Long time no update. Since the last update I had two appointments and the next one is to follow on Tuesday.
When we last left off, I spent 7 weeks doing nothing and letting my bite settle. I didn't notice much improvement. Neither did the ortho. There was still just barely contact between my left first molars. She asked me if I'd like to try elastics again, possibly making my tmj act up again. I accepted as I don't really know what other option there would be. Also the pain usually started after 5 weeks, so trying them again for 4 weeks might just be enough.
She gave me a wax marking paper to take home. She said that I can test myself if the bite improved. Once I'm satisfied, I should continue wearing the elastic for about a week for retention but could then stop.
I told the ortho about me wearing the upper plate a few hours every few days, trying to wear it as little as possible, which made my left upper lateral incisor move outwards and back again. She stated that it's not healthy for the tooth to move back and forth all the time.
She suggested that I could wear it during one night, come to her office in the morning and she'll bond a permanent retainer for my upper jaw. However, as I'm not satisfied with the upper incisors yet, especially since the gaps behind the canines opened up again, I rejected.
Over the next four weeks, I tested around with some wear times.
When I use the removable plate during the night, my bite feels off a bit in the morning, which gets better after breakfast.
Wearing the removable plate while actively thinking not to suck negative pressure I don't notice adverse effects.
However, if I didn't concentrate on not sucking, it gets worse again. For example when working from home, just 2 hours affect my bite more than the 8 hours of weartime during the night.
I also tested reducing the time using the elastic. In the end I settled on wearing the elastic 12-14 hours during the day but not during the night. During the night I put in the removable plate.
This seems to resolve the tmj issues, as I didn't notice any tmj pain or problems anymore since switching from full-time wear to just during the day.
My bite not feeling much better during the 7 weeks of settlement may be due to the incisor. Wearing the plate every night moved it further out of the way and my bite in general felt way better.
Unfortunately, after about 3 weeks, I noticed that my premolars started to lose contact. I checked with the wax foil the ortho gave me, which proved it. The contact of the first molars improved distally, but still lacked mesially towards the front.
There was one more complication though: the elastic between the two molars tilted them inward. It even reached a point where contact started to deteriorate.
Thus, I stopped using both the elastics and removable plate a week before the next appointment. Both the molars and premolars got better again, but the incisor moved back. Luckily it didn't affect my bite just yet during the appointment.
That next appointment was 4 weeks after the previous one. The ortho checked the bite and confirmed the same improvements I was seeing. Distally the molars touch well, but mesially it's still lacking just a bit. Also contact between the premolars did suffer a little.
To fix the molar contact mesially, she suggested removing the button on top and the bracket from the lower first molar and replacing them with elastic hooks mesially on the tooth. That ensures the elastic force is focused in the front and should also reduce inward tipping of the molars.
Removing the glue from my upper molar was pretty painful as that tooth is extremely sensitive. The rest was quick and uneventful. She used metal buttons with loops (
https://noreferrer.me/?https://www.gcorthonline.com/wp-content/uploads/2019/02/42-0030-0000.jpg). The upper one is pretty visible when I smile wide, though I don't expect most non-braces-affectionate people to notice.
My lower left wisdom tooth rotated back quite a bit since the wire through the three brackets was removed, which is something we need to tackle again. I'm not sure what she is planning in that regard. Maybe also using elastics as she suggested during one of the first consultations? I guess I'll see when we get there.
I asked the ortho what she thinks about a case study I found where the holding clasps of a retainer resulted in a degradation of bite, so they switched to a modified wraparound hawley (
https://noreferrer.me/?https://moroortodontia.com.br/leitura/wraparound.pdf). I asked her if she thinks something like that might work in my case.
She thought about it a bit before discussing that it could work and we might as well just try it. She said for me it would require the full palate to be covered in acrylic as otherwise I'd have the slightly painful impressions of the plate in my palate again. But before tackling the upper jaw again, she first wants to finish fixing my occlusion.
I mentioned that this might be one of the last possibility to spare me of a fixed upper retainer. She agreed that if we can get such an appliance to work without (or at least with controllable) side-effects, it could be used as retainer.
This means that I'll get another quite hefty removable upper brace some time in the future with some nice pictures
Since that appointment, I stuck with wearing the elastic during the day and the upper brace during nights. So far no major tmj issues, although my right jaw joint is starting to crack a little.
The contact between my left first molars feels pretty much perfect, so the new elastic hooks definitely helped. Apart from that, the incisor is still nagging, and due to wearing the upper brace the contact between the premolars is lacking slightly.
I'll wait and see what the ortho will do on Tuesday and how we're going to proceed.
