English > Orthodontic Treatment

Looks like I’ll be getting braces again!

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Person:
It looks like I will be getting braces for the second time! It’s not totally decided, at least not where and when, but here is where things stand so far (I'm breaking it up into multiple posts in this topic).

My orthodontic background: I got braces when I was 13 (back in 1998). full metal brackets, bands on my first molars, elastics, and a removable biteplate for roughly 6 months. My teeth didn't look bad before getting braces, but I think it was at least partially to correct a deep bite. The orthodontist I had never explained what was going on (called the biteplate a retainer, and I was given no warning that I'd have one; one appointment they just set it down on the table and tell me that I need to wear it), and I can remember at the consultation, he just talked to my mom and didn't really talk to me. I got my braces off after 15-16 months. I was given an essix upper retainer and a permanent lower retainer. I did a good job wearing the upper retainer for the first two or three years, I think, but then mostly stopped wearing it. The deep bite came back pretty quickly (recollection was maybe even within a few months of getting braces off).

So, fast-forward to now. Starting about a month ago, I noticed that when biting down it didn’t feel the same on the right side as it did on the left side. Looking in the mirror, I could tell that the teeth on the right weren’t meeting together the way the teeth on the left did. Luckily, I had a normal dentist appointment scheduled for about two weeks later.

Before that, though, I found a highly rated orthodontist in my area who had a thing on their website for a virtual consultation. It guides you through taking a few photos of your teeth and submits them to the ortho’s office to be looked at (some googling and it looks like a lot of orthodontists around the US offer this same service using the same software, SmileSnap). They called me after a few days and told me that I had an edge-to-edge bite on the right side, where the teeth bite down on the cusps, instead of fitting in between each other. Didn’t give me a price or length of treatment over the phone, but asked if I wanted to come for an in-person consultation. Told them not at the moment, since I wanted to talk to my dentist and my wife before scheduling an in-person appointment with an orthodontist.

Told my wife that my bite wasn’t feeling right and didn’t look right, and that I’d be bringing it up to the dentist even though I pretty much knew the only thing they could really do is recommend seeing an orthodontist. She basically said let’s see what the dentist says.

At the dentist office on May 3rd, I mentioned it to the hygienist first when she asked if any teeth were bothering me (they always ask that right as I sit down). The hygienist didn’t seem to believe me that something was off, even though I told her that I had sent photos to an orthodontist and what they had said. After my teeth were cleaned, the dentist came in and I told her. She kinda looked at it some and was asking me questions like “Did you bite on something really hard? Did you get hit in the face?”. Which, no, nothing like that happened. The dentist did agree that the right side wasn’t quite right, and so she recommended two additional orthodontists that I could get opinions from.

I scheduled consultation appointments with those three orthos. One that my dentist recommended didn’t have an open consult appointment until late July! And this was scheduling in the first week of May! That office is also not open Fridays.

I’ve had the first two consultations, but I’ll make those as separate posts in this topic. Starting a little before the dentist appointment and going until those two consultations, I have also felt a tiny bit of tenderness if various teeth here and there, which leads me to believe that things have been pushed around in the last month as my mouth is adjusting to what's happening with my bite.

Person:
First consultation (Ortho A)

Had my first consultation last Friday. This was the orthodontist whom I sent photos to through their website.

They took photos and a panoramic x-ray there, and then had the orthodontist come in to look at my teeth and bite and measure and evaluate it. During this, he said "class 2 div 2", class 2 division 2, which I hadn't heard of divisions of class 2 before, but looking it up after the fact it means upper teeth are too far forward, but my upper incisors are tilted back (retroclined), which hides the amount of overbite. He explained this about my teeth without specifically telling me the classification terminology (though the letter that they said they will send my might, I don't know). So, what I was noticing that didn't feel right was the class 2 on the right side (left side is really close to class 1). I also have a significant deep bite, and a moderate curve of Spee. There are also a few small things that have mildly annoyed me for years, but none of which are bite issues that are causing issues.

With how my bite is, the teeth on the right side could wear down each other's cusps, and the deep bite with retroclined incisors will eventually cause my lower incisors to be worn down, too, against the backs of my upper incisors. I have to slightly pull my lower jaw back to bite down on my back teeth, because of the deep bite and retroclined incisors.

Here is what this orthodontist recommended:

First, brackets across the top front 8 teeth, first bicuspid to first bicuspid, for 4-6 months. This would be to correct the tilt of the upper incisors. Overbite would seem to get worse during this.

Then, they would remove the brackets from the bicuspids and canines (leaving the brackets on the incisors), and give me a Carriere distalizer appliance on both the upper right and upper left, canine to first molar. I would get bands on my lower first molars to hook the elastics to, with a lower lingual holding arch connecting the bands. This would be for 4-6 months, to correct how the teeth in the back match up when I bite down.

After that, the Carriere and lower lingual holding arch would be removed and I would get full braces, with box elastics to close up my bite in the back. If necessary, they would give me bite turbos on the back of my upper incisors to keep me from biting on the lower front brackets.

For retainers, they would give me an upper essix and lower permanent retainer, like I had before. However, they would also give me a lower essix for wearing at night. I appreciate this idea, since my lower bicuspids and molars moved after braces the first time and they had no retention. Also, and I found this very interesting, they would give me a clear upper retainer with acrylic behind the front teeth that my lower incisors would bite down on, like a biteplate, for wearing at night. This would be to prevent the deep bite from coming back and to provide transverse support (I think that's what the treatment coordinator said; I guess it provides stiffer support to the arch width that a normal essix).

Total treatment would be about 18 months, for $7,175. About the top end of what I was expecting to hear for the price. Clear brackets would be an extra $350.

There are other treatment options they could suggest if I just wanted to fix the alignment of one or two teeth or something (my left lateral upper incisor is a little further back than the other incisors, for example), but it wouldn't fix my bite, and that's what's bothering me and causing issues ("wreaking havoc" in the words of the treatment coordinator).

This office uses only Damon braces on all patients, except young kids who have expanders; they said they use the traditional twin brackets on those patients' front teeth (I don't know why). The treatment coordinator did mention that teenagers at their practice do still enjoy getting colored ligatures, but based on the models they showed me, it looks like they just put them entirely behind the archwire.

I really liked the treatment coordinator, who explained a lot of the details and answered a bunch of questions for me, though I wouldn't really interact with her as an active patient (though she said I can always email her during treatment if I have a question of what something is or why we're doing something). The office isn't too close to my home or work, but it isn't super far, either (15-20 minute drive, depending on traffic). I think it would be interesting to have the Carriere and the lower lingual holding arch (I've always wondered what one of those or a TPA would feel like to wear), but having brackets on just the front four teeth during this makes me wonder a little if it'll make me look like a little kid (I'd be even more worried about this if I had shorter hair and no facial hair). The downsides of essix and permanent retainers have annoyed me, but it does seem like, with diligent wear, they can do a better job of holding teeth in place than hawleys. The extra retainers for night is appealing to me, since it eliminates some of the concerns I've had with the retainers I have/had after having braces the first time. Kinda glad the clear brackets cost more, since I'd prefer metal and wouldn't want my wife trying to talk me into clear (I have no idea if she'd even have a preference).

Don't know if I'd ever try to ask for colors on the Damon braces; one of my regrets of my first time with braces was not trying out other colors and color combos. I just had blue ligatures and powerchains the whole time because I was afraid of any attention I'd get if someone pointed out or commented on the color on my braces changing. Looking back, this was a ridiculous worry, since literally like a quarter to a third of the kids in my grade had braces at the same time.

Overall, walked away from this consultation with a positive feeling about the office and the treatment they recommended.

Person:
Second Consultation (Ortho B)

I had this consultation this past Tuesday. This orthodontist was recommended by my dentist. The office is pretty close to where I live, and I have heard of this orthodontist. Some people I went to school with probably got their braces from him. He has a very good reputation (in fact, on their website he claims to be "one of the most celebrated orthodontists in the entire Midwest"; at most I think this might only be slightly exaggerated).

Different feel to the office. Ortho A's had a more open feel, with higher ceilings in the reception area and longer sight-lines. This office felt much more closed in (probably mostly just because it's a bit older of this type of building). While sitting in the waiting room, saw an ortho assistant walk a young girl (maybe 8?) out to her mother and overheard her tell the mother that the girl would continue to wear her headgear at night.

Again, had photos and a panoramic x-ray taken (this x-ray machine would talk, it was kinda weird). Orthodontist comes and examines me. Discussing what he saw, it's the same diagnosis as Ortho A, though before he explained things he stated that he's very conservative about removing teeth and never wants to remove a healthy tooth. I appreciate hearing this, but I wasn't under the impression that was something I personally would be presented with. Ortho B spent more time talking about how my teeth could wear themselves down. He said that in 15 years, I'll probably find my lower incisors feeling rough as they sort of get shaved down by my upper incisors.

The models on the desk were only Damon braces again, so I don't know if this orthodontist uses traditional brackets on anyone.

Ortho B, pointing to a model on the desk, said that most adults coming in want clear brackets, and he can do that, but he said the metal Damon braces have ben updated a few times since the clear ones have been, and so they just have a higher level of technology. He said if I were his son, I'd get metal.

Recommended treatment is very similar to Ortho A Just some of the details are different (I wonder how much of this is that these two orthodontists used to share a practice, and how much is they are both very good orthos who honed in on the same issues and how to correct them). I am curious about the differences, and may contact them later to ask why.

As to the differences, Ortho B would start with brackets on all upper teeth when tilting the upper incisors. Same 4-6 month forecast. Then, he would also place a Carriere on both sides, but one tooth further back, first bicuspid to second molar (my wisdom teeth were removed several years ago). Instead of a lower lingual holding arch, he would put the lower brackets on at this point. He would leave the upper brackets on the incisors and canines. This would also be for 4-6 months. After the Carriere is removed, brackets would be put back on all the upper teeth. No description of what kind of elastics may or may not be needed at that point. I asked the treatment coordinator (after the ortho had left), and she said the deep bite would be corrected by the braces, but didn't elaborate on potential elastics or bite turbos or anything.

Retainers would be exactly what I got after I first had braces, upper essix and lower permanent. No extra nighttime retainers. The orthodontist did say that if I really wanted, after 5 years or something they could remove the permanent retainer and give me a lower essix. He said he's a big fan of permanent retainers and remarked that his oldest daughter (who is an orthodontist at this same practice) has had hers for 20 years. I've had mine for 23 now.

Total time for treatment is estimated at 21 months, maybe less if I'm really diligent with elastics wear. Cost would be $8,415.

Ortho B mentioned that he doesn't recommend invisalign for my case because, as attentive and detail-oriented I am with what's going on with my teeth, aligners couldn't get 80% of what I want and I'd be unhappy with the result.

I did not have quite the same positive feeling from this office. I'm sure the results would be great. However, the treatment coordinator wasn't as friendly and didn't go into as much detail about things (luckily I had had so much of basically the same thing explained in lots of detail four days earlier). She also kinda confused me about one or two things, though they did get straightened out. For example, when she showed me the form explaining the cost, she went through it explaining how paying in full or monthly payments would work, and then just sat there looking at me for a bit. She then said she'd like to make a copy of it. I said okay, and looked back at her. After an awkward few second, she finally asked if I needed time to think about it or if I'd like to get started. My interpretation of what happened is that she expected that I would want to start right away and so I'd sign the form, but she never asked that or even asked me to sign it. The treatment coordinator at Ortho A's office explained the same kind of form, but then did ask my to sign on a second blank, and explained that (at least for their office) signing was not any kind of obligation and just showed that the costs had been explained to me. Ortho B himself didn't give me significantly different vibes than Ortho A himself, but between the less positive interactions with the treatment coordinator, the $1,200 price difference, and not having the nighttime retainers that while maybe not necessary would make me feel more sure of the results being maintained long term, I feel pretty confident ruling out Ortho B. I think I may prefer having more brackets earlier and longer during treatment, but I can't justify that price difference with just that, and the lower lingual holding arch from Ortho A might be interesting.

Person:
What to do now

Discussing what the dentist and orthodontists have said, and how it has felt weird to bite down, my wife does agree that I should probably go ahead and pursue treatment. It is a lot of money, but we can afford it; it'll just push back house projects we want to do. Fixing my bite now and preventing the wear will be less expensive (and painful) and more healthy (and comfortable in the long term) than waiting until the teeth have gotten worn down and I need both orthodontic treatment and restoration of the teeth.

The treatment coordinator at Ortho A's office said "You're going to need braces and some kind of correction at some point in your life", and then told be about an 84-year-old patient they have whose bite has beaten up and worn down his teeth his whole life. His dentist can't restore it because the there's not enough space (as your teeth wear down, your bite closes down), so he's in braces to open up the bite and make space for the restoration. So why wait until that point? She said I'll have to address it at some time in my life, when just might depend on budgeting and what's going on in my life, but it will be a priority at some point.

Now, I have a couple decisions to make.

Do I seek a third (or more) consultation? I think I would be happy with Ortho A and what they've proposed. If I went to another consultation, and I wasn't quite as positive about them but they were noticeably cheaper, I'd feel odd telling my wife I want to spend $1,000 more or whatever just because I had a more positive feeling about the office and the people there. On the other hand, getting an opinion from someone who doesn't use Damon braces and maybe doesn't use Carriere appliances would be interesting to hear how they'd approach it.

I do have a consultation scheduled with the other orthodontist my dentist recommended (Ortho C), but their earliest consultation appointment wasn't until late July). If I'm going to get braces, part of me wants to start sooner so that I'll be that much sooner to my bite feeling comfortable again. On the other hand, my bite is going to be off for those two month either way, since it'd be 4-6 six months before the Carriere begins to correct that, and 4-6 months after that before it should be corrected. So my bite might be off, potentially still feeling wrong, for anywhere from 6 to 12 months. In light of that, starting two months later doesn't seem like a huge deal. A couple months of potential wear probably isn't much, considering Ortho B talked about really noticing the wear in 15 years or something.

I could still seek more consultations that are sooner than Ortho C, and just cancel that appointment. However, Ortho C is highly rated, like Ortho A and Ortho B, and in a fairly convenient location. Looking up other top orthodontists in my city, there aren't any in convenient locations. Not that they'd be hard to get to, but they're not near work and home, or along my commute somewhere. Ortho C being scheduled so far out shows high demand, I guess, but also leaves me with a negative impression. His office is only open Monday through Thursday, but open a little later than others. I'd be trying to make all my appointments during my work hours so that I can still get home in time for dinner and helping my wife with our young kids, so Ortho C's office hours are a turn off, as well (mostly that they’re closed on Fridays, but also don’t want them scheduling something for like when I’d normally be sitting down for dinner with my family).

My wife didn't voice an opinion one way or the other when I mentioned that I'm not sure if I should wait until the consult with Ortho C, find a different ortho sooner, or just go with Ortho A.

If I leave it at the two consultations I've had, I'm going with Ortho A. One thing my wife brought up and would make sure to do first is to get a credit card with a good promotional offer (of the "spend so much in the first few months or year, and get this much extra cash back or rewards points"). The orthodontists do take credits cards, so paying in full up front would hit that and more.

Person:
It's kind of exciting to thing that I'll be getting braces again. I've wanted to have them for a second time for more than 10 years at this point, I think, but didn't have (or hadn't noticed) any issues that justified spending thousands.

It's also weird to think about for a few reasons. One is that if you just see me talking or smiling, you'd probably say my teeth look straight and I don't need braces (or at least most people would; people here might notice the incisor that's a little out of line; my wife couldn’t really even notice how that tooth was different after I pointed it out to her). I have family and friends with teeth that are significantly more out of alignment, at least what is visible when they talk and smile, so it feels weird that I'd seek treatment and they wouldn't, but maybe they just really don't care. My mother's upper incisors are similarly retroclined, or maybe worse, and her upper arch is narrow and kind of V-shaped, but I've never heard her express any dissatisfaction other than the slight gap between her two front teeth (her childhood dentist cut her frenulum to try to let it close up some when she was a teenager, I think).

I don't want to have to explain to people why I have braces in my late 30's, but I have a legitimate reason so it shouldn't be hard, I guess. Nice in some ways that I'll be done with braces, and mostly done with 24/7 retainer wear, before I turn 40.

At the very least, I'm waiting until I get the letters with the measurements and diagnoses from Orthos A and B that they said they'd send before officially making a decision (not that those should really influence me, but I want to see just how similar they are).

I wanted to post all this here since I thought people would find it interesting. I know I included a lot of detail. I’ll continue to post here as things progress, and I can try to answer question you all might have for me.

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