SARPE Preperation.

Prior to my upper jaw operation taking place, braces were placed on my upper teeth from August 2008 - July 2009, this was done because the orthodontist who was responsible for overseeing the project was not satisfied by my top teeth and felt that it needed to be straightened before SARPE took place. This required me to go back and forth from Aberdeen to London once a month during my third year in order for my braces to be tightened.

Every now and again to judge if my top teeth had become straighter, a model was taken and renewed every few months.

Two weeks before undergoing SARPE a SARPE brace was placed onto the roof of my mouth in order to assist with my upper jaw expansion:



The brace is fitted in before surgery as it is the main mechanism responsible for the expansion of the upper jaw. The purpose of SARPE itself is to weaken the upper jaw by splitting the upper jaw in two so that it is mouldable. The incision is normally made bang in the centre of the roof of the mouth.

Once it is weakened, my orthodontic surgeon is hoping to expand my upper jaw by 10mm, by telling me to use a key mechanism and twist the brace (there is a hole in the silver box in the middle) 3 times a day until the desired amount of upper jaw expansion is reached. Each twist of the brace widens my jaw by 1/4 mm.



A change in toothbrush was required to ensure proper cleaning post operation. I was required to change my toothbrush to one with a small head, so that I could reach those hard to reach areas post operation.



Yes I know what you are thinking, and yes it is a toothbrush for 2 year old girls!

In addition to this prior to my operation I had a pre-op assessment with a Facial Maxillo doctor who told me about what laid ahead. In her words, she branded this whole journey to be a "life changing experience", as it not only will be hard and painful, but the rewards at the end of it will be amazing. This however remains to be seen...

The Anterior Open Bite - what is it?

I have spoken extensively about what this is in my previous posts. And as pictures are worth a 1000 words, the following image is of another sexy poor sod with the condition:

BEFORE:



A patient prior to treatment in Japan with an Anterior open bite, and long face syndrome. She does not however have a slanted bottom jaw, or a narrow upper arch (crossbite) unlike myself.





Despite looking like I have no problems at all physically, given that I am a relatively attractive guy. If you look closely you will notice that I do suffer from an AOB just from my outer appearance with my mouth shut. I have a) long face syndrome b) my bottom jaw is not aligned at the centre of my face, you can see that my chin slants the right - which this woman does not suffer from. The big give away however is a weak "pointy" jawline. So not only will my bottom jaw need to be respositioned (or reset), my teeth also need extensive work on as shown from the next batch of photos, me smiling with teeth:



My bite.

In the above photos you can see how narrow my upper set of teeth are in comparison to my bottom set of teeth. The purpose of my first operation SARPE is to correct this by expanding my upper jawline so that it is the same size (width wise) as my bottom jaw.

By doing SARPE first, this will ensure that I will have a perfect bite once they operate on my bottom jaw to close the gap between my top and bottom teeth.

BEFORE & AFTER:






Same patient after successful treatment two years later. You can see that the longness of her face has been reduced, much more defined jaw-line (pointyness has gone), her teeth now touch, and her smile is great. This at the moment is the best example of how I expect my face to change after everything is completed, and although the changes are subtle, her physical appearance has changed ever-so slightly. From an aesthetic point of view, incidently, oral facial maxillofacial specialists refer to this type of physical change as "bringing balance" to ones face during the correction of ones bite.

So to conclude this post, an anterior open bite is one where ones top and bottom teeth do not touch as shown above. When ones jaw is narrow, and this could be either/or both the upper or bottom jaw, is technically referred to as a "crossbite".

References:

Severe Anterior Open-Bite Case Treated Using Titanium Screw Anchorage

http://www.angle.org/anglonline/?request=get-document&issn=0003-3219&volume=074&issue=04&page=0558

The four year battle

Before any treatment could begin, the following conditions needed to be satisfied as requested by my hospital:


a) Excellent oral hygiene
b) Staying in the same location throughout the treatment, in my case this was London.


To ensure that treatment goes to plan, you are assigned an orthodontics consultant who oversees the whole project and makes sure it is going to plan. Typically to assess your bite, the procedure that is typically initially taken place is to take moulds of your teeth, X-rays, and standard braces are normally put into place to make sure that your teeth are aligned correctly prior to surgery. You then have another consultant who in effect is a surgeon, his role is to do any surgical procedure involving your bite and that’s it. This obviously varies between individual, but one thing for sure moulds will be taken as they need to assess how bad your malocclusion is before putting forward a plan of action.

In 2005 at the age of 19, I was first put forward to a different orthodontic consultant to the one I now have. Anyway, the situation became complicated as she was very unhappy that I would be studying in Aberdeen during term time. If it wasn't this, then she would nitpick on me due to my plaque levels. To cut a very long story short, the first stage of treatment did not get rolling (braces) due to my previous orthodontic consultant being stubborn and difficult. This resulted in me taking a gap year at 22 as I was adamant to get this issue resolved as soon as possible. That and I wanted to have some real world experience for a while.

I remember during this period of my life feeling very depressed by the whole thing, when you are a young man, you want to be your best self physically as you are playing the dating game and socially it did affect me immensely psychologically. As I couldn't smile with my teeth touching (I have been asked on more than one occasion by girls I have courted to smile with my teeth during a photo taken with them), my face (although not noticeable to others) being asymmetric, jaw pains, linguistically being affected - my bite has resulted in me sounding very nasal for example (due to the jaw being connected to the nose), and my pronunciation of certain words is not perfect as it requires phonetically for my bite to touch. For instance back in the day I took a module at university to learn Spanish for the banter, I learnt from a Spanish girl on a drunken night out that to pronounce the word "Espaniol", you will find that to do this correctly requires your teeth to touch. In the German language there are many many words that require this, and it was little things like this that dented my confidence badly over time. Saying that despite its drawbacks, I have had to learn to adapt to this issue rather then let it dictate my reality, due to the demands of an active social life even if it is subconciously in the back of my mind.

Furthermore, aside from the above, not getting anywhere with my previous orthodontic consultant added to the frustration and pain, if say my oral hygiene was perfect for example she would complain that I was studying in Aberdeen, and as I am not in London throughout term time, treatment could not begin due to hospital policy. She was very happy however for me to get treated in Aberdeen despite the fact that:

a) I am not in Aberdeen for most of the year anyway! So it is no different if I get treated there or in London. If anything, getting treated in London would have been logically a better idea due to my family being here!

b) Any operation during term time would seriously disrupt my studies due to the post recovery period following any operation involving my jaw.

Leaving me to think what is the difference, even if I got treated in Aberdeen they would have the same problems. Given the above I had to take a calculated risk, I had no choice but to take matters in my own hands as I realised that she saw me as another patient with no power; she was on an ego trip. Adamant to get the ball moving, first and foremost I eradicated each excuse one by one. To ensure that she could not complain about my oral hygiene I would get my teeth cleaned by my dentist the day before my appointment. This however had no effect, as the problem then was Aberdeen. With this seriously pissing me off as I was unable to reach a compromise despite their flawed logic, I kept a record recording everything that had been said (complete with dates and the name of the person who said it), built a case and brought this topic up with my local member of parliament. I just was not happy that she expected me to stop my studies during a critical period of my life when my schedule at university is flexible enough to work around. It was logically all utter bullshit to me, and it came across as though she didn't want to treat me.

In the end, my actions had a positive outcome, my previous orthodontic consultant who was overseeing the project moved position, and was replaced by another one. I have had no problems with the new one since.

After this happened, I felt very proud of myself as my hard work paid off. I fought and won.
So my advice to ANYONE else going through similar problems with consultants of any nature is to stand up and show them that you can't be pushed around, by first trying to reach a compromise with them. If this fails get their superiors on their tales that are no way affiliated with the hospital trust (due to bias), but rather are politicians or highly influential people that will listen to you because they need your votes and directly/indirectly affect decision making within the hospital with regards to funding etc etc.

My first post

Right where do I begin? It is two weeks post op from my SARPE operation, and before I go into that, first and foremost I will give you some background info on how and why it got to this stage.

Note:

Before I continue, my intention of this blog is for it to serve two distinct purposes:

a) Inform those individuals suffering from an Anterior Open-Bite, or Cross-bite of what to expect during THEIR orthodontic journey. I wish I had this information avaliable to me, but I had to search long and hard on google to educate myself about my condition.

b) To give those that are interested an insight on what it was like going through this. I am hopeful that after reading this you will go away feeling much more aware of orthodontics surgery and the work that is done during it.

*) As I know people are generally lazy when it comes to reading vasts amounts of material, to avoid repetition I will add material, text, photos to my existing posts. This will save me from repeating myself as this should make this blog concise and straight to the point as well as user friendly - in the sense that you don't have to go sniffing through 10000 posts to see what the deal is!

Now back to my little story, a combination of mouth breathing, excessive sweets caused me to lose my baby teeth very early at the age of 5. This along with thumb sucking had a negative impact on my bite. The mouth breathing had an affect by causing me to" develop long face syndrome"; where my face is quite long, whilst the thumb sucking was responsible for my upper jaw to be very narrow which resulted in the development of a cross-bite. Due to the combination of both, this inevitably resulted with myself developing an Anterior Open Bite. An othodontic term to describe when your upper and bottom teeth do not touch.

It is often argued that this is caused by genetical reasons, and although this may be the case for many, given that many members of my immediate/extended family do not suffer from this condition I doubt that this was the case for me.

Unaware until the age of 19 of my malocclusion (improper bite), due to not knowing any better. It was only after my first trip to Scotland prior to choosing my University, that my Uncle Tony pointed out that I should get braces fitted in. After a short trip to the dentist to address this, my dentist referred me to the orthodontics department at Kings and then the next stage of my battle began, getting treatment started to correct my bite. This I will address in my next post.

References:

http://www.answers.com/topic/long-face-syndrome

For a brief History of the development of Orthodontics go here:

http://en.wikipedia.org/wiki/Orthodontics