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Author Topic: My Journey to Removable Braces  (Read 10309 times)

Offline Embracer

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Re: My Journey to Removable Braces
« Reply #60 on: 30. October 2021, 22:29:14 PM »
How did your recent adjustment go?

Offline foobar

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Re: My Journey to Removable Braces
« Reply #61 on: 16. November 2021, 00:48:00 AM »
Last adjustment was rather quick and simple. I told the ortho about the painful spot I had, which made her grind away a little material from the inside of the bottom plate there just to be careful. I also explained that during the few days I couldn't wear the braces, the bottom teeth's height started to equalize partially. She changed the labial bow to only apply pressure to the one tooth she's currently moving (42) and created space between the labial bow and the other three incisors. Since then, the slightly intruded lower incisors did actually extrude. They aren't all perfectly equal in height, but that also wasn't the case before I started treatment, so it's probably as good as it'll get with removable braces. They're also just at barely different heights.
In the top the ortho activated springs to move out the incisors and canines that were "blocking my bite" (i.e. the only teeth touching when I tried to bite together). Even with those changes, I still can't really bite down. Only one molar and one canine are touching when I bite down. At this point I'm not sure if it's really the incisors that are messing up my bite, or if it's rather my molars having intruded due to the bite planes and clenching.
I mentioned my 21 still being tilted to the ortho. She explained that that kind of rotation can't be done with removable braces. I said that I compared it to 6 year old molds for my night guard back then and while that tooth has always been a bit tilted, it wasn't nearly as much as it's now since I started treatment. She answered that she can try applying force to the inside left of that tooth to maybe change it a little. Unfortunately, since then I haven't seen much improvement in that regard. However, when I was little, I broke of the right hand corner of that tooth which has been fixed with some glued plastic composite several times (since the plastic breaks off every few years). Maybe after treatment is finished, I'll have the corner reconstructed to give the tooth a more straight look, and not have such a noticeable step to the 11.

I observed that when the ortho activates springs to push out my upper teeth, she doesn't stretch out the springs as much as she bends them upwards. That explains why the plate always sits lower after adjustments and why I need several days to adjust to speaking again. I just have less space in my mouth after each adjustment.
Since the last adjustment, the plate is pretty low. You can even see a gap between my upper incisors and the plate hanging below them. When I'm concentrating on work and subconsciously suck a vacuum, my upper lip now gets caught in that gap, leaving marks which hurt sometimes. Interestingly, I noticed that those marks are happening mainly during the day when I'm concentrating and not during the night.
I'm used to years and years of marks in my cheeks and tongue, and I don't even notice those anymore. In one of the earlier appointments the ortho said that she was a little concerned about those. But I don't even notice those anymore. It's unfortunate that my body seems to have adapted to relieve stress through grinding, clenching, sucking, lip biting and similar means.

Since the adjustment, my upper teeth have been pushed so far forward, that there are noticeable gaps between them. In fact, even my upper labial frenulum now fits between my central incisors. I guess that's also a side-effect of my 21 having force applied only to the left side. Either way, that diastema is getting larger and larger every day and rather visible. I'm glad that I have the next appointment tomorrow in the hopes that those gaps will be closed. I still feel like while my bottom incisors are becoming better and better, my upper jaw becomes a construction site more and more. At least the upper wisdom teeth are staying in their positions even with their springs removed and seem to be done. To be honest, I kind of miss those springs and notice my tongue trying to play with them, but they aren't there anymore...

Offline foobar

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Re: My Journey to Removable Braces
« Reply #62 on: 17. November 2021, 17:34:39 PM »
Well, the appointment yesterday was very interesting!

It started very normal. The ortho asked me if my bite had improved since the last adjustment and if more teeth are touching now. I responded that nothing really changed and I still only have contact between my left canines and my left 7s. She reacted surprised and took quite a deep look at my upper teeth and bite. After also studying the notes in my file, she asked, what I think about completely leaving out the upper plate for now and only wearing the lower one, coming back for another appointment one week later. Now it was my turn to be surprised. She explained that she moved my incisors and canines outwards so much that they are starting to flare, yet my bite still isn't improving at all. She wants to let the upper teeth settle for a while to see if that helps.
After taking another look at the upper teeth, she shook her head and adjusted the springs for my 22 and 23 on the upper brace, saying that we can first try pushing out the teeth a little more.

Next was her examining my lower teeth. She noticed that the step from my left first premolar to the canine had become quite large. She explained to me, that the posterior bite-plane together with me clenching quite strongly and wearing the plates religiously way more than most of her patients, could maybe have resulted in my molars intruding. Which interestingly is exactly what I suspected in my last post. I wanted to ask her about this later during the appointment, but she came to the same conclusion beforehand. She fetched my impression model from before I started treatment for comparison. It confirmed not only that my molars intruded, but also that in addition my left lower canine extruded as it was not covered by the bite plane's acrylic. She said that she had never seen such a thing as all of what is happening with my teeth in her career.
She explained that she wants to extend the occlusal coverage to go over all lower teeth including the incisors to prevent any in- or extrusion. However, that will only be possible once my lower teeth are completely finished with the treatment as the acrylic is going to enclose all those teeth, locking them in place.

She went back to my models, the braces and her notes and thought for several minutes. When she came back, she suggested the complete opposite of her first plan: She asked me to only wear the upper plate and completely leave out the lower brace. As the lower left canine is the only tooth touching the upper plate's acrylic, that might result in the tooth intruding again and giving my molars space to come back up. Testing out how my canine interacts with the upper plate without the lower one, we realized that the canine slips to the side. The acrylic where my canine hits is also relatively thin, such that the ortho has concerns about it breaking off.

This was when the ortho decided upon a complete redesign of the plates. My braces will go back to the lab technician. The posterior coverage will be completely removed from my lower plate. The upper plate will gain an anterior bite plate to intrude that canine and give my molars space to erupt again.I took the chance to try and push my luck further. I again asked if it was possible to make the acrylic cover my full palate. This time I also showed her what I mean directly on the braces. I also explained the reason more, that I'd like to try to distribute the pressure of the acrylic more, as the plates had always left marks in the gum of my palate. I don't think that we talked cross points as we did last time, as she asked "The whole palate?", which I confirmed.

After writing down everything, she wanted to perform yet another slight IPR on my bottom incisors. They are getting better, but still have a bit too little space. So we went to the other area with three chairs next to each other, where she stripped away a bit more between all incisors up to the canines. I still can't get used to that feeling and still hate it as much as during the first time.
Then came another set of impressions. Every single time so far, the upper jaw required at least two impressions as my wisdom teeth wouldn't fit properly even on their largest (XL) impression spoon. This time, after three failed attempts by the assistant, the ortho used a bit of wax to increase the length of the spoon. Only then, with the fourth attempt, the impression was finally usable. The ortho checked that the impression of my palate was good as well, a further indication that maybe this time I might finally get full palatal coverage.
After getting fluoride applied for the IPR and making an appointment for Thursday, I was finally done with the appointment. The whole appointment took well over an hour. When I left, there ware at least 5 children with their parents in the waiting room.

All in all quite a rollercoaster of an appointment. I'm super excited for tomorrow and really hoping to finally get full acrylic palatal coverage. I also expect that I'll struggle with lisping for several weeks again.

Offline foobar

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Re: My Journey to Removable Braces
« Reply #63 on: 30. November 2021, 02:47:28 AM »
The appointment two weeks ago where I got back the modified braces went exactly as I had hoped!

When I was called back into the treatment room, my models with the plates were already laying on the table. Taking a quick glance I was able to see that the upper plate does go back quite a bit and that the front is pretty thick. The ortho said that she can't imagine anyone liking a plate that fills the palate that much. I mentioned that I'll probably be fine with it if that stops the acrylic from digging into my gums. She mentioned that those marks are clearly visible in the impressions, so we can at least give it a try.

Before getting into more details, here are images of my new-ish plates:

https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871058593624124/1.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871059168235592/2.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871059923206154/3.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871060460089374/4.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871061080838154/5.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871061659648060/6.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871062297215036/7.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871062804705290/8.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871063509364758/9.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871064138502154/10.jpg
https://dereferer.me/?https://cdn.discordapp.com/attachments/863502137362743399/914871150117535764/11.jpg

When I sat down, the ortho first showed me the lower plate. The thick posterior bite plane has been removed, making the brace look quite delicate compared to before. The acrylic on the inside goes back further than before, stopping after my wisdom teeth. She explained that she had the tech incorporate a spring to derotate my 38. She also noticed that my 48 is rotated slightly, so another spring for that one was added as well. She inserted the lower brace into my mouth and it fit surprisingly well on the first try. There were a few rough corners and edges, which were fixed, and that was it for the lower plate.
Then came the upper brace. Upon inserting it, it hung quite low and didn't feel right. There was at least half a centimeter between it and the roof of my mouth (that's 0.000003 miles for the non-metric speakers). I tried to tell that to the ortho, but whichever sounds came out of my mouth were very far away from what I wanted to express. I just couldn't talk. I've never had such a strong lisp. Not even when I initially got the braces. Somehow the ortho was able to understand whatever I tried to say. After some grinding and me saying where the acrylic was poking into my gums, the plate fit better. It wasn't perfect and there was still a little gap between my palate and the acrylic, but it was good enough. The next step was to investigate the bite plate. She had me bite down several times and used marking foil to see where my teeth and the bottom plate were hitting the top plate. She removed some acrylic from the bottom plate and the right side of the bite plate to ensure that only my left canine touches, to intrude it.
After everything fitted and was done, I asked her if she could polish the plates to remove the roughness from the drill bit, which she did. No springs were activated as I should get used to the new braces first.
She stressed repeatedly, that if there is any problem or anything that bothers me, especially with the palatal coverage, I should call immediately and make an early appointment even though my next scheduled appointment will only be two weeks after.

Since then, I fully enjoyed the new braces. The upper plate almost entirely covers my hard palate except in the back middle, where it could go back slightly more for my liking. It is quite thick in some places, especially where it becomes the bite plate. The bite plate itself feels crazy huge in my mouth even though it doesn't look that large to me just looking at the brace. My tongue has very little room and needs to sit quite far back.
I expected the lower brace going back pretty far not to be much of a problem. Surprisingly, it does interfere with my tongue's normal resting position. My tongue now rests on top of the acrylic of the lower plate and in the vertical gap between my teeth created by the bite plate, making the space feel even more restrictive. The springs for my lower wisdom teeth poked my tongue in the first few days, but I got used to it.
Speaking is a whole different beast. It's similar to when I first got the braces, but even more severe. I've actively practiced talking and reading aloud. It's gotten better and I'm understandable, but I notice a strong lisp and quite some mumbling. In retrospect, while previously my mouth was very full, the "talking" areas weren't that inhibited and only few sounds were affected. The bite plate and full palatal coverage do interfere strongly with most sounds.

Due to my negative-pressure-sucking the upper brace seems to have deformed a bit and now fits snugly in the roof of my mouth. I can't feel or see any marks created by the acrylic in my gums, so that part seems to be working as I hoped it would. Unfortunately with my tongue not having much space, it presses into the expansion-screw slots, which hurts at times. I did think about these rough edges during the last appointment and wondered if I should have the ortho smoothen them. But I thought that maybe they won't be a problem this time. Welp, guess I'll ask her to smoothen the edges during my appointment tomorrow.

Offline Embracer

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Re: My Journey to Removable Braces
« Reply #64 on: 30. November 2021, 14:55:35 PM »
Wow that upper brace is now enormous with a very thick bite plate!  It is amazing that you can speak at all. I would say that the acrylic goes about twice as far back as that of my recent hawley ( I have no first premolars ) and it is at least double the thickness. And I thought my hawley was fairly bulky. Does the bite plate show beneath your incisors? Is there a danger of this bite plate allowing your molars to erupt further, leaving you with an anterior open bite? Presumably your ortho will be keeping an eye on this.

Fixed braces are very much the normal approach in Europe these days, but quite complex orthodontic work was done with removable braces maybe 40+ years ago so it is interesting to see your ortho having a go at it. If I were in your shoes, I would ask the ortho to finish off with fixed braces anything the removable ones can't  achieve so your teeth are as good as they possibly can be after all this effort. But kudos to you both for using removables.

Offline Embracer

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Re: My Journey to Removable Braces
« Reply #65 on: 30. November 2021, 15:26:16 PM »
PS  You probably now have space for two additional expansion screws.... :)

Offline bracessd

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Re: My Journey to Removable Braces
« Reply #66 on: 30. November 2021, 16:54:27 PM »
Those look great!

Offline retained

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Re: My Journey to Removable Braces
« Reply #67 on: 30. November 2021, 22:14:04 PM »
Looks great. I fully agree with you about wanting full coverage.
Yes, it looks very thick, and that certainly will add to the experience. I am sure you will get fully used to wearing them quite quickly.
Its very strange that my thickest, fullest coverage plate with bite plate area is the one I can speak with best. Not sure why. It also makes 'S' sounds easier and more forward.
I do find that my bottom retainer makes speech more difficult although its quite small and fits perfectly and tightly.

Offline Embracer

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Re: My Journey to Removable Braces
« Reply #68 on: 02. December 2021, 11:01:20 AM »
PPS Why do you have an adams clasp at one side of your upper brace but arrowhead clasps at the other side?

How did your adjustment appointment go?