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My Journey to Removable Braces

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foobar:
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://dereferer.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://dereferer.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.

bracessd:
Thanks for the update! Looking forward to seeing some progress pics...

foobar:
I'm practically living the dream. I currently have all at the same time
• 2 brackets with a wire
• 2 buttons for elastics
• elastics
• a removable upper brace
• a bonded fixed lower retainer

Previously I had
• upper and lower removable braces at the same time
• a lower removable brace with a thin posterior bite plane (2mm)
• a lower removable brace with a thick posterior bite plane (10mm)
• a thick upper anterior bite plate filling my whole palate

In the future I'll have (or at least will have the option of)
* a lower bruxism guard (also to be used as retainer instead of or in addition to the fixed retainer)
• a wraparound-style active upper plate filling my whole palate with buccal acrylic
* maybe a fixed retainer on the lower left to retain my wisdom tooth
• maybe an upper fixed retainer over 8 teeth including the first premolars
• technically I could ask for brackets to fix my upper incisors and canines which the ortho would probably like a lot (but I won't)


Last update I wrote that the contact between my molars feels very good now. During my last appointment, the ortho checked using wax foil and saw some improvement, but said that I should continue wearing the elastics.
She inserted a wire to the two brackets on my lower left second premolar and wisdom tooth to derotate the wisdom tooth again. She said that she'll use a round wire to not tilt my molar. However, when I got home, I noticed that instead I have a thin (height) but wide rectangular wire. She bent a step into the wire as my molar and wisdom tooth are at different heights.
She considered if we should start with the new wraparound upper plate or wait another appointment. In the end she decided to wait for now so any deteriorations in the bite of my left molars can be traced back to the new wire. Additionally, she hopes to remove the elastic buttons next appointment to make the design of the upper plate easier.
She said that she's a bit concerned about the next step as she expects complications all over the place again, just as we experienced so far.

In the first week after the appointment I felt my bracketed teeth moving and the bite worsening so I didn't wear elastics to better be able to notice any changes. After a week the bite felt better again and I started to wear the elastics during the day. During nights I wore the upper plate for 4-5 days a week with a 2-3 night break.

For my appointment in two days I see several different options. If the wisdom tooth is derotated, I may ask for a bonded retainer there (which she mentioned as option quite some time ago) to retain them until I get the lower bruxism guard (which will then be used as retainer), because the wire through the brackets is pretty sharp. If the elastics worked, I assume that at least the upper button will be removed and I'll get the new upper plate. If not, I wonder if I'll still get the upper plate designed around the button and will still need to wear elastics. I could also imagine that she'll want to let my bite settle again for a few weeks before starting with the next steps.
I'll have to wait and see.

foobar:
Last appointment was uneventful. My wisdom tooth wasn't fully derotated yet, so the ortho added another bend to the wire. The bite where I wore the elastics was fine, so I stopped wearing them. And with that, the appointment was already pretty much over.

I asked the ortho if it's possible to pull my wisdom teeth more together as I feel the vertical gap between them could be reduced. She was rather apprehensive about it as they do have contact when testing with the wax foil. She also sees an indentation in my cheeks between my wisdom teeth on both sides. Even if she were able to pull them more together, the pressure from my cheeks may open the space back up.

I'll ask her about it again during my next appointment on Tuesday. I haven't gone through a two year treatment already not to have at least tried to get a fully satisfactory result. And it's a way to increase the time in braces :)

foobar:
Before last appointment I used polymorph (plastic which is moldable when warm) to create a bite registration ish to test and see how my bite fits currently. To my untrained eyes it looks pretty good, all teeth have good contact. I showed it to my ortho during last appointment, who was amused to say the least. She said my bite looks very good. She wants to take impressions for an analysis model to confirm that we're done with my bite. If that's the case, she recommended that I schedule a visit to my dentist for a lower bruxism night guard. I reminded her that the gap behind one canine is opening back up slightly, and that I'd like for my upper and lower incisors to touch, i.e., if she can pull them back a bit. With these slight modifications still open, I asked if it makes sense to have the night guard made now as it's adjusted to the bite and contact positions of the upper teeth.
She concurred that she'll first make the upper wraparound style retainer. By applying pressure to the labial bow she'll push my incisors back and thus also the canine.

I had one upper and lower impression made for the analysis model and another upper one for the wraparound retainer. They bought new impression trays just for me as the other ones never really worked that well for me. But those trays didn't have a palatal section. The first upper impression had a large air bubble and was thus unusable for my retainer that should fill the full palate. The solution for the second and third attempts was to first fill my palate manually with the impression material and then use the spoon. Which meant that my mouth was overfull with the impression material and it oozed everywhere.
The next appointment was scheduled for in two weeks time (which is tomorrow).

During that appointment the ortho asked me if I'm still apprehensive regarding the fixed retainer. I have less problems with it than I expected, but I still don't like food getting stuck there. She said that her treatment plan always intended the fixed retainer to be used. But if I really want to get rid of it once I have the lower bruxism guard, she'll remove it against her recommendation.

And wouldn't you know, when flossing last Thursday, the retainer came loose from my right canine. I called and went in that same day. The excess glue was removed, everything cleaned, etched and the retainer glued back to the tooth. The glue blob is way larger than before, giving it an even more artificial feeling.
The wraparound plate was already finished, so the ortho test-fit it. If it were to need a larger adjustment with new impressions, those could be done until the scheduled appointment 5 days later.
To fit the plate, first the elastic hook on my upper left first molar needed to be removed. I find it interesting how strong the hook is held on the tooth, but how little force is required to pop it loose. As that tooth is extremely sensitive, the ortho was very careful when grinding away the glue and applied lots of fluoride varnish afterwards.
The plate fits well. Only few small adjustments were needed like bending the wire in one place and grinding away some acrylic. She checked that I don't bite into the acrylic and only my teeth touch, for which she needed to grind away a bit more in the front. I was told to try wearing it for 10-12 hours a day and see if I notice any adverse changes. The ortho will start activating the string and labial bow during the next visit tomorrow.

I didn't get to choose a color and expected blue to be used just like for all my other appliances to far. Unfortunately, instead, it's transparent, which from my experience with the previous bruxism guard will quickly turn yellow-brownish (which is why I went for blue).
The wire is very thick, thicker than any of my previous plates.
The acrylic starts at the tooth and covers all of my hard palate, exactly as I wanted. It goes back very far to behind my wisdom teeth. It's rather thin, especially towards the back.
I (unfortunately) don't have any kind of lisp when wearing it. I was exited for some kind of lisp. But there's nothing. Even when it was first inserted, I didn't have any trouble speaking. If you didn't see me wearing it, you wouldn't be able to tell.

It fits rather nicely. It was applying lots of pressure on the inside of my upper right first molar. I took the liberty to use a small file (intended for 3D print cleanup) to file away bit by bit day by day from the plate at that tooth until now it doesn't apply that much pressure anymore.
I also bent the labial acrylic down and to the left a bit because it wasn't touching my incisors but pressing significantly on my gums. The right U-loop was also pressing into my gums, so I bent it away a bit.
The back edge of the acrylic was very sharp and dug into my palate. I used some sandpaper to round it, but didn't get far as it's so thin. I think about asking if it could be made thicker to better round it. The sanding helped a bit, but could be better.
These were only very slight modifications and the plate does fit way better now. I don't know if I should tell the ortho tomorrow or if she will scold me for it.

To conclude, here are some images of the wraparound retainer:

https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/1102593341696254013/1.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/1102593342170214410/2.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/1102593343080382534/3.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/1102593343654998157/4.jpg

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