Welp, I've got fixed braces since Tuesday. Ish.
During my last and this appointment, the ortho studied my models and bite. In the appointment on Tuesday she explained to me that my bite on the right side looks good and has good contact. The left side however is blocked by my second molar. When I had the thick posterior bite plane, my strong clenching resulted in that tooth tilting forward while intruding. Now the forward part is stuck below the cusps of my first molar. This results in the back of the second molar to be raised, blocking my bite. The ortho explained that reversing this is the type of movement that can't be done with removable braces. While I didn't want anything fixed, this can only be fixed with brackets. She needs three brackets, one on the wisdom tooth and one on each molar in my bottom left jaw to upright the second molar. As a consolidation she said that it shouldn't take too long, maybe three or four weeks. Knowing my luck, it'll probably be at least double that.
She continued that my bottom incisors are looking good. With the performed IPR they moved back and straightened just as she wanted. She recommended placing a fixed retainer to finish and stabilize them as soon as possible. However, I'm not fully satisfied with those teeth yet as they started to shift within the last four weeks of not wearing the braces. My left central incisor moved forwards while the right one is rotating inwards. She looked at the models again and confirmed that she can see the rotation and understand that I want that fixed first. It could be corrected with fixed braces in 1-2 weeks and we'd be done with it. But I'm not too keen on that. Three small little brackets (boy was I in for a surprise) on the last three teeth are somewhat acceptable to me as they are required at this point and at least won't be too visible. But if possible I'd still like to avoid brackets on my front teeth. While I think she wasn't happy with that response, she said that my lower removable brace could be used after my molars and bite are fixed. Depending on how well I get along with the brackets, she may or may not keep them on some more time for stabilization. In that case the lower removable brace can be modified to work with the brackets still in place.
Either way, she wants to only tackle one movement at a time now. First the lower molar must be fixed. Only then we're going to correct the lower incisors. Once the permanent retainer is in and my lower jaw finished, we'll get back to the top jaw. Upon the end of the treatment, she suggested a top retainer with full posterior and anterior acrylic coverage as bruxism night guard. That way I likely won't need a permanent retainer for my top jaw. (I was slightly surprised by that statement as she previously vehemently insisted on permanent retainers for both jaws, always citing that removable retainers may not be worn regularly enough. I guess she can see that weartime won't be a problem with me
)
After she told me all this, I was somewhat overwhelmed. It wasn't that I didn't expect something like this already. On the contrary. During the week before the appointment I thought about possible treatment continuations myself. The posterior bite plate didn't work as it intruded my molars. The anterior one intruded my incisors too much. Thus, no bite plate it is, accepting some tooth wear until I'm finished with treatment. If my bite problems were due to movements possible with removable plates, they'd self correct or at least get better while not wearing my braces. However, the left side didn't change during the last two weeks. Therefore, the only logical conclusion is that movement is needed which requires fixed brackets. Still, I didn't want that to be the truth and tried to suppress those thoughts. Now with this actually being the reality I was startled.
As I didn't really respond, the ortho asked if she should repeat the treatment steps again. I answered no and summarized: First three molar brackets, then a removable lower plate for the incisors, afterwards a permanent retainer, and finally the upper jaw. She asked if I agree to the proposed treatment or if I want to sleep over it. I concurred that I ultimately kind of expected something like what she explained already. She asked when I'd have time to get the brackets bonded. She usually would have lunch break soon. However, knowing that I need an hour to the practice, she offered to do it right then and there anyway if I have time. I thought about sleeping over it, but decided there was too much of a risk of be chickening out of brackets. So right then and there it was.
I was led to the open treatment area chairs and asked to sit down. While the ortho prepared the brackets, the assistant cleaned, etched and dried the three to-be-bracketed molars. Once done, the ortho placed the brackets one by one, moved them around on each tooth a little and removed excess glue before the assistant cured them. I don't think she got all excess glue away, as I can feel some rough residue in some places. Next, she got a wire and cut off a piece. She said that she won't start me on a rectangular wire. A thin round wire should be plenty of force for the required movement. She started to thread it through my brackets, which surprised me. I'd expect her to lay it into the brackets and fasten it with ligatures, not thread it through them. I also realized that she never asked me about any ligature colour. While I had all of these thoughts floating around, the ortho was close to being done with the archwire, bent its edges in the front and back and clipped off a bit more in the back. During all of that I was incredibly tense and my heart beat very strongly and fast.
Not even ten minutes after sitting down everything was finished. My mouth was as drier than I thought it could get. My tongue, lips and cheeks were incredibly sticky until I wet them again. The chair was raised and I was handed a mirror to look at what had just been done to my teeth. What I saw was way more metal than I expected. It wasn't three small little brackets. It was more like three times a quarter of a molar band with a long tube instead of a small bracket glued to it, which were glued to my teeth. In fact there is less white visible than grey. Three large buccal tubes with hooks instead of three small brackets.
The ortho asked me how it feels apart from something I never wanted to feel. I was frozen from the realization of the large buccal tubes and couldn't formulate anything. She continued and explained that the brackets will feel very rough in the beginning, but the cheeks will eventually get used to it. As I had quite some problems with my cheeks with the removable braces, she gave me two boxes of wax and suggested to use it preemptively to prevent sores in the beginning. She further said that I can pull forward the archwire a bit if it moves back too far. And with that, it was done. I now had fixed brackets.
Parting, the ortho said that she wants to see me again in three weeks at the very latest. If nothing happens, or too much happens, or something weird happens, I should call her immediately for her to decide if I should make an emergency appointment.
The assistant gave me a date and time for my next scheduled appointment and I left.
Once home, I immediately went into the bathroom to look at my mouth in the mirror. The brackets were still just as large as when I left the ortho. Who would have guessed. The bracket on my first molar is straight on the tooth. The one on my second molar is low in the front and goes up towards the back, making the wire apply pressure the opposite way. The bracket on the wisdom tooth is moved towards the front to finish the derotation started with the lower removable brace. The way the brackets are placed and the way the wire is weaving through the tubes makes the teeth look way more out of place than they actually are.
Luckily I realized that even with the large size of the braces, they aren't visible when talking or smiling. Only when I smile wide or laugh, a trained eye can make out a little bit of grey. Also my webcam is low-res enough that even when I pull away my cheek and try to actively expose the brackets nothing can be seen in the pixely mess in meetings. So in that regard, I'm good.
In the beginning my cheeks took everything without any problem. I didn't use any wax during the rest of the day and also decided against using it in the night as I didn't feel anything. What an error that was. While my cheeks didn't hurt during the night itself, they immediately started to hurt in the morning. I've been wearing wax pretty much full-time until yesterday. It's nearly as if the ortho has experience with all that stuff recommending me to use wax immediately...
Honestly using wax doesn't feel much different to a removable brace. Instead of taking out the braces before eating, I need to remove the wax. After eating, I brush my teeth before applying wax instead of putting in the removable plates. Except when everything hurts, I can't just take the brackets out.
Eating didn't really change, except that the brackets are food magnets. As my right teeth are fitting better than the left ones currently, I've primarily been chewing on that side anyway. But even doing that, so much food gets stuck below the brackets and under the wire between the brackets. I'm not even chewing there. How does food even end up there?! Only having three brackets, it's quite easy to clean them though. After eating, I can get out most of the stuck food with my tongue and the rest with a rinse of water.
Brushing is similarly more complicated, but only a little. I can still brush over 90% of my mouth regularly. Only those three teeth require a bit more attention with additional cleaning using an interdental brush.
I can only imagine how much harder all of that is with brackets on every single tooth.
The first night was bad. Not because of pain, but because of the omnipresence of the brackets. Although I expected that fixed brackets might be among the possible outcomes, and agreeing to them, I'm still not fully accepting them. Neither am I really enthusiastic about them, nor am I completely satisfied with the status quo. With that in mind at all times I slept extremely bad and couldn't fall into a deep sleep, always needing to think about what happened that day and what I've gotten myself into.
Regarding pain, apart from my cheeks there wasn't any movement-related pain. My teeth are very sensitive to acids in general (e.g. when I eat lots of fruit or sour gummy bears, my teeth often hurt for some days). With the etching, I had the exact same problem. Although the ortho did apply a layer of fluoride after curing the brackets, even now there is one spot left that's extremely sensitive when I brush my teeth.
While I didn't feel any movement-pain, I did feel some pressure the first few days. Putting some ice cream on the brackets felt like a relieve. It wasn't that I actively felt pressure. It was rather that with cooling the NiTi archwire something I didn't feel beforehand was gone. Like with noise outdoors which suddenly stops. Even if the lawnmower outside doesn't really register, it still feels good when it is finally turned off.
When I wanted to add the appointment to my calender on Thursday, I realized that the appointment wasn't in three weeks time but in four. This was weird as the ortho specifically said she wants to see me the very latest in three weeks. I called the practice, only to find out that they are on vacation in that week, so the appointment in four weeks is correct. I slept over it but it didn't feel right. Even though the practice is closed on Fridays, the ortho said previously that she always answers emails. Thusly, I wrote a mail to ask if I should come back in two weeks time or if the appointment in four weeks is good enough. The ortho answered, asking how much pressure I felt and how much my bite improved already. As she was expecting very quick results, the brackets should have made a significant difference already.
I tried to provide a detailed description, stating that my bite didn't change much. The vertical gap between my first premolars seems to have closed a little, the wisdom tooth is derotating quite nicely and now has contact with the upper one, but I don't see or notice any difference with my molars. The step from my second molar to the first one (where the second one slid below the first) is still higher than on the other side. She responded that in that case I should come in after two weeks time and bring along my removable braces. I'm glad this was her response, as currently I'm in favour of more appointments rather than less. After all it was the long time of seven weeks between two appointments which started all of this mess.
In conclusion, I'm still somewhat dissatisfied with the whole fixed bracket situation. I need them, I agreed to them, I have them, they are there, but that's it. They are exactly how I expected them to be, a bit achy, rough, cheek-penetrating, and one heck of a chore to clean. While I think I can get along with them, and maybe even accept them, I don't think I'll learn to enjoy them. Definitely not in the way that I enjoy removable braces, which I do start to miss the feeling of.
At least I am now able to also experience some of the joys and challenges of fixed brackets. And they will allow me to experience having fixed brackets and removable braces at the same time, which I am very intrigued and excited about.
es passiert nicht sooo selten, dass man einen mit nen Headgear sieht. Manche mit Brackets, manche mit ner losen. Schön, dass es hier eher das Gegenteil ist.
