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Author Topic: Dream Treatment  (Read 17256 times)

Offline Charlie0186

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Re: Dream Treatment
« Reply #45 on: 07. May 2024, 05:04:46 AM »
Why have the old multi-band cases gone out of fashion in orthodontics?

You raise an interesting question, Stefan.  Every reference but one to multi-bands I've seen written by or for orthodontists stresses only the cosmetic benefit of direct-bonded brackets.  I've always considered this the "good" reason.  I think your suggestion is closer to the "real" reason.  The one exception is Dr Bill Wyatt on his YouTube channel where he does one clip dealing with some technical disadvantages of bands.  He supports your view that the disadvantages of bands are almost entirely for the orthodontist rather than the patient.

Offline Stefan

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Re: Dream Treatment
« Reply #46 on: 07. May 2024, 10:28:32 AM »
Hi Charlie,

I think you could summarize it technically like this:

Advantages of multiband therapy:
- Better rotation control of the teeth
- Less bracket loss due to incorrect food

Disadvantages:
- After the braces are removed, there are residual gaps due to the bands.
- Longer duration of insertion of the braces
- Greater aesthetic impairment
- Poorer hygiene and more difficult to clean teeth

Greets, Stefan

Offline Embracing

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Re: Dream Treatment
« Reply #47 on: 07. May 2024, 10:31:45 AM »
My dream(!) treatment would include multiple build up steps.

First of all it starts with ceramic brackets on top and metal on bottom. I'm told that later in the progress I would need expanders, elastics and - if they won't do their job - headgear. To protect my bottom braces biteturbos are added on two of my upper teeth.
On the next appointment the Ortho finds out I bit off the biteturbos and didn't come in to get this fixed. I get them back on and I have to wear elastics from the upper front to the lower molars. One on each side for 24/7. Pretty simple but irritating.
Four weeks later two of my bottom brackets are loose since i bit them off, along with the bite turbos. Despite I tell the Ortho otherwise, I didn't wear my elastics for 24/7 - not even close. My Ortho gets slightly mad and tells me that this is my very last chance to cooperate otherwise my treatments gets a nasty twist regarding the necessary devices.
Of course I won't change any of my behaviour which results in an extented appointment the next time I come in: Since my lower brackets broke off so often I get fully bands on all my lower teeth. To further prevent me from biting them off, I get a fixed biteplate on top. Heavier elastics are added and I'm free to go.
On the next appaointment I receive the upper and lower expanders which are completly covered in plastic. They look like hawley retainers and in addition to the biteplate I have a significant lisp.
To make this worse on the following appointment my Ortho detects a tongue thrust caused by the biteplate. But instead of removing the plate the upper expander will be modified. While the lab works on the expander, my upper ceramic brackets are exchanged to full bands with huge brackets. The new upper expander consists of a thick acrylic plate with a screw and integrated biteplate. To prevent my tongue from pushing the inner side of the biteplate have spikes. Two more elastics are added and that's it.

This is my setup for the next 1,5 years before the combi headgear is added for 20 hours a day and a lipbumper on bottom. This is for another year - given that I wear my headgear and lipbumper as prescribed.
After 3 years the headgear and lipbumper are removed and I have to wear zigzag elastics which don't allow me to open my mouth any further than a few millimeters for half a year.

On removal day my Ortho gives me a permanent retainer on top and bottom and Hawleys for 1 year 24/7. Afterwards Hawleys for 8 hours and clear retainers for at least another 8. If I fail to wear them and my teeth shifts back, everything from before will come back on immediatly to stay there for a minimum of 1 year.


Offline duncombec

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Re: Dream Treatment
« Reply #48 on: 07. May 2024, 11:46:51 AM »
I think social acceptability has a lot to do with the decline of bands as well. If you are presented with a choice of brackets like all your friends, or bands like your grandparents might have been forced to wear, which would you choose? (Assuming a patient without our interest).

As braces become more and more common for mild cosmetic fixes as well as noticeable need, it seems things will continue to move in the direction of smaller, less visible, less time.

But with Smile Direct going bankrupt... Perhaps there is a little hope?

Offline Stefan

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Re: Dream Treatment
« Reply #49 on: 14. May 2024, 15:36:10 PM »
In case of enamel damage, for example, more teeth than the first molars can still be banded today. Another indication are severe rotations.
These problems can also be communicated to friends.
The problem for orthodontists is that bands are now rarely offered for premolars or canines, let alone anterior teeth. It is therefore only a matter of time before a real multi-band appliance will only be known from photos...

Offline RetainedJms

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Re: Dream Treatment
« Reply #50 on: 16. May 2024, 00:05:54 AM »
My dream/nightmare orthodontic treatment would take place in my late teens when it would cause me the most amount of embarrassment and humiliation. Most of my piers would be getting their braces off and my dentist refers me for my first ortho appointment shortly after my sixteenth birthday.

My orthodontist is a gorgeous woman in her early twenties who’s only recently qualified and is taking on new patients in my area. She has a beautiful smile herself and always wears cute sundresses shows off a lot of leg whilst she works. I immediately develop a heavy crush on her lying in her chair having her poke around my exposed mouth.

She lies me down and has a good look at my teeth, watching me as she instructs me to bite together and move my jaw around. After spending a good twenty minutes looking me over she tells me that unfortunately my dentist referred me much later than would have been ideal, and starting treatment so late is going to be difficult and unpleasant for me at times. However she will do what she can to be mindful of my age when proscribing treatment and appliances but I should expect a treatment of at least three years. She then takes impressions and a series of photographs of my mouth with the cheek retractors in and tells me to book an appointment in another three weeks to have my appliances fitted.

Im horrified by the thought of having braces fitted at the age of sixteen. I don’t have a girlfriend and I would like one, but I think wearing braces into my late teens is going to kill off any chance of that.  However I secretly can’t deny how much I’m looking forward to be the pet project of my gorgeous newly qualified orthodontist for the next three years.

Three weeks go by and I’m back lying anxiously in her chair. The cheek retractors are in and she begins her work. She installs brackets on my upper and lower arches with a total of eight bands on my very back teeth. Then, as she brings forward two bulky looking pink plastic appliances and I realise she hasn’t actually told me anything about my treatment plan yet! I thought big plastic appliances like that were only for younger kids. She told me she’d be mindful of my age when proscribing treatment so I naturally assume these will be something i’ll have to wear to bed. She fits me with a large twin block appliance and instructs me to wear it 24/7. It feels huge in my mouth, my tongue feels like it has nowhere to go because of the mass of smooth acrylic covering my pallets and my lower jaw is awkwardly pushed forward and open.

She removes the cheek retractors and I immediately find myself struggling to even close my lips over the braces because of how my jaws are now held.

Prising my lips apart with her gloved fingers she inspects the braces and plastic appliances approvingly telling me they look great and that I should book another appointment to see her in a month so she can check up on me and start putting a bit of pressure on my arches.

I’m simultaneously horrified and ridiculously turned on at the thought of having to wear not only the metal braces but these enormous plastic appliances too. I can barely close my mouth let alone speak! The thought of my new embarrassing life dealing with these devices in my mouth, reporting to my orthodontist every month for more punishment is both my worst nightmare and my darkest dream come true. Part of me dreads the idea of her adding more and more additional appliances to my dental and social torture, but the other part yearns for it. I want her to fix me up with devices so embarrassing I barely leave the house except for more visits to her and her dreaded chair, relinquishing total control of my social life to her.

I get my wish.

She keeps me in my twinblocks for a full theee months before admitting they aren’t doing what they’re supposed to and that it must be because of my age. She sympathetically explains that more drastic steps need to be taken.

She takes new impressions and tells me to book another appointment in a week’s time.

I spend a week terrified and turned on at the prospect of what she described as “more drastic steps” and soon I’m back in the chair with her showing me my new ‘improved’ twinblocks and THEY, ARE, HUGE. They take up much more space inside my mouth. The blocks themselves are significantly larger forcing my jaws further apart and my lower jaw further forward. The plastic covering my pallets now extends much further back in my mouth and under my tongue and is noticeably thicker than before. It’s now extremely difficult to close my lips around my brackets and even when I am, I have to make a consistent effort to keep them there. My speech, which after six months is just starting to get less lispy and garbled is now worse than it was then the old appliances were first fitted.

Three months later I’m fitted with a facebow. I can barely hide my ‘excitement’ as she installs it for the first time, gently lifting my head as she wraps the many headgear straps around my face. She tells me how sorry she is that I have to put up with headgear at my age but that I’m doing really well and that I only have to wear it ten hours a day. She says normally she’d ask for more wear time from younger patients but she wants to start slow hoping she can extend the treatment time in exchange for not having to wear it for more time during the day.

Ten hours per day, turns into twelve hours three months in. I’m now nearly seventeen, wearing full braces, HUGE twinblock appliances and headgear twelve hours a day and I’m loving it. I’m fully in the grips of my pretty young orthodontist and her chair.

I psychologically hand myself over to her entirely when she presents me with my upper and lower lip bumpers shortly after I turn seventeen. She ties the lower one in permanently with wire and explains that the top one is to be worn anytime I’m not wearing my headgear which should now be for fourteen hours pre day. With both of the lip bumpers fitted it’s now basically impossible to close my lips and my braces are on show permanently. I can draw them closed over the bulky plastic pads but only for a moment.

I suffer ten months of my fourteen hour headgear routine, diligently swapping out the facebow and multiple straps for the lip bumper which I wear from 08:00 to 18:00

I’m nearly eighteen when she tells me she wants to start expanding my pallets and give my lower jaw more resistance to work against and that it’s time for new twinblocks and elastics. My treatment is about to take over my life.

She shows me my new devices. They’re much the same as my current devices but I can see that the blocks fit together differently. I can also see the slit down the middle and the chunky expansion devices set in the plastic making them even more bulky than the last ones. She fits them both and then fits two strong elastics on each side of my mouth from my lower canines to my upper molars. I immediately feel how these devious devices work. The elastics pull my lower jaw backward and the blocks slide over each other, forcing my jaws apart and my mouth wide open. I have to actively push against the elastics permanently or my mouth is propped all the way open.

She hands me a bag of elastics and tells me I need to change each of the four elastics every two hours I’m awake. She then shows me how to turn my expanders. Both upper and lower jaws every four hours I’m awake.

Lastly, she gets to work wiring the twinblock appliances in permanently, explaining that because of the pull of the elastics she doesn’t want them to start accidentally coming loose in my mouth. She instructs me that with so much hardware in my mouth at this point she’d like to see me every week just to keep an eye on my welfare and to take the twinblocks out to clean them for me.

At this point I’m all in, my life revolves completely around my braces. My entire existence adhering to an hourly schedule of my orthodontist’s wishes.

8:00, remove my headgear and replace with lip bumper. Swap elastics, turn expanders

10:00, swap elastics

12:00, swap elastics, turn expanders

14:00, swap elastics

16:00, swap elastics, turn expanders

18:00, swap elastics, swap lip bumper for headgear

20:00 swap elastics, turn expanders

22:00, swap elastics

And of course, my weekly two hour extended visits to my orthodontist’s chair for cleaning and inspection.

I endure this routine for a further eighteen months before my ordeal is finally over and my braces are removed.  However not without a set of extremely bulky hawley retainers and my orthodontist’s private number. After over three and a half years being her personal orthodontic pet project, maybe there’s room for more fun yet?…
Braces, bare feet, ball gags and bondage!

Offline duncombec

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Re: Dream Treatment
« Reply #51 on: 16. May 2024, 02:25:58 AM »
My dream/nightmare orthodontic treatment would take place in my late teens when it would cause me the most amount of embarrassment and humiliation. Most of my piers would be getting their braces off and my dentist refers me for my first ortho appointment shortly after my sixteenth birthday.

[...]

I endure this routine for a further eighteen months before my ordeal is finally over and my braces are removed.  However not without a set of extremely bulky hawley retainers and my orthodontist’s private number. After over three and a half years being her personal orthodontic pet project, maybe there’s room for more fun yet?…

Another excellent 'story' for this thread, which takes some fairly simple braces and appliances but turns them into something very significant and life-disrupting for the patient. Especially like having to change elastics every two hours whilst awake, as it you could ever forget they were there!