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.