Patients' Experiences w/AOO Surgery

how it really feels, and how they feel about it

Dea Ann, age 56, of Arkansas

Dea Ann had her AOO/Wilckodontics procedure done in September 2004. I asked her several questions about her experience. Here are our questions and answers:

How much did you pay for this procedure? Was any of it covered by your insurance? Did you have to pay up front, or on a payment plan?

The AOO was $4000. The braces were $5750. They cost--I can't recall exactly--about $550 more than regular because of the additional adjustments every 2 weeks (some more often, as needed). The periodontal cost for the initial consultation was $90 and digital x-rays $85. Two cleanings to be done towards the end of my 6 months at $170 each.  I don't have dental insurance. I paid upfront, but could have worked out a payment plan with the doctor.

What sort of doctor did your procedure?

I used a periodontist, working in close conjunction with the orthodontist, who referred me. Together they decided on how to proceed after I had decided to do it. They were wonderful, compassionate men, calling, emailing, sending flowers the first week.

What did you have to do to prepare for it?

To prepare: get a good night's sleep (yeah, right), arrive with clean
teeth, have a driver.

Did you get your braces on beforehand? If so, how long before?

My brackets were put on 2 days before, but the doctors. decided to leave
the wires off to possibly speed up the stitching, not having to work the thread behind the wires. The brackets were very uncomfortable without the wires-- more biting -- and the time wasn't that much less, so they have returned to putting the total braces on before surgery.

What type of anesthesia was involved?

 I had a Valium for the night before, and one for the morning of the
surgery, then many shots of Novocain to completely numb the gums. The bottom took 45 minutes to go numb, the top 15, but the top had to have another shot near the end when I noticed some mild sensation. The shots, especially in the top, were painful but not for long. The surgery was then totally painless.

How long did the procedure take?

The entire thing, counting going numb and resting afterward, took a little over three and a half hours. The bottom was done, then we had a short rest, then the top was done. He cut and pulled the gums back, then used an electric tool to scratch the bone surface all around the teeth, then put in a bone grafting powder, then pulled the gums down and put a stitch between each tooth.

The stitches looked like a mouth full of dental wax. I think the perio said they were Teflon. They had to be removed after 2 weeks, which only hurt some when the technician pressed the little pointed scissors into the gums to cut them. Pulling them out didn't hurt.

How did you feel immediately afterward? One day later? A few days later?

I felt exhausted immediately afterward and thrilled it was finished and hadn't hurt. I kept my eyes shut the whole time, praying, and when the dr. asked if I wanted to know what he was doing, I said, "No."

The next day I felt fantastic, thinking, "This is a piece of cake!" But the second day, my lower face rapidly began to swell right up into my sinuses. This swelling lasted 9 days, but I saw the dr. twice in that time and he reassured me it wasn't excessive and the gums were healthy, all looked fine; the second time I went, though, he realized I was having more pain than usual and told me to finish the narcotic pain pills he had given me for the first few days; I had only taken 3, not having real pain then. Stupid me, he said take them the first couple of days if needed, then switch to Tylenol, so that's what I did, but the Tylenol did no good. 

But the biggest part of the throbbing jaw was the elevations on the back teeth to open my bite installed when the braces were put on to keep me from hitting the bottom brackets with my top teeth and let crossbites move. From the surgery, my gums felt raw and the roof of my mouth felt sore. 

The first day of swelling, I held a cold pack to my face constantly; the days I was swelled after that, I held a hot pack to my face constantly. I slept (some) in the recliner so I could manage the packs and to be more upright to help the swelling. The swelling felt tight and stiff and affected my talking. I was on liquid food since the stitches filled my mouth, between every tooth. I could not brush/floss, but was given a prescription for a mouthwash to use after each eating that stained my teeth brownish a little. It didn't taste too bad; the stains have cleaned off since I began brushing.

How much did it hurt? Can you compare the pain to anything else that other people would be familiar with?

Honestly, the rawness and soreness of the gums from the surgery were something I could handle had I not had the throbbing of the jaw teeth. The swelling didn't hurt, it was just tight, tiring, and uncomfortable. Mine lasting 9 days is very unusual, I understand.

How much swelling was involved? How much bleeding? Any bruising?

There was no bleeding and no bruising.

The day after the stitches were out, I had the wires put in. Two days later I called the ortho because all my front top and bottom teeth were so smashed together that I was sure they would damage each other, and there were embrasures between those teeth, apparently from the roots widening when their tops were smashed together! That is how fast they were moving! He said basically it often has to get worse before it gets better and did no adjusting. My first adjustment was the next week (2 weeks after the wires went in) and he put on some springs to make room for 2 crossbites. Pressing on the brackets to open/close them had me in tears.

When were you able to go back to work/school afterward?

Luckily, I am retired, so I was able to crash. I don't believe I could have gone back to work comfortably until after the stitches were out; I was too grossed out.

What about eating -- did you have to avoid certain foods? Were you able to chew somewhat normally? Or, were you on a soft or liquid diet for a while?

I was on a liquid diet until the stitches came out, and because of those darn jaw teeth elevations, I am still on liquids or soft-cooked foods I can mince enough to swallow without chewing. I have no chewing surface! Plus my teeth are too sore to chew on, I am pretty sure! I have lost 6 pounds in 6 weeks.

The ortho did seem to agree that my teeth are more sore with the surgery because they are all somewhat loose and all moving at the same time. The brochure for Wilkodontics said adjustments were less painful with the "softened" bone, but that is not true. The 3 other people I have talked to (who had AOO) -- even those finished in a few months and into retainers before their 6 month movement was finished -- had sore teeth and had to eat soft food for 6 months.

Did you take any pain medication afterward? If so, was it a narcotic or a Tylenol-type?

I took 3 of the narcotic pain pills initially, then went on Tylenol, as directed by the doctor, but the pain of the jaws throbbing put me back on the narcotics for 3 more days/4 nights. Once they stopped throbbing, I was pain-free, just swollen and tired of it all!

What sort of braces do you have?

I have full metal braces, self-ligating. They don't look exactly like the pictures of the Damon braces, though.

How long will your total treatment take?

My total treatment is estimated at 12 months (compared to 24 without the surgery) but all the people who are finished have done it faster than the estimated time. I am older; I have quite a few things to correct, I doubt I am faster, but I wish I would be!

So far, how are the results?

After almost 4 weeks in braces, I can only see the front and bottom teeth are smashed together. I can feel a lot of tingles, vibrations, occasional soreness, different widths between teeth for flossing. At my second adjustment, the clinician and doctor, comparing all my photos and x-rays, tell me my teeth are moving amazingly. Oddly, I can't really see it. But I can believe it from how they feel: like huge foreign objects.

Would you recommend this to others? Why or why not?

I had decided not to do the surgery if my periodontal exam was good. But it wasn't: I had 4 pockets that needed to be eliminated and I have a narrow arch that could use more bone to widen. After learning those things, I went for the surgery since the pocket elimination surgery is basically the same as AOO, just less so. I am expecting to be thrilled when my teeth begin to go into place, but right now they are SO very sore from all of them moving and responding to the braces. 

The ortho said he hopes to have most of the straightening done in the 6 months that the teeth are easily moveable. After 6 months, the bone grafting powder finishes joining the regular bone and the teeth solidify in the gums and any movement then is like regular ortho. work. 

Right now I cannot advise anyone whether to do the surgery: it was a big deal and expensive and I have no way to compare the results yet or the pain with normal braces. When I am out of braces in a year instead of 2 or more, then I will probably say it was worth it!

What was your orthodontic problem that lead to this? 

I have 3 crossbites on top, crowded bottom front teeth, and the bottom side teeth are leaning in.

Are there any other comments or suggestions you want to add about the AOO procedure that we haven't in these questions?

There are a lot of medications. I had the Valium and Novocain for the surgery. I had a week of steroid pills to help with the swelling and a week of antibiotics to ward off infection (my gum grafting powder did not include antibiotics; safer in case there is a reaction to the med.) I had the narcotic pain pills and 3 anti-nausea suppositories in case the pain pills made me nauseous. (I used them, just in case, at first.) I had the medicated mouthwash to use during the stitches.

Next: Read Jennifer's AOO Story

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