Correcting a crossbite: adult braces and double jaw surgery AHOY

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Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Correcting a crossbite: adult braces and double jaw surgery AHOY

#1 Post by Sideways » Fri Jul 15, 2016 10:00 am

Hello! Thanks for joining me on the wacky/wonderful journey of adult orthodontics and orthognathic surgery.

I apologize ahead of time if the posts get lengthy (particularly this first one)!

===================
Background
===================

I'm 29 years old and have a severe crossbite. My lower jaw is shifted about 7mm to the left (though I measure it as a tooth-and-a-half) and I have a very narrow maxilla. Unsurprisingly, my teeth are crowded. I had an impacted canine that had removed along with the remaining baby tooth, hence the gap on the left. On the bright side, I can stick a small straw through it and drink without opening my jaws, which is kind of a cool party trick I haven't been able to do since I was 9.

My usual smile: http://imgur.com/RchgCOA
My natural bite: http://imgur.com/SG3U1q5

I won't lie: the cosmetic benefits of correcting the bite are a huge motivator for me. I've always been extremely self-conscious of my smile, and random, concerned comments from strangers about my jaw make me acutely aware that the asymmetry is rather obvious, despite what my friends and family say. The functional benefits are a bonus.

Presently, I have don't have any pain, nor do I think I have any loss-of-function due to the crossbite. For 15 years, I've been hemming and hawing about getting it fixed, as the only option available to me was surgery-- non-surgical solution would camouflage the bite somewhat, but I'd still be at risk for uneven wear and TMJ issues later down the line. Coupled with what I hope will be an improved aesthetic, I finally decided to exercise my right as an adult to get her teeth wrapped in metal and face cut open.

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Treatment Plan
===================

* Get wisdom teeth removed

Got this done when I was 17, but just as a forewarning in case you're thinking about orthgnathic surgery as an adult and still have them.

* Get the impacted canine removed

I had the option of an expose and bond to save the impacted canine, but doing so would add at least year onto my treatment plan, and, according to my orthodontist, had a 30-40% chance of failing. Another option would be to plan for an implant at the end of treatment, which sounded complicated and not particularly attractive. After speaking with two oral surgeons, I decided that removing the canine was the best option for my goals. An uneven number of teeth on my upper arch could be dealt with. Given that my canines aren't that big too begin with, they don't expect the missing tooth to be too obvious.

The removal was relatively quick and easy. Since it was stuck pretty high up on the palate, I went under general anesthesia and woke up with little pain. The tissue behind my two front teeth was desensitized for about three weeks, but I've since regained full feeling.

* Get an expander put in and do a MARPE

My maxilla needs to expand by about 10mm to fully fit over my mandible. A 3-piece LeFort typically has an upper limit of 8mm before things get unstable. Early on, a SARPE was a dealbreaker for me, so my orthodontist presented the MARPE (micro-implant assisted RPE) as an option. It's a relatively new technique that involves securing an expander with micropins/screws on either side of the midpalatal suture. Once activated, the screws would exert pressure on the suture and hopefully break it open. Failing that, I have decided that a SARPE is back on the table, but I want to give the MARPE a try.

* Do the braces thing

Currently, four temporary anchorage devices (TADs) have been planned to pull my teeth towards the back of my mouth. I've opted for low-friction stainless steel braces on both arches. I've budgeted about 18 months for braces before surgery. The TADs will be removed prior to surgery, and I'll continue to be in braces for year after.

* Double jaw surgery

I decided to go with the team at UCSF for my surgery. The procedure would consist of a 3-piece LeFort and a BSSO. I've received mixed input on whether or not I need a genioplasty, but given the asymmetry of my jaw and that the chin tends to grow with the asymmetry, I suspect that I will. But who knows!

===================
MARPE Installation
===================

The MARPE installation came in three appointments that spanned three weeks. Week 1, I got spacers put in around my upper first molars and had a whole week to eat porridge and cheesecake because my teeth were so sore. Week 2, the spacers were removed and I had my molars sized for brackets, followed by a mold for fitting the expander. Week 3 was installation.

* Got my expander installed on June 28th

Here it is in all its glory: http://imgur.com/iYRullz

(Sorry about the watermelon scraps)

In a nutshell, getting four screws drilled into my upper palate was fine. The most painful part of the procedure was getting the lidocaine injections, and even that was dulled by the application of a very bitter-tasting topical anesthetic beforehand. Just a sharp pinch followed by pressure. After I was numbed, the expander was cemented onto my first molars. Once he confirmed that my palate was fully numb, my orthodontist pre-drilled four holes onto the bone, then screwed in 11mm micropins. Some people have described a strong need to sneeze as the pins break through into the nasal cavity, but I didn't feel anything besides some pressure here and there.

The second most painful part was when the lidocaine wore off and my body realized that it had four screws screwed into the upper jaw. The pain wasn't unbearable-- just a throbbing soreness and sensitivity to cold. My advice: schedule the appointment as late in the day as possible and eat beforehand because chances are you'll just want to sleep it off.

The next day, I felt absolutely fine. Aside from having a big metal thing stuck to the top of my mouth, I feel no discomfort from the screws and am able to function normally (except for the cleaning)

* Upgraded to 13mm pins

Remember how I didn't feel the urge to sneeze? It turns out that the front two pins were too short to fully break through the bone. One of them was clearly loose, so my orthodontist removed it the next day and ordered longer pins. I came in a week later to get the two front 11mm pins replaced with 13mm pins. Again, no pain while the pins were going in, and extreme throbbing discomfort afterwards. Again, I didn't feel the urge to sneeze, but my orthodontist said that the screws were now securely in place.

* Wait a month for the bone to heal

I'm currently scheduled to activate the expander in early August. In the meantime, I'm waiting for the bone to heal around the pins.

===================
Expander Care
===================

Having a big metal thing screwed to the top of your mouth is about as fun as it sounds. The expander doesn't really limit my diet much outside of eating anything sticky or stringy. Still, a lot of food gets stuck up in the space between the expander, the screws, and the top of your mouth. My orthodontist told me to buy some microbrushes off of Amazon, and they have proven invaluable when it comes to pulling out food debris and disinfecting the spots where the pin enters the soft tissue.

I bought 400 of these bad boys: http://imgur.com/X6mPot9

(400 brushes, not bottles)

In addition to microbrushes, I also bought a Waterpik, which really helps blast out the bulk of the food scraps that get stuck.


That's it for now! I'm excited for this whole thing to begin, and will try to update regularly on my progress. Thanks again for stopping by :D

carzfrm60s
Posts: 56
Joined: Fri Jun 16, 2006 2:13 pm
Location: Tennessee

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#2 Post by carzfrm60s » Fri Jul 15, 2016 1:50 pm

Congratulations on getting started. I think that may be the hardest part.
Hope all goes well for you.

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#3 Post by Sideways » Fri Jul 15, 2016 3:13 pm

Thanks! I definitely became a lot less anxious once I decided to pull the trigger and start. I'm actually pretty excited about the whole thing!

Woohoo068
Posts: 16
Joined: Tue Sep 20, 2016 9:32 am

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#4 Post by Woohoo068 » Wed Sep 28, 2016 3:21 pm

How is it all going for you ?

SingleJawMelb
Posts: 229
Joined: Sun Sep 25, 2016 8:48 am

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#5 Post by SingleJawMelb » Tue Oct 18, 2016 11:19 pm

Savage :ThumbsDown:

Can't wait to see the results

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#6 Post by Sideways » Tue Oct 25, 2016 12:12 pm

Sorry about the big long wait, but I'm happy to report that the procedure was a success!

After waiting about 10 weeks for the bone to heal around the screws, we activated the expander on at the beginning of October, going at the pace of 2 turns/day (approximately 0.26mm/day). My orthodontist told me to look out for a gap between my two front teeth

Here's the expander/upper palate about 3 days in: http://i.imgur.com/dgZilAK.jpg

After a week of turning, I felt this burning/snapping sensation along the roof of my mouth-- this was probably when the midline suture finally broke apart. Soon after, I noticed a teeny tiny gap between my two front teeth. Needless to say, I was SUPER excited to go back home to try and floss and sure enough, the floss no longer caught between the two teeth. We continued to turn for an additional week, until we maxed out the expander at 8mm.

Here's the gap after 10 days: http://i.imgur.com/pUu9npG.jpg
And here it is at around 14 days: http://i.imgur.com/HjturiO.jpg
And here's the upper palate and fully-expanded expander (sorry about the gross oatmeal crumb): http://i.imgur.com/NUwhrE1.jpg

My orthodontist estimates that I've expanded my upper palate by about 4mm-- not as much as a SARPE, but I didn't have to go through surgery and the process was relatively painless (just slow). My two front teeth have shifted inwards, so the gap in front is gone, but I don't think I've relapsed much, if at all. My bite is worse than when it started, but I was sort of expecting that, given that my jaws had a lifetime of compensating for the size difference.

The plan now is to let this expander sit for about 6 months while my ortho starts de-compensating my lower teeth. At my next surgical consultation, I'll discuss with the surgeon whether or not I should go in for a second expander prior to surgery.

Happy to answer any questions in the meantime!

shortcircuit
Posts: 64
Joined: Sun Oct 16, 2016 4:37 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#7 Post by shortcircuit » Tue Oct 25, 2016 1:22 pm

What has been your experience with UCSF so far with things like scheduling, communication, insurance issues, etc? I'm asking because it seems like they are the only surgeons in-network on my insurance and there is the possibility that I may have to wind up down there; from the reading I've done about dental work from teaching hospitals overall the reviews seem very polarized, people either say they do fantastic work or rant about really long wait times and disorganization/lack of communication.

Good luck, looks like you're making great progress :D

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#8 Post by Sideways » Tue Oct 25, 2016 3:30 pm

shortcircuit wrote:What has been your experience with UCSF so far with things like scheduling, communication, insurance issues, etc? I'm asking because it seems like they are the only surgeons in-network on my insurance and there is the possibility that I may have to wind up down there; from the reading I've done about dental work from teaching hospitals overall the reviews seem very polarized, people either say they do fantastic work or rant about really long wait times and disorganization/lack of communication.

Good luck, looks like you're making great progress :D
Thanks!

I've had a pretty positive experience with UCSF so far. They bill my insurance promptly and the EOBs have been transparent and the staff is pretty responsive and proactive when it comes to getting things scheduled. I wouldn't say the staff is peppy, but they seem efficient at handling administrative tasks. Then again, maybe I'll be singing a different tube come operation time, but so far, so good. I went with UCSF because the team of surgeons seems really good (though I work with one in particular) and my hope was that, as a teaching facility, they would be up-to-date on the latest technologies.

My only gripes so far are that every appointment has started about 20-30 minutes late and the parking garage at the Parnassus campus is difficult to navigate in anything larger than a Ford Fiesta.

shortcircuit
Posts: 64
Joined: Sun Oct 16, 2016 4:37 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#9 Post by shortcircuit » Wed Oct 26, 2016 4:26 pm

Sideways wrote:
shortcircuit wrote:What has been your experience with UCSF so far with things like scheduling, communication, insurance issues, etc? I'm asking because it seems like they are the only surgeons in-network on my insurance and there is the possibility that I may have to wind up down there; from the reading I've done about dental work from teaching hospitals overall the reviews seem very polarized, people either say they do fantastic work or rant about really long wait times and disorganization/lack of communication.

Good luck, looks like you're making great progress :D
Thanks!

I've had a pretty positive experience with UCSF so far. They bill my insurance promptly and the EOBs have been transparent and the staff is pretty responsive and proactive when it comes to getting things scheduled. I wouldn't say the staff is peppy, but they seem efficient at handling administrative tasks. Then again, maybe I'll be singing a different tube come operation time, but so far, so good. I went with UCSF because the team of surgeons seems really good (though I work with one in particular) and my hope was that, as a teaching facility, they would be up-to-date on the latest technologies.

My only gripes so far are that every appointment has started about 20-30 minutes late and the parking garage at the Parnassus campus is difficult to navigate in anything larger than a Ford Fiesta.
Thanks for the info, I'm really hoping I don't have to go that far because that's about 4 hours away from me (more with traffic, the Berkeley/Richmond area is of course always a problem). I can see the trip home becoming an extremely unpleasant ordeal very quickly :FeelSick:

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#10 Post by Sideways » Thu Oct 27, 2016 10:14 am

shortcircuit wrote: Thanks for the info, I'm really hoping I don't have to go that far because that's about 4 hours away from me (more with traffic, the Berkeley/Richmond area is of course always a problem). I can see the trip home becoming an extremely unpleasant ordeal very quickly :FeelSick:
Oo, yikes! That is a bad commute (I'm coming in from the San Jose direction-- so the traffic is okay until you actually get into the city). I'm not looking forward to the trip home after the surgery (or the follow-up appointments after). I'll probably have to enlist the help of family or Uber to get me to my appointments while swollen, bruised, and grumpy.

If you have the option of going with Kaiser at some point, Dr. Felice O'ryan works from out of Oakland. I think she's one of the better-known Bay Area OMF surgeons. Granted, I believe someone on this board had a really bad experience with her, so approach with caution.

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#11 Post by Sideways » Wed Sep 20, 2017 10:21 am

Oh man, I can't believe it's almost been a year since my last update!

Got my lower braces on November 2016
After my first expander was fully activated, the ortho wanted to leave it in for 6 months to give the bones time to settle. In the meantime, we started on the lower braces because supposedly the lower jaw "takes longer," so we might as well get a headstart. By March 2016, the bottom teeth were pretty much straightened out and I've been sitting with the same wire on them for the past 6 months until the upper jaw can catch up.
IMG_0498.JPG
IMG_0582.JPG
Got my second expander on June 2017, fully activated by July 2017
At the start of treatment, my ortho estimated that I needed at least a 11mm palatal expansion to get the bite corrected. Since SARPE was a dealbreaker, he proposed a two-expander method. The first expander was fully activated at 8mm, and my ortho estimates that I got about 6mm of expansion from that. I got my second, 10mm expander installed in June 2017 and, unlike the first, the ortho proposed a much more aggressive activation schedule: instead of waiting 2 months for the bone to grow around the micropins, I could start as soon as the next day, and I was to try 3 turns instead of 2 turns a day. I waited a week before starting.

About 2 weeks in, I felt (and heard) a loud pop in my left cheek-- it sounded like someone cracked their knuckles...in my face-- followed by a sharp, throbbing pain. The diastema showed up later that night. While the first expander was relatively painless, this second expander was uh, much less pleasant. I was on Tylenol and a no-chew diet for a full week and a half. While the first expansion was pretty symmetrical, round 2 was pretty much isolated to my left side. My ortho was unconcerned and even happy that it turned out that way as, according to him, my left side was deficient. My surgeon was also impressed with the results and said the expansion was plenty to work with. He can correct the asymmetry that happened during uneven expansion.

Another thing that happened with the second expander: the left side of my face went numb. It started with sporadic numbness along the cheek, then full-on, can't-feel-a-thing numbness that has since subsided, though I still have reduced sensation in the inside of my nose on the left side. I suspect it's because the nerve got stretched during the expansion, and it's probably just a preview of what's to come when I get double-jaw surgery :cry:

Started upper braces August 2017
After the expander was fully activated, my ortho cut the arms off and removed the bands to make way for the upper braces. And that's where we're at now!
FullSizeRender.jpg
Overall, I'm really pleased with the progress, even if my bite is definitely suboptimal right now. My smile is noticeably wider, and for the first time in my life, the teeth on the left side of my mouth touch! The expansion and straightening of the upper teeth have definitely made the downward cant of my upper jaw more obvious, but I'm hoping this will all come together with surgery.
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ughcrossbite
Posts: 5
Joined: Sat Aug 12, 2017 4:21 am

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#12 Post by ughcrossbite » Mon Nov 27, 2017 8:15 pm

Hello! It is good to "meet" another adult crossbiter(?) here :)
I am so happy to see your progress, and will follow your thread :D

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#13 Post by Sideways » Fri Dec 22, 2017 10:55 am

ughcrossbite wrote:Hello! It is good to "meet" another adult crossbiter(?) here :)
I am so happy to see your progress, and will follow your thread :D
Thanks!

Quick update before the holidays:
IMG_0835.jpg
IMG_0897.jpg
Now that the arches have straightened out, my bite has become much more open and the asymmetry in my jaw is a lot more obvious. Only three teeth are touching on the left side, and not very stably, so eating is an exercise in patience. Sometimes I get lazy and just call it a soup day.

The good news is that my ortho feels that I'm about ready for surgery. I'm aiming to schedule it for spring 2018, so fingers crossed!
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atrixa
Posts: 159
Joined: Fri Jan 27, 2017 9:30 am

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#14 Post by atrixa » Sun Dec 24, 2017 8:01 am

Amazing progress so far! Good luck for your surgery :D
Upper arch braced (traditional metal) on 17/02/17
Debonded 17/01/18 with a fixed retainer
Estimated treatment time 18 months, actual time 11 months :-*

Sideways
Posts: 33
Joined: Mon Jul 11, 2016 7:36 pm

Re: Correcting a crossbite: adult braces and double jaw surgery AHOY

#15 Post by Sideways » Mon Dec 25, 2017 2:55 pm

atrixa wrote:Amazing progress so far! Good luck for your surgery :D
Thank you! So excited (and nervous) for next year!

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