Going in for these adjustments has been a little different because they are just so damn minute.  The tiniest little fine tuning changes, which is why I think the appointment frequency has been shorter at 3 weeks.  Doc kept saying "I am really happy with your bite.  Bite looks great.  Just need a softer landing on those front teeth."  I think I can tell he's adjusted the angulation on my front teeth a smidge, my midline seems more centered now, and we're working on tweaking my elastics to give me a good balance where we keep everything tidy, yet prevent that right 6-7 tooth segment from clashing down on the teeth below it more than they should. Wires out, and my doc wiggled my front teeth.  Heeby freaking jeebies!!!  Gggaaahhhh!!  It's not necessarily painful or anything, but it doesn't give me warm and fuzzies, especially when it's somebody else doing the wiggling unexpectedly. But they felt really loose... like, really really loose.  They felt like how loose baby teeth felt when they came out when I was little.  Bleh.  Damn these front teeth.  :(  A bend or two in the top wire and back in it went with new power chains on the top and bottom. My lower wire has not been adjusted since late 2015.  I am going to assume we're done with my lowers and it's just being retained for the most part. Rubber band jail has been tweaked a smidge.  He still would like full time on the current elastic set up, but told me to use my discretion to get out of them for a bit here and there if that right side is bugging me a bit.  Just need a balance of keeping everything closed up and tidy yet not closed up too much on that side where I have too much contact between the upper 6-7's on it's lower neighbors.

I did a records dump from my surgeon.  I got in the habit of getting all of my records and having them after my first round of treatment.  I was using them for consults then, but now it's mostly just to have and to satisfy my geeky curiosity seeing things like my surgical report.  It's neat to read my treatment notes from all of my appointments in 2016, and especially cool to see the surgical report. Like everything else in my re-treatment, what a night and day difference from my Kaiser report.  SO much detail.  I know Dr. Karas mentioned to me post op that he had to abandon the split ramus osteotomy he wanted to do and go for the normal BSSO along the same jaw cuts that were already there.  I kind of never knew why though, but figured it had something to do with the structure of those cuts and compromising the stability of my jaw any further.  My report says there were huge gaps where the bone didn't have a full union, so he couldn't make a separate cut and compromise things further.  Same with the top jaw.  He said my left side had little bony contact and was pretty much largely open still, and my right side had better bony contact.  Question now is, is this completely a physiological/biological response and I just naturally didn't get as much osteogensis as I should have post op, or was it more in response to how torqued and offset things were; so much so that it just didn't allow for good bony contact to heal. Who knows.  I'll have to ask in a few months at my next follow up.  Also in my notes are the words I have been desperately wanting to hear through all of this-- "Patient is class I."  I am officially class I!!!!  I had to pinch myself after reading that.  I figured I was class I after he called my bite "near perfect" last week, but it's nice seeing it in black and white as class I.  Otherwise, the notes read as good as what he's verbally said to me in each appointment.  I basically healed without incident, and for that I am incredibly grateful.  It's still so weird for me to go from a position where nothing ever went right and I was constantly in a posture to catch the other shoe when it dropped, to now settling in to feeling what a normal course of treatment feels like.  Unfortunately, it's finally happening at the end of my treatment, but oh well.  Every ounce of anxiety going through revision has been worth it.  

Otherwise in general house keeping notes- I think I can finally declare my numbness back to what it was pre-op (still permanently numb/tingly on the right half of my lower lip/chin/ lower right gums).  I do have some additional numbness in some other spots on my gums, but it seriously does not bother me at all.  I would say my swelling is about 85-90% gone.  Some days I am puffier than others.  The tenderness on my right side and upper jaw has greatly improved the last week or two.  The disc that was slipping in my right TMJ has been great the last month...but then after having my mouth cranked open for a teeth cleaning Mon and orthodontist appointment yesterday, it just crunched/slipped again real quick today for the first time in a long while.  I'll try to take it easy on it the rest of today and do some heat on it too.  Speaking of the teeth cleaning, my hygienist said my teeth and gums look the best she's seen in the last year or so, so she's putting me on a 4 month recall instead of 3.  And this is after surgery and all of the reduction in cleaning at first due to my opening.  Nice!  I finally gave in and bought a waterpik and that thing is fantastic.  Really makes a difference I guess!  So, who knows.  Maybe my next teeth cleaning will be brace free!!!

Few shots to show where teeth and swelling are settling.  I noticed my smile is starting to feel slightly less robotic and more normal.  Hopefully this is the beginning of more scar tissue settling as well as me getting used to the new positions of everything.

I'll try to keep this short since I am also doing a vlog with the post, but you know how things go with me and keeping posts short.  Saw my surgeon today for my 3 month post op check up.  Six weeks since my last visit with him.  I also saw my ortho unexpectedly since my surgeon agreed that my bite was slightly opening on my left side but nothing awful in the least.  He said since I was going right past my ortho's office on the way home I might as well stop by and see what he says.  But otherwise.... he said my bite is near perfect and he was really happy with everything.  Bite....perfect...... same sentence.  I feel like I have to freaking pinch myself!! 

All checks out well.  My surgeon looked pretty happy again and said I look great aside from the normal residual puff/swelling I've got going on still in some areas.  I took a new pano and that looks great too and he said my bones are healing nicely still and the hardware looks good.  I can really see the deviated septum on this pano, so I asked him about when I should get that fixed.  He said he likes to wait a year to let all the scar tissue settle and everything else.  I would need to get with an ENT to fix it.  Bbboooo....I was hoping Dr. Karas could do it!  I don't want to go through the anxiety of getting with a new doc that I don't trust.  Hopefully Dr. Karas can give me the name of somebody he trusts, so therefor I would trust. He's happy with my opening, and happy to hear the numbness and nerve issues are shrinking back in to the original strip of permanent numbness and tingling I had left from the first surgery along my right side of my lower lip/chin.  I asked him about the pea sized hard lump that was up around the orbital rim area under my right eye, and he said if that hasn't resolved by now it's probably not a hematoma and could be a bone spur or the very edge of that plate and screw set under there.  So, we'll address more at my next appointment, which will be in 3 months!  Gah!  3 months not seeing Dr. Karas makes me feel vulnerable...but a LOT less so than before.  I think I am at the point now where I am ready to fly on my own and not need those constant checks and reassurances that all is the way it's supposed to be this time. 

My ortho was nice enough to squeeze me in unannounced.  And again, I think he was glad I stopped by.  He knows when I stop in it's usually not for nothing.  He agrees my bottom jaw was slacking back again.  He thinks because I was SO compliant with wearing my elastics, to just almost take them off cold turkey was abrupt and just allowed things to float where they wanted.  We'll ease off of them next time and hopefully that will transition things slower to stay where they need to be.  I really hope that is the case....scary to think I could be out of braces and no elastics and my bite just floats back and I relapse.  I freaking hope not! 

Vlog and pics below.  I went ahead and chopped the rest of the mop off the top of my head, so now I am officially back to full pixie! :)  Don't mind the tired eyes in the vlog, today is my third day in a row coming off of 5 hours of crappy sleep before my 4:45am shift at work.  God, I can't wait to work a job where I am not doing crazy hours! 

And here is a few comparisons thanks to fb memories showing a few posts to me the last couple of days.  I don't even look like the same person in some of these pics, which gives me mixed emotions.  I am not 100% a fan of all of the visual changes that came with aligning my bite/jaws.  I do miss a lot of my old face.  I feel like it was more youthful, and for the love of god, I miss the more narrow nose before any of the jaw work.  BUT, it doesn't matter, I am so grateful to be able to bite through some foods I've never bit through cleanly before.  A few aesthetic changes I don't like is  fair price to pay for the function, IMO. 

I was again anxious to get my adjustment done.  I think because its such new territory for me and I don't know what is what now that maybe it's getting me a little riled up for these appointments.  I think I also get some anxiety over hearing more news about my front teeth as well as experience them out of the bands/wires and feel the full power of how loose they are.  And I can see the looks on the assistants and doc's faces, trying to be so delicate handling my front teeth.  Really wish I wasn't in this position dealing with them, but it is what it is.

I get my wires out, and I'll be damned if the bracket on tooth 7 fell off again!  What is it with this tooth?!  And it just stays in place so well that I can't even tell it's broken, so who knows when it broke since the last appointment a month ago, but I have a sneaky suspicion it had to be early on because that tooth was still hung up (shorter than the rest of the teeth being extruded around it) and it feels looser since it's not supported by the wire.  So, we again rebond the bracket on tooth 7.  Doc looks at my bite and is VERY happy and said I must be really great with wearing my elastics because everything is more than where it needs to be.  Yes, I am really good with complying with rubber band jail.  And I figured everything was where it needed to be because I could feel my bite really click in a few weeks ago.  Only thing I would say is that I feel like I could be closed up a smidge more on my right side still, especially in the back.  He must have noticed this too, so he did some polishing of a few teeth on my left to make them sit better, and I noticed it gave me more play on the right side too.  So, new bends in the wire.  He tells me we're "orthodontically extracting tooth 7."  That is a new one for me.  I knew we were going to extrude it, but I didn't think to call it an orthodontically assisted extraction, but that is really what it's going to end up being.  Pull the tooth out some more.  There is barely any root left to it, so when it gets to a point where it's extremely loose, he said he is going to put a splint on the back of it to help keep it supported.  Doing this will allow my natural bone to fill in where the root was, and this will set me up for my implant better.   So...goody.  I get to watch tooth 7 have a slow painful demise.  Ugh!

No adjustments on my bottom teeth otherwise.  New c-chains back on.  Tooth 7 has been disengaged most of the last few months at this point, so getting the new bracket on that and having it extruded has made it a touch sore this  morn, but really not bad.  I feel like it's irritated when I bite down though.  I don't think the lower incisor is touching it, but I think the K9 next to it is touching the lower bracket below it when I bite down and I can see the whole tooth segment between the lateral incisor and that K9 moving when I bite.  Gives me the heeby geebies looking at it.  It feels worse when I am in the bands, which makes sense since the bands are pulling down on the teeth there.  Might have to reach out to my ortho today and ask them about it and see if I need to come in to have them take a look.  I leave for a backpacking trip tomorrow for the weekend and don't want this getting worse and risk irritating those already fragile front teeth with bite trauma.  Nothing like being out in the woods and then having bite issues that keep you from eating the required calories on a rigorous backpack trek. 

On a different note, I was talking with a few of the girls who work at the office, and I kind of found out through conversation that my ortho still does quite a few cases with Dr. O'Ryan.  They've never had an issue with her like what happened with my case, so I guess from their stand point, there is no reason to not do business with her.  I have mixed emotions on this.  The rational/practical part of me understands.  It's just business.  But then on the personal/emotional side, I guess maybe I feel like after them seeing what she did to me and still referring patients out to her is a little... well, I don't even know what to call what I am feeling really.  Like, are they OK with that kind of treatment for another one of their patients?  Even though they haven't seen it happen to one of their patients before, they've now seen my case and know it's a possibility that it can happen.  Another jaw patient in the area told their orthodontist what happened to me, and that orthodontist stopped referring out to Dr. O'Ryan after he heard the story.  But yet my own orthodontist is still working with her?  I'm  not even the other guys patient and he stopped referring patients out just after hearing my story!  I really hate to think negatively in any way about them because of this, but I can't help myself but feel a little put off by it.  I think it's normal and human to feel that way though.  But, I am going to try to keep an open mind about it and latch on more to that rational/practical side and remind myself that it's just business.  I still love my ortho and he has done right by me in every way possible so far in my revision treatment. It's very difficult to remove emotions from a situation like that.  I'd be lying if I said there wasn't a little sour taste in my mouth over it, but like everything else, it is what it is.

I see Dr. Karas next week for my 3 month check up.  3 months post op-- time flies!  I'll get a new pano and hopefully get some updated records from him.  I think I am going to ask him what the plan is for my deviated septum down the road in the not too distant future.  I am not sure if he can do it or if he'll send me to an ENT.  If he can do it, I might ask him to take out all of my top hardware while he's in there.  The top plate/screw sets, similar to last time but better still, are tender and I know they are there.  The bottoms I can't tell, so they can stay.  I'd just rather have the top ones out.  And if all of this gets done after braces, then I might as well have him take tooth 7 while I am under too.  Kill 3 birds with the one anesthesia stone.  So, we'll see what he can do!