Warning, this is going to be a lengthy post. A few tid bits to catch up on for this one. First.... I am five months post op today. Not much change since the last time I updated on the jaw house keeping. I've been out of 24/7 band and now just night time only and my bite is still holding up great. My right side that has felt more wonky has also started to feel a little better now that it has a bit of a break from the tight elastics that were stacked on my right side the last 4.5 months. So, all is kind of quiet on the jaw front, but everything else is busy.
First, lets open up with this story. And I've been thinking about it all day wondering what the hell the odds of this happening were. So, all that stuff going on with my front teeth. Major business, and even though I trust and adore my team (as much as I can. As I've said lots of times before, I am scarred for life after my first treatment experience. I'll never be able to trust fully ever again no matter how good the docs may be), this is major work and it's protocol for me to get second opinions. So, I have a friend refer me to another prosthodontist in the bay area. An hour across the bay from my current prosthodontists office and closer to where my ortho and surgeon are. I get a missed call and message from the doc the day before the appointment. I didn't think it out of the ordinary to call me before hand because some doc want the background on my difficult case before seeing me. Well... it wasn't quite what I was expecting. She said, "well, I was in your orthodontists office yesterday for my kid's appointment with him (which was the first weird coincidence-- what are the chances we use the same ortho?). I told him that I had a patient of his coming to see me but couldn't remember your name. 30's, braces, two jaw surgeries, front teeth severe resorption and need to be replaced. He said, "Oh, Ashley? But isn't she your husbands patient?"" Seriously... this prosthosodontist that I had the second opinion booked with is the wife of my current prosthodontist. Her office is an hour away across the bay from his, and she kept her maiden name, so I had no clue. And the referral was from a friend! I didn't even find her myself!! What are the freaking chances?!?! So, my plans for telling my team AFTER my consults that I went on second opinions was now long gone. And now they found out I was doing it without me telling them, so that didn't sit well with me. I was never going to not tell them, but just was waiting until after I went on the consult(s). So, I sent a nice long email to all of them and cleared the air. Got my feelings/motivation for second opinion off of my chest. Explained to them the situation where after the first round of treatment I can't trust and need that reassurance. How this has nothing to do with them or anything they've done, because they've done 110% right by me and have done everything to have my full trust, but I just don't have it to give after being burned so bad by my first surgeon and ortho. My surgeon responds a few hours later and said what he's said to me in the past, which is not only does he not mind, but he is totally supportive and encourages all the opinions you can get. He wants his patients to be educated and informed about treatment, including guidance from other doctors. He's told me this in the past, and I know that is the vibe of this team (as it should be with all good docs), but I was still super glad to get that response from him.
Speaking of the surgeon, I had an appointment with him today for my first consult about my implant work and stuff. My head is still kind of spinning from it and it's a lot to digest. He was nice enough to spend about 25 minutes with me, which I was really thankful for. I was worried we'd have a rushed 10 min consult block booked. Maybe we did, who knows, but if so, I really hope I didn't put him behind the rest of the day. I am so glad I got to see him today. First we got to chat face to face over the whole second opinion fiasco and he put me at ease even more about all of that. He seemed to get a chuckle out of it, and said the other docs did as well. And then he was really able to lay out and present all of the stuff on the implant plans well. I love my prosth, but my surgeon just clicks better with me in the way he conveys things and presents things to me. Like, instead of being a crying and slightly confused messed leaving the office, I had this warmth and wholeness wash over me; confidence that I am pushing forward and in amazing hands with the right plan.
Unfortunately, he's got his hands full with me again. He basically never sees resorption this bad. Some is normal with braces, but not like this. This is extreme. He just kept saying over and over again that he felt bad that I was in this position, especially with how young I am. He was cautiously optimistic I'd be able to keep some of these teeth for a while, but after seeing the latest scans that everybody has been looking at and talking over, he's with my prosthodontist in terms of not feeling very optimistic anymore. There's just not enough root left, and in some cases, almost no root left in the bone. My right lateral incisor is literally being held in by gum and arch wire. But on the bright side, this also helps the implant process along. Since the root has disappeared, new bone has filled in behind that. So, instead of doing the normal extraction, bone graft, wait 3-4 months, then implant, etc.... now we get to extract and implant in one swoop same day since I should have enough bone that has already filled in behind the root. He still plans to bone/tissue graft anyway, but I should be able to get the implant same day as extraction. I'll also get the implant for my missing molar done as well.
So, get my braces off-- yes, braces are coming off sooner rather than later. Surgeon is with my prosth and said there is really nothing else to be done and I look finished up. He's going to phone my ortho tonight and push him for a time line on debanding so I can get on the books for implant work. Get some 3d scans and see how my bone is. Get some scans of my teeth to mold the new teeth to be put in. They'll knock me out, get them out, get the 3 implants in, and I'll wake up with some falsies in the gaps. That will allow gum/tissue to heal in the right shape around the tooth and when the permanent crowns are in, they'll go right in with the gum healed in the right shape already. I'll get all the surgical work done with my jaw surgeon, and then pop back and forth to the prosthodontists to get the restorative crowns and all. They'll probably do a lingual splint across my upper 4 to help stabilize the two main incisors and then we wait to see how they go. If the inflammatory process does not stop on them and I lose bone (they'll check with periodic xrays), then we take them out asap. If not, then I go on keeping them for as long as I can take them. If they firm back up enough (which they don't think will happen, but they're willing to see) and are supported enough in the splint, maybe I can go on with these for a little while. Regardless, surgeon said it's best to do this in stages and not do all 4 at once. Much more can go wrong, and the results tend to be better both aesthetically and functionally if it's done in stages like this. The other item up for discussion was the screw that pops out in my right orbital rim. Same as before, it's not super painful, but I have to touch it every single day to apply make up and it just gives me the freaking heeby jeebies. And if I press hard enough, it is kind of tender. Definitely does not give me warm fuzzy feelings. So, as much as he doesn't like to remove hardware unless it's infected and/or causing a lot of pain, he can see why I would want this one out in this spot. He can take out the upper hardware, but wants to give the rest of the year to allow full union of the bones and only do it after another 3d scan to check on them. Fair enough. We can tackle that down the road in 5-6 months.
So... a lot to digest with all of this. I can tell my surgeon totally understands where I am at emotionally not just with what is currently going on, but also with what I've had to go through in the past with my treatment. I can tell the guy just feels genuinely sorry for me in a lot of ways, and I appreciate his empathy. He also reminded me that I have such a good attitude going through all of this, and said he's seen patients go to a really bad place after being wronged by a doc. It's hard to let go of it and remain positive. I'm definitely still proud of myself for the way I've handled this situation the last few years, and I am glad my good attitude is appreciated by my docs. It's definitely had an impact on my retreatment with these guys, I'm sure! So, I'm hoping to hear back and see if I am getting debanded soon, but I see my ortho in a couple days on Monday and I bet they'll wait to update me then. It's the weirdest feeling... debanding is supposed to be such a joyous occasion. Especially after you go through jaw surgery (in my case TWO!). But I am kind of dreading this. My front teeth are going to be SO unstable and loose. And it means turning right around and starting the process of getting my front teeth out, and that is just something that sucks. It also means closing a chapter and saying goodbye to my ortho. It's so hard to explain, but these guys really have a special place in my heart because they saved me from a really bad spot when nobody else would. That goes for my whole team. As much as I am glad to be done with them when the time comes, it's also sad to say goodbye. But, rest assured, I am pretty sure my ortho is going to see me. Every time something gets adjusted or new implant put in on these teeth, he's going to need to do a new retainer for me. Ugh... I am NOT looking forward to that. Molds and the cost of the retainer itself. Ick.
Here are a few 5 month post op shots. Nose is still puffy, but otherwise things are settling nicely.
First, lets open up with this story. And I've been thinking about it all day wondering what the hell the odds of this happening were. So, all that stuff going on with my front teeth. Major business, and even though I trust and adore my team (as much as I can. As I've said lots of times before, I am scarred for life after my first treatment experience. I'll never be able to trust fully ever again no matter how good the docs may be), this is major work and it's protocol for me to get second opinions. So, I have a friend refer me to another prosthodontist in the bay area. An hour across the bay from my current prosthodontists office and closer to where my ortho and surgeon are. I get a missed call and message from the doc the day before the appointment. I didn't think it out of the ordinary to call me before hand because some doc want the background on my difficult case before seeing me. Well... it wasn't quite what I was expecting. She said, "well, I was in your orthodontists office yesterday for my kid's appointment with him (which was the first weird coincidence-- what are the chances we use the same ortho?). I told him that I had a patient of his coming to see me but couldn't remember your name. 30's, braces, two jaw surgeries, front teeth severe resorption and need to be replaced. He said, "Oh, Ashley? But isn't she your husbands patient?"" Seriously... this prosthosodontist that I had the second opinion booked with is the wife of my current prosthodontist. Her office is an hour away across the bay from his, and she kept her maiden name, so I had no clue. And the referral was from a friend! I didn't even find her myself!! What are the freaking chances?!?! So, my plans for telling my team AFTER my consults that I went on second opinions was now long gone. And now they found out I was doing it without me telling them, so that didn't sit well with me. I was never going to not tell them, but just was waiting until after I went on the consult(s). So, I sent a nice long email to all of them and cleared the air. Got my feelings/motivation for second opinion off of my chest. Explained to them the situation where after the first round of treatment I can't trust and need that reassurance. How this has nothing to do with them or anything they've done, because they've done 110% right by me and have done everything to have my full trust, but I just don't have it to give after being burned so bad by my first surgeon and ortho. My surgeon responds a few hours later and said what he's said to me in the past, which is not only does he not mind, but he is totally supportive and encourages all the opinions you can get. He wants his patients to be educated and informed about treatment, including guidance from other doctors. He's told me this in the past, and I know that is the vibe of this team (as it should be with all good docs), but I was still super glad to get that response from him.
Speaking of the surgeon, I had an appointment with him today for my first consult about my implant work and stuff. My head is still kind of spinning from it and it's a lot to digest. He was nice enough to spend about 25 minutes with me, which I was really thankful for. I was worried we'd have a rushed 10 min consult block booked. Maybe we did, who knows, but if so, I really hope I didn't put him behind the rest of the day. I am so glad I got to see him today. First we got to chat face to face over the whole second opinion fiasco and he put me at ease even more about all of that. He seemed to get a chuckle out of it, and said the other docs did as well. And then he was really able to lay out and present all of the stuff on the implant plans well. I love my prosth, but my surgeon just clicks better with me in the way he conveys things and presents things to me. Like, instead of being a crying and slightly confused messed leaving the office, I had this warmth and wholeness wash over me; confidence that I am pushing forward and in amazing hands with the right plan.
Unfortunately, he's got his hands full with me again. He basically never sees resorption this bad. Some is normal with braces, but not like this. This is extreme. He just kept saying over and over again that he felt bad that I was in this position, especially with how young I am. He was cautiously optimistic I'd be able to keep some of these teeth for a while, but after seeing the latest scans that everybody has been looking at and talking over, he's with my prosthodontist in terms of not feeling very optimistic anymore. There's just not enough root left, and in some cases, almost no root left in the bone. My right lateral incisor is literally being held in by gum and arch wire. But on the bright side, this also helps the implant process along. Since the root has disappeared, new bone has filled in behind that. So, instead of doing the normal extraction, bone graft, wait 3-4 months, then implant, etc.... now we get to extract and implant in one swoop same day since I should have enough bone that has already filled in behind the root. He still plans to bone/tissue graft anyway, but I should be able to get the implant same day as extraction. I'll also get the implant for my missing molar done as well.
So, get my braces off-- yes, braces are coming off sooner rather than later. Surgeon is with my prosth and said there is really nothing else to be done and I look finished up. He's going to phone my ortho tonight and push him for a time line on debanding so I can get on the books for implant work. Get some 3d scans and see how my bone is. Get some scans of my teeth to mold the new teeth to be put in. They'll knock me out, get them out, get the 3 implants in, and I'll wake up with some falsies in the gaps. That will allow gum/tissue to heal in the right shape around the tooth and when the permanent crowns are in, they'll go right in with the gum healed in the right shape already. I'll get all the surgical work done with my jaw surgeon, and then pop back and forth to the prosthodontists to get the restorative crowns and all. They'll probably do a lingual splint across my upper 4 to help stabilize the two main incisors and then we wait to see how they go. If the inflammatory process does not stop on them and I lose bone (they'll check with periodic xrays), then we take them out asap. If not, then I go on keeping them for as long as I can take them. If they firm back up enough (which they don't think will happen, but they're willing to see) and are supported enough in the splint, maybe I can go on with these for a little while. Regardless, surgeon said it's best to do this in stages and not do all 4 at once. Much more can go wrong, and the results tend to be better both aesthetically and functionally if it's done in stages like this. The other item up for discussion was the screw that pops out in my right orbital rim. Same as before, it's not super painful, but I have to touch it every single day to apply make up and it just gives me the freaking heeby jeebies. And if I press hard enough, it is kind of tender. Definitely does not give me warm fuzzy feelings. So, as much as he doesn't like to remove hardware unless it's infected and/or causing a lot of pain, he can see why I would want this one out in this spot. He can take out the upper hardware, but wants to give the rest of the year to allow full union of the bones and only do it after another 3d scan to check on them. Fair enough. We can tackle that down the road in 5-6 months.
So... a lot to digest with all of this. I can tell my surgeon totally understands where I am at emotionally not just with what is currently going on, but also with what I've had to go through in the past with my treatment. I can tell the guy just feels genuinely sorry for me in a lot of ways, and I appreciate his empathy. He also reminded me that I have such a good attitude going through all of this, and said he's seen patients go to a really bad place after being wronged by a doc. It's hard to let go of it and remain positive. I'm definitely still proud of myself for the way I've handled this situation the last few years, and I am glad my good attitude is appreciated by my docs. It's definitely had an impact on my retreatment with these guys, I'm sure! So, I'm hoping to hear back and see if I am getting debanded soon, but I see my ortho in a couple days on Monday and I bet they'll wait to update me then. It's the weirdest feeling... debanding is supposed to be such a joyous occasion. Especially after you go through jaw surgery (in my case TWO!). But I am kind of dreading this. My front teeth are going to be SO unstable and loose. And it means turning right around and starting the process of getting my front teeth out, and that is just something that sucks. It also means closing a chapter and saying goodbye to my ortho. It's so hard to explain, but these guys really have a special place in my heart because they saved me from a really bad spot when nobody else would. That goes for my whole team. As much as I am glad to be done with them when the time comes, it's also sad to say goodbye. But, rest assured, I am pretty sure my ortho is going to see me. Every time something gets adjusted or new implant put in on these teeth, he's going to need to do a new retainer for me. Ugh... I am NOT looking forward to that. Molds and the cost of the retainer itself. Ick.
Here are a few 5 month post op shots. Nose is still puffy, but otherwise things are settling nicely.
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