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many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 12:16 am
by wendydong
if people remember me, I had tiny bit of crowding on the lower teeth that I wanted to fix. Went to an ortho, asked pretty much zero questions, got put on braces for 6 months.

The effect of 6 months of braces are:
1) severe flaring of my incisors.
2) arch shape got more V shaped.
3) maloclusion got worse. Originally, my left upper canine lined up with bottom canine. Now, my left upper canine is between bottom lateral incisor and canine. Basically, originally, i was a half tooth off. Now I am a whole tooth off.
4) lot of my anterior teeth don't touch. only the back molar touch

Ortho informed me midway that my jaw is crooked... and I figured out later on that my overlapped bottom teeth were probably nature's way of masking my crooked jaw.

The ortho got pissed with my questions, threatened to stop treatment if I don't shut up. So i stopped treatment.

I've been going to many consultations during the past month or so. After about 6,7 consultations, I am starting to think that he wanted to quick the treatment because it was going to be extremely difficult/impossible to fix these issues above.

And I am hating that ortho more and more. He has totally ruined my teeth. Sometimes I get angry. I think once I nail down a new ortho, I would review the old ortho and write detailed reviews. And I sometimes think about putting my experience down on a flyer and basically hand out the flyer to every customer going to that old ortho's office

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 12:25 am
by wendydong
Teeth before.
Teeth Before.jpg
Teeth after 6 months of braces...

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 12:43 am
by wendydong
so i've gone to about 6,7 consultations. lost count really.

weirdly, the first words out of every one's mouth is your jaw is crooked. In order to correct your bite, u need surgery

most ortho say: either jaw surgery, or basically about a year of invisalign. The main benefit of 1 year of invisalign is to pull my anterior teeth down, and let all of my teeth touch. The maloclusion (being a whole tooth off) would not be changed at all. They say "your jaw is crooked, the only way is jaw surgery"

The flaring of teeth can only be improved a bit by doing IPR. But I will always have a larger overjet. Originally, i had a normal overjet about 1mm.. now i have an overjet about 5mm. Some ortho estimate maybe I would end up with an overjet about 3mm.

some ortho mentioned that they can decrease the flaring of upper teeth by doing IPR. But they cannot decrease the flaring of lower teeth. The reason is that if they do IPR on the lower, that would make the lower teeth circumference smaller, thus retract the lower, but at the same time, increase the overjet...

But I got two orthos that thinks the Carriere distalizer may help improve the maloclusion a bit. I am probably going to pick one from those two. I am going to detail my consultation experience with those two, and seeking some suggestions.

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 1:08 am
by wendydong
Ortho 1:

This ortho is the nicest, most patient, and gave me the most options. She examined my teeth, and gave me 3 options:

1) jaw surgery
2) extract my wisdom teeth. 1 year of invisalign to let all my teeth touch. doing IPR on top to unflare the incisors a bit. no IPR on the bottom because she doesn't want to make my lower arch smaller and thus increase the overjet. Leave the maloclusion as it is.
3) Do Carriere distiller in the beginning. move my left upper teeth back a little. then do number 2). The whole process would be about 2 years. The added "benefit" would be have my left upper canine aligned with my lower canine, thus my maloclusion would be off by half a tooth instead of a whole tooth. However, there's a side effect of having my upper midline off about 1mm or so.

The ortho says that currently, my upper midline is a little bit canted. It starts in the middle, but doesn't end in the middle. so even though the upper midline would be off a little bit in the end, it would be straight.

Ortho 1 even included a invisalign simulation for me, and let me sort of see what the end product would be. It's very hard to simulate the effect of the carriere distalizer, because she doesn't know what the exact effect of that would be. She's mostly just "hoping" that it would move my left upper molars back a little.

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 1:39 am
by wendydong
Ortho 2:

This ortho is the most unique. she looked at my pano xrays, and says that my crooked jaw could also be due to an anterior disc placement. Basically, the TMD disc has slipped, and caused my condyle to slip.. this is also the reason for my TMJ. She says that my crooked jaw could be due to a combination of "jaw bone asymetry" and "condyle disc displacement"

her proposal is exactly the same as Ortho 1: 2 year of invisalign. Use Carriere distalizer in the beginning to treat my maloclusion. IPR on top to unflare the upper incisor. Lower incisors would be as they are currently.

However, when I asked if my upper midline would deviate due to the distalizer, her answer is that it depends. If my crooked jaw is due to my jaw bone, then it would deviate more. If my crooked jaw is mostly due to my condyle TMD, then my midline would barely deviate.

i saw this carriere promotion video on youtube

it does say it corrects condyle displacement. But seriously, it's a promotional video, and from my research, carriere distalizer is pretty much the same thing as class II elastics... so I am very doubtful. I tend to believe what ortho 1 said that she doesn't really know what the distalizer would do and just hoping for the "best"

The reason I like this ortho #2 is that she told me something that nobody has told me before. When I mentioned that I am not looking for a perfect bite, i am just looking to go back to where i was.. she said "no, we will make it better than what you had before".

She's the only doctor that didn't get gloomy after looking at my current teeth...

However, when I asked to see a invisalign simulation through a follow up email, she said it's useless. Because there's no way of simulating Carriere Distalizer. She said that she would use the distalizer for about 6 months or so. Aftewards, she would rescan my teeth and then she can have a video.

She then said in the email that it's about trusting the ortho.. If I don't trust her, I can go somewhere else.. (not her exact words, but that's her meaning). This brought me right back to my trauma with my previous ortho who fuccked up my teeth.. So that makes me a bit hesitant with her. She doesn't seem to be as patient as Ortho #1. But she did point out something no other ortho pointed out (condyle displacement), this makes me want to go with her.

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 2:18 am
by wendydong
has anyone had any experience with Carriere? is the Carriere distalizer the same as class II elastics?

which ortho should I go with? their treament plan is basically the same. Ortho #1 is nicer and more patient. Ortho #2 told me something no one has told me before (not sure if it's a good thing....)

i made a final appt with University of Washington dental school. They take patient where an orthodontics student will treat you under the supervision of a faculty member. I think I am going to ask every question i can think of alongside the orthodontics student..

Re: many consultations later, Suggestion needed

Posted: Sat Feb 02, 2019 7:08 pm
by EmilyTravels
Personally, I would go with ortho #1 and option 3. I watched the promotional video for the carriere distalizer, and if I had to do it over again, I would be very interested in this. My ortho didn't even suggest it. I had a pretty significant overjet due to jaw fracture on both condyles (bike accident), which shifted my mandible way back. I wanted the quickest solution that would provide a satisfactory result, since we were full-time travelers, and I didn't want to be stuck in one place due to orthondontia for too long. At age 56, I wanted to get my life back as quickly as possible (I had already suffered through jaw-wiring surgery and recovery from that), and my ortho said he could do it with class 2 elastics and standard brackets in 8-12 months. As it turned out, I was in braces for 14 months, 9+ of which I was in either Class 2 or triangle elastics, and in an ideal world, I probably would have had braces for longer. I got a good but not perfect result, so I am happy, since my ortho never promised perfection -- he said I would need jaw surgery for that. At my age, perfection was not what I was shooting for, and jaw wiring once was enough!

I think patience and an understanding attitude, particularly with a patient who is knowledgeable and asks a lot of questions, like yourself, is a huge factor in choosing an orthodontist. As you know, this is a relationship that you will have for 2+ years, so you need to choose someone you respect and (hopefully) like, and who will not end up pissing you off.

Re: many consultations later, Suggestion needed

Posted: Sun Feb 03, 2019 1:39 am
by assertives
Personally, I would pick ortho 1 with option 3 too. While ortho 2 brought up something none of the other orthos have, there doesn't seem to be an active action plan specifically to correct the disc displacement. So essentially, both ortho's treatment plan is the same in that hoping the distalizer would help improve things. It just boils down to the ortho's chairside manner and personality.

As someone who also know more than my ortho's average patient, is bothered by things most don't care about and have asked more questions than his other patients, I would say that the fact that my ortho has been very patient with me really does help alot. My ortho has put up with alot of my weird antics and questions and has been really patient and gracious towards me. Despite that, still I had a hard time fully trusting him. But even if the treatment hasn't exactly been going as well as I had hoped, my ortho's chairside manner and patience towards me does certainly help alot even if it's just to come to terms with how things will never be perfect or as I had initially hoped.

I've said this before, that there is no such thing as a perfect treatment plan, every plan has it's own risks and limitations.
There are many ways to skin a cat and what treatment plan an ortho proposes is affected by not just their expertise and experience, but also their training, personal philosophy towards treatment and the patient. So at the end of the day, it is also very important that you find someone you can trust and is also patient with you. Otherwise you will find it very tough going through treatment.

Re: many consultations later, Suggestion needed

Posted: Sun Feb 03, 2019 9:15 am
by Gia
Wendy, I agree with Emily and Assertives. I think trust and patience are going to be huge issues in treatment given your experience. My issue with panic and anxiety is completely different than yours, but my orthodontist's patience and understanding, as well as my complete trust in him has made all the difference in my being able to continue treatment. Trust your gut about how comfortable you are, it's a long process.

Re: many consultations later, Suggestion needed

Posted: Sun Feb 03, 2019 5:05 pm
by Mpkh
I would pick the orthodontist that you feel like you can develop a good rapport with, and one whom you can trust. Seeing as how both orthodontists’ plans are very similar, practically the same, the difference lies in the orthodontists themselves. Braces and Invisalign aren’t exactly fast processes—the average time that people spend in orthodontia is 2 years. That’s 2 years of going to the same orthodontist, and having incremental work done on your teeth, with progress that likely won’t be linear. The going will get tough (and the tough will get going, eventually, and often very, very slowly). Your teeth will get worse before it gets better and despite you and your orthodontist’s best efforts, sometimes teeth just doesn’t want to move according to plan. Or, move at all. So needless to say, the relationship you have with the orthodontist is paramount to the success of the braces journey.

I would also mentally be prepared for the fact that Invisalign may not work out for you for whatever reason, or that the actual treatment time will be longer than the estimated time. Like Assertives said, no treatment is perfect, and each treatment comes with its own set of pros and cons, and what you are willing to trade off for the results that you want.

I personally would not take too much stock in the fact that the second orthodontist told you something that no other orthodontist has told you before—perhaps other orthodontists have noticed it too, and just never mentioned it to you because it is irrelevant to their treatments. Or simply, it’s not important enough of an issue for them to raise up, especially if they weren’t going to treat it. I would also not post a negative review of your previous orthodontist—if desired, I would write a letter to the office and reach out to them that way. There are two sides to a story, and we only have yours. I’m not saying this to be mean, but simply that if you are going to heavily imply that your previous orthodontist had somehow done you wrong teeters on the edge of medical malpractice, and to do that, you’d need ample evidence.

Good luck with your whichever orthodontist and treatment plans you choose!

Re: many consultations later, Suggestion needed

Posted: Mon Feb 04, 2019 1:20 pm
by pamelah0109
I vote for #1. It so important that you are comfortable with the ortho, as you know from past experience.

Re: many consultations later, Suggestion needed

Posted: Mon Feb 04, 2019 3:36 pm
by kplatt2010
I vote for #1. Whomever you choose; I agree with mpkh and that it's not going to be a quick easy fix. It's also going to get messy before it gets pretty.

It will be 3 years for me on March 11th. This is the date that ortho has tentatively scheduled de-bracing. I was so ready for him to say 4 weeks from today but ortho looked in my mouth this am and said "I'm a little OCD and I want to adjust that canine a little." New elastics config is a small triangle.

I've got complete and utter respect for the guy though for putting up with my BS and prolonging the de-bracing. Then he wants to leave them for another month LOL..