4-30-2019 Email Update

I submitted, over 2 emails, additional questions that I forgot to ask to the orthodontist. Here are her replies!

First email:

1. Why the implanted expander and not a similar one that is not implanted? What is the benefit for my case? Any risks I should be aware of?
She was the first to recommend this to me; my other consultations recommended either no expander, a Schwartz expander or surgery. I was unaware of an implanted type and would just like more information as it seems a bit intense.

Docs response: The upper jaw is done growing at age 7, thus a conventional expander would do nothing more than tip the teeth in the current bone. The goal of an implant based expander is to actually expand the maxilla (upper jaw) and not just tip the teeth into a wider portion of the jaw. The benefit is your upper jaw is very narrow, try to regain ideal size, as well as improve the base of the nose thus helping you breath better through your nose. The risks are varied, I do not place the skeletal expander, my colleague the Periodontist does therefor the consult with her will answer more questions on the risks. The main risk I see presenting itself is the jaw may not separate and expand, the implants may not work. We do not know if this risk is going to present itself ahead of time, there are patients in the expander who have not expanded.

2. Would I get an expander on the lower jaw as well?

Docs response: We would not expand the lower jaw, in a true sense, as it is just one piece (the upper jaw is two pieces and can be pushed apart to be made wider). When an orthodontist is saying they would expand the lower jaw, we mean upright the teeth and make the teeth wider as that is the only option with the lower jaw.

3. What type of retainer can I expect to get once treatment is over? Permanent? Or perhaps one that looks like an Invisalign tray? And, can this be modified to also act as my night time TMD bite guard?

Docs response: Retention varies based on how each patient responds to treatment, in general for a case like yours I would anticipate a clear retainer (like Invisalign) that we modify to act as a bite guard as well, by adding acrylic.

4. Why types of scans do we do along the way?
I ask because working with my current NeuroMuscular “specialist” I was scanned, hooked up to a TENS unit for an hour, then re-scanned to find ‘where my jaw wanted to go’ before we made my current orthotic. Do you do similar scans, or would I see him on occasion to make sure my bite is progressing into the ‘correct’ location? Or neither

Docs response: The imaging would be a 3D CBCT to evaluate your anatomy for the MSE (maxillary skeletal expander) which would be taken pre and post op. We would also take radiographs in my office as needed to assess treatment and aid in treatment decisions. I do not use a TENS unit in office, I would be happy to try and work with your current provider to ensure the jaw position is ideal - which may require scans in their office. If we have a difference of opinion it would be up to you to determine how to proceed.

Second email, after I had the CBCT and consult with her Periodontist:

1. The periodontist mentioned that my lower jaw is pretty narrow and doesn't expand like the upper. She mentioned bone grafting, as a possibility way down the road, maybe-maybe not, if you needed help matching my lower teeth to my upper, once I'm fully expanded and in braces. That doesn't sound pleasant at all and I would like to avoid it. By looking at my scans, can you get me to 100% of my potential without that? 75%? I am willing to compromise if it's a high percent sans grafting. My goal is pain relief and breathing over aesthetics.

Docs response: This is a tough one because you are very narrow on the upper, and as an adult I have no way of knowing how your bone and soft tissue will respond. All I can say is we can 100% try to upright the lower teeth without any additional intervention.

2. Since my palate is expanding, does that expand the entire width of my upper jaw, TMJ to TMJ? Basically, will this process have a chance of making pain in these joints worse?

Docs response: There is always a chance, however I have yet to see that happen - there is a stronger correlation with the narrow jaw and TMJ symptoms. The expander would expand the entire upper jaw, but the TMJ joint is on the lower jaw

3. We didn't talk actual measurements from my CBCT. How bad is my airway, really? Everything I read online mentions specific measurements. Dr. Anderson mentioned I might need to see an ENT when I am all done with orthodontics to correct the deviated septum.

Docs response: There are no set guidelines for airway size and dimension, partially because the airway moves/flexes etc., can vary based on tongue posture in the image and head posture. I do not take airway measurements from the CBCT as I do not use the machine, but you could ask the Periodontist to have it read by a radiologist (there is a fee) for exact measurements. I recommend an airway case based off of symptoms and patients quality of life - I see it all the time where it "looks" like a horrible airway but they have no symptoms, and the reverse.

4. Once I start this process, my current bite guard/orthotic becomes obsolete. Would I go without one until I am brace-free, or just use a cheap DIY one from the store?

Docs response: Yes - we will try to make something if we can but because the teeth will be constantly moving something over the counter may need to be used.

-------

I understand any type of doctor can never give you a 100% chance of anything, but this all seems pretty good. Right? I should move forward with the MSE?? I do have to say, the ortho and perio were beyond attentive to my 4000 questions, did not make me feel rushed at all whatsoever and seem like legit really good people who want to help me feel better and not just look better. I'm scared but so far have no reason to believe this will hurt more than what I have been dealing with the last 20 years. And the MSE will be in for 6 months- It was $300 for the CBCT which is paid for already, $1000 for the perio and $500 for the Ortho. I can afford this now, or over the 6 months.