My nightmare would involve sticking through a difficult treatment only to quickly relapse, having an ortho who doesn't know what they're doing, and having the second round be slower and more difficult. I'd start my treatment when I'm school age, wearing a cervical headgear full time (I won't like it, but I'll agree to do it) and an activator at night for two years and wear the activator full time for one more year. Then I'll graduate to fixed upper and lower braces, no more activator, and headgear only outside of school for another year, along with full time elastics. My teeth will be all in their places except for I will be missing my canines and still waiting for them to come in. I will have been promised that I will have my braces off before my senior year, but during my junior year I am still missing teeth and my ortho finally figures out my canines are impacted and I need to have gum surgery to reveal them and then have them attached to my braces with a metal chain and later elastics to bring them down into their place. This normally takes several years to complete, but my ortho promises it can be done in only one year, and he delivers. I get my braces off before I graduate and go away happily to college, only to return for a check up over christmas break to find my canines moving back up into my gums again (doing it in one year was clearly a mistake.) My ortho tries to adjust my retainers and tells me to come back in the summer. I make it a point not to come back because I do not want to get braces put on again, but eventually, I decide to be a grown up about it and return the next christmas when my canines have entirely disappeared. By then it is too late to do anything but put the braces back on, because even though I've been wearing my retainers some things have gotten way out of place. The spaces where my canines go have gotten too small and my lower teeth have become very crooked. I get a spring across my bottom front teeth to make space to straighten them out, and springs in the gaps where my canines need to go, and am told to come back in a month. I can't, because I'm too busy with school, and don't make it back until summer. My ortho sees that my teeth are not moving so gives me a tighter wire and a lower expander to help straighten out my lower teeth. I make four appointments in a row over the summer, at the last of which my ortho decides my lower jaw is moving too far forward. Instead of my front teeth overlapping my lowers, they now touch edge to edge. He gives me super strong elastics to pull my lower jaw back, lower canines to upper molars, plus three more. Box shape around my front teeth and box shape around my molars, one on either side.
I make it back for an appointment in the fall, where he says the elastics are working and my bite is fixed but for some reason I still do not have space to pull down my canines and I still don't have enough room. More elastics are added. Over christmas break, my ortho determines the braces are not working because I must be fiddling around with them too much and installs and upper and lower lip bumper. Now I can't close my lips over my teeth. He also gives me a high pull headgear to wear at night, to make sure my molars are not pushing into the space that my canines need to occupy. It's my junior year of college and I live in an apartment style dorm and I try my best to wear the headgear, because I am really tired of these braces and just want to bring my canines down and be done with it, but it's really hard and I go out most nights, so the headgear gets worn for a few hours a night if at all. My bite seems okay to me and the spaces seem to be slowly opening, and I try my best to make it home for at least one appointment between breaks, but I get so busy with my last year of schooling and I've given up on getting these braces off before I graduate and I just try to accept that I'll be wearing them a few more years.
The summer after I graduate my ortho finally realizes that my wisdom teeth have been trying to come in, and I throw a fit and blame him for this long and purposeless treatment. He should have done periodic X-rays and known that it was my wisdom teeth causing problems all along. He insists that this is all my fault for not wearing my headgear as directed. I point out that there were clear issues before the headgear, and its probably his fault I even need the headgear. A week later, I get all my treatment records and impressions mailed to me along with a letter saying he will no longer treat me. I try my best to find a new ortho to finish up with these braces. I don't want to just quit because my canines are still impacted and I don't want them to damage my teeth further. Also, my bite has gone back to my front teeth meeting edgewise and I am having trouble eating and chewing. No ortho will see me until I've had my wisdom teeth out, so I have to wait until I can see an oral surgeon. I wait six months to have this procedure done, all the while with inactive braces on my teeth. I do not wear the headgear, and my top teeth move forwards again and my bite seems to fix itself. After I get my wisdom teeth out (I've now started my first "real" job out of college and it's a very good one!) I try again to find a new ortho, but have a tough time because none want to take my "difficult" case. I finally find someone who specializes in relapses, and she immediately removes the expander and lip bumpers, takes new impressions, and tells me to come back in a month to start my new treatment.
When I return (I have now been wearing this second round of braces for four years) she explains to me that my wisdom teeth pushing to come in while I've been wearing braces has pushed my upper and lower teeth so far forward that although there is a space for my canines to come down into, it is far away from where my canines are actually located. Since they were moved so quickly the first time and moved back quickly, she is afraid if we try to move them too far they will not be able to stabilize and either move back up again or fall out. I do not want them to fall out after all this effort to keep them! The only thing to do is to move my upper and lower teeth back into their original positions, slowly, because my bite has already been messed with so much. I agree to this. She wires in a twin block appliance to keep my bite in the correct position and has me wear strong elastics on either side so that it is difficult for me to open my mouth farther than the appliance already keeps it open. Then she shows me my new headgear. I will wear a high pull headgear for my top jaw and a cervical headgear for my lower. They are both set at extremely low force, so they should not be uncomfortable, but I need to wear them both full time for them to work without further damaging my teeth. I initially refuse, saying there must be some other way to get the same result, but she explains that my teeth are already in a fragile position and this is my only option. If I won't wear the headgears, she will remove my braces and I can discontinue my treatment. I ask for a week to think it through, and eventually decide to do it after studying in the mirror how my teeth now stick out and I still have the conspicuous gaps on the sides were my canines belong. I expect to wear this headgear full time for two years before I can have surgery again to expose my canines, and it will take 2-3 years to pull them into position and retain them there.
This is my nightmare treatment. I did, in reality, have impacted teeth (that could not be saved with orthodontic work, so I just had them removed, like what is done with wisdom teeth) and so I do often imagine how trying to save them could have gone horribly wrong. This is only one scenario. Of course this would never happen in reality, but sometimes I like to fantasize about the "nightmare" side of things.
