Thursday, March 5, 2009

The Braces are off!

First, I have to apologize for not posting for a couple months. It is amazing ... a few months after my orthognathic surgery, life does not revolve around my mouth anymore! It is true ... there is life after orthognathic surgery ... and it does not consume my every waking thought anymore (or while I'm sleeping for that matter)! So, unfortunately, I am quite sure I will leave out a few of the details in my brief recount of the last couple of months, but the meat of my blog I really do believe is during the 6 weeks post-op recovery period, anyway. I do apologize for all my spelling errors and typos during the first couple weeks after surgery, but I didn't want to go back and edit because I was reminded by the blurred vision, so my horrific writing is a true reflection of a part of my post-op recovery.

So, January was relatively uneventful orthodontically. I traveled quite a bit for work, so that made the month fly by. I had a couple of migraines, but not alcohol induced. They were most likely hormonal, given the timing. I guess I need to be more diligent about taking my magnesium again. On February 2nd, I had another orthodontist appointment. Got a powerchain all the way across the top, and no longer on the bottom. Elastics only on the right side at night. Here is a progress pic from that appointment:

The following day, I had an appointment with my OS. Everything looked good, except my ROM, which I expected. I was only at about 30 mm, and I don't think I've progressed much more since then. So, I am not released yet from his care until I get up to at least 40 mm. I have a follow-up appointment for May, at which time I hope to be to where I need! I will be working on it daily, as I am afraid that if I don't I will loose it. He doesn't want me to do tongue retractors or put anything physically in there, for fear I could damage my teeth. So, stretching exercises it will be.

At some point in February, I thought I had a piece of food stuck in between my tooth/band on my upper left side, so I started digging with a toothpick. Well, I don't have the feeling back in my upper gums, so little did I know that I was actually picking at my gums. I made a mess out of them, and with the band around the tooth, it didn't allow it to heal very well, so it is still a bit of a mess. Things should get better now, though.

One week before debanding, I had a DOUBLE power chain put on my upper teeth, one below the archwire and one over top of it. That was fun. While putting it on, one bracket popped off my upper right tooth. We got the bracket repositioned and back on, and wouldn't you know, the other bracket popped off the upper left tooth. Geez! The objective of this torturous dual powerchain configuration was to close the gaps next to my upper canines. Soon after the visit, the one on the left was closed. But the stubborn one on the right persisted, and I was incredulous that I would really get my braces off yesterday. So, skeptically, I went to my debanding appointment.

I am not going to sugar coat it. It was a painful experience. With the feeling starting to come back in my upper gums, everything is ultra-sensitive. I used to love brushing with my sonic care, and even that was not a pleasant experience any more. The vibration against the brackets is annoying. The wierdest part, when sanding off the glue, the feeling is criss-crossed along the gumline above my top front teeth. My bottom teeth didn't like the pressure when taking off the lower brackets, either. I felt bad for the hygienist. She was trying so hard to be gentle, but I felt like somewhat of a baby. I usually have a pretty good threshold for pain. But, I got through it, and I was willing to endure ANYTHING to get those babies off. Before getting the brackets off, she put a double power chain on the upper front teeth to close the remaining gap. It opened back up after taking off the chains, but the tooth is mobile, so the retainer will put it in its place.

I need to forewarn those who have bands on their back teeth. Although I felt I've kept very good hygiene throughout this process (except for the weeks post-op when I wasn't allowed to brush), there was a very disturbing stench when taking those bands off. Luckily, the hygienist wears a mask, otherwise I would have fully expected her to gag.

Since debanding, I do have to admit I have been obsessively narcissistic, looking in the mirror incessantly at my new shiny teeth and bite. "This isn't my mouth!" I exclaimed when I had my first look. The results, using the words of my orthodontist ... "Perfect".

So, now that I have completed the majority of this process, I feel that it is high time to give due credit to the amazing team of professionals that have gotten me to this point. I have added a list on the left side of this page that includes a hyperlink to my OS, OD, and dentist. I wouldn't have started on this journey if it wasn't for my dentist, Dr. Villwock, referring me to see an orthodontist. From there, Dr. Lin, my OD, took over and diagnosed me with vertical maxillary excess with mandibular AP hypoplasia. Dr. Lin referred me to Dr. Parmar, my OS, who is the most empathetic surgeon I could ever ask for! Combined, they have provided me with a result far superior to what I could have ever envisioned. I am so grateful for their expertise, patience, and professionalism. I wouldn't change a thing about any part of my treatment. I was and am truly blessed. And, I could never forget everyone at their offices who were always my biggest cheerleaders, along with my family, friends, and of course all of my fellow ortho bloggers! Cindy, Lisa, and Traci at Bellevue Family Dentistry have always been wonderful to me, and especially through this process! The countless number of techs at Orthodontic Specialists who worked on me and always had positive and encouraging things to say. And the receptionists at Bay Oral office who I got to know very well since I was there once a week for oh so many weeks post-op while waiting for that exposed plate to heal over. Sorry if this sounds like an Oscar acceptance speech, but I am forever grateful to everyone involved in this process, the results have been truly amazing. Now, when I place my hands on each TMJ and open my mouth, I no longer hear the cracking in the right joint and feel the popping out of the left joint. I can actually see my bottom teeth when my teeth are together, and at the same time I can feel the back of my upper teeth with my tongue! There are so many functional differences, not to mention the relief that I am not continuing to wear down my joints. The cosmetic improvements were a very positive side-effect. This was all so worth it.

So, I am sure you want to see pictures of my naked teeth! I'll start off with a picture of Dr. Lin and I, freshly de-braced!

Below are my before and after photos. The befores were taken in June, 2007, and afters in March, 2009. I now introduce you to my Class I bite!:

Front view, no smile. Notice the lack of lip incompetence! No more puckering of the chin when my lips cme together. Also, the nose has changed. I didn't think I wanted my nose to change from this surgery, but I definately think I like my new nose better!

Front view, smile. No more gummy smile! I no longer need to posture my jaw forward so I don't have a double chin!

Right profile. I have a chin! Nuff said. Also, look at the difference in the angle of my upper lip. Dramatic difference.

Front teeth, closed. My lower teeth are now visible ... no more deep bite!

Front teeth, slightly open. Dramatic difference in the crowding of the lowers.

Left and right occlusion. Check out that Class I relationship. No more overjet or overbite. Very swollen gums from lots of torture, but an extremely satisfied patient!!

Upper Arch. Check out how much it widened and rounded out.

Lower Arch, a picture is worth a thousand words.

For retention, I have a fixed lingual retainer on the bottom, and an essix retainer on the top. I am to wear the essix day and night for 3 months, until instructed otherwise. My gums are too swollen at this point to get floss in at my gumline on my lower teeth, so I need to allow the swelling to reduce and work on that with some oral pix. I plan to give my mouth a rest for a while, and next year I need to have one of my molars crowned due to a large filling, and will slowly get my metal fillings replaced by composite ones.

I will post again soon with some of my reflections on this whole process. I still follow all of your blogs, and look forward to your updates. Hopefully, my blog will serve to educate future orthognathic surgery patients as your blogs have educated me! In the process, it has been incredibly therapeutic and I have created a diary of my journey along the way.

Monday, January 5, 2009

4 months post-op

I received my early Christmas present a few days before Christmas ... a call from the dentist's office that there was a cancellation and I could get my teeth cleaned the next day! The gals are always so cheery when I go in there, so it is always a treat to see them as well. Hi Ladies if you're reading! :)

Today I had an ortho appointment with Dr. Lin ... he looked in my mouth and said everything looked excellent. I got a new upper and lower wire, and kept the power chain on the bottom but only have a power chain on the front four teeth on the top. I need to now wear an elastic on the left side of my mouth 24/7, and on the right just at night. The best news of all ... I have a debanding date!! March 4th and I will be brace free! I couldn't believe it ... I still can't. That will mean I will be de-braced just a few days shy of my 6 month mark post surgery.

My teeth are sore tonight from my adjustment, but I don't care ... I have a debanding date!!

In other news, I did have 2 migraines over the holidays, but I must confess they were purely alchohol induced. I figured it was too good to be true that I wouldn't even get a migraine from drinking. At least that is something I can control myself though.

I will have new progress pics taken at my next OD appointment at the beginning of February, which I will post at that time. I am making progress very slowly on my ROM, I can get my index finger and middle finger in sideways up to my first knuckle. Dr. L mentioned that he has referred several of his surgical patients to my web-site, so if any of you are reading, know that you are in great hands with Dr. L and Dr. P!

Tuesday, December 9, 2008

3 months post-op and exciting news!!

Recovery from the plate removal was much better than I expected. I had absolutely no swelling, and I didn't need to take any pain meds, not even OTC. By the next day, I was feeling absolutely normal.

Today I am 3 months post-op. I had an ortho appointment, which went very well. Dr. L looked at my bite, and could tell I have been very diligent about wearing my bands, because my bite is almost perfect! He said that we won't even need to put in the TADS anymore to pull my bite back! So we can close up the space that was just opened with the coil. He said that in the "old" days, when they used the splint, it could actually work against the orthodontics if the splint wasn't exactly in the right position, and the orthodontist is basically SOL. But now, without the splint, he can get started much earlier with elastics to move things into place before they set. I believe I read on Archwire that teeth are more mobile than usual in the couple of months post-surgery, due to the prostaglandins that are released around the damaged tissue. The OD can make the most of this by getting a lot of movement done in those few months. And it looks like that held true for me!

Given the good news on my progress, I finally had the courage to ask about a potential debanding date. The news that followed made my day, and was honestly much better than I ever had hoped. He said I could expect to get my braces off in 4 months, which would put me at April! I have been in braces for just over a year now, so I can handle another four months. I am so excited ... I really didn't expect to get them off so soon.
I now only need to wear my bands after dinner and at night, just to keep my bite wear it is. I got my power chain replaced on my upper teeth, and a new power chain on my lowers. The coil came out as we are going to close up that hole between my molers now that we don't need the TADS. I also asked about my airway, so Dr. L ordered a Lateral Ceph so we could compare. Below are the side-by-side images ... it is amazing how much my airway opened up!

In addition to the wider airway, there is a dramatic difference in the soft tissue around my chin in the above x-ray. When I got my plate removed last Thursday, I mentioned to Dr. P that I haven't had any migraines. He mentioned that coventional wisdom points to my now stable occlusion and less load on the joints, however he also has been reviewing some recent research on airway and I believe he said fibramyalgia. Basically, these studies show that there is a correlation between pain and small airway. When the airway is opened, the patient many times doesn't experience some of the pain they suffered from before. This could also be something that is helping to reduce my migraines, in addition to to my TMJ's being much more stable now. The piece I don't really understand is why I used to get migraines when I drank alcohol, and now it seems that alcohol does not trigger a migraine for me anymore. I was hoping for my migraines to be reduced with the surgery, but I honestly didn't think they'd be eliminated completely because I never thought it would prevent me from getting one when I drank. In the end, I guess I don't need to understand it, I am just elated that they have been almost non-existant! I just hope it stays that way!

Below are my 3 month before and after pictures. I am so happy I went through this. It has been worth it in every way and I am very pleased with the results thus far, on all accounts.

Here is my panoramic x-ray, so you can see all of my hardware. You can also see the gaps in my bones from where my mandible was advanced.

I will post more pics of my teeth and bite later this week. My teeth were somewhat sore after my ortho appointment today, I don't know if it is because that space is already trying to close up, or because I was really aggressive with chewing today. I am hoping my ROM will start to increasing at a faster rate now that I am only in bands at night.

Thursday, December 4, 2008

Plate Removal Successful ...

I am back home, everything went very well, in fact I believe I was awake for most of the procedure and remember most of it, but felt nothing. I had to stop on the way home for my antibiotics, but at this point no pain and no swelling as far as I can tell. Hopefully it will stay that way! I have to be on the Peridex another 2 weeks which is when I will see him next, and hopefully after that I can schedule a cleaning!

I forgot to mention yesterday on my post that when I run my fingers along my lower jaw line on both sides, I can feel the gaps from where they advanced my jaw! He took another x ray today after the plate removal and I am down to 7 plates now, 39 screws. The sutures should disolve much more quickly this time, within a week or so. I am hoping I will be feeling this well later when the IV sedation wears off ... so far a piece of cake!

Plate Removal Tomorrow and Before and After Pics

I thought since I will be puffed up tomorrow on my left side from my plate removal procedure, I should put some before and after photos from the month before surgery to 12 weeks post-op. You can really see a difference in my nose. I think there is still some swelling in my nose because my nostrals are uneven, so it will be interesting to see how things settle out. You can also see a big difference in my lip incompetence, no more gummy smile, and a more defined profile.

Lately I have been getting a lot of food stuck in between my last two molars on my upper right side. The other day, I took a toothpick and usually the end would tightly wedge in between the two teeth. Well, I forgot about the coil that was creating a gap in between the two teeth, so the toothpick went right in and stabbed me. I put my tongue up there and a siqeable gap has opened up. So, that's good news. I have also been flossing for the last few weeks ... I can feel the floss in between my lower teeth, but I can't in between my upper teeth. If my teeth have even a tiny gap between them so the floss doesn't "click" between them, I keep putting pressure waiting to hear the click, and then realize that the floss is already on my gums. They don't bleed, though, I think because the surgery cut off the blood supply and all of those blood vessels have not reconnected and regenerated yet.

My lower incisors have dark stain marks on them from the Peridex. I am hoping things heal up quickly from my plate removal so I can go in and have a cleaning. Hopefully I won't have to keep taking it. That would be a great Christmas present, my pearly whites back!!

I'll post an update after tomorrow's procedure ...

Sunday, November 23, 2008

Pics - 10.5 Weeks Post Op

It's hard to believe, over 10 weeks since surgery. Here are my pics from today ...

Saturday, November 22, 2008

Plate Removal Scheduled

I saw my OS on Thursday. He asked me how soft chew was going, I said good ... I can just about eat anything as long as it is small enough to get between my teeth. No pain what-so-ever. That's what we were waiting for to remove the plate. Everything appears to be solid, plus I will still have the other plate that will still be in the side they remove it from, so there shouldn't be any risk of relapse. He will also cut away some of the over growth from my cheek at the same time so i am not chewing on my cheek.

I scheduled to have it removed on Thursday, December 4th. I was hoping to do it on a Friday so I had the weekend to recover, but that didn't work out so I took off on the 5th. If I don't have to take the heavy duty pain meds after (I will try to get away with just OTC if I can, but certainly will take the heavier ones if needed), I may try to go in to work the next day, we'll just play it by ear.

As far as the procedure goes, I will be sedated with a cocktail of Versed, Fentanyl, and a steroid to reduce the swelling. You are half awake, half asleep for the procedure, but 95% of people don't remember. Hopefully the fentanyl won't affect my vision again, I guess it is just temporary if it does, although I'm not sure if it was my anti-nausea patch or the fentanyl patch that blurred my vision so much after my bimax surgery . The procedure will last about 45 minutes. Pretty straight forward and MUCH less invasive than the last time.

Recovery wise, it shouldn't be too bad, I will just need to keep away from the stiches and incision site again. I am prepared for the lopsided swelling, but hope it doesn't linger too long so I am back to normal by Christmas and New Years. It should be pretty good after a week. It could limit my ROM some, we'll have to wait and see. I can get 1 finger in there now, vertically, all the way back to the back knuckle, so I still have a ways to go. I think I was able to get 3 fingers in before surgery.

I'll post if anything happens before my plate removal, but no appointments between now and then. I'll try to get some new pictures up before plate removal.