Palate Expansion Appliance

Well, here I am day one with the RPE in. This definitely feels weird. I am salivating profusely, and I can taste a bit of the cement still. Not shown in the picture are the hook type thingies on the outer side of the bands. They are annoying and I'll need to put wax on them when the eventually start irritating my cheeks.

It doesn't really hurt at all. Talking is ok but not perfect. Imagine holding something in your mouth while trying to talk. I seem to have trouble with C's, H's, P's, Q's, T's, and V's so far.

Drinking feels like a fountain in my mouth, the water sort of filters through the appliance and I have to smack my lips to swallow it, sort of. It's hard to describe.

Eating is a total chore now. Like doing gymnastics in my mouth. I managed to slowly eat a Nutrigrain bar and a banana this afternoon. That wasn't so bad. For dinner it took over an hour to eat a can of brown beans and a piece of bread. I constantly have to work food out from between the top of the appliance and the top of my mouth. My first strategy for eating was to just let food build up in that space whereby the second mouthful pushes the first mouthful down so I can swallow. That sort of works but not great, and I can only let a little bit of food build up before I feel like gagging. The other strategy is to try to chew in my cheeks like a chipmunk, again, sort of works but still gets pushed up there via the space on the side. Either way I have to keep swishing with water as I eat, and chew very thoroughly. I also tried some lettuce, that didn't work too well.

Dr W wants to see me on March 25th at 8:30am to begin expanding. He thinks I'll need to have someone do it for me. He said I can get him to do it if necessary via stopping in to the office or coming over to his place since he doesn't live too far from here. I'll certainly give it a try myself though. I know other people have been able to do it themselves.

I hate paperwork.

Got my pre-op package in the mail from Dr. T. There is a form I have to get filled in by my family doctor, which I technically don't have, so I'll be going to the walk-in clinic to get Dr Engineer to do it...he's probably the next best thing. I really should get myself properly set up with a family doctor. There's a new clinic across the street that I'll probably investigate.

One form is for basic health pre-op which has to be signed by a family doctor within 30 days before surgery. Then there's another couple of forms for hosptial administration.

There is a pre-op clinic inside the hospital which I will go to on March 21st so that I'm all set for surgery on the 23rd. Check-in time on the 23rd is 6:30am.

Dr. T's in-office fee for SARPE went up $100 since my consultation 6 months ago, urgh. It is now $600.

Spaced out...again!

Just got back from the ortho. I'll be sporting these sexy spacers for another 8 days. Today I got fitted for bands and had another mold taken. Patricia is the assistant doing the work. She's a sweet lady and does her work as gently as possible. First she took the spacers out, one or two of those hurt but just for a second. I was surprised at how they just sort of popped out when she pulled them without much tugging. My mouth felt really odd, another weird new bite, but it was nice to have the pressure off of my palate. Short lived though! She then flossed where the spacers were and clearly some room had been created. Slight problem with my left 4th though as I seem to have a small 'step' in the way that tooth is shaped, so the separator for that one didn't create the needed space. Patricia was perplexed and didn't think she'd be able to get a band on that tooth. She had Dr. Waese come over to look at it. He then use a thin piece of special filing paper to file the step down a little bit and then they tried a few more sizes of bands until they were satisfied. Popping different sizes of bands on and off hurt a bit, but again just for a second. The bands feel like a vice around the tooth and they have what felt like hooks on the sides which were digging in to my cheeks a bit. I can tell that once I have the RPE in permanently those hooks are going to annoy me. I kept filling my cheeks with air to move them away. Once the bands were on we took a mold. Painless there and worked on the first try. Mmm, strawberry goo! Then she took the bands off and quickly put them on the mold before it was set. And then of course she put the spacers back in. It feels like I have more pressure now than I did 3 hours ago but I seem to be able to bite down without much pain. We'll see how dinner goes tonight.

I also gave them 50% of my down payment. I'll give them the other 50% next week, and then my 23 monthly payments begin March 28th. Boo! I was hoping for payments every 6 weeks, oh well.

Dr. W is also going to work on my profile prediction photograph this weekend. I'll post it here once I have it. Gotta remember that it is just a manually done prediction and often the actual result will look better.

Spacers day 2

Well my research was right. Spacers hurt more the day after they go in. I've been loading up on extra strength Tylenol every four hours, which helps some. Later in the day I decided to try Advil as well. I think it's working but still hard to tell.

My two front teeth feel like they've been pushed outwards more and my bite is off since I can't really close the same way I can without the spacers in. I guess I ought to get used to my bite changing though because that's how it goes with ortho for a while.

Eating has been painful. I've managed to get down a mushy bowl of Rice Krispies, 2 Nutrigrain bars (which were harder than I thought they'd be to chew), a Hot Cross bun (slow, tedious and painful), and for dinner a can of Heinz beans which was fine and some bread and salad which was mostly lettuce, and I found that easier than I thought actually. I think maybe the Advil helped.

Sleeping last night was ok, better than I thought it would be as I drifted off to sleep. I did toss and turn but not too much. Oh, and my ears were ringing a little while before I finally rolled out of bed. It's happened a little bit during the day also but not too bad.

I'm feeling a little dizzy or wabbly right now though. I wish I had'of gone back to the CST before this. The dates got set before I had a chance to go back. I might try to tough it out until after the 28th when my expander is in. I don't think I should be in any pain by that point.

Spacers in!

Just got back from the ortho. I now have 8 spacers in for my maxillary 4's and 6's. Installation was relatively painless, they snapped in with just some gentle force. I took 2 extra strength Tylenol before I went. Not much pain right now, but we'll see how it is overnight and tomorrow. It feels like pressure more than anything. I've had sinus colds which have caused me more grief. I can feel it in my cheek bones though, which I hope will go away. ...The assistant mentioned that one of my molars seemed loose. Hopefully that's not something to worry about. I'm told the spacers will be removed at my next appointment, but I'm wondering if that's right or not. I'm expecting them to fit me with the bands then but I'm not sure if they are going to actually cement them in.

Cranial Sacral Therapy

Part of my overall plan is also to visit a cranial therapist. Cranial sacral therapy is concerned with the movement of the plates in the skull via the tiny sutures that they mesh together on, all the way down to the sacrum at the bottom of the spine, hence the name Cranial Sacral therapy. This type of therapy is relatively new and is just beginning to be accepted in the medical community, particularly as it relates to orthodontics. The therapist applies very gentle touches to the skull, neck, spine, and feet, and the surface of the teeth to get the system "moving" properly.

I've only been to one appointment so far, and I was skeptical going into it. Afterall, how can just gentle touch make any difference? Well, I am now a believer! I really felt more "balanced", in a way, and my neck no longer felt so terribly tense. My jaw was also loose and free of tension. This type of therapy is also sometimes helpful for vertigo, which coincidentally I had been experiencing. After my treatment I felt much better and didn't have another episode of vertigo for at least 2 months or more. I can tell I need to go back very soon. It's peaceful and relaxing.
My therapist said maybe 4-5 treatments ought to get me in good shape before my big surgery.

I did feel some strange sensations for a few days afterwards, as if someone was pushing on my head or jaw with the tip of their fingers. This sensation was a bit startling at first, but it only lasted one or two seconds usually.

The therapist is actually an RMT so my insurance will pay for some of it. The Cranial Institute is downtown on Duncan street.

Here's a site with some good info if you're interested:

http://www.ccst.co.uk/

How Much is this Going to Cost?

Dr Waese - $7000CA. Includes everything. Braces, retainers, the RPE appliance, and office visits. Down payment is $2400 followed by payments of $200 each.

Dr Tocchio - $500 for the first surgery, $2500 for the second. This includes office visits only. The actual surgery is paid for by OHIP here in Ontario (I'm very lucky it hasn't been delisted...yet...since it costs around $20,000). And the hospital stay is covered by my benefits from work.

I'll also have to pay for several visits to the Cranial Institute, which are $115 each. I'll talk about this in another post.

And when all is said and done, I'll probably elect to have some bonding or something cosmetic done on my one upper tooth, which is genetically deformed. They call it a 'peg' lateral due to it's peg shape rather than the usual tooth shape like the one on the other side.

So spread out over two years, and with the help of a new line of credit, this should be manageable. Even though conditions at work have deteriorated considerably I decided that I need to do this for myself no matter what.

Ready...Set...Go!

After months of ruminating and coming to a final decision about whether to actually go through with this, as well as waiting to hear about whether my job would be in jeopardy, and getting through holidays and other family crisis, I finally called Dr Waese's office to give them the green light.

Here's my upcoming schedule:

Feb 13 - get separators in (10 mins at OD)
Feb 20 - take molds, install bands (50 mins at OD)
Feb 28 - install RPE appliance (1 hour at OD)
March 21st - pre-op appointment at OS
March 23rd - pre-admit hospital appointment and surgery

Meet Dr. Tocchio

My suregon is Dr Tocchio. He is said to be the best oral surgeon in Toronto and has done tons of these operations. When I went to see him for a consultation in July 2005 he said he was doing 3 or 4 per week!

My visit to his office was short. He took some measurements and answered a few questions. I didn't have very many since I had been researching a lot before I went.

Later on that summer I heard through another web site that he had injured his wrist while on vacation in Italy. Yikes! Sounds like he's fine though.

In English please?

Ok so what does all of that stuff mean from the previous post? Basically it's like this:

- First I'll have a surgery which will allow my palate to expand. Basically the surgeon will break or cut my palate in strategic places so that the expansion appliance that I'll have cemented in my mouth for a few months will make my upper teeth wider. This is called a SARPE, or surgically assisted rapid palate expansion. Had I gone to an orthodontist when I was in grade 6 this likely would not have been necessary since the bone at that age is much softer. As an adult, surgery is the only viable option. This means that I will have a huge gap between my front teeth for a while, somewhere around 8mm I think. I'm told the gap will close on its own in about 6 weeks after the surgery, so we'll see.

- While my palate is healing, my lower braces will be installed.

- About 3 months after the SARPE surgery, the appliance will be removed and my upper braces will be installed. This will close the gap in my front teeth for good.

- I will then wear braces for about 15 months with regular adjustments.

- After the 15 months have passed and my teeth are fairly straight I'll have a second surgery where they will move my top jaw forward (LeForte I) and make my bottom jaw shorter (BSSO, bilateral saggital split osteotomy). This is a big operation and recovery will be long, but is necessary because the bones in my face don't match like they should. Luck of the draw in my genetics - thanks mom and dad! But in the end I'll finally have straight teeth! My appearance will be slightly different, but new people I meet won't know the difference. I've looked at tons of other people's before and after photos and 100% of them look better after the surgery and they are usually very happy with the results!

- About 4 months after the big surgery the braces will be removed and I'll be wearing retainers for a LONG time, eventually just at night.

The Plan of Action

After a couple of weeks I went back to Dr. Waese to get the blue print for my smile makeover, as I like to call it. What follows is the fine detail of it all complete with ortho-speak! Haha.


Pan:
8's are missing
TMJ is normal
No pathology visible

Ceph:
A-O concave midface: Pathognathic mandible

Verticle long lower face height

Lower incisor angulation retroclined

Interincisal angle obtuse

The lips are open slightly at rest: forced lip closure

Normal lip rise 8mm

There are dark spaces on both sides of the intra oral smile

Mouth breathing; low tongue posture

Scalloped marks on the sides of the tongue; white marks on the cheeks from possible cheek biting

Generalized mild recession of the gingiva

Loss of attached gingeva on the 43: generalized loss of attached gingiva possibly from tooth brush trauma (…but I seriously do it gently, I don't know why he thinks this??)

There is a crossbite of all the teeth except the maxillary centrals

Angle classification: class III
Overjet: 1mm Overbite: 10%
Crowding: maxilla -3mm Mandible: -12mm

Goals of Treatment:
1. Correct the crowding
2. Correct the crossbites
3. Balance the facial bones
4. Control the habits to protect the gingiva, TMJ and cheeks
5. Long term retention of the corrected problems

Treatment benefits:
- Crowding correction for periodontal and functional and aesthetic improvement
- Align crossbite teeth for better health and function
- Improve aesthetics by reducing the protrusion of the teeth and improve the position of the lips over the teeth
- Remove dental interference to improve jaw function
- Improve facial balance

Orthodontic strategy for treatment:

We will arrange for a surgical consulation for:

a. Surgically assisted Rapid Palate Expansion (SARPE)
b. Maxillary Leforte I surgical advancement (LeForte I)
c. bone implants suborbitally to increase the prominence of the cheeks (he said this would be very subtle just to keep things rounded out, and it will use the bone taken from my jaw. We're not talking Joker from Batman or anything here!)
d. Mandibular sagittal split reduction in size (BSSO)

2. I suggest a referral to the Cranial Institute for:

a. Diagnosis and treatment of poorly moving cranial bones (I went for one of these back in the
summer and she said probably 4-5 treatments would get me in good shape. I even noticed quite a difference after just one treatment…and I can tell I need to go back! I can really notice the tension has returned in my jaw and neck.)

b. Osteopathic support for post-surgical healing

3. To prepare for the braces we need to consider the effect of the habits on the dentition and oral structures. Since there is probably a cheek sucking or biting habit, an oral sheild will be needed to hold the cheeks away from the braces at night. This can be accomplished with a non-protrusive FFMP with buccal shields that extend from the occlusal bite pads and a lower labial shield. This will be made after the RPE surgery.

4. Separators will be placed for a RPE supported on the maxilliary 4's and 6's. The RPE will be made and placed for the surgeon to facilitate the RPE.

5. Cranial support is strongly suggested to help the healing at this time.

6. 1 month after the expansion has been done we will take impressions for a non-protrusive FFMP with buccal shields that extend from the occlusal bite pads and lower labial shield.

7. The lower braces can be placed while the maxilla is healing. The FFMP will be inserted for nighttime wear to protect the oral structures.

8. After 3 months the RPE will be removed and the upper braces placed. Continue the FFMP n.o. and the cranial support at less frequent interval.

9. The teeth will be decompensated: ie the lower incisors will be proclined and the upper teeth aligned. Note: if the lower incisors and cuspids appear to be at risk for gingival stripping, a single lower incisor may need to be removed to creat space for lower teeth alignment.

10. After alignment (about 15 months into treatment) the facial surgery will be done.

11. After 3 months the braces can be removed and retainers placed.

12. Retainers will consist of:
a. lower 3-3 retainer to keep the lower incisors straight
b. upper day time Hawley retainer to maintain upper arch width
c. Night time non-protrusive FFMP with buccal shields that extend from the occusal bite pads and lower labial shield.

13. Continued cranial support is suggested to long term maintenance to promote long term healing and control of the intra oral habits which may stem from the cranial abnormalities.

14. Possible graft somewhere on the bottom gums (can't read his writing)

Retention: extended

Meet Dr. Waese

So off I went to meet Dr. Waese for a consultation in May of 2005. He has a really nice office and a great staff who really made me feel welcome. I noticed my name up on the 'welcome new patients' board as I walked in. Cheri is my case manager and she is extremely helpful and answers all my questions. I also met Sandy who took x-rays and molds for me while making extra sure I felt comfortable and said that she likes working there because nothing they do in the office involves pain. I'll take that with a grain of salt, but it was nice to hear nonetheless.

After answering some standard questions with Cheri, Dr Waese came in to take some measurements and give me a general picture of what would be needed. I felt like he truly cared about my interests and that he would work very hard to help me. He seems like a very intuitive man and considers both the actual treatment and me as a person in his decisions. He is a very busy guy but is a perfectionist as well. Perfect teeth are fine with me!

Dr. Waese was very interested in my case and had an air of fascination about him as he examined me. "This is very interesting!" he repeated numerous times. Afterwards he asked if he could have my permission to bring my case to his study group so that he could get some consensus on what needed to be done. I heartily agreed and so in the end it was like having 7 orthodontists look at me!

And so it begins...

After years of being unhappy with my teeth, I finally decided that it was time to do something about it. Dentistry and orthodontics have come so far in the last 20 years that it's really just a choice as to whether one wishes to have straight teeth or not, assuming one can afford it. I'm almost 30 now and I have a desire to get this handled after years of being self-conscious about my smile.

From a historical viewpoint the only orthodontics I've had previously was a retainer that I wore for a while when I was about 12 years old cira 1988. I think the idea was to widen my palate. I have no memory of whether this was considered successful at the time. I didn't continue with other treatment and braces because my parents couldn't afford it for me.

Fast-forward to the spring of 2005. I have a confession to make - I had been watching the television show Extreme Makeover and was inspired by some of the people on it to do something for myself. They made it look like magic of course, but I knew I could relate to how the people on the show felt self-conscious, ugly, unnoticed, etc. I was always absolutely amazed at how the doctors, and denstists in particular, were able to make such a profound improvement in their clients appearance. For me, I knew that my teeth were the one thing I would change about myself.

After 10 years of not seeing a dentist (yes, very bad, I know!) I knew that I had to go for a general check-up and then find out about cosmetic options. It turns out that the cosmetic dentist that I ended up visiting (right across the street!) has been a consultant on City TV and is well respected. His name is Dr. Goldshlager and I would recommend him to anyone. After several rounds of minor cavity fillings and a cleaning by the hygenist (after 10 years I really was lucky to have a mouth that was in very reasonable shape!) we had a chat about what my options were. Initially I had it in my mind that I would just get veneers, a quick fix, like the people on Extreme Makeover. My dentist offered to use a product called Lumineers on 10 of my top teeth. However, it was clear that he knew I would benefit much more from orthodontic treatment since I have a fairly bad problem with my bite. Lumineers would only mask that problem as it continues to get worse the older I get. "Graham", he said (I'm paraphrasing here), "if I was your brother, and knowing what I know now as a dentist, I can give you a cosmetic solution but I really think you need something more comprehensive". Naturally I wanted to understand all the options and had him refer me to an orthodontist.