Not the crown! and other news

Well, back in October I apparently slept clenching my teeth sooooo hard that when I woke up I had pain my my 2nd to last molar of the lower jaw. Both of those last 2 molars have crowns but only the last one has a root canal. The one experiencing the pain was the 2nd crown (luckily I only have two which is more than enough).

I thought it was fractured and only kept together by the crown. A couple of days of very uncomfortable pain. I had to take some pain killers and typical of Dutch medical care I had to wait a couple of weeks before I could be seen by a dentist. This one was specialized in "fearful patients" and endodonthics (root canal).

She looked at it and told me the pulp at the end of the root was not infected but irritated but so far no need for a root canal. I was supposed to have a follow up 4 weeks after prior to my trip but by then I was so busy that I had to cancel. The pain had gone away.

A few days ago (already abroad) I decided to bite some peanuts (not hard) on that side and since then the crowned molar is acting up. I don't think I will have time to visit my orthodontist any time soon so I will probably have to deal with it here.

As for the jaw surgery I am doubting whether I should proceed with it. Now I have a calcium and vitamin D deficiency caused so I wouldn't want my bones to be hammered and cut when I have a calcium deficiency. I just hope my teeth don't break when they remove the braces. Oh yes, I am also thinking of just having them removed and go on the rest of my life as I am so far.

An inspiring jaw surgery video

To this date I had only seen jaw surgery videos that while they portraited the positive sides they also freaked me out big time!

Well while facebooking in the jaw surgery FB groups I was pointed out to this video. Really reassuring.

Post jaw surgery video

Now one of my remaining problems is that my insurance in the country where I will have the surgery sees it as a “precondition” and therefore opted for not covering this surgery!!! whereas my insurance abroad was willing to cover with a letter from the orthodontist but I don’t think they would cover this surgery abroad :(

So, no insurance coverage, no surgery for me that is decided. At this moment it depends on that plus the fact that I have already had 5 months of misery due to a back pain problem which I am just getting through.

Looking good so far!

It has been about 1.5 months since my last visit to the orthodontist and I am still abroad. He told me the elastic power chain would fall off by itself (or I could cut it off myself) between 1 to 1.5 months since it was installed.

The power chain hasn’t fallen but it does not bother me at all, it keeps my teeth in better shape and they are transparent. Well, they have colored a bit (stain) due to the coffee but are mostly transparent.

By now the molar that was out of place in my lower jaw is now perfectly aligned. The new archwire on the lower jaw is still doing its work (I feel movement) and even that same day I was able to pass a flossing thread between the two lower front teeth, something I couldn’t do since nov. 2008! In other words the lower front teeth are rotating and realigning.

I also noticed that the archwire on my lower jaw is now straighter than before! previously it was arhed upward on the six (three on each side) lower frontal teeth. It isn’t totally straightened/leveled but getting there. These teeth also have to lower themselves so that they are not hidden behind my upper front teeth.

And this picture shows a historical animation (made by me) of the progress made on my (over)bite since the beginning on the various follow ups. The first frame (19 nov 2008) is just before the brackets but after the 4 upper front teeth had been “restored” to their initial grace by some aesthetic reconstruction because they were worn out due to the malocclusion.

PS. This silly blogger does not support animated GIFs, the file is transformed to show only the 1st frame. Shame on you blogspot!

Power chain and new archwires

With renewed teeth and some happiness (I never feel happy to go to the dentist!) I went with my future wife to the clinic of Dr. Ibarra for the big appointment. In my previous visit a few days ago I had my teeth cleaned and a visual inspection of the progress.

By now the two brackets that were on my two crowns (back molars of lower jaw) had fallen over the past months. I live abroad so I could not visit him to have that taken care of.

The 2 fallen brackets posed no problem for the treatment because my lower jaw molars and teeth were almost totally aligned and with sufficient space. He chose to simply replace my lower archwire to a thicker wire (more force now) and cut the archwire so that the two crowns remained without brackets. Brackets don’t bond well with (porcelain) crowns even with more powerful glue as he had used.

The replacement of my lower archwire was very painful, pfew! stressful too! in the past months the two lower front teeth had rotated slightly, in fact for a few months I had not been able to pass floss between them due to their tightness. It was impossible to completely place the wire through the bracket so in the end to save my some pain he had to tie them. Looks as if it is through but well, saved me more discomfort.

My upper archwire was also replaced with a thicker one. This one is the last (and thickest) to be placed there while my lower jaw will still require a thicker one on the next follow up (December).

In order to close down the gap between the upper front teeth and align them Dr. Ibarra put on a “power chain” on my upper jaw. The “power chain” (see video below) is an elastic chain with loops that are put around each bracket to close space/gaps, they apply extra force. That first day was a bit uncomfortable but bearable and I noticed results that same day (the gap was closed!).

My power chain is transparent to make it discrete so for the purpose of this blog I am showing somebody else’s chains (in pink, see (a)). There is also a video of the application of a power chain (again another person).

Surgery Update: Meet your surgeon

On this same appointment (3rd) Dr. Ibarra introduced me to the surgeon that will do my orthognathic surgery. She is a relatively young woman with a lot of experience in more difficult cases.

We discussed my situation for about an hour in which they explained everything to me and let me ask a lot of questions about my worries (I have never had “major” surgery).

The panoramic X-Rays taken a few days ago showed all my teeth and their roots perfectly vertically aligned and this was quite a change! I hope to get copies of that later. They also showed me the plaster mold and I could see my upper jaw has also widened to make more space and become rounder, quite a nice change too!

There have been a lot of retraction too and I feel and see that I no longer have to force my lower jaw way forward in order to have my teeth meet each other.

Because I live abroad and can’t come often they decided it was better not to perform extractions now because they wouldn’t be able to monitor it or perform maintenance on the archwires that my stick out when the gap closes.

Also, the original plan (nov. 2008) was that I would have surgery on my lower jaw to enlarge it. During my earlier research I learned that there are two big nerves in that area which cause a lot of numbness & tingling for months and it presents a risk. I was (am) very worried about it so I discussed it.

They also told me that now that she has evaluated my case there were several (4) alternatives and it has been chosen to do the following:

• Perform the two extractions on the upper jaw during the orthognathic surgery.
• Perform surgery on the upper jaw instead of the lower jaw. This would involve shortening (pulling back) my front side which would change the profile of my face. They would do the cuts on the gaps created by the extracted teeth (bicuspids).
• Having done that they would then evaluate if that is enough. If not, then they would also perform surgery on the lower jaw to enlarge it. In this case the advancement will be shorter than the original assessment (9mm) and therefore involve less risks.

Naturally I was more worried to hear about surgery to my upper jaw, still worries me but I hope that the lower one can be left untouched.

My surgery has not yet been scheduled, that depends on the assessment made on the next follow up in December. However they estimate it could be around June 2010 (I don’t want to have that for my birthday!). If I was not abroad maybe even earlier!

Also, since I am scared about it Dr. Ibarra told me that even if I changed my mind and decide not to have the surgery the current results are still very good. In the meantime they will practice the surgery on the plaster (?) models they make of my mouth.

Power Cleaning on 3rd revision

The day came on June 13th, 2009 when I was at the waiting room of Dr. O.A. Ibarra for my 3rd revision after having braces put on on November 2008.

In my previous visit (Jan. 2009) I was told that probably I would have two teeth removed from my upper jaw to make some space and that was to take place now and I was worried about it. Also because in April I suffered a new back injury which has kept me with uncomfortable pain and incapacitation for quite some time.

Today was only a quick follow up of about 30-45 minutes in which he ordered another panoramic X-ray of my mouth to get an updated view of the current state of affairs.

My teeth were cleaned thoroughly with some sort of bicabornate (baking soda) sand blasting technique. It was cool! it was painless! and my teeth looked slightly whiter too as they had suffered some extra coloration during the past months! Naturally I had a stingy feeling on my mouth for part of the day.

According to my orthodontist the previous minor surgery I had on my gum to remove the fraenum healed perfectly. My upper frontal teeth were almost together but for about 1 millimeter.

The lower molars were almost totally aligned (I have been amazed about this change after 45 years!) and believe it or not even my upper teeth feel pulled back. My bite feels different.

On my next visit a couple of days from now I will be examined by the surgeon that will do my orthognatic surgery and have some things installed by my orthodontist.

His other colleague (dentist) did a retouch of the aesthetic reconstruction of my upper frontal teeth (two) given that they have done quite a lot of rotation and alignment. Now they look even more beautiful like they had never been before!.

Lost another bracket, bands are coming :-(

It was bound to happen, 5+ months into treatment the 2nd bracket came lose and I had to remove it from the wire before I swallowed it.

So my wisdom teeth do not exist since my early 20s, these are teeth 17 & 32 (lower) and 1 & 16 (upper). On right side of my lower jaw just before the missing wisdom tooth I have two molars who tragically had to be replaced by crows (teeth #30 & 31).

My orthodontist told me since the beginning that brackets don't bond very well on crowns due to the material of the crowns (ceramic) so I had to avoid eating on that side (and I did avoid it!). Well in spite of the fact that he used extra strong glue to place the brackets on those two crowns those are exactly the 2 brackets that have deserted, first the one on the back, then the next one.

Now I have this long piece of archwire there without brackets to hold them :( Since my visit won't be until the first week of June when I am in town again I have to hold it until then.

I did speak to him though and told me now that they have fallen he will then have to replace those with bands, ouch!!! I was hoping never to wear bands, now I will need two and on adjacent teeth (so forcing double space in between them). Not the kind of news I wanted to hear.

My extractions may not take place after all, he and the surgeon will reexamine me to determine progress and whether extractions are needed or not.

Anyway, brackets minus two... more pain in sight.

Time for some orthodontic wax :(

Oh my, I remember when I got my braces 5+ months ago and could not stand all the sore spots on my lips and inner cheek thanks to the railroad tracks installed on my teeth.

Well luckily this doesn’t happen very often but for the past two weeks I have been pestered by an open sore spot on my lower lip (almost healed now) caused by one rebellious bracket.

And then the one that annoys me the most these days is on the linen of my inner cheek, right beside the bracket that is on my last upper right molar (no I don’t have wisdom teeth). For some reason there is something there that is hurting my cheek. It has something like a tit as if it was caused by a wire that pulls the cheek linen out and then dislodges itself.

I examined that bracket and there is no protruding wire so I guess it must be the bracket itself that is injuring my cheek and causing that much discomfort.

So, I had no other alternative than to pull out some orthodontic wax to cover the offending bracket at least until the inflammation goes away or I get to visit my orthodontist 10,000 kilometers away.

By the way in the link “Orthodontic Personal Care” on the right you can find the items I have found most helpful to cope with braces.

Lost a bracket :(

One month ago I was in a company meeting and was enjoying the dinner with my colleagues. The food was delicious (Indonesian) and soft. When I got home I started playing with my tongue -that way all brace wearers know- and felt something odd in the back of my mouth near the last molar.

I was thinking "Oh my God! please NO, not another broken tooth!" and my world was falling apart because believe it or not I HATE having dental work that has potential for being painful. Yes, don't ask me how I got to wear braces, I am holding on so far.

Anyway, when I got to the bathroom I spit out that piece of something that felt metallic. That is why I thought it was a big chunk of filling (amalgam). Well, as it turned out it was a full bracket! Thanks God I did not swallow it!!!

As it turns out it was the bracket sitting on my last molar which happens to be a crown. My orthodontist warned me that even though he used a much stronger glue for those two brackets-on-crowns it was possible that they might fall off. I was told to only eat soft things on that side.

Well, now I have a fallen bracket on the right side (lower jaw) with a large wire sticking out. I have not cut it, don't have where to but it is not bothering me so far. Then on the last molar (a real one) on the other side of the lower jaw I have an orphan bracket that lost the wire. As you read before in this blog the ortho that helped me out cut it.

I am having more inconveniences with the orphan bracket that has no wire than with the wire that has no bracket. I have to wait until June when I get my next appointment abroad. That means my lower archwire will have to be replaced. That means having all my lower brackets opened up (I have Damon self-ligating brackets) and that is PAINFUL.

Oh well, one day two years from now I hope to be smiling without a bunch of electromagnethic antennas installed on my teeth.

Counting up since the day eating ceased being something enjoyable...

Yes, even though I am scared of the upcoming surgery I can't wait to have these things taken off my mouth!. Since I have no specific date for the surgery (and even less for getting them removed) I can't count down to such joyous event.

The tools of the trade...

Having reached my first two (2) months with braces I have found these things to be time savers and ameliorate the nasty things of wearing braces...

• Using regular flossing which is time consuming with braces? struggling with the threader? well, get yourself the Super Floss from Oral B! it comes in a box with 50 of them, each having a built-in threader, a thick floss section for the brackets and a regular floss section for the flossing. A time saver! a bit expensive but well worth it!
• Get the WaterPik! nothing like a jet of water to help cleaning those teeth and brackets!
• A good mouth wash without alcohol. IF you are given a special mouth wash such as PerioGard for use after a periodontal treatment or oral surgery, use it only for no more than a week or it will stain your teeth! it happened to me because I thought I could just finish the bottle.
  
• Get a pack of mini-brushes.

The purpose of it all

Well some people criticize adults with braces as if one were to do it for fun. Let me tell you there is no fun to it. Also, those people either never wore them or never think there is a FUNCTIONAL purpose to all of that. In my case I view it this way:

Visual or Physical and Improvements:

• Eliminate the growing gap between the two frontal teeth on the upper jaw. Requires fraenum surgery (see earlier post).
  
• Terminate the movement of the frontal teeth towards outside and the sides which has been causing a lot of tear and wear. Requires the installation of braces and tooth restoration with resin.
  
• Align the 5th tooth on the left side of the lower jaw which was nearly 40% pushed towards the inside (the tongue) by its two neighbours. Done by the braces.
  
• Push the front teeth back and straighten them in general. This was getting worse over the years.
• Fix the lower jaw which did not grow enough. Requires orthognathic surgery :(
  

Health Improvements:

• Put an end to the nearly extreme wearing off of all the teeth. In particular the upper/lower frontal teeth were so worn out that it was reaching the core and losing shape. These need to be restored to their original grace.
• Improve speech, the position of the upper two was so far out that it hinders the pronunciation of sounds that require the tongue to establish contact with the front teeth
• Eliminate the problem with the jaw joints making cracking noises when moving (TMJ).
• Eliminate over stressing neck and jaw muscles

Other improvements:

• To finally gain confidence for smiling normally and without shame, what else?! I have not done that for as long as I can remember.
  

Oops! wires popped out, who can help me?

It was bound to happen though I was hoping not so soon... Given that I can no longer eat the delicious things in life I was having some natural fiber in the form of Mango chunks I bought as a salad in the supermarket.

Apparently some chunks were not as ripe and as a result the arches (archwire) that terminates on the very last molar has popped out of its hole. To my surprise this happened on both sides of the lower jaw so both ends of the archwire are now lose.

I hope some orthodontist here can help me because I won't be seen my "home" orthodontist for another 5 months! I can't manipulate them (the back teeth!) myself and I don't have any tools for that. I also wonder if doing that might cause any further damage.

New wire and remove stitches!

Tomorrow I am heading back to my home country so my follow up was scheduled for today.

At 17:00 we had the appointment with the periodontist and orthodontist. They examined my mouth and were happy that the skin graft had held well and that the tissues have been scaring properly. The diastema has been closed 100% for the first time in around 10+ years I had no gap on my front teeth!

The orthodontist removed the rubber that was forcing the two upper teeth towards each other. We were all happy the gap had been closed, because the graft well it meant the fraenum would not grow back. However, they could see that it was already trying to grow there but thanks to the graft it could not grow further. Then he removed the wire that ran through all the brackets of the upper teeth. This removal involved opening the Damon brackets, something was was very painful on some teeth. My God, to imagine I have to go through some more of these wire changes!

The periodontist did a full clean up and it was easier on the upper teeth because the wire wasn´t there for now. Unfortunately I kept on using the medicated mouth wash a bit too long on two ocassions which caused the teeth to be stained :( I will have to wait for the whitening when my orthodontic treatment is over. Some of the cleaning was painful because there was no anesthetic applied and doing that with brackets installed is quite a shore that makes the instruments of torture come very close to the gums. I am a chicken for these things remember, specially when there is more pain than my threshold, my legs where trembling like mad and I had a hard time controlling them. I was relieved when this part of the procedure was done. Pfew! I can breathe!

The plastic-like paste that was covering the open wound on my gum where the graft was taken was removed. The stitches from there too but that was not very painful. Normally they would have removed them some days later but I was leaving tomorrow so no other option. Luckily it had held well and healing well too.

The stitches that held the graft over where the labial fraenum was were removed. How many I don´t know but some where hard to remove because the fraenum was trying to grow back and thus making removal more difficult. This was a VERY painful part where I sweat a lot and suffered but the only alternative was to apply an injection (anesthetic) to the gums and that I judged was going to be probably more painful. I had to hold myself together. When it was over I was GLAD.

Then the easiest part that did not cause much pain or distress. The new thicker wire was installed across the brackets of my upper teeth to align them further. This new one can hold up to a year but I will keep it for 6 months until my next appointment in June.

The diastema being closed and the lower molar aligning further into place it is expected that in June I will have a lot of progress and be ready for the two extractions :(

The next few days were the usual nightmare. An open wound on my palate that still needs to heal further makes eating a challenge, I can chew on the side of my two crowns so I have to be careful. I have been eating very soft things such as creamy soup, bread and the like. In addition to that thanks to the new wire adjustment my teeth and molars are on the move again and thus every bite is not only a challenge but also very very painful making eating something unpleasant. Naturally I did not enjoy the food on the plane nor any food for the coming days. I took pain medication only for a day (Dolex and Apronax which is based on Naproxeno).

Labial fraenum surgery (Frenectomy) and new wire

My experience so far is that having braces takes out the joy of savouring and enjoying food the way you used to. Nevertheless given this limitation I managed to enjoy the Xmas and New Year celebrations. For that reason this appointment was moved from December 30th to January 3rd.

So at 11:00 AM I was together with my fiancée at the orthodontists clinic ready for "labial fraenum surgery" (frenillo labial). This is that relatively thin strip of flesh that extends from the upper lip down to the palatal vault. It also exists on the lower lip but there it isn´t a problem for me.

In my case my upper labial fraenum was the culprit which over the years created and enlarged a so called diastema. A diastema is when your two front teeth (in my case the upper two) are separated from each other more than the usual, I had a diastema of about 2.5mm. This is because the fraenum grows and extends in between the two teeth thus creating a force to separate them from each other.

Today´s surgery was designed to solve that problem by doing this:

• Replace the wire that runs across all the brackets of the lower jaw
• Cutting the upper labial fraenum
• Placing a gum graft on the open area above the two teeth
• Installing a small chain or rubber around the brackets of those two teeth to push the together (painful).

So I embarked on this, luckily I was not aware of all the gory details until it was too late hahaha. I am chicken for those things.
I was placed on a horizontal position on the chair of torture and observed him doing all those things until I decided it was better to close my eyes. Some painful anesthetic injections where applied on my palate vault (ouch), very painful, yes, painful.
Then a long procedure started of around 1:15 hours started. First my orthodontist removed the wire that holds the brackets of the lower jaw together (november) and replaced it with a new wire now that the teeth were better aligned. Previously there was a discontinued part where a small wire had to be put because I had a molar that was pushed in between its two neighbours. Now it was more in line -but not totally- and he was able to use a wire frame on the whole length. The opening of the damon bracktets was painful.
In the 2nd part of this procedure the fraenum was cut including the extra gum that was forcing the two upper teeth apart. To protect this open wound above the two teeth and prevent growth of a new fraenum (yes, it always tries to fill up the space) a skin graft had to be placed. For this my palate was scraped to obtain the skin graft from it. I could hear the blade grafting but felt no pain (thanks to the painful injection).
The graft fell down and a new one had to be scraped. The 2nd one installed correctly. Then stitches where applies on the gum above the teeth to keep the graft in place.
A special plastic-like paste was applied to the palate near the molars to cover the open wound from where the skin graft was taken so that my tongue would not cause unnecessary pain and help it heal. To ensure it would remain in place some other stitches were placed on my upper palate to fix it.
Last but not least a small rubber tube size 5 was placed holding the brackets of my two upper front teeth. Thanks to the aneesthetic this time I did not feel much pain when this rubber was applied. This would take care than in this short period the rubber would push both teeth together to close the gap so that they appear as in any normal smile.
My fiancée was shown the results of the surgery while I was still on the chair. I was given a pain killer to swallow and a recipe to have one every 12 hours for 2-3 days.
On the way home I could see my upper lip was swollen as if I had been given a punch. At home someone came to visit and the situation made me smile or laugh and oh my God! what a painful experience, I could feel the stitches nearly coming apart, blood started dripping down my teeth. Ironically my fiancées sisters are very cheerful in their conversations so many times I had to use my fingers to hold my upper lip pressed to keep the pain down and avoid as much as possible break the stitches. Nevertheless, many painful smiles.
I went for lunch which was a painful experience, from now on I would only eat light things because the graft was taken from the side I can actually chew harder objects. Lots of cold drinks to reduce swelling. I started feeling the anesthethic fading away and that burning sensation come to my mouth. Luckily this kind of sensation and pain faded away with the medication.
My orthodontist gave me the "happy" news that I would need some exodental treathment after all. So in June two molars will be extracted from my upper jaw to make some space to fit with the lower jaw. This in turn will delay the orthognatic surgery further 6 months, so about June 2010 instead of December 2009.

The picture on the left shows how it ended up after today´s procedure:

1. Not very easy to see but these are the stitches holding up the graft where the fraenum was cut off.

2. The rubber that pulled the two frontal brackets together to close the gap. It also helped straightening them.

3. The paste covering the wound from which the graft was taken. You can also see the "rope" of the cross-stitching to hold it in place.

4. The actual stitch on the palate. The two front teeth already show quite an improvement.

See Frenillo labial