Confessions Of a Metal Mouth
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Unexpected Christmas Gift

11/23/2014

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Heard from the new ortho the other day.  Couple things I wasn't expecting.  1.)  My braces are coming off Dec 2nd.  Time to celebrate?  Well, no.  It's just temporary.  I was expecting to get them off and swap into fresh new appliances in a set up from their office, but I did not expect to have an extended break.  Sounds like they are going to fit me for retainers, take some new scans/models and examine me without all the business of somebody elses appliances all over my teeth, and evaluate where they should go from there with the advice of my surgeon.  They're actually going to evaluate me and see if invisalign is an option.  Again, something else I wasn't expecting to hear.  From what it sounds like they are going to see if I can do invisalign vs. traditional braces, and then do some computer modeling to see what the outcome will be with each, and then with each see what the outcome would be like if I have some extractions vs. no extractions.  And there is the next part I wasn't expecting to hear.  The "E" word never came up with my old ortho and surgeon.  I know some people get extractions as part of their ortho treatment, but it was just never on the table with me.  Personally I am good with that.  I don't like the idea of removing healthy good teeth and causing more trauma to the bone structure in my mouth.  I think the reason they are looking at that as an option now is because there is just no room to do the work that needs to be done with my jaws.  My surgeon needs to move my upper jaw back 4mm and would like to move the lower jaw forward a little bit more to get a good functional and esthetic relationship.  Right now with a 5mm overjet he doesn't have the room to do that.  He'll give me an underbite if he does.  So, thanks to my old surgeon and ortho, now I am in a position where they have to make room.  If they extract the bicuspids from my lower arch, they'll close those gaps and bring the teeth in more, ultimately bringing that lower arch in/back further and creating more of an overbite and overjet for me.  So if they can get my overjet to say 8-10mm (I started with 8 and easily could have been taken to 10 had my ortho/surgeon done what they were supposed to do), then that gives them room to get my upper jaw back 4mm and lower jaw forward a little more and still be in a class I relationship when this is all done.  And I'll be able to close my mouth comfortably again.  Sweet baby jebus I can't wait for that!  Anyway.... braces come off Dec 2nd, I get retainers fit that very day (I told them I can not leave the office without them since my teeth move REALLY fast), and I'll probably look at doing the new appliance with them in early Jan 2015.

Not technical/medical related, 2.) the treatment estimate is $7500-7800 over a span of 14-16 months.  Yep, a 16 month sentence to be in this mess still.  Tough pill to swallow since I've already been in braces almost 20 months and should have been out of them as of probably 3-4 months ago had this all not went to hell.  During my records appointment, the new ortho made a comment like "wow, most of your work is done" in terms of my teeth being straight and not having the crowding and stuff I started out with.  I was hoping he would see he doesn't have to do the initial work and maybe this would all be over sooner rather than later and the price would reflect a shorter treatment, but nope.  Oh well. I am a surgical case and this is going to take extra time on his part to do the planning/work for my case.  And I am just happy he took me on as a patient, so I am willing to pay whatever he tells me to pay.

So.... guess I can look at the break from brace jail as an unexpected christmas gift.  I hate to get all excited about it though when it's not going to last long.  And getting your braces off is traditionally a joyous celebratory experience, but this definitely won't be the traditional get your braces off day for celebration.  I am dreading it.  I hate just having brackets off and rebonded.  I absolutely can't stand the scraping of the cement off my teeth.  Sends me up the wall!  I am OK on the back teeth, but my front teeth just make me want to scream.  The feeling/sound of it sends shivers up my spine (like, I'm getting goose bumps right now just thinking about it.  No lie!!), and my front teeth are so loose/sensitive that it just doesn't feel great.  Usually they have to take the polishing tool and the ortho has to come over and hand polish everything off for me.  I hope they do that for me for this appointment.  I am going to need to chow not one, but two xanax before I go in for this one.  I know it's going to be rough.  Maybe I can get my teeth whitened while the brackets are off.  That would be a HUGE bonus!  My teeth are still so stained from all of this, especially the post op period with the peridex mouthwash.  That stuff sucks so bad!
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Being A Bad Blogger Again... 

11/17/2014

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Here I am being a bad blogger again.  Haven't updated in a while.  I've let the blog go for a couple of reasons that I can't get in to much right now, but they're good reasons.  Anywho...this will probably be a long update to catch up.

I've had some big changes recently.  I am still moving forward with my new surgeon, Dr. Karas.  I've spoken with him and my prosthodontist a few times in the last month or two, and every time I get the feeling like they want to say something to me regarding my ortho, but they're holding back.  They say just enough to give me the hint.  I already knew I had to find greener pastures in terms of the ortho, but I've seen five orthos and nobody will take me on because, 1.) I'm a super complicated case now, and 2.) All of these orthos know my ortho and I guess there is this code among orthos that you don't take a buddies case over from him.  I got pretty discouraged after traveling up to an hour to see five different orthos and hear the same story from all of them regarding their relationship with my current ortho and why it was a conflict.  I gave up and figured I have to make the most of what I've got with the current ortho, despite his past and continued mistakes. My prosthodontist finally had it though, and on the last appointment for a teeth cleaning, he got pretty blunt with me once he found out the reason I was still with my ortho is because I felt I had no other choice.  He flat out said I need to find somebody else, and mentioned that he was even a little ashamed of his profession right now because these docs shouldn't be doing this to me.  Dr. Karas has been just as blunt already and told me to cut my ties with him (this was after he did a post mortem on my records and saw how much my ortho screwed up and continues to screw up).  They teamed up and referred me to a guy in Danville, about 40 minutes  north of me.  I was dreading another appointment where I would hear the same story.  Turns out.... my expectations were wrong.

I walked into the ortho office and I could tell I liked the place.  Much different than the orthos I saw in the other parts of the bay area.  I didn't want to get my hopes up though because I figured they wouldn't take me on as a patient for the same reasons the other orthos wouldn't.  Doc looked at me and said "If you choose to come over as a patient, I would do...."  Wait, wait, wait..... you mean you'll take me on?!  Did I just hear this right?!  He was surprised that I was surprised, and I told him my experience with the other orthos.  He said he can't believe that happened to me and that is not the way it should be.  This is what is best for the patient, what I want, and if that is the way it is, then you put your feelings/friendship aside and do what is right for the patient.  He offered to call my ortho and do the transfer himself.  Wow.  I was speechless.  I was also holding back tears at that point, but they were happy tears.  FINALLY ..... an ortho who is doing the right thing.  And not just some ortho I had to settle for.  He's a good one and he works exclusively with my surgeon, so they have done tons of cases together.  I can't tell you the relief I felt walking out of that office that day.  Still  nervous about how the transfer would go down (not that I should care if my old ortho's feelings get hurt, but I do for some reason), but so relieved to have an awesome new ortho who works with my surgeon a lot.  It's important to have that team element this time around.  I was scheduled to come back for my records a few days later.  They called my ortho the next week to initiate my transfer, and not only did it go well with no hard feelings, but my ortho offered to refund 100% of my money right off the bat!!  I got all $8300 back!!  I was shocked!!  Was that because he really feels bad that this all went so wrong?  Or Maybe he is just so glad to see me gone that he doesn't care and just wants to be done with me, including my money?  Or is he afraid I'll come after him for all of his screw ups in this and hopes this will stop me from doing that?  Maybe a little of all of the above, honestly.  Some glamor shots from the records with my new ortho:


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Yet another round of xrays and scans.  I think my brain is going to be fried after this year.  But, it's been interesting to see the progression of bone growth since the surgery.  Here is a look at the pano a week post op and the one I got with my new ortho:
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1 week post op
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6 months post op
::sigh:: I hate looking at the pictures for the records.  Can definitely see the crooked jaw jetting out to my left.  I hate the visible strain trying to close my lips over a top jaw that was moved way too far forward.  And I really hate how wide my nostrils are now.  For the xrays....Almost looks like a normal pano again.  I can still see some dark spots that more new bone needs to strengthen in, but overall I can't believe how much bone regrows in 6 months, especially in the gaps where the lower jaw was fractured and moved forward 3-4mm.  All in all my lower jaw feels really solid.  My upper jaw is still a little wonky and the areas around the plates/screws still weird/tender to the touch.  I hope that doesn't last forever.  Otherwise, you can see the work my ortho has done to cover the surgical mistakes up.  My bite appears better to the eye, but it's not a long term stable bite.
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6 weeks post op - midlines shifted, canted down to my right (left on the pic)
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6 months post op with a ton of ortho "corrections."
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6 weeks post op - edge to edge bite on my left
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6 weeks post op - overbite on my right half of my mouth.
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6 months post op. 5mm overbite
So, there has been a ton of ortho compensations done to my teeth the last six months (which should have never been done!).  Easier on the eyes?  For sure.  Good for a long term stable occlusion?  Nope.  So, all the surgeons unanimously say these compensations have to be reversed to the way it was when I came out of surgery in those 6 weeks post op pictures.  That way they can correct it the right way surgically, since the discrepancies were due my jaw bones being reset crooked.  I haven't gotten a new plan from my ortho yet, but I hope he and my surgeon can talk soon and let me know what they want to do and also get some kind of time frame for everything.  So, I am in ortho pause now (have been since Oct-- they are not actively moving my teeth and instead just retaining them with a light wire) to let my roots have a break and in general it's wait and see mode for everything.  All will depend on what my surgeon/ortho come up with as a plan and we'll go from there.

Otherwise, no major changes at the 6-7 months post op mark.  I would say the numbness on my chin/lower lip hasn't change in the last 3 months.  My lower jaw feels pretty good (outside of being crooked and still making my joints sore) and solid, but the upper feels a little wonky still.  The area around the plates/screws still feels weird and is tender.  Not sure if that is something that will be permanent or will still get better up to the 12 month mark.  If it's permanent, I'd rather have the plates/screws out after this next surgery then.  I would say my puffiness has been the same the last 2-3 months.  Some days I am puffier than others, especially around the nose.  If I fly it irritates things, sleep wrong, stay up late drinking, etc, all causes some additional puffiness.  I'm eating almost back to normal (minus biting in to anything directly with my front teeth so loose. and I still don't go to town on super hard stuff a bunch since it does make me sore eventually), so I've gained about 8 lbs back out of the 11 lost (some of it is good muscle weight this time, but just a little. lol), and that has actually helped hide the lopsided face issue a bit.  When I was thinner it was def more noticeable.  I definitely still notice it at least.  So much so that I did ask the photographer that did my boudoir photos (got them done for Matt's anniversary present) to shave down the jaw that sticks out more on my left.  She did a good job and it looks a little more like my old jaw before it got all messed up in surgery. 

So, I'll leave this post on a good note with a shot from the boudoir session.  It was nice to get my hair/make up done and feel good about myself for a day! :)
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