expect to be highly compliant.

A big welcome to the blog's first visitor since I started tracking. On the 4th June, a Comcast cable customer running Firefox visited my blog for 101 seconds. It makes it all worthwhile somehow.

Upstairs, Downstairs

A beautiful spring weekend in Budapest. Last visit, Dr H was concerned about my lower canines straying out of line and I had been wearing the lower set a lot more during the day. I felt the canines had improved and Dr H agreed. But he was concerned about three upper premolars which were relapsing because they had not rotated enough, possibly because I had skipped set 16. This meant set 18 was very hard to wear and was losing its grip on the problem premolars. He talked about going back to set 14 or making a midcourse correction (having the remaining aligners remade), but eventually decided to fit attachments on the teeth and use very strong elastic to pull them back into line. So for the next two months I will stay with set 17 and be fiddling with elastic which takes forever to put on the attachments. Actually, it's not that bad. The first time I fitted the elastic it took well over half an hour - it's amazing how quickly you get better at these things and now I can do it in under ten minutes.

Losing a Set

On a flight to Tokyo I lose my washbag which contains aligner set 16. Dr H had said this usually is not too much of a problem because you can move onto the next set. It was a bit of a close shave because I nearly put sets 16 & 17 in the washbag, and losing both would have been a disaster. Set 17 is really hard to wear, so I alternate 17 at night, 15 during the day for about a week.

March Visit

I take the Thursday afternoon flight to Budapest. P meets me at the airport and drives me to the apartment overlooking the Opera. I try to get my ipod fixed at the Apple store just down Andrássy, but the store seems to be more for show than fixing things. I take a mate out to dinner at the Pava restaurant in the Gresham Palace - over-priced and pretty ghastly customers. As we cross the top of Váci Utca, a couple of nice friendly local girls stop us and ask the way to Bécsi Ut. I know where Bécsi Utca is - it is the road to Vienna going northwest out of town going past Dr H's surgery. One of the girls blows it a bit by giving me a small lecture on the difference between an Ut and an Utca. We offer them our map and they ask us if we would like to go for a drink in a bar they know nearby. We say maybe later and head for dinner. I explain to my out-of-town friend that this sounds like a standard Budapest scam. The drinks will be 200 euros per round and heavies will appear to take us to the nearest cashpoint to pay up. And the police will take no interest if you complain. My friend thinks the girls were too nice to be involved in something like that, but when we cross Vorosmarty Tér after dinner they are still there looking for Bécsi Ut. It is actually just a block away, so I think I was right.

In my experience, Budapest feels like a fairly safe city full of friendly, capable, interesting people and their reputation is the real victim of this sort of crime. The police and authorities could end this scam pretty much overnight if they chose to.

It has been nearly three and a half months since my last visit and I suppose I have become a little complacent in the number of hours that I have been wearing the alingers. Dr H is disappointed with my teeth on Monday morning. The lower premolars have not moved as much as they should and there is now a gap between the teeth and the aligner. I promise to wear the aligners more hours a day and he asks me to come back in ten weeks.

I spend the rest of the morning looking around the Roman amphitheatre opposite his office and getting lost finding the tomb of Gul Baba, a Turkish mystic credited by the locals for introducing the rose to Buda. On the flight home, I sit next to a couple of Romanians who turn their mobile phones on mid-flight just to prove there is no signal.

New Year's Eve

I go away with friends, who don't know I am wearing aligners, for New Year's Eve. Since we are going to be sharing a small flat and continuously eating and drinking, I decide not to wear the aligners for the 48 hours. This turns out to be a big mistake. I can't believe how much ground the teeth lose in such a short period and feel the course of treatment is put back by over a week.

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.