Been a long time coming... (38/M)

[gorillatoad]

Hello!

I'm one of those folks who probably needed braces as a kid but came from a family that couldn't afford it. Man... It's taken me close to 40 to feel confident spending the time and money to fix things, but I'm finally doing it! I had numerous consultations, and here was the general consensus:

- An intermediate case of crowding, top and bottom.
- Wisdom teeth grown in at an angle, pushing other teeth forward and making the crowding worse.
- A few teeth rotated 90 degrees.
- Around a 5-6mm overjet.
- An open bite, which is exaggerated by the overjet.
- Crossbite.
- The premolars/molars are sharply angled in on both arches, especially the bottom.
- Very narrow arches on both jaws, which cause numerous issues.
- Result: A wacky bite in which there are only 2 to 3 points of contact with the opposing jaw, depending on where I position my mandible.

So I'm not the most extreme case by any means, but orthodontists have been interested in the sum total of my features. Apparently it's not the most common list of co-existing things, and I think they are intrigued by the logistics of how to go about fixing stuff. I ultimately went with my city's local dental university as my choice of orthodontist. While they're considerably slower in process of appointments and decisions compared to private practices, it's due to senior faculty oversight, and I can't say enough about how great the student-doctors have been who have worked on me. (It's also, uh... WAY cheaper than anywhere else.)

Step 1 - Wisdom teeth removal. February 2019, done! All 4 removed. I did get an infection in one socket and that was pain worse than a broken limb, but once I was able to get some antibiotics it cleared up in a few days.

Step 2 - Records, March 2019. As the dental school is training students, they're very meticulous about this. A full afternoon of molds, trays, wax bites, x-rays, and more.

Step 3 - Treatment consultation, 2 weeks ago. The doc laid out the game plan. Full braces for 24-30 months, with elastics to close the open bite. Due to the inward angle of all of my "side" teeth I'm apparently a good candidate for a palate expander, which would be expanded at a slow speed (I'm all for it, I'll avoid surgery if I can). The overjet may be helped with elastics or maybe another appliance but the idea is "wait and see" after a period of time.

Sounded good. I think. Honestly anxiety set in heavy. So I set up the 1st treatment appointment ASAP so I dwelled on it as little as possible. 2 weeks out, argh, but it's what is available.

Step 4 - Initial bracing, TODAY! THAT was interesting. They used negative molds of my teeth to rapidly apply the metal, but it did lead to some glue leaking around and between my teeth, which needed to be chipped off. Brackets attached to all teeth but the back two on both sides top and bottom. The orthodontist actually did attach brackets to all my my bottom teeth, but removed the 4 rear ones because of how much they interfered with my ability to close my mouth. She said she'll add them back later once tooth/jaw position makes them less intrusive. The upper 4 top rear teeth were left bare for expander purposes. Spacers were put in, and I'll be going in next week to get metal bands.

Overall: http://i67.tinypic.com/15hn6zb.jpg
Top arch: http://i68.tinypic.com/qyxr8j.jpg
Bottom: http://i67.tinypic.com/2ljjdxh.jpg

The fun thing is, I'm a middle school teacher. Half my kids have braces. I'm not a very self-conscientious person to begin with, so I may just have a little fun with this in regard to colored bands. Why not, eh? In the mean time I'm trying to figure out how to eat and talk and not bite my cheeks. The angle of my side teeth are making those brackets literal spike traps. Also my only 2 points of contact between top and bottom are two top teeth that hit two brackets on the bottom. The orthodontist said stick to the soft stuff and take it super easy for a while, so we'll see how that goes.

I suppose I'll update once I get the palate expander in. Fun times...?

[gorillatoad]

1st adjustment today even though it's been just a week. The intent was to add the final brackets to the bottom, fit upper molars with metal molar bands, then take a palate mold so that the palatal expander can be custom fabricated. Unfortunately all but one of the rubber spacers that were making room for the molar bands broke/vanished (i.e. I probably ate them) over the last week, so both the molar band fitting and mold couldn't be done. Ugh. The orthodontist then wedged new spacers in of a thicker gauge and I cannot say it's much fun. Stuck with 'em for 4 weeks until she tries again. On the positive side, this puts the palate expander's installation schedule at the end of the school year (I'm a teacher), so I won't have to sound like I have a mouth full of marbles during the semester.

I am now fully braced on the bottom though, so 'yay' to that, but it does mean that I literally cannot chew. The rear-most brackets hit my upper molars, preventing me from closing my mouth. The orthodontist says it's a necessary evil until those bottom molars angle from the current 60-70 degrees up to a straight 90 degrees. It sucks, but I can deal. Pretty worried about biting off the brackets though. Ortho says that if it becomes a problem or too uncomfortable that she can build up material on the rear molars to prevent contact, but it would come at the cost of being able to close my jaws even less for a while. So we'll see. Honestly the feeling of my upper molars hitting metal is not good at all so I'm heavily considering it. I'm on a mostly non-chewable diet already so it wouldn't be that different.

[Jethro]

Hey gorillatoad, congrats on starting your orthodontic odyssey. Sounds like you'll be in good hands at the uni. As you've probably found out by now, the first few weeks can be challenging.

All the Best,

Jethro

[gorillatoad]

Thanks! Yeah it's been ups and downs, as I'm sure most people here know.

What's really 'no bueno' is the bottom back brackets hitting my upper teeth. One wrong bite and not only is pain radiating out of the teeth that hit, but also any teeth they are connected to that also pick up the impact through the braces. Unconscious jaw clenching while sleeping is the worst and entirely unpreventable. Currently I'm fairly certain I'll take up my orthodontist on the offer of molar buildups. It'll be annoying, but I'll take annoyance over random radiating pain that is difficult to prevent.

[gorillatoad]

1st adjustment!

*Ben Kenobi voice* The mouth is more machine now than man...

- Palate expander and molar bands glued in place.
- Bite blocker (the blue stuff) added to prevent the biting of brackets.
- Wires changed, but same sizes as previous.

Welp. This is a feeling. Talking and eating have just become Olympic feats with this expander. I'm sure it'll improve but it's one heck of a speech impediment currently. Food... yeah, I'll have to figure that out. I'm stuck with it for 6 months at least so there's time to get better. The plan is to turn the screw every 7 days throughout the summer for slow but steady "adult" expansion.

The bite blocks are honestly great. To be able to actually sleep through the night without waking myself up by crunching on metal is amazing. That first pic is as far as my mouth closes and I only have two small points of contact, but hey, even before braces I have an open bite and only two points of actual bite contact so whatever.

Same wire thickness but the ortho says she'll be putting heavier ones in next appointment, 6 weeks from now.

[Jethro]

Congrats on moving forward with your treatment...Hope speaking and eating have become easier by now!

All the Best,

Jethro

[gorillatoad]

2nd adjustment!

We went with red/orange alternating bands this time at the request of a student of mine. I wanna say it's a .016 wire on the top and a .014 on the bottom now? I think they were both .012s to start. I'm also told the bottom wire is actually meant for the top, but it's there to try to start putting more force on my bottom molars to pull them outward (apparently "top" wires generally have broader arches). While not a giant jump up, oy, my few rotated teeth are screaming at me right now.

I'm to turn the palate expander for another 2 weeks, then stop. That'll put me around... 4mm expansion I think? While that doesn't sound like a ton, I definitely have a wider smile now on the top and - this may be anecdotal - I've had less breathing issues. Then it's 4 months of the expander just hanging out in my mouth to stabilize things. It should come out in November, during which I'm told they're going to switch me over to a TPA. In the meantime at least I'm 95% able to speak normal. The long "E" sound is the worst of it, I spit a bit because of higher-than-average saliva content, and I quickly turn to mushmouth if I'm very tired or have had a few strong beers.

Now where's my mashed potatoes and soft foods...

[gorillatoad]

3rd adjustment!

- 1 size thicker NiTi wire on top.
- A steel wire on bottom, not sure of thickness but it looks about the same as the previous NiTi wire there. "Outward bending" to start widening up the bottom arch.
- First elastics, triangle formation, to start closing the open bite. Very light but it'll still take some getting used to.
- Rainbow bands! Why not!

20190826_172550.jpg

Otherwise I'm very happy with the progress. The two most notable things are a much wider upper arch due to the expander, and the top incisor (yellow band) that has de-rotated a ton in the last 6 weeks. The expander is staying in 12 more weeks it sounds like... in 6 weeks she'll pop it out, take a mold for a TPA, then pop it back in, then in 12 weeks replace it with a TPA for the remainder of my treatment time. There was concern about tongue thrust and also with my lower jaw sitting a bit too far back, so we'll see about those things in the future I guess.

[Stinkfut]

It's so encouraging to see people my age with braces. I've been considering braces (for a second time) at 42 but didn't think it was something that was done often. Great progress, how are you handling speaking at work/socially with the expander?

[gorillatoad]

After about 2 weeks with the expander my speech was hardly affected. If I'm not mindful of tongue position sometimes the "ee" sound comes out as "eh", but besides that it's all fine (despite a big chunk of metal in the roof of my mouth).

4th adjustment!
Posting a week and a half late but here it is.

10-31-19 1.jpg

- 1 size larger on both archwires.
- Halloween colors.
- Metal ties on 4 teeth, 2 for the sake of triangle bands again.
- Expander was popped off, mold taken for a TPA, replaced. 5 more weeks of the expander then it's gone!
-In addition of TPA switch, will also probably have some brackets moved next appointment.

So. Yeah. Holy crap at the effectiveness of those triangle elastics judging by the last 2 pictures, eh? Having my teeth actually overlap feels really weird. In fact they're overlapping so much that my front top incisors now hit my bottom brackets. Unfortunately I sense bite turbos in my future again, but c'est la vie. In the bite department - it really sucks right now. Basically, nothing makes sense. That's okay though. If "the cars are moving in the parking lot", there's going to be a long period where nothing really lines up at all. I also have no idea where to hold my jaw currently... hopefully that starts to go one way or another soon.

I've also been threatened with either a tongue thrust guard or spikes as I'm having a hard time getting a handle on unconscious tongue positioning. Not looking forward to whatever solution that may entail but if it's for an improved end result I suppose I'm all for it.

[gorillatoad]

Hey hey hey. A week late and no pics (maybe I'll add some later), but the last adjustment was big.

The expander is gone! Long live the expander! It was replaced with a TPA to hold the expansion gap. While I have more room in the palate of my mouth now, I dunno, the TPA is almost more annoying. It takes up less room, but the expander was a large object and this is a single thick wire. You'd think it impedes less, but I'm finding that more food sticks in it by far. On the plus side, the "Eee" and "Y" sounds are no longer difficult as the expander is gone. It sounds like the TPA is going to stay in place for the rest of my treatment (1 1/2 to 2 years, oh boy).

I had 4 brackets repositioned. One was expected - my janky sideways tooth - but the rest not. Between these and the new molar bands for the TPA, I've been super sore lately. Back to the front teeth soreness of Week 1.

My bite is totally dumb. Not sure where it should be. That sounds normal though.

The triangle elastics have functioned well... perhaps too well. I went from an open bite to a ton of overlap. To get my teeth in chewing position I need to jut my bottom jaw forward, and when I do, my upper front teeth firmly connect with my bottom front brackets. My orthodontist (who is a new doctor and unsure, but I'm OK with that) isn't positive I'm biting in the correct spot or not when I jut my jaw forward. Either my bite is totally off by like a whole tooth, or my bottom jaw sits back too far and it should be farther forward. I'm thinking the latter but we'll see. Either way, hitting brackets isn't good but she's holding off on addressing it until next adjustment.

The tongue thrust is a problem I'm having issues getting under hand. It's so unconscious. The doc says that based on the jaw alignment issue she'd like to wait til next appointment, but it's looking like I'll need some more direct intervention to prevent the open bite from re-opening.

I'm all steel now! Round steel on the top. The wire was bent to pull one of my front incisors up (too much of a "bunny tooth" going on). The bottom is now a square steel one.

Anyway. Definitely my roughest adjustment since starting. New aches in new places. Trying hard to be patient. I went with green/red band colors for Christmas but kinda regretting it.

[BracedRico]

How is the progress going? Looks great so far.
I have bite blockers too, they really don’t bother me, but my clenching has stopped.