Elastic man

Today was adjustment #9. I dragged my butt out of bed at 6am to get there for 7:30am since it was the only slot available on such short notice from last week. It was nice and quiet though, almost like having the place all to myself!

As planned, two brackets on my lower left side we rebonded. The burr didn't bother me at all this time - sweet. Janet was my technician today and she did a great job. She was almost ready to let me go when I mentioned the class II elastics. My lower wire was downsized one or two weights so she figured I'd have to wait until my next appointment to get them on but Dr W chimed in and said they should be put on today. So I have one on each side going from #7 on the bottom to #3 on top, and these buggers are a bitch to put on. My molars are fairly sore right now and I can also feel my front lower incisors getting pushed outward. I also have a power chain on top from 3 to 3 so I don't get any gaps opening up due to the elastics. Overall, lots of opposing forces going on in my mouth now! My bite is already different; my lowers are back to being in front of my uppers, for the most part. Perhaps I'll be able to chew slightly better until surgery now.

The other good news is that Dr W thinks I'll be able to stay on the surgery list for October. Arlene is going to call and see if they can get me in for late October but if not then Dr W said he'd just do whatever he can until my actual date. He said he thinks I'll make it given that we have all of September and part of October. I've already started thinking about beginning the handover for things at work. Not too sure how that will turn out.

Oh, and I could have sworn that he said my lower right canine needs to be rotated (and presumably rebonded). I'll ask next time.

Photos are on my Flickr site.

Surgery, here I come!

Yep, as I expected, surgery is indeed in my near future. I went in for the verdict today and Dr W pretty much confirmed what he had planned for me right from the beginning. Once he looked at my records it was very clear to him that class III elastics wouldn't be sufficient and that surgery is required. He began by showing me tracings from the ceph x-rays, one from pre-treatment in 2005 and the other from two weeks ago. He superimposed them to illustrate to me the changes that have taken place since 2005. I wish there was some way to show you all online, so instead I will give you his observational notes below.

Notes on the ceph from May 9, 2005 to August 12, 2007:

1. The maxilla has slightly tipped down and rotated counter-clockwise.
2. The maxillary teeth have extruded 2mm.
3. The mandible has been rocked 8mm down and 2mm backward because of the interference of the incisors.
4. There is no posterior occlusion at this time in centric relation.

Summary:

1. The maxilla is still behind the mandible in an Anterior Posterior position. The face is still concave. The photos confirm this with flatness under the eyes and the upper lip tipped backward.
2. The lower dental midline is 2mm to the left characteristic of a mandibular asymmetry.
3. The lower occlusal plane is not level on the left side: the 34 needs to be elevated and uprighted with the root moved more mesial.

Directions:

1. Surgical simulations point to maxillary advancement of 6-8mm as a very good solution.
2. Most likely the mandible will not have to be reduced in size surgically, however the surgeon will make this decision.
3. The 34 should be rebonded to correct the root tip and infra-eruption.
4. The 33 should be rebonded more mesially to correct the rotation.
5. Light Class II elastics can be started to procline the lower incisors.
6. The maxillary surgery can probably be scheduled for November or December 2007.

So, to put it simply I'll be having upper surgery and possibly lower. I forgot to ask about whether the upper will be segmental or not but I guess that's a better question for Dr T when I see him. Despite point #2 above, Dr W said he suspects the lower jaw is too long and that once my lower incisors are proclined to the proper angle this will be more apparent.

I'm going back on Wednesday to have the 2 lower brackets rebonded and the class II elastics put on. Just to clarify, as most of you know I have a class III jaw relation, but the class II elastics are used to procline the lower incisors. So my under bite is going to appear worse up until surgery. There might be a benefit to that however - it might mean my teeth will touch again before surgery. Oh to eat a veggie stir fry again!

As far as scheduling goes, I'm already on the surgeon's list for October. The question now is whether I will be ready by then since Dr W needs time for Wednesday's adjustments to take effect. We're really close to the wire (no pun intended!). :) Arlene wasn't sure what would happen if we had to push me into November, so we're going to talk about it more on Wednesday.

Overall I'm happy with the information I received today. Everything makes sense and I'm on my way to getting what I've wanted all along. Not exactly looking forward to recovery but I know this should be the one last big push I need to get through on my way to a killer smile!

Somebody pinch me!

No surgery?! Huh? ...Well maybe.

Yesterday was adjustment number 8. The first order of business, as planned last time, was to re-bond my lower 5-5 brackets. Jasmine detached the brackets and then removed the wire while they were still seated around the wire. That was a neat way of doing it; and she later used the wire as reference for putting the new brackets on. I then had to endure the burr tool again, but I must say that she did a great job and I felt pretty relaxed. I think I counted only two or three sensitive spots that made me jump. Then once my teeth were all polished and naked of any hardware she let me look in the mirror. It's amazing how much better they look without brackets, and I'm very happy with how straight they have become. Now that the brackets are back on and and repositioned she said things will begin to level out. I've been waiting for that! I think level teeth are a sign of being close to done with braces, perhaps not for me, but it's something I've noticed in others.

Dr W was busy with another patient so I sat in the waiting room while listening to annoying children's programs on the tv. Thankfully the kids in the room finally left so I turned the volume down.

Dr W called me in and it was time for him to work his magic. He put a new wire on the bottom, a wire with some special thermal properties that he wanted to use me as a guinea pig for. My impression was that it worked very well. On top he put two bends in the wire to "intrude" my central incisors since they are a bit long. He said this will be important cosmetically.

Then came a surprise...

"Graham, have I redone your records yet?"

"Nope, but you mentioned doing that last time."

"Ok, let's make an appointment to do that. We'll do a new PAN, CEPH and photos. Your teeth are touching right on edge so I want to see if we should correct it surgically or whether we should do it dentally with class III elastics. It is possible to procline your upper teeth some more."

Huh?! You mean I might not need surgery? I really have mixed emotions about this and I'm still quite upset about it today. On one side I know that surgery has risks and that avoiding it can sometimes be ideal. It also means I'll save some cash and not have to go through months and months of extended recovery. But on the other hand I don't want to cut any corners. I don't want to extend my treatment by going off on a tangent with elastics only to find that they didn't work well enough or that I later relapse. And I don't want anything less than an ideal solution both functionally and cosmetically.

It turned out that they had some time to take new x-rays and photos as soon as Dr W was finished with me. Good. Less waiting. I go back on August 25th to get the verdict.

So what are class III elastics and how do they work? I found this link (PDF format) last night which does a reasonable job of explaining it (Figure 8.7 on page 223 seems to be the state I'm in). It appears that elastics can correct an under bite within a certain threshold. I assume measurements can be taken from the x-rays. I'm right on the borderline, hence my anxiety.

So here I wait. Agonize. Anticipate.



Lower incisors are finally pretty much straight.



Bends to intrude the central incisors.