AndrewP has tripled his melt value.

If you want to share the detailed saga of your braces story, this is the place to do it. You can use this forum as a braces journal, editing and updating your posts as your treatment goes on. Remember to also visit the main ArchWired.com site for additional stories from other readers!

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andrewp
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Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

AndrewP has tripled his melt value.

#1 Post by andrewp » Mon Sep 29, 2008 9:17 pm

I had braces when I was 12. I had sucked my thumb for most of my childhood resulting in a prominent open bite. I wasn't the best patient. I would only wear the rubber bands for maybe half the day and just keep them on a few days before checkups. It wasn't long after the braces came off that my bite started opening back up.

I had heard the longer after 25 you wait to get braces the worse it hurts. When I first looked into retreatment I had two years until this virtual deadline. At a consult I was informed of new advances and techniques for treating an open bite, based on the microscrew (or miniscrew) temporary anchorage device (TAD).

This method of treatment had seen widespread use and success in Asia but was only recently adopted in the US. The orthodontist, son of the orthodontist who treated me when I was younger, was very enthusiastic about the prospects. However being such a new product he had only had the opportunity to treat a cadaver. I decided to wait.

So here I am, following the plan. I'll make an effort to post a picture when there's significant progress. If anything this will serve as motivation for myself to keep me on track. I've got to get everything right this time around and keep it in line when I'm done. Comments welcome!
Last edited by andrewp on Tue Sep 30, 2008 6:30 am, edited 1 time in total.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#2 Post by andrewp » Mon Sep 29, 2008 9:25 pm

I just decided to start this so the braces have been on for about a month now. Picture quality isn't great from a cell phone, but it works. My open bite...

Image

Image


To treat the open bite my upper molars will be intruded into my jaw. This will allow my lower jaw to rotate and align properly taking pressure off the TMJ. I've been experiencing joint pain for several years and I hope for some relief from this treatment.

To intrude the molars the microscrew anchors were placed in position last week. The microscrews are located high on the outside of my jaw near the cheekbone and on the inside above the molars.


Image


They weren't that bad going in. They can't use much anesthetic, but the pain was alright. Shortly afterward though was warp speed to the pharmacy. Imagine someone just drilled a screw into your face, times eight.
Last edited by andrewp on Mon Sep 29, 2008 10:01 pm, edited 9 times in total.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#3 Post by andrewp » Mon Sep 29, 2008 9:31 pm

The anchors quickly began burrowing through my tongue. I soon realized I could not eat and could barely swallow. I ended up constructing a sort of false palate out of wax to cover the archors.


Image


I form it under hot water and press it into the roof of my mouth while still pliable. Then I quickly rinse with cold water to set it somewhat. Talking is still kind of difficult but I can eat soft foods and I'm not constantly snagging on the anchors.
Last edited by andrewp on Mon Sep 29, 2008 9:41 pm, edited 2 times in total.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#4 Post by andrewp » Mon Sep 29, 2008 9:36 pm

The oral surgeon who installed my microscrews stressed that the greatest problem is allowing too much time to pass before attaching a load. The risk is the screws loosening and falling out, requiring another round of painful placement.

Today they attached a load.


Image


The rubber bands wrap from the two pair on the inside, over the molars and over the wire, to the two pair on the outside. This applies constant pressure to intrude the rear teeth. As there is tension on both sides a transpalatal arch will only be used if it becomes needed.


Image


Vicodin. Don't try this without it.

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Clo
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#5 Post by Clo » Tue Sep 30, 2008 12:46 am

Hi,

it is great to see you indeed started this blog. Thanks !!
Now there are 2 of us here undergoing attempts to intrude molars to close an
open bite. When you look at the last 5 pics of page 1 of my blog :

viewtopic.php?t=27507&start=0

then you will see some familiar things. Like some piece of powerchain to exert
a pull up force. The headgear I had and now the rapid molar intruders should
do the very same thing. I really wonder if this will work for you. I really hope
it will. For me, up to now it didn't. For obvious reasons, I will visit your blog
from time to time. Were you given options to close your bite ? Was surgery
mentioned ? Questions, questions ...
But most important : best of luck !
May the forces be with you and close the bite !

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Arbywhopper
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#6 Post by Arbywhopper » Tue Sep 30, 2008 5:05 am

The only thing i can say is: OUCH!!!!!!!!!!! That looks way to painful!!! I couln't even imagin that!!! My mouth just hurts looking at it!!! Let us know how its going!!!

-Arby
Spacers: October 2, 2008
Top Braces: October 7, 2008
Sentence: 36 Months
Click the "www" for my braces story!! Progress Pic's Posted!!!
Image

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#7 Post by andrewp » Tue Sep 30, 2008 5:45 am

Ouch indeed and I'm running out of vicodin! I just awoke this morning and I can feel the tension of the elastic on each individual screw and the force on my rear teeth. I'm using a more natural pain reliever in the evenings but that's more for neuropathic pain and I prefer not to use it before going to the office. Hopefully the pain dulls soon to something ibuprofen or straight apap can handle. My poor liver!

Holy Crap Clo! At one point you could play Stairway to Heaven on your teeth... in two chords! I'm going to be doing the elastics up front again but hopefully they don't get THAT crazy. I guess they did that before trying to intrude your molars? That is one of the options they gave me. It was discouraged though because they realized it's just a temporary solution and the open bite returns as mine did. Surgery was also an option presented however I didn't want to get that invasive. I'll deal with the jaw pain before I start cutting out sections of my face. I know I'll be getting some elastics up front to pull the front teeth in, but I don't think much is being done with them for the open bite. That's all intrusion.

So far I can definitely feel the upward pressure on my rear teeth and these are fairly weak bands I believe. Just something to load the screws and prevent loosening. My teeth in general are already noticeably straighter and they just put in the first real wire.

I keep forgetting to ask them but there's no bracket on my rearmost upper molars... they sit higher than the rest of my teeth so maybe they're already where they need to be? I hope they aren't planning on removing them. Like surgery I'm really hesitant to make that move. Hopefully it doesn't come to that.

Lisa65
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#8 Post by Lisa65 » Tue Sep 30, 2008 9:12 am

Hi Andrew, I'm glad you started a blog as this is all very interesting. Did you really not struggle with the palatal screw insertions? Initially I had 2 inserted into my palate, but I had a lot of trouble with inflammation and pain, and one loosened quickly. Eventually the plan for using them was abandoned. I was not made aware at the outset of the need for immediate loading, and they were left untouched for weeks.

vicodin isn't available in the UK, but I wonder if you might find a NSAID better for dental pain relief. If ibuprofen is not strong enough at present can you ask for something like naproxen or diclofenac. Diclofenac is about 6x as strong as ibuprofen. You can also double up ibuprofen and acetaminophen, as they work in different ways to block pain. NSAIDS a bit tough on the stomach but OK as long as you eat with them and don't take them for too long. Ultram is also reported to be better than vicodin for tooth pain.

http://gateway.nlm.nih.gov/MeetingAbstr ... 23582.html

Your last upper molars might not be brought in until your other molars have got to the same "height" maybe? If they were wired up now, they might move down too far, thereby adding to your extrusion problems. If they're not contributing to your open bite problem, maybe the plan is to let sleeping dogs lie, as it were.

Keep us posted on how you get on.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#9 Post by andrewp » Tue Sep 30, 2008 9:51 am

The palate ones have themselves felt relatively fine so far. Going in they definitely hurt the most. There's a little irritation I think from the wax pressed against the skin and whatever motion is caused by swallowing action and whatnot, but they're otherwise OK. Most of the tissue irritation has been around the outer screws. When I smile I can feel the skin tugging around the screw and it gives a tearing sensation. I know it's still healing but I hope I don't gauge out the hole or anything.

I'm just branding with Vicodin for simplicity... it's really generic hydrocodone+apap 5+500mg. I've tried taking 800mg ibuprofen in one dose and it didn't even phase the pain. Naproxen I try to avoid except for severe muscle pain because of the risk of cardiac problems which I already have issues with. My alternative treatment doesn't work as well as the vicodin but it works better than the rest so far. I'm intentionally refraining from naming the medicine out of respect for the board operators as it is not a legal treatment in my state nor is it legal under Federal law. Suffice it to say, keeping this safe and natural medicine illegal is one of the dumbest things this government is doing. And that's a challenge.

I'm hoping that's the plan for those in the rear. Reading around I guess if they're going to do an extraction they do it before starting the braces? Hopefully once my bite is closed and I start the elastics that also progresses well so they don't have to do anything major.

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Clo
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#10 Post by Clo » Tue Sep 30, 2008 10:15 am

Hi,

there was a time that they thought it was simple. Open bite in the front. Ok,
let's extrude the front teeth. They did it in my case too. And yes, this is not
stable at all. Only weeks after the front elastics were gone and back I was
on square 1. If the bite is closed, some minor occlusion tweaks can be done
with front elastics, but not all the correction in that way. I even argued with
my ortho she was doing again just that (third pic from the bottom up in the
blog I mentioned). An open bite can only be corrected by intruding the back
molars, surgically by a Lefort 1 posterior impaction, or by trying the same
orthodontically.

If the second molars are higher than that is good. Very good. It makes it all
a lot easier. They indeed may be high enough. Plus they kinda stick a bit to
the ones in front of them. If those raise a bit, the second ones will follow a
bit. I don't think they will remove them. Yet. If the intrusion fails, then they
may propose this. But them being higher already, I really doubt that.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#11 Post by andrewp » Tue Sep 30, 2008 10:34 am

Hope so. If the intrusion fails I'm not going to continue trying to treat the open bite. I'll just have them do the elastics to pull my front teeth in so I'll quit biting my lips when I eat and call it done. So far I'm optimistic though. When my wisdom teeth were coming in my front lower teeth started crowding and one of my incisors jutted out a bit. In just a month with the starter wire my lower teeth are much straighter and the incisor has been pulled back in line. If my teeth progress as well as they have so far I'm hoping to be one of those lucky few that only has braces for a year thanks to these microscrews!

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#12 Post by andrewp » Tue Sep 30, 2008 5:52 pm

Yesterday they also put the banded brackets around the lower molars. On the left side apparently the tooth is off just right to push the bracket up so I bite on it. I have no tooth contact at all, not even on the right side. I wonder how long nutritional shakes will continue to be my primary food source.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#13 Post by andrewp » Thu Oct 02, 2008 7:16 pm

I have a bite! It's been getting better steadily through the day. Nowhere near perfect but the number of foods I can eat just got bigger.

Last night I could literally feel the incisor that was pushed out before moving more. I could feel the friction between it and the surrounding teeth give way repeatedly. A very strange sensation.

Fair amount of constant pain from my rear upper jaw. This microscrew treatment is definitely working.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#14 Post by andrewp » Sun Oct 05, 2008 1:21 pm

I've noticed it is extremely difficult to clean food from around the outer anchors and elastics. This concerns me because they are located right where the tissue transitions from hard keratinized skin to soft elastic flesh. This means the tissue around the anchors will be prone to inflammation and that can be a catalyst for screw failure. So, Water Pik can thank ArchWired for a sale. After reading many posts I decided on the Waterpik Ultra.

Image

The orthodontic tip in this thing is awesome. It has a tiny bristled head. I can reach up and with a light jet easily clean around the anchors. Food collecting under the elastics is quickly washed out. I recommend one for anyone having problems keeping their hardware clean.

andrewp
Posts: 35
Joined: Sat Sep 27, 2008 5:52 pm
Location: Missouri, US

#15 Post by andrewp » Fri Oct 31, 2008 11:21 am

ARG. The back right TAD in my palate has loosened. I noticed yesterday it was starting to feel funny and this morning there was clearly something wrong. I got squeezed in today to take a look at it and they've pulled the load off it to let it rest and see if it is still usable. The ortho says if it improves we can either continue with it loose which they've apparently done without problem unless it actually pulls out, or remove it and continue without it or replace it. From what I've read screws at this location in the palate commonly fail so at this point I suspect what'll happen is it will not improve and will need to be removed. Have to see what happens after that.

I'm not terribly surprised at this. Apparently at best TADs have a 90% success rate. That means 1 in 10 fail and I have 8 in my mouth. Odds were not in my favor.

Eating sucks again. Every time my tongue grazes the TAD it wiggles and sometimes hurts. I'm thinking by next week if there's no improvement at least in the feel of it I'll opt to have it removed. Movement has been good so far and I can tell my bite is closing, so hopefully whatever changes will maintain progress.

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