John held up an ‘appliance’ which just looked like a mess of plastic and metal, there was no way that was fitting into my mouth! He pointed to it “now this is a frankel appliance – that will help to retrain your mouth muscles and you will wear that 24/7 – I will do a slight modification of this as I will add the lip buttons to the top as well as the bottom. This will help to retrain the way you swallow too – if you ‘suck in’ then they will rub so you will learn to speak, eat and swallow again in an improved way.” He placed that down and picked up the next one which was a lump of pink plastic with a short facebow poking out ‘we may then move to a van beek activator with the headgear to help reposition your jaws - again it's a 24/7 appliance” He put that down but didn’t pick anything up again so I was hoping that would be the worst over, he turned back to me “once we have finished with that you will then get your expander back on the top– that might be combined with twin blocks if it’s needed at that point to maintain the jaw position. Then once we have finished that phase we will move to fixed braces” Bands across teeth, jaw’s positioned with a herbst or maybe an alternative like a forsus appliance – we will see closer to the time. He turned around and picked up a tooth model with whole hunks of metal wrapped round every single tooth. “ now we used to use bands in the 60’s 70’s and 80’s. They were very effective but went out of favour because of their appearance and the extra work. You are going to be part of my study to see if we complete bands using more modern materials if they are cheaper, easier and as effective as brackets – it could be a game changer for people who need to keep their costs down. So we will use modern metals to create bands for every one of your teeth, we will put spacers between each tooth and insert them. We will measure the forces applied and how much movement we get compared to normal brackets.” I couldn’t help but stare at the model, seeing how little white there was on view made me panic even more knowing that my mouth would look like that – shiny and grey.” He picked up metal bars and clipped them to the model which looked even more ridiculous now with giant “now this is an example of a type of herbst, this helps to keep your jaw in a better position. Like I said there are other options like springs but we will assess closer to the time. Lots of people think a herbst means no headgear – but remember if we want to move the upper jaw back then we can also add a facebow at this time.” Jessica spoke up at this point and I could practically hear the glee in her voice “this time, with the van beek and again later? Ellie you could be the first person to have 3 different facebows, 3 different times during their treatment” John nodded along enthusiastically “indeed! What a story to tell”. I groaned internally knowing that he would for sure find a way to add this now. Finally he reached over, put the ugly banded tooth model down and picked up ‘normal’ braces on a tooth model again “Obviously the bands will leave tiny gaps between each tooth so once we have achieved what we want then we will switch back to brackets with power chains to close the gaps. Now normally we would remove the braces but I think we will leave the brackets on for a short period of retention since you will have had so much more done” He then placed the models down and picked up two pink acrylic appliances “Then finally we will go to Hawley retainers, none of those silly clear ones. You’ll wear these full time for 18 months – 2 years as a preventative with monthly checks. Then you can go to 18 hours, 12 hours then overnight in time”. So even after braces I was going to but stuck with plastic and metal full time for at least 2 years?!
He turned to Jessica “obviously as Ellie is going to be used as a study and in promotional videos and marketing the cost of these appliances are all covered – it will still be the basic payment you agreed at the start. The cost of the hospital stay will be covered under a grant so nothing to worry about – we will explain to them that Ellie’s future oral health is at risk” Jessica smiled widely and nodded along.
Now the difficult thing is time frames here – usually the frankel appliance and van beek would be 9-15 months each” my heart stopped for a second there but john quickly carried on “But we don’t have those time frames, and because we can add fixed appliances later we can use them to see how you respond. I’d say 3-4 months in the frankel will give us enough time to retrain those muscles – we can then simulate this with lip bumpers and shields if needed with the fixed braces. If time allows then the van beek will be closer to 5-6 months, everyone thinks jaw growth has stopped by your ages but we can usually get a little bit of extra growth so this will be focused on that. The expander will be similar to what you have now, luckily we have already done your bottom jaw so as long as there is no reversal with those appliances it’ll only be the top to do. I don’t expect this to take more than 4 weeks because of the progress we have already made and we will be able to doing multiple turns a day while monitoring you. The fixed bands will be likely 12 months – we will have done the bulk of the jaw work so just the repositioning at this point as long as the bands move things as quickly as we anticipate. Then 3 months of repositioning with the brackets and probably another 3 months for retention.” Jessica smiles widely at John “that all sounds great – really well thought through!” John smiled gratefully “it’s a slow process but slow and steady brings the best, long lasting results” I looked between them, after adding up the times “ but, even if everything goes to plan that’s a really long time – its 10 months with those two massive appliances, another month for the expander, a year with the bands then 6 months with the normal braces…that’s 29 months…that’s 2 and half years! You cant keep me in hospital for that long! I will have finished school, I’ll need a job! I’ll be nearly 22 by the time I finish!” Jessica piped in again “don’t forget the two years of retainer use sweetheart, 24 by the time you’re out of them! But lets spin this around, 24 and out of braces with your teeth fixed forever…what a lucky girl. 24 is still a baby!” John nodded “Exactly Jess, the world will be your oyster, but to answer your question – no you won't be in hospital that entire time. I’d estimate 12 months of everyday, when we move to the fixed appliances we will transition you back out, but you can still come to the office for check and observation – but you’ll be able to sleep at home at night. You’re very lucky Jess and your dad are being so supportive, besides – if you start behaving you’ll be an inspirational patient – I am sure we could sort out a job here for you, it’s a win win. The patients get to see somebody who is really committed – and you’ll be on my posters, facebook and website so they’ll be used to your face, I get to keep an eye on your compliance and you get some income” Jessica gushed how great that would be while I nearly cried thinking about the next 4 years and what my life is going to become. I took a deep breath “And there is really no way around this?” John shrugged his shoulder “absolutely, like you were told – buy your way out of the contract – pay for the treatment in full today and you’re out. But if not, no – this is my office and we are doing things my way”. Tears spilled out my eyes as I nodded my agreement, knowing I had no money, no qualifications and no way to get out of it. John clapped enthusiastically.
“GREAT! So we will take everything out your mouth today, get some impressions and see you next week to get the treatment started!” Jessica jumped up quickly “wait! Just before you do, can I get a couple of pictures? Just so we can remember?” John nodded quickly whilst I sighed. Jessica snapped some photos of my grumpy face, with my mouth being held half open by appliances and the facebook snaked around my neck, just as she was about to sit down john piped up “hang on, I’ll put the lip spreader in and you can get some close ups of her mouth, in fact I think we will too for the website – just to journal how it all goes and how simple it could have been for her!” Both of them snapped photos of me like I was a zoo animal, but finally he laid the chair down, put glasses on me and went through the process of removing all my braces and appliances, after what felt like hours he sat me up – my teeth felt slimy but also worse than I ever remember. He handed me a mirror and said “the thing about treatment is it makes everything worse before it’s better – so your teeth probably are more gappy and crooked than before due to the appliances but obviously we never got to finish. Enjoy having an empty mouth for the next few days, when you come back Monday we will have all your first appliances ready and will admit you to the ward.”
I nodded and stood up sheepishly, feeling like my life was over, for the next few years at least!
Probably the best place to end it?!
