Tag: AOO

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Yea or Nay?

By Sue Seboda, Dental Part 18

Start down the long road or not? The Phoenician Steps

Sooooo, you might wonder after hearing this dental saga, am I happy with the choice to do Wilckondontics and orthodontics?  Without question, the answer is yes.  The outcome is nothing short of amazing.  And correcting my bite will result in good dental health well into the future whereas pulling an overcrowded tooth to resolve pain would have created nightmares both functionally and aesthetically.  Is doing surgery and orthodontics a challenge and expensive?  Yes, but it would have been far worse  if I had done nothing.

Combining Wilckodontics with orthodontics was a winner, especially at my age.  First of all, I needed the bone graft to even move the teeth and second, Wilckodontics reduced the overall time in orthodontics dramatically.

So what’s next?  In a couple months after my back teeth settle, the periodontist will install a permanent retainer on the lower teeth and pull out the blue paper and grinder to make final adjustments to the bite.  Remember the wear pattern on the teeth is based on the original location before the teeth were moved.  It makes sense that the wear pattern may need to be adjusted before the bite is correct.  This is done with subtle adjustments to the tooth’s surface.  Unfortunately, I also have to replace some crowns for the same reason.  Sigh.

After the bite is adjusted, my dentist with her artistic flare will do some bonding to fix the chips and minimize the appearance of the vertically challenged teeth.  I have no interest in veneers or other invasive procedures that are strictly aesthetic.  And that will be a wrap (I hope).  Before and after pictures will be forthcoming.  Plus I will do a complete summary of the pros and cons of the experience.   If you need the list before it’s posted, please send a message.

The choice to do Wilckodontics and orthodontics should be made with open eyes, fully understanding your goals, the total cost, benefits, potential side effects and consequences of doing nothing.  It is a long process requiring patience and perseverance.  For me it was worth it.  On the other hand, if the goal had been purely aesthetic, not sure my opinion would be the same.  Pick the right team and feel free to ask for recommendations.  My team is excellent.  Which leads me to discuss an interesting trend….

 

PS.  Thanks Lori for the perfect description of this experience, a saga.  

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Holding Patterns and Other Unpleasantries

Dental Part 16

Holding patterns are not my favorite thing.  I am a moving forward kind of gal. So I was disturbed to learn that the second set of trays would take almost a month to arrive.  I offered any amount of money to expedite the trays.  Nope, not possible.  The orthodontist made hard plastic retainers to hold my teeth in place and I wore them night and day. 

Aside from adding a month to the overall time in orthodontics, this month is critical if having Wilckodontics.  Recall that a tremendous benefit of the Wilcko bone graft is that for 4-5 months teeth move very quickly when orthodontic forces are applied.  For example, instead of spending two years in braces, one would be finished in 6 months.  Since I completed the first 38 trays in 3 ½ months, I wasted the final month of fast moving time waiting for the second set of trays.  This is a huge downside of Invisalign when doing Wilckodontics.

The refinement included 16 trays and lasted 3 months, almost as long as the first 38 trays.  The photos below are trays 1 and 16 for the bottom and top .  Unfortunately, my teeth once again did not follow directions.  While there was notable progress, I did not achieve all of the expected movement and a third set of trays was recommended.  

What to do???  The primary goal was to fix my bite which would curtail bone loss and give a chance to hang on to my own teeth.  The periodontist was confident he could perfect my bite without additional Invisalign.  Therefore the third set of trays would be a purely aesthetic effort.  I ultimately decided against it.  Why?  Instincts.  For the second time, my teeth started to firm up and my instincts were screaming that loosening them for a third time could have unknown and unpleasant consequences.  Not sure science supports this fear, but it was too strong to ignore. 

For those considering Wilckodontics, this paragraph is for you.  I strongly suggest discussing the pros and cons of braces vs Invisalign.  As horrible as they are, braces may be preferable since they provide a more constant force on the teeth and a higher level of control.  If a tooth goes walkabout, the braces can be adjusted immediately rather than waiting a month for a new set of trays.  This is a highly individual decision and there are many factors that influence the choice including things that have nothing to do with your teeth like your travel schedule.  For example, if you have braces and your teeth don’t follow directions, the braces need to be adjusted immediately.  Things go real bad if not, so its best to be consistently near the ortho office.  Find a good orthodontist who will dig into this with you.  And if your orthodontist is unfamiliar with Wilckodontics, find another.

Takeaways:

  • Several rounds of Invisalign may be required to achieve goals. Understand the worst-case scenario before starting.
  • The gap between scanning for and receiving the next set of trays could be as long as a month. Add this into the overall time calculation.
  • Review the type of movement required, ie. lateral, vertical, rotational and ask which appliance is better suited for that type of movement, braces or Invisalign.
  • Do a thorough comparison between braces and Invisalign if considering Wilckodontics. In this one instance, vanity may have to take a back seat. The driving factor should be which appliance will manage the required orthodontic movement in the shortest time period.

 

 

 

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The Back Foot Comes Forward

Dental Part 15

Remember dating?  The early days were all smiles and perfection with the well-turned, best foot forward.  But as always, that back foot inches into view and we are reminded that nobody is perfect.  Bummer.  Turns out Invisalign is not perfect either.  So let’s have a look at the “back foot” so well informed decisions can be made. 

The orthodontist will explain prior to starting Invisalign that a “refinement” period may be required.  A refinement is more appropriately described as another set of trays because your teeth did not follow instructions during the first set.  Requiring a refinement is reasonably common and becomes more so when the desired orthodontic movement is complex.  Since I had tremendous success for the first few months, it appeared that I would have only a minor refinement period.

Unfortunately, the wheels came off in the last few weeks when my front tooth dropped down.  In addition other teeth did not move vertically or rotationally as expected. On the positive side, the lateral movement was excellent.  Without lateral movement, there would have been no room to sort out overcrowding, the main problem with my bite. 

Because the trays still fit very well on the back teeth, it was agreed that the best course of action was to finish the set, complete the lateral movement and then tidy up the vertical and rotational issues in a second set of trays.  Would post the photo of my teeth but it is simply too unattractive in that selfie, horse teeth sort of way.  This photo with the retainer on gives an idea of what happened to the front tooth.

Here is Invisalign’s “back foot” #1 and #2:

  • Moving teeth can be an unpredictable business. It does not matter if you have the best orthodontist (I do), once your teeth loosen up and start moving, they may move the wrong way or get stubborn and stop moving.  Everyone’s teeth loosen during Invisalign.  They loosen exponentially when doing Wilckodontics so I suspect that the possibility of teeth going walk about is higher.
  • Invisalign may have trouble “finishing” when notable rotational and vertical movement is necessary and it could take several sets of trays to achieve the desired result.

So let’s look at how the second set of trays went…

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A Bad Thing Happens

Dental Part 8

Nine days after surgery and all is going well. Feeling confident, popping the trays in and out, eating solid food although nothing too crunchy or hard to chew. In hindsight it reminds me of a ski lesson many years ago. I was learning fast, feeling good, ready to get to the next level. At the bottom of the slope, preening in all my glory, I noticed another student skiing out of control straight for me. Maybe I wasn’t so great after all. Worse, she crouched down just before impact. I yelled don’t bend down but it was too late, she came in fast and low. I was propelled into the air, landed flat out leaving my skis exactly where they were.  What a great photo that would have been.

Back to teeth. The orthodontist office is one big open area with 4 dental chairs. Doctors and nurses tend to patients in soft, calm voices creating a serene ambiance. On this day all the chairs were occupied by young kids with mothers perched nearby and of course me, not a kid. We are ready to put in my second set of trays. As you may have guessed there was substantial difficulty even for the doc. So I am attempting to force the tray on my lower teeth and my finger slips and digs into my tender, Frankenstein gums. Yes, the F bomb came out of my mouth, vigorously you might say.  It was not my finest moment. Of course I stood in the no longer serene room and apologized to all the young moms.

Which led me to another observation. Am I the oldest patient they have fitted with invisalign? There was a long pause before answering the question in the negative.

 

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Zombies

Dental Part 7

Soooo, let’s get to the question you have been dying to ask. How do you look after surgery? Not bad at first but the swelling kicked in on Wednesday and peaked Friday. Fair warning, these photos do not grasp the extent of the swelling but perhaps this story will paint an accurate picture. Earl was away for the weekend and when he returned on Sunday the swelling was almost gone. He duly noted that and then told me that I had looked like an old lady who lost her teeth. Hot.

I thought I had escaped any real bruising but no I was sadly mistaken. On Friday, two bruises popped and started draining down my face. Peak blackness was Sunday but those babies lingered through the following weekend. Come up with a good story. People either stare or ask. I like the “askers”. What I needed was some black lipstick to complete the look but alas my black lipstick was in Key West where such things are needed.

To sum up, swelling gone in a week and bruising gone in two.  Not a bad tradeoff to reduce the time in braces/invisalign by more than half.  The first selfie above was the day after surgery, the second was 3 days after and the selfie with the zombie base makeup was at 6 days.  And for comparison, the nonselfie photo was taken just before all this started.  My vanity demanded inclusion of a normal photo.

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Don’t Believe Everything You Read Online

Dental Part 5

I appreciate the irony of that statement. But really, do not go online and start reading what others say the day before your surgery. That is a sure fire way to ramp up anxiety to previously undiscovered heights. Plus my imagination went a little crazy with the idea that I would not be completely under during the surgery. The periodontist said I would be able to hear, respond and talk but would not remember anything. That sounds a little like being conscious, a totally unacceptable state when having bone grafts.

They provide a happy pill the night before surgery to aid in sleep and something similar to take an hour before your appointment time. Not a fan of painkillers and all their friends but I slept and was a bit looped by the time I arrived that morning, a good thing. And it was true, the last thing I remember is the novocain shots and the next thing I remember is an angelic voice quietly saying open more, turn your head, open a bit more. This was at the end of the 2 ½ hr surgery. As I started to come to, they put ice packs on my face. Note to self, when on anesthesia do not attempt to discuss the relative merits or lack thereof of putting ice on swelling. I think all I could manage was, “no ice, no ice”.

Earl picked me up and I honestly have limited recall of the drive home. Of course I wanted a photo immediately after the surgery for this article and to Earl’s amazement, I was sitting in the car taking a selfie. I have no memory of this. As you can see I was not dripping in blood or any other horrible state your imagination might conjure when considering dental surgery. I do have to work on selfie skills however. Why did selfies ever get popular? They are horrible.

And I needed food. Luckily Earl helped with that too. It was a bit of a challenge getting that soup actually in my mouth and staying there.

Here is the amazing thing. While uncomfortable, I experienced no pain. I was giddy with relief. Consider this statement on another periodontist’s website: “The pain after Wilckodontics can be rather pronounced, but everyone’s pain threshold and experience is different. With that in mind, patients who undergo Wilckodontics may notice major issues with pain even if they bite or chew soft food items. It’s for this reason that patients should take all pain relievers as recommended in the early days and weeks after surgery and that they follow their post-surgical instructions to the letter.” Does she moonlight for the drug companies I wonder? At my first follow-up, I told the periodontist that I had no pain and he said all his patients say the same thing, discomfort yes, pain no. Two questions and an observation come to mind. Who would you hire? Why don’t more people do this? And I have been spelling Wilckodontics wrong.

 

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The Invisalign Survival Kit

Dental Part 4

One week before the Wilcko surgery, it was time to start Invisalign. I walk into the orthodontist office with no small measure of trepidation and the patient coordinator said you must be so excited. No, not that. Many other adjectives came to mind and some preceded by an odd expletive or two. But it truly gave me some comfort because to even consider a state of excitement she must clearly see a positive end game. I know it is there.

Step one is placing the fasteners on your teeth. These are bits of composite that are temporarily attached to your teeth and aid the trays in moving the teeth accurately. I have a lot of them. This is an easy procedure, no sweat. Then it is time to put the first set of trays on. This was not an easy procedure and there was a lot of sweat. I couldn’t get them on and I couldn’t get them off. Plus the attachments were shearing off as I tried. When it was time for my flustered self to go, I said I would put the trays in before bed. Very bad decision. I soon discovered that my teeth had been weaponized. The attachments on the lower front teeth ate holes in the inside of my lip while I was engaged in some much needed retail therapy. As soon as I got home, I rushed to put the trays in but the damage had been done and now the edge of the tray was having its way in the same area. I should have called the orthodontist for suggestions but instead made the first of many trips to the dental and first aid aisle trying one thing after the other to alleviate the pain. I ended up tearing off a bit of napkin and shoving it in there at dinner and it was blessed relief.  I didn’t even care that I looked like I had a chew in.  

Save yourself time, money and aggravation and get the invisalign survival kit and avoid repeated trips to this aisle and go straight to the ice cream instead. Buy dental wax, emery boards, hydrogen peroxide and salt for warm salt-water rinses. That’s all you need. The orthodontist loaded me up with wax and I threw all the useless items away and bought large quantities of hydrogen peroxide and kosher salt

It would be a lie to say the first few days were easy. They were unpleasant at best but everything turned around by day 4 and I struck an uneasy alliance with the trays. By the day before surgery, the inside of my lip was healed and the trays were easy to put in and out. Good thing too because no dental wax was allowed after surgery…

 

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My Love Hate Relationship with Invisalign Begins

Dental Part 3

When I asked the orthodontist what Invisalign was, no doubt he wondered what hidey-hole I have been in. Here is the short answer. Once the periodontist evaluates the bone/gum situation, the orthodontist will recommend braces or Invisalign based on what you have going on in there. Some folks can do either and some will have a better outcome with one or the other. In my case, Invisalign was recommended by my excellent orthodontic team. Plus also note that everyone in the office is dedicated to making the experience positive. Since you will spend a great deal of time there, this is important.

To begin, the orthodontist completed a 3D scan of my teeth. Invisalign uses this scan to produce clear plastic aligners or trays which when worn sequentially will shift the teeth into the proper position. For me, 41 trays were produced. Consider this process a real life flipbook.  

My primary concern with Invisalign was a requirement that the trays be worn a minimum of 22 hours a day and removed when eating or drinking anything besides water. The math simply doesn’t work. Imagine a relaxing Saturday. Start the day leisurely drinking coffee followed by breakfast (1 ½ hrs), lunch (1/2 hr), dinner on the town starting with a cocktail (1/2 hr), followed by appetizer (1/2 hr), main course (1/2 hr) and if I have no self control, ice cream (1/2 hr). If we are kicking over the traces, we may go out after dinner and that could be any amount of time. But let’s say 1 hr. This totals 5 hrs and does not include the endless snacking I do all day so let’s throw in another hour for good measure. Even on a weekday, total eating/coffee time is definitely over 2 hrs a day. It was a question of lifestyle vs. snaggle teeth. Time to run???

Did not run, discussed further and the solution is simple, don’t take them out when you eat and clean trays and your teeth afterwards. Great. I got the answer I wanted and stopped stressing.

Your approach will depend on whether doing Wilcko surgery or not. Without Wilcko, each set of trays is worn for two weeks or so. They will stain badly and suddenly Invisalign is disturbingly visible. One small serving of curry chicken salad will tinge them yellow. A blended vegetable drink turns the trays a lovely shade of light green. Plus great gobs of food get stuck in them. Really attractive. And let’s not forget cavities.

On the other hand, with Wilcko surgery, each tray is only worn for a couple days since the teeth are moving so fast. Therefore staining is much less of an issue. I still have a little fear since no doubt even keeping them in will require adjustments to my daily feeding frenzy.

Up next, the first day of wearing the trays…

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My Travels Through the Scary World of Dentistry

Dental Part 1

The tooth fairy was clearly in a bad mood when visiting me.  This along with my parents’ decision to forgo braces has led to adult snaggle teeth.  A dentist would refer to this as significant overcrowding.  My teeth are not straight when viewed from any plane.  They jog up and down and back and forth with a bit of caving in to make it really interesting.  And when my permanent teeth arrived, the dentist decided to grind down the extra long canines to avoid that unpleasant vampire look. I am not making this up. Plus my teeth were very cavity prone.  Not sure it had anything to do the bandaid box of sweetarts I brought to school everyday but lots of cavities meant lots of dreaded dental visits often without novocain.  To make it worse our family doctor supplemented our diets with constant antibiotics.  That does amazing things to the color of your teeth.

Fast forward to 58 years old.  I figured by keeping my teeth tidy and gums healthy, the really scary dental work magnified by an active imagination could be avoided.  To this end I had my teeth cleaned 4 times a year, flossed, proxabrushed and replaced amalgam fillings with composite.  But the snaggle teeth would not be ignored and I started to experience pain.  My dentist said I needed braces.  Whoaaa, I am 58, is that even possible?  He said to see an orthodontist.  This was the beginning of a learning curve that culminated in a decision to fix my teeth with Invisalign and Accelerated Osteogenic Orthodontics (AOO) also known as Wilkodonics. Unfortunately there is an incredible lack of awareness about Wilkodonics, even among the dental community. So in an effort to change that, I will chronicle the process from beginning to end. Hopefully it helps someone else out there.