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Fourth Post Op Adjustment...And Then Some

6/21/2016

9 Comments

 
So I finally get in for that appointment I messed up last week and missed (and I brought donuts today for my penance).  What was supposed to be a quick in/out adjustment like I've seen for the last few adjustments turned out to get quite interesting today.  I had a feeling something was up when the doc himself sat down to start doing all the worker bee RDA tasks like untie me and take the wires out.  Of course he goes straight for those front teeth.  And he's not super happy.  Ugh.  I am not even sure what he did to the wire.  Almost nothing at this point.  I think maybe just one bend in it to help extract that lateral incisor some more.  He wanted to see where it was at, but just by feel, he thinks it's ready to be out.  And based on the wiggle to my front teeth, his concern is growing there too.  He sneaks me in for a quick pano and decides to call my prosthodontist to pow wow and see what the game plan is.  Based on what I just saw on the pano, I have a feeling we're revisiting what is going on with these front teeth sooner rather than later.  My prosthodontist wants me to swing by to get some PA films and have him take a look at a few things and chat.  Took me 90 minutes to get over to his office in AM Bay Area traffic....sucked!

As soon as my prosth took the PA's and I saw the films pop up, I could tell where this was going.  Compared to last year's PA's, there is significantly more root gone on my 4 upper fronts.  Makes sense based on how  much looser they feel on me now.  And I shouldn't be surprised.  Seriously.... why am I surprised?  Or why does this seem harder and harder to have the discussions about all of this when I knew this was coming?  Maybe because having to actually do something about it is really not that far off finally, and unfortunately my hopes of MAYBE being able to hold on to 3 out of the 4 teeth for a while is just getting more and more crushed at each visit.  The prosth gets more and more pessimistic each time.  He really doesn't see any good long term (or even short term) prognosis of these teeth.  Even if I chose to try and keep them for a bit, I then risk them being continually loose and inflamed and it could prevent the osteogensis I need to support the implants and stuff that I need.  I definitely do not want to lose what already diminished bone that I have.  Catch is, now that my occlusion is class I, my upper and lower teeth touch a little bit (as they should), and that is just going to keep wiggling and be inflamed if I leave the teeth.  Also, if I replace just the right lateral incisor and wait on the other 3, then I risk uneven gum/tissue ware and recession and could end up with a whacked out looking gum line when we do finally decide to do the other 3 teeth (and we will have to do it.  It's not an if, it's a when...and they are saying the when would end up sooner rather than later anyway now).  So, there are risks vs. reward to weigh out here all around. Do them all at once vs. a few at a time? Do the implant supported bridge vs. all implants?  And depending on what I do, there is a greater risk to the aesthetic side of the house vs. functional with some things and vice versa if we go another way.  So, I had to tell my prosth today what is my primary area of concern-- function or aesthetics.  As it has been in this whole journey, I am not willing to sacrifice function for aesthetics, so I want that to be his main concern.  Obviously I don't want to look super jacked after this, but I am sure he's not going to do that to me and while aesthetically it won't be perfect, it will totally be just fine and dandy for me. 

So, my prosth, surgeon, and ortho will all put their heads together again and see what the best option is now and get back to me on everything.  Prosth asked me how much longer in braces, and I told him I was tempted to ask today but I didn't, so I don't know.  He seems to think I look pretty near done.  Like, braces could come off at any time.  So, he's more inclined to wait until braces are off to start all of this work since that will probably be happening pretty soon.  Same as last time after this appointment, I bawled in my car like a baby.  I have no clue why this doesn't get any easier coming to grips with the fact that I am losing these teeth.  It's a mixed bag of emotions.  I am sad over the act of losing the teeth, but also because of the reasons too.  I am angry about the reasons I am losing these teeth.  I usually keep it classy on this blog, but quite frankly, this is all bullshit.  I shouldn't be dealing with this, especially after having to deal with the mess of having to have this all redone.  I went on this journey to save my teeth and instead I've got this to deal with now, and most of it is all thanks to my first ortho and surgeon.  And it infuriates me thinking about that.  I really need to stop thinking about it because there is nothing I can do about it.  I can't change it and I can't do anything legally about it and nothing will come of it.  My first ortho and/or surgeon are not going to call and apologize.  They're not going to offer to help pay for me to fix their  mistakes.  So all I am doing is driving myself crazy for no reason if I continue to think about it, but I can't help myself.  Ugh.

So, for now next ortho appointment isn't for another 3 weeks.  My 6 month follow up with my surgeon isn't until August, but sounds like I'll probably be seeing him sooner rather than later to take care of these front teeth.  We'll see what they say when they call me with the news from their meeting on my case. 

I forgot to mention one good thing that came out of the ortho appointment--  I am stepping out of rubber band jail! Cleared to try going to nights only again.  He said it's OK if my bite slips back a tad.  He wants to give those front teeth a break and doesn't want to close them up any more at this point. 

Here are some glamor shots from today. 


9 Comments
Katherine
6/22/2016 01:35:32 pm

You definitely have reason to be frustrated! The whole process is frustrating to begin with and yours is double that plus some! Totally understand but you seem to have a good attitude. And you are close to the finish line!

My surgery coming up is also my second go round, but not as close together as yours were. I will need to get two implants after the braces come off as well. So interested to see if you go with implants vs bridges.

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Ashley
6/22/2016 02:53:16 pm

What teeth do you need implanted? If they are stand alone teeth and not next to each other, then I would most definitely go for the implant. The only reason my teeth are up for debate is because they are all right next to each other and they are front teeth. Combine that with the fact that I have a gummy smile just a tad still, they don't want the tissue around the implant to look all nasty in a few years. They said one implant alone is fine, but when you have multiple together, you can lose quite a bit of tissue and gum around them eventually down the road and they end up looking like crap. So, they are suggesting the bridge. Only thing at this point that I have to lose is spending money for the implant supported bridge and then finding out in a few years I want the implants anyway, which I can then turn around and do and will just be out the extra money for the implants. So, I'll go with the implant supported bridge first and see what happens. Just got a call from my prosthodontist this morn to get the update on the little conference call he had with my surgeon and ortho, and sounds like they are getting me in with my surgeon to consult with him and then go from there. That will be July 7th (that guy is always booked out a few weeks!), so we'll see what he says!

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Traci
6/22/2016 08:23:08 pm

After my double jaw surgery, I had to go in for implants, as well. I've probably told you this. I was born without my lateral incisors on top and had always just had a bridge. When they tried to put my implants in (not by my normal surgeon), they found that my front two teeth are very loose, as well. I think they said I have 40% bone loss in them. My canines are too but not to the extreme my front teeth are. They also found that there wasn't enough room made for the implants but fortunately my surgeon was able to fit a slightly smaller diameter implant into each side. Win! The implant surgery/process was long but really fairly minor in recovery. My worry is that I'll lose my front teeth down the road, especially since I'm back in braces, and there may not be enough room for 2 more implants.

On another point, I went and saw my surgeon yesterday because I felt my bite was relapsing. Turns out that the class 2 bands were pulling out my molars causing my jaw to basically rock on the uneven teeth. My surgeon filed down my teeth and my bite feels much better!

Ashley, did you have a lot more pain with your revision surgery? I'm having a lot more aches and pains in my lower jaw as I'm healing...right where the plates, screws, pins are. Of course, it is the worst at night. You have every right to be frustrated! I understand and sometimes we can only be strong so long before it gets to us!

Katherine, why do you have to have another surgery? What will they be doing? If you look back, I had to have my lower jaw redone after 4 arthrocentesis on my TMJs and 2 fat graft procedures on my left TMJ and 1 fat graft procedure on my right TMJ. All of this and the fact that my condyles remodeled after my double jaw surgery, led to a severe relapse in my open bite. I hope your second surgery and implants go well. 8 surgeries later, I'm alive...but tired of all of this!

ashley
6/23/2016 05:41:25 am

Traci-- I wonder if your front teeth will firm up a bit again after treatment. I think after braces are done and your teeth get out of that inflammatory state, the periodontal ligament firms back up around them and you can built this cementum around teeth, even pretty badly blunted ones, and they can become less mobile. That is kind of why I am advocating for a wait and see to see if I get lucky with that, but they think my roots are so far gone that it's not going to go that way.

RE: pain. Yes, my revision surgery was quite a bit worse than the original. The original they didn't give me enough anesthesia, so I was pretty alert and could have even driven myself home if I wanted to after. I was SUPER dosed for revision, so the first few days were rough and a blur. The pain was also less manageable. I actually stopped taking any pain meds, even OTC, overnight in the hospital the first time. Second time I was asking for morphine every couple hours, and then when I got home I had to take the liquid vicodin every few hours on the dot too. I bled a lot more for revision as well. Scar tissue can bleed like hell. Overall it's just a lot more work and manhandling done to your face for revision, so you'll feel a little worse for it the second time around. I was still able to pretty much go cold turkey off pain meds (even OTC tylenol) by day 5 again still like the first time. I say take what you need but try to step yourself off of the meds when you can.

Katherine
6/23/2016 10:22:55 am

Ashley - That makes sense. It is my second lower premolars that are missing. So it will be implants I guess!

Traci - I had lower jaw surgery about 8 years ago to correct a severe underbite. But since they only did the lower and not the upper it did not fully correct it and my lower second premolars were pulled out to bring my lower teeth back under my upper. This was fine for a while, but I still had issues that have gotten worse in recent years such as receding gums, constricted upper airway, as well as tmj joint pain. So my surgeon will be bringing the the upper jaw forward 6-7mm and using a distraction technique on my lower jaw to create bone for my implants (essentially they cut in between the teeth where the implants will go and then my teeth are just secured with the distraction device (no screws/plates) and starting a week after surgery I will "crank it" twice a day to generate bone growth.

My surgeon also will be putting mitek anchors in my tmj dics because they are displaced, especially on the right side, which he says will continue to get worse and lead to arthritis and wearing away of the discs even more.

I am starting to get nervous, especially because he said I will likely be under for 6-7 hours, which freaks me out a bit! But I am looking forward to being on the other side and working towards recovery!

8 surgeries - Yikes. Hopefully this was your last! What causes the condyles to remodel? Relapsing after all this would be awful!

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Ashley
6/23/2016 10:40:35 am

Katherine-- how does your displaced disc feel? I'm worried about my right side. After my first jaw surgery I had a little stiffness and cracking that lasted a few months and my joints were sore from the bad bite, but didn't feel wonky like something was slipping out, popping, locking, etc. My right side this time has felt worse since day 1 and left side felt really great out of surgery. Right side has been tight and feels like it just needs to snap and go and release tension or something. Hard to describe. A few times it does this weird thing where the only way I can describe it is it feels like it slips out of alignment for a quick second when eating, yawning, and it's happened a time or two while talking too. No searing or sharp pain or anything, but just is weird and takes my breath away for a second when it happens. And usually after it happens, it can happen again the rest of that day until it gets some rest overnight and settles again. I feel like I am grinding a bit on that side too, which goes past the cracking I had after the first surgery. I talked to my surgeon about it and he didn't seem too concerned, especially since there was no pain. He thinks the disc may be inflamed and needs time to settle down and hopefully all of this subsides. The other thing is I have been in 24/7 bands now for 4.5 months (and heavier on my right side), so I want to also wait and see if being out of the bands opens up that side some more and I'll now see the disc settle better. How do you know it's disc displacement? Is it normal to not have sharp pain with that and instead just this weird instability and horizontal quick slip during opening?

Reply
Traci
6/23/2016 02:15:13 pm

Wow, Katherine, that's a lot of work your surgeon will be doing. It's going to go great! My first double jaw surgery was a bit more than 3 hrs, each TMJ fat graft surgery was around 2 hours, and my most recent lower jaw surgery was 2 hours. I've never had a 7 straight hour surgery...you'll have a good nap, right? Good luck! I've found my lower jaw to be more painful with healing than my upper jaw so I hope your discomfort is low!

My TMJ issues started when I was 12. My disc(s) would displace and my jaw would lock open. It never stayed locked for long but was terrifying. I went the next 20 years with manageable TMJ problems...headaches, popping, etc but was fine. After my double jaw surgery in 2013, I immediately had joint pain and couldn't open my mouth more than 21mm....16mm before I finally had surgery. I had constant unmanageable pain, couldn't chew, had grinding and grating as my bones were grinding against each other. My discs were bad to begin with but displaced after surgery. They were balled up, flipped backwards and unsalvageable. My surgeon removed them, put fat in to rebuild them, and hoped I would have no other problems. Why did my condyles remodel? Less than 1% of orthognathic patients experience some type of remodeling or resorption after surgery. Because I did, my change in shape of my condyles plus a bad PT experience that resulted in having to have one fat graft redone, my joints caused my lower jaw to relapse. The nurse at my surgeon's office has never seen a patient like me. I had a 4-5 mm openbite before my lower jaw was redone.

Ashley, coming from someone who's had displaced discs too... My surgeon said pain with popping, etc is bad...sounds, popping without pain is not bad. It does sound like your disc is popping out but hopefully it will not get worse. Mine were displaced right away I think...maybe even before. After my arthrocentesis they were able to pop, wash my discs back in, I was able to open wider for a short while, and each time felt those dang discs pop out within 2 days. I just thought I'd share my take on that.

Thanks for responding about pain and teeth. My teeth didn't firm up much after my first surgery. They told me I'll never be able to bite with my front teeth again in order to try to save them. I have a wire on the back of my front two teeth. Hopefully I'll keep them! In regards to pain, my surgeon gave me enough pain meds for 3 days if I'd taken the max every 4 hours. I managed to make it last 7 days! I do take ibuprofen and Tylenol for pain as needed. I would love to be off of all meds but with all my TMJ issues, complications I've had to take a lot of OTC meds the last few years.

Thanks!

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Paul B
6/30/2016 07:48:38 am

Wow, what a roller-coaster ride you've had! But sounds like things are looking good at last.

I count myself very lucky that whilst my teeth have had many fillings - and now crowns - my teeth have been straight and in good alignment, so I've never been anywhere near an orthodontist, let alone a ortho-surgeon!

So what about the non-treatment things in your life? Have you had any time away doing the things you enjoy? Like jumping out of planes...

And what about the new job / training, how is that going?

Reply
Ashley
6/30/2016 08:43:56 am

Hi, Paul! No airplanes for now. I haven't even been on a road bike or anything either. I am really being good and trying to stay away from anything that could give me a knock to the face for a long while as the bones continue to heal and fill in to the osteotomy gaps again. Just some 1-2 night backpacking trips here and there but otherwise have laid low from the more involved activities where I could take a hit. New job is still in the works. The federal government is not quick with anything, including processing employees for a job. So, Aug will be a year that I have been in limbo with my security clearance, medical clearance, etc. Still waiting and it will probably be more hurry up and wait since I heard on a national level they are WAY backed up on processing.

You're lucky to be without the greater teeth woes. My husband is extremely lucky in that sense too!

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