I apologize ahead of time if the posts get lengthy (particularly this first one)!
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Background
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I'm 29 years old and have a severe crossbite. My lower jaw is shifted about 7mm to the left (though I measure it as a tooth-and-a-half) and I have a very narrow maxilla. Unsurprisingly, my teeth are crowded. I had an impacted canine that had removed along with the remaining baby tooth, hence the gap on the left. On the bright side, I can stick a small straw through it and drink without opening my jaws, which is kind of a cool party trick I haven't been able to do since I was 9.
My usual smile: http://imgur.com/RchgCOA
My natural bite: http://imgur.com/SG3U1q5
I won't lie: the cosmetic benefits of correcting the bite are a huge motivator for me. I've always been extremely self-conscious of my smile, and random, concerned comments from strangers about my jaw make me acutely aware that the asymmetry is rather obvious, despite what my friends and family say. The functional benefits are a bonus.
Presently, I have don't have any pain, nor do I think I have any loss-of-function due to the crossbite. For 15 years, I've been hemming and hawing about getting it fixed, as the only option available to me was surgery-- non-surgical solution would camouflage the bite somewhat, but I'd still be at risk for uneven wear and TMJ issues later down the line. Coupled with what I hope will be an improved aesthetic, I finally decided to exercise my right as an adult to get her teeth wrapped in metal and face cut open.
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Treatment Plan
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* Get wisdom teeth removed
Got this done when I was 17, but just as a forewarning in case you're thinking about orthgnathic surgery as an adult and still have them.
* Get the impacted canine removed
I had the option of an expose and bond to save the impacted canine, but doing so would add at least year onto my treatment plan, and, according to my orthodontist, had a 30-40% chance of failing. Another option would be to plan for an implant at the end of treatment, which sounded complicated and not particularly attractive. After speaking with two oral surgeons, I decided that removing the canine was the best option for my goals. An uneven number of teeth on my upper arch could be dealt with. Given that my canines aren't that big too begin with, they don't expect the missing tooth to be too obvious.
The removal was relatively quick and easy. Since it was stuck pretty high up on the palate, I went under general anesthesia and woke up with little pain. The tissue behind my two front teeth was desensitized for about three weeks, but I've since regained full feeling.
* Get an expander put in and do a MARPE
My maxilla needs to expand by about 10mm to fully fit over my mandible. A 3-piece LeFort typically has an upper limit of 8mm before things get unstable. Early on, a SARPE was a dealbreaker for me, so my orthodontist presented the MARPE (micro-implant assisted RPE) as an option. It's a relatively new technique that involves securing an expander with micropins/screws on either side of the midpalatal suture. Once activated, the screws would exert pressure on the suture and hopefully break it open. Failing that, I have decided that a SARPE is back on the table, but I want to give the MARPE a try.
* Do the braces thing
Currently, four temporary anchorage devices (TADs) have been planned to pull my teeth towards the back of my mouth. I've opted for low-friction stainless steel braces on both arches. I've budgeted about 18 months for braces before surgery. The TADs will be removed prior to surgery, and I'll continue to be in braces for year after.
* Double jaw surgery
I decided to go with the team at UCSF for my surgery. The procedure would consist of a 3-piece LeFort and a BSSO. I've received mixed input on whether or not I need a genioplasty, but given the asymmetry of my jaw and that the chin tends to grow with the asymmetry, I suspect that I will. But who knows!
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MARPE Installation
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The MARPE installation came in three appointments that spanned three weeks. Week 1, I got spacers put in around my upper first molars and had a whole week to eat porridge and cheesecake because my teeth were so sore. Week 2, the spacers were removed and I had my molars sized for brackets, followed by a mold for fitting the expander. Week 3 was installation.
* Got my expander installed on June 28th
Here it is in all its glory: http://imgur.com/iYRullz
(Sorry about the watermelon scraps)
In a nutshell, getting four screws drilled into my upper palate was fine. The most painful part of the procedure was getting the lidocaine injections, and even that was dulled by the application of a very bitter-tasting topical anesthetic beforehand. Just a sharp pinch followed by pressure. After I was numbed, the expander was cemented onto my first molars. Once he confirmed that my palate was fully numb, my orthodontist pre-drilled four holes onto the bone, then screwed in 11mm micropins. Some people have described a strong need to sneeze as the pins break through into the nasal cavity, but I didn't feel anything besides some pressure here and there.
The second most painful part was when the lidocaine wore off and my body realized that it had four screws screwed into the upper jaw. The pain wasn't unbearable-- just a throbbing soreness and sensitivity to cold. My advice: schedule the appointment as late in the day as possible and eat beforehand because chances are you'll just want to sleep it off.
The next day, I felt absolutely fine. Aside from having a big metal thing stuck to the top of my mouth, I feel no discomfort from the screws and am able to function normally (except for the cleaning)
* Upgraded to 13mm pins
Remember how I didn't feel the urge to sneeze? It turns out that the front two pins were too short to fully break through the bone. One of them was clearly loose, so my orthodontist removed it the next day and ordered longer pins. I came in a week later to get the two front 11mm pins replaced with 13mm pins. Again, no pain while the pins were going in, and extreme throbbing discomfort afterwards. Again, I didn't feel the urge to sneeze, but my orthodontist said that the screws were now securely in place.
* Wait a month for the bone to heal
I'm currently scheduled to activate the expander in early August. In the meantime, I'm waiting for the bone to heal around the pins.
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Expander Care
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Having a big metal thing screwed to the top of your mouth is about as fun as it sounds. The expander doesn't really limit my diet much outside of eating anything sticky or stringy. Still, a lot of food gets stuck up in the space between the expander, the screws, and the top of your mouth. My orthodontist told me to buy some microbrushes off of Amazon, and they have proven invaluable when it comes to pulling out food debris and disinfecting the spots where the pin enters the soft tissue.
I bought 400 of these bad boys: http://imgur.com/X6mPot9
(400 brushes, not bottles)
In addition to microbrushes, I also bought a Waterpik, which really helps blast out the bulk of the food scraps that get stuck.
That's it for now! I'm excited for this whole thing to begin, and will try to update regularly on my progress. Thanks again for stopping by
