Thank you!  And I was wondering if anyone had even read the last chapter.  And that tandem expander I linked/posted is actually in the roof of someone’s mouth now.  It just looks brutal.

Dr. Morales was callous towards Megan.  That is a bad thing to do with Dr. Miller. 

I absolutely love this story!!!!!!!!!

Chapter Fifty Three:

Dr. Miller excitedly tore the box open.  He just had to see it with his own two eyes to believe it.  He had asked the lab to push Dr. Morales' appliance to the top of the list.  And while they told him they had trimmed their normal lead time to less than a week and could have it to him by the end of the week if they overnighted it, he hadn't really believed them.  Yet that Friday he held in his hands a brown cardboard box from Specialty Orthodontics Lab.

After ripping the flap off the box like a kid at Christmas, he peered inside.  He saw there were 11 smaller individual white boxes inside.  They were unmarked, but he knew each one represented a patient.  He knew that Dr. Andi had been busy with new patients, but seeing so many appliances made him realize just how busy she had been.  Dr. Miller was only awaiting appliances for two patients.  He realized the other 9 must be for Dr. Andi's new patients.  Using the little knife he kept at his desk just for opening letters and packages, he carefully opened the first of the smaller boxes.  Inside was a folded packing slip with the description of the appliance and the patient's name.  But he didn't even need to look at it, he could see the appliance in the box was just a simple fixed bite plate seated on a mold of the patients teeth and mouth.  This was not the one he was looking for.  When he opened the seventh box he found what he was looking for.

He carefully withdrew the huge appliance from the box and pried it from the molds. Holding the appliance he thought it was amazing.  And horrifying.  It had some weight to it he realized.  It was by far the largest and heaviest orthodontic appliance he had ever handled.   He smiled seeing that they had welded the lower tongue crib into the buccal tubes on the lower molar bands as he had requested.  This was different than normal.  Normally, he would have inserted the tongue crib into the tubes after installation and slightly bent the ends to hold it in place.  But he knew that it was possible for a patient to straighten it and remove it if they really wanted to.  But by welding it in place, he knew there was no chance of that.  He had also requested they weld the telescopes in place instead of using the normal screws.  They had done this as well.

He held the appliance up and admired it from all directions.  It was truly a work of art.  He pushed his thumb against the spikes of the tongue rake.  He could see they had sharpened them to a point as he had requested.  Feeling them though, he realized just how sharp they had gotten them.  Like a row of ten fishhooks.  He smiled thinking about Olivia feeling them with her tongue for the first time.  He placed the appliance back onto the molds and carefully laid it on his desk so that it was open.  He then pulled out the pink acrylic plate that was also in the box.  It was not on a mold, instead simply in a little plastic bag.  He removed it from the bag and inspected it.  It looked exactly as he had ordered.  He gently mated it onto the steel Miller appliance.  When he carefully closed the appliance, like would happen when Olivia bit down, he saw that it fit like a glove.  A huge glove that would give Olivia's tongue no room to probe.  Or speak.  He pulled out his phone and sent the text.

He was working with a patient fifteen minutes later when he felt the phone in his pocket vibrate.  He was eager to finish with the patient, it was just a routine wire change, so he could check his phone.  Five minutes later he looked down at his phone.  He saw the text reply from Olivia.  She said she could come in tomorrow, a Saturday, to have the appliance installed.  He replied simply with "YAY!"  He had added a smiley face emoji.  He thought that last little part was a bit ironic, maybe even cruel, as he doubted that Dr. Morales would be doing much smiling for quite a while.

That afternoon during their routine Friday afternoon staff meeting, he had announced that they would begin offering limited Saturday appointments.  He apologized, he said he knew how important weekends were.  But he said with so many adult patients who had fulltime jobs, he wanted to offer them the option.  Just another service to offer to their patients and a way to differentiate themselves from other providers.  But he explained they would only do it two Saturdays a month.  He looked at Dr. Bender as he said "Dr. Andi and I have discussed it, we will alternate.  So that means each of us will only have to work one Saturday a month."  He then looked at Maggie, Alex and the new assistant Katie and said "and you girls can alternate too.  Only one of you will need to come in on Saturdays, we won't be stacking patients on top of each other like we do during the week.  And we won't see new patients on Saturday, only existing patients.  So, there are three of you and only two Saturdays a month we will be working.  So each of you won't even have to work 10 Saturdays a year.  Unless you want to.  But here is the kicker, we will be offering Holiday pay on Saturdays.  And we will be offering a full 8 hours of pay even if we only work a half day.  I want to make it worth your time.  And show you how much Dr. Bender and I both appreciate you giving up a Saturday.  I know it is short notice, but we have our first Saturday patient tomorrow.  A real VIP, Dr. Morales.  Who wants to volunteer to come in for a half day tomorrow morning?"  All three girls eagerly raised their hands.  Dr. Miller laughed and exclaimed "I love your enthusiasm!  But I will only need one of you.  We will set up a calendar this afternoon and you can work out who is working what days.  And you can swap out too if something comes up.  But for tomorrow, and please don't be mad Maggie or Katie, I am going to go by seniority.  Alex, will you please come in at 8 tomorrow morning?  Dr. Morales is scheduled to come in at 9.  Her appointment will be extensive, much longer than normal.  But I hope we can get out of here by noon."  Alex smiled and said she could.

The next morning Dr. Miller helped Megan out of the BMW and walked with her into their office.  They had dropped the boys off with his mother again.  He had explained to Megan the night before that he would be working some Saturdays.  But that he did not want that to cut into their time together.  He had also explained he thought it would be a good idea for her to start working in the office a couple of days a week.  The contractors had finished up Dr. Andi's office and she had moved into it, thus freeing up her previous workspace.  Dr. Miller said he had a surprise he wanted to show Megan where her previous office had been.  He asked her if she would come to work with him the next day.  He knew she would say yes, because she knew that if she didn't he would not like it.  And Megan did not want to disappoint her husband.  Dr. Miller thought she was genuinely excited about the idea by how eagerly she said she would love to.

He walked with Megan down the hall, stopping at the closed door of Dr. Andi's old office.  He opened the door and asked "so, what do you think?"

A huge smile broke out on her face.  She awkwardly hugged him, there was no other way for her to hug while wearing her halo brace, and said "I love it.  Thank you sir." 

Dr. Brad kissed her on the top of the head and turned his head back towards the office.  Only it was no longer a small cramped office.  He had turned it into a nursery and playroom.  He said "I miss you and the boys so much when I am here.  Now we can spend more time together."  He squeezed her before letting go of her and joking "and I am going to put you to work."  He laughed and then said "I have one more surprise too.  Do you know who today's patient is?"

Megan looked at him.  How could she know who the patient was.  She responded "no sir.  Should I?"

Dr. Miller said "it is Dr. Olivia.  She is getting her new appliance today.  Come and take a look at it."

Sitting stiffly across the desk from Dr. Miller, Megan looked at the appliances on his desk.  She gasped "oh goodness, that is big."

He picked it up and slid around the desk so that he was beside her and held it out towards her.  He said "you can hold it if you want."

She carefully took it from him.  She flexed the telescopes open and closed and asked "do these lock like mine?"  He assured her they did.  She then did as he had done when he first handled the appliance and felt the tongue rake.  She pulled her finger back in shock as she squealed "ouch!!  Those are so sharp."  She thought a moment before she said "they will make her tongue bleed."

Dr. Brad reached over and picked up the acrylic appliance from his desk and replied "not if she wears this.  She just won't be able to speak very well.  Maybe not at all."  He then looked at Megan seriously and said "and if she bleeds, she bleeds.  She made you bleed last week angel."  There was more he thought about saying but decided to just leave it at that.  Instead he finished by saying "her case is very complex, and complex problems sometimes require complex solutions."  At that moment Alex stuck her head in his office door.

When she saw Megan she was momentarily caught off guard.  She didn't expect to see her in the office this morning.  But more than that, the halo brace and protraction bar were jolting.   She knew that Dr. Miller and Dr. Olivia had fitted her with the brace.  But seeing it in person for the first time was a shock.  She recovered quickly though and exclaimed "Megan!  Good morning!  So good to see you!  You look gorgeous this morning.  But you always do!"  Dr. Miller stepped back as Alex took a few steps over.  She leaned down and gave Megan a little hug.  Alex then asked "so how are you doing with the new brace?"

Megan replied "I am doing well.  The first few days were a little painful.  But that is over now.  It is an adjustment not being able to move my head at all.  There are some things I just can't do.  And a lot of things I have to do a little differently.  But you wear a CTO, so you know about that.  Not being able to drive sucks.  But probably the worst thing is not being able shower.  Brad has been so sweet and helps me with a sponge bath every day.  But I haven't washed my hair since I got it."

Megan said "well, I would never know.  Your hair looks incredible."

Dr. Miller had an idea and said "baby, I am afraid to wash your hair.  But I just had an idea.  I will take you to the little hair salon you like so much.  Mal and Kari will be able to do a much better job than I can.  Plus, I need to check on how they are doing.  Kari just had her appointment this week.  She got her Miller headgear set up for protraction.  And she started turning her expander.  And Mal came with her.  Mal insisted she get a Miller headgear too, set up for retraction, instead of the high pull she was wearing.  It was really sweet watching them together.  So good to see two friends so supportive of each other."

Megan didn't know if it was her place to say anything.  But she didn't keep secrets from her husband.  She thought about the pictures and posts from Mal and Kari's personal facebook pages.  Megan said "they aren't just friends.  They are married."

Dr. Miller looked at her in surprise and said "oh, wow.  I didn't know that.  But that makes sense.  And it explains how Mal was holding onto Kari after her appointment.  She was a little upset.  But anyway, I don't need to talk about patients."  He changed subjects when he asked "baby, would you like to go help Alex sterilize everything?  I would like for you to learn how."  He looked at Alex and asked "would you mind training Megan a little bit?  She is going to be working her some now."

Alex smiled and said "oh yay Megan!  You can keep him in line for us."  He turned back to see that Dr. Miller was smiling at her comment.  Alex said "of course I don't mind training her."  She turned back towards Megan and excitedly said "you have her appliance in your hand."  It was the first time Alex had really looked at it.  She said "holy cow... that is huge."  She shook her head and continued "ok, put the appliance in the box it came in..."

Brad said "two appliances."

Alex said "ok, put both appliances in the box and come with me.  I will show you how we sterilize everything.  Instruments and appliances."

The two had been gone only a couple of minutes when Dr. Bender stepped into his office.  She was wearing her Miller headgear with its four elastics hooked to her maxilla, pulling it forward, while the facebow was attached to her mandible, distalizing it in place.  She smiled as best she could and cheerfully said "Good Morning!"

Dr. Miller looked up and gave her a big grin and said "Good Morning!  This is a surprise.  To what do I owe the honor?"

Dr. Andi said "I wanted to see the installation.  And how the patient, uh Olivia, handles it.  I don't think she is doing too well though."

Dr. Miller asked "why do you say that?  She seemed ok when we were texting yesterday."

Dr. Andi said "because she is sitting in her car in the parking lot right now bawling." 
   

Great chapter, I hope we get a new chapter soon.

I plan to continue, I have just been too busy and will be for a few more days.  Maybe later this week. 

Chapter Fifty Four:

Dr. Brad was surprised to hear this.  And he felt conflicted.  On one hand, Dr. Morales was a patient.  And his natural instinct was to try to comfort her and make her treatment as easy as possible.  But he also remembered how cold she had been towards Megan a week earlier.  He told Dr. Andi "that is surprising.  Olivia is always so clinical.  She certainly doesn't let emotion dictate her treatment of patients."  He thought a moment before he asked "would you do me a huge favor?  Would you go and speak with her?  Try to calm her down.  Maybe it will help that you have a similar appliance and are going through the process yourself?  She at least came to her appointment.  Maybe you can help get her to come inside?"

Dr. Andi cheerfully replied "of course.  It would be my pleasure.  I will be back in a few.  With Dr. Morales.  Do you want me to take her directly to the treatment area?"

Dr. Brad responded "no, would you please bring her back here to my office please?  I would like to sit and talk with her.  And I would like it if you would join us.  Would that be ok with you?"

Dr. Andi smiled as best she could manage and said "of course.  I will be back shortly I hope."

Five minutes later Dr. Andi strode into Dr. Brad's office holding a TMJ and Sleep Plus drawstring bag.  Dr. Brad knew it was Dr. Morales' CTO brace.  A few steps behind her was a red-eyed disheveled looking Olivia.  Upon seeing his patient, Dr. Brad stood.  As he took a few steps towards her he said "Good Morning Olivia!  Thank you so much for coming in on a Saturday."  Before she could respond he offered instead of a handshake a hug.  She accepted it.  He briefly hugged her and then let go.  She had still not spoken.  Dr. Brad said "this is an exciting day!  A good day!  You are making so much progress.  Please don't be upset, be excited.  You are getting closer and closer to the finish line.  But you look upset.  Would you like to talk?"

Dr. Morales hesitantly made eye contact with Dr. Brad.  Dr. Brad realized he had never seen Olivia like this, so vulnerable and scared.  Dr. Morales said "yesh..."

Dr. Andi gestured towards the far chair in front of Dr. Brad's desk and said "Olivia, please take a seat.  I know we talked some outside."  Looking at Dr. Brad she said "Olivia is most worried about her speech and how she will interact with her patients."  Dr. Andi guided Olivia over to the chair and helped get her seated and then took a seat herself in the chair beside her.  Dr. Brad made his way back around his desk and took a seat as well.

He looked at Olivia and stated "Olivia, I understand your concern.  And it is the main concern Andi had as well.  Isn't that right?"

Dr. Andi said "yes, that ish correct.  And while I still struggle with a few shounds, S's and K's primarily, you can hear I communicate just fine.  You will too with a little practice.  The fact that you already have a tongue crib will help tremendously."

Dr. Brad agreed "she is right.  Olivia, let's be honest, you have had a fairly significant speech impediment since you got your current appliance.  You have soldiered on though and not let it impact your practice or your treatment of patients.  And remember, Dr. Andi here has both a tongue crib and a lower tongue rake.  It was tough on her the first few weeks.  But she adjusted.  You will be able to do the same with this new appliance as well.  In fact, if you can train your tongue to stay off of the tongue rake, you will likely find that you actually are able to speak better with this new appliance than your current appliance.  The acrylic appliance I want you to wear at first will interfere greatly with your speech.  Dr. Andi has one as well and she can confirm that.  But, without it she speaks just fine.  You will just need to learn to keep your tongue from pressing up against the back of your teeth.  If you can do that, the tongue rake will actually be less intrusive than an upper tongue crib.  It will just be less comfortable if you do press against it."  He went silent and looked at Dr. Morales.

She processed what Dr. Brad had just told her.  She replied "you said I would need to wear it for yearsh though."

Dr. Brad replied "your total treatment time will take a few more years.  But your active expansion will not take that long, though I do like to leave the expander in during treatment as a kind of retainer.   To ensure we don't lose any of the expansion that you worked so hard to achieve.  But, and this is a maybe, depending on how you progress with your tongue thrust habit we may be able to get you out of a fixed appliance sooner than that and transition to a removable part time appliance.  And the same goes for the lower lip bumper.  Look Olivia, this will be an intrusive appliance.  I won't lie.  But I think you would agree your current appliance is pretty intrusive as is.  This new appliance will be more effective and efficient.  And haven't I heard you say yourself that the most important consideration in orthopedic treatment is effectiveness?  Why would it be any different with orthodontic treatment?"

Dr. Morales looked at Dr. Brad.  She didn't say anything but did nod her head up and down in agreement.

Dr. Brad smiled at Olivia.  He said "the sooner we get you in your new appliance, the sooner you can start getting acclimated to it.  What do you say we go on out to the treatment area?"

After getting Olivia seated in the number one treatment chair, Dr. Brad looked at Dr. Andi and asked "would you please go and see how they are coming with sterilization?"  As Dr. Andi departed, he looked at Olivia and said "there are three incredible people that will be helping us this morning.  In addition to Dr. Andi and Alex, Megan is also here.  I thought maybe that would help.  You know how much she has gone through and how grueling her treatment is.  And how she has tackled it head on."  The real truth was that Dr. Brad wanted Megan there to see him inflict a little payback against Dr. Morales.

Dr. Brad looked at Olivia and gave her a reassuring smile.  Her nerves were evident on her face.  Dr. Brad said "first, we need to go ahead and remove your current appliance.  I will numb up your TAD sites so you won't even feel me removing them.  And I am excellent at injections, you will barely feel the shots.  Just like last time."

When Dr. Andi returned to the treatment room with Alex and Megan in tow, Dr. Brad had Olivia reclined back.  He was hunched over her administering the third of six injections.  True to his word, Olivia barely felt the needle go in.  All she really felt was the burning of the anesthesia as the plunger was depressed, injecting the burning liquid into her delicate palate.  He was so focused on the task at hand, he didn't notice the trio arrive. 

Dr. Andi waited until he was done administering the shot.  Dr. Brad raised himself and was reaching for the stainless tray lined up with hypodermic needles when she said "Alex says Megan is a natural."

A bit startled he looked over in the direction of Dr. Andi's voice.  He saw Alex and Megan standing behind her.  He noticed that Megan had a smile on her face.  He looked at her and said "I knew she would be.  She is amazing at everything she does."  He noticed that Alex was holding a tray full of instruments and appliances.  He added "I am certain those are the most sterile appliances in the history of orthodontics.  Let me finish up with Olivia's shots.  We are halfway there.  Are you doing ok Olivia?"

Olivia had a lip retractor inserted in her mouth with blocks holding her jaw open, showing off the extensive amount of metal already in her mouth.  She croaked "ahh haah".

Dr. Brad picked up a full needle from the stainless tray as Alex sat the tray she was holding down beside it.  Dr. Andi rolled a pair of stools over and helped Megan get seated on one.  Afterwards Andi took a seat on the stool beside Megan.  Alex rolled a stool over beside Olivia but continued to stand beside the trays.  It only took a few minutes for Dr. Brad to finish administering the shots into Olivia's mouth.  Once done, he sat up and gave her a big smile.  He had a celebratory tone in his voice as he announced "that will be the worst part of today's appointment Olivia.  You did GREAT!  Let's give the anesthesia a few minutes to take full effect.  But, while we wait, Alex can go ahead and start removing all those pesky upper spacers.  I know you will be glad to see them go."

Alex took a seat.  With a dental pick she quickly began removing the blue rubber spacers from between Olivia's upper teeth.  Megan realized watching her just how practiced she was by how quickly she went.  She seemed to be done almost as quickly as she started.  After she placed the last blue rubber o-ring onto the tray with the empty needles she looked at Olivia.  She gave her a metallic smile and said "I bet that is a relief."  Alex looked at Dr. Brad and asked "do you want to go ahead and try to remove her tads or wait a few more minutes?"

Dr. Brad said "no, I think we can begin.  But I don't want to remove them.  I want you to do it."  He handed her the ratchet.  He could see the nerves in Alex' eyes.  Dr. Brad said quietly "you will do great.  You are more gentle than I am."

Alex took the ratchet as Dr. Brad stood and wheeled his stool out of the way over beside Megan.  He sat and wrapped his arm gently around Megan's lower back, being careful to avoid jarring her halo.  He would have liked to have wrapped his arm around her shoulders, but her brace prevented it.  He looked over at Alex who was sitting where he had been, positioned to work on Olivia's mouth.  Dr. Brad saw Alex was looking at him.  This would be Alex first time removing a tad in an expander.  Dr. Brad said "Alex, it is just a tad.  And you have inserted and removed a ton.  This is no different."  With the words of encouragement, Alex turned her attention towards Olivia.

Alex said "Olivia, I am going to start removing your tads.  You will feel pressure.  This is normal.  If you feel acute pain though, raise your hand up off the arm rest."  Nervously, she inserted the ratchet into Olivia's mouth and seated it over the head of the first TAD.  She began to remove it, keeping a close eye on Olivia's face for signs of distress.  She finished removing the first tad and placed it on the tray beside the spacers.  She asked Olivia is she was ok.  Olivia gave her a thumbs up.  With a little added confidence, Alex worked a little faster on the remaining tads.  After fifteen minutes she had removed all of Olivia's tads.

Dr. Brad stood and took a few steps over beside Alex and Olivia.  He looked down and said "you BOTH did incredible.  Alex, why don't you go ahead and remove Olivia's scopes and lower bands.  We will leave her lower brackets in place.  Then we can remove her upper appliance and that dreaded tongue crib.  I will assist you Alex."

Alex quickly unscrewed and removed the scopes from Olivia's mouth.  She then pried the bands from Olivia's lower arch.  When she went to remove the expander she glanced at Dr. Brad.  He said "with the TADS removed, it is just like removing a standard RPE."  Using the band removing pliers in her hand, she quickly had the expander loosened and carefully removed from Olivia's mouth.  Dr. Brad said "great job Alex.  And great job Olivia.  Alex, why don't you remove the blocks and lip retractor from Olivia's mouth.  I am sure she would love to feel her mouth free from appliances and have a chance to brush and floss without navigating around so much metal."

Alex quickly obeyed and raised Olivia up to a seated position.  Dr. Brad looked at her and said "not so bad was it?"

Olivia looked at him and said "no, but I know the installation will be worse."  She then got a funny look on her face.

Dr. Brad chuckled and replied "your mouth feels huge doesn't it?"

Olivia ran her tongue around her mouth and the outside of her upper teeth.  She responded "yes, it does.  And no lisp.  And no pokies."

Dr. Brad said "Olivia, just imagine how great it will feel when you finish treatment.  If you think this feels wonderful, just imagine how it will feel when you are completely done.  Keep your thoughts on that.  Why don't you go ahead and go brush and floss."

As Olivia brushed and flossed at the sink with Alex and Andi by her side, Brad sat down beside Megan.  He quietly said "I am so proud of you angel.  I knew you would do great.  Did you enjoy it?  Getting to help Alex with sterilization.  And did you enjoy getting to watch us work on Olivia's mouth?"

Megan said "I did.  It is fascinating.  The fact I was holding and sterilizing an appliance that would soon be in someone's mouth for months if not years.  I don't know how to explain it, but it was amazing.  And yes, I did enjoy getting to watch you.  I can't wait to see you install her new appliance.  That will be even better."

Dr. Brad leaned over and kissed Megan on top of the head.  He said "good kitten.  I know how much you want to please me.  But know that all I want to do is please you.  Olivia may have a tough time with her new appliance.  And the fact that I am going to tell her that I am prescribing a halo protraction brace for her.  I mentioned it but didn't tell her it was definite.  Will you talk with her?"  Upon the mention of Olivia getting a halo brace, Dr. Brad had seen the excitement in Megan's face.

She said "sir, oh yes sir.  I would love that.  I would love to talk to Olivia about my halo brace.  And her new halo brace.  That makes me so happy.  That I won't be the only person wearing a halo protraction brace."  As she had been speaking, the volume of her voice had been rising excitedly.  The trio at the sink had heard the last sentence.  Olivia had turned and looked in Megan's direction.  Her face was flush.

As the trio made there way back to the treatment chair from the sink, Dr. Brad noticed that Olivia was walking with her head down, as if studying her shoes.  As she got back to the chair, she raised her head and looked in Dr. Brad's direction, but avoided eye contact.  Dr. Brad had certainly never seen this side of Olivia.  And he was relishing it.  Olivia quietly asked "so you do want me to go into a halo brace?"

Dr. Brad said "Olivia, I just think it makes sense.  Walk the walk.  We have installed one on our patient Ellen.  And my incredible wife.  And your receptionist Kylie is scheduled for one.  I think it only makes sense that the inventor of it, you, would proudly wear one as well.  Especially as it would be beneficial to your treatment."  Dr. Brad was braced for a fight.

He was surprised when Olivia simply slumped her shoulders and said softly "ok.  When do you want me to get it?"

For the first time Brad felt sympathy for her.  She looked broken and defeated.  He said "how about we get your appliance installed today and then we can discuss that.  Not right this second.  I want to give you some time to get acclimated and adjusted to your new appliance.  Maybe in a few weeks.  But we can talk about it."

Olivia said "ok, let's get this over with" as she sat down in the treatment chair.

Before reclining her back, Dr. Brad said "do you want to see your appliance before we install it?"

Olivia said angrily "no.  Just put the damn thing in.  I will have plenty of time to look at it won't I?"

Dr. Brad said "Olivia, it will be ok.  You are doing the right thing.  You will be so glad when this is all over."

Olivia repeated "just install the damn thing Brad."

After Alex had gotten Olivia's teeth prepped, Dr. Brad began the installation.  Because of the welded on telescopes, they had to insert both upper and lower appliances at the same time.  It had taken both Dr. Brad and Alex to get it positioned and seated in her mouth.  Dr. Andi and Megan had looked on enthusiastically.  Once he had tested the fit of the appliance, they had removed it from Olivia's mouth.  With the addition of cement to all of the molar bands, Dr. Brad had placed it back, firmly seating and cementing it in place.  After Alex had cured the cement with the UV light, Dr. Brad had inserted the lower lip bumper into the lower bucal tubes of the appliance.   Satisfied with the fit, he again used cement to afix it permanently.  For added security, he had also bent the ends of the wire at a 90 degree angle so it could not be removed even if the adhesive failed.  With the appliance installed, he looked at Olivia and said "I will now install your tads.  There will be eight of them."

Forty-five minutes later Dr. Brad sat up.  He was physically tired from installing the eight screws.  He looked down at Olivia.  She was simply facing straight ahead, eyes closed behind the safety glasses on her face.  He said "Olivia, you are doing wonderful.  We are almost done."  He looked at Alex and said "why don't you go ahead and remove the suction hose, retractor and blocks, and sit her back up.  Let's all take a little break."

Once done, Olivia was seated back upright.  Everyone looked on as she felt around her new mouth with her tongue.  With her new lip bumper, her lower lip was plumped out.  It looked like she had something between her gums and lips, which she did.  And which she would until Dr. Brad removed the appliance.  After a minute, Dr. Brad asked "so Olivia, we are all done except for installing your bands and checking the fit of your new acrylic plate.  Is anything poking or digging in?"

She said "thish tongue rake ish.. ahh...  itsh sho.. shit... sharp.  How can I... fuck... talk?  Live? With thish?"  She stuck her tongue out and tried to look down at it.  Everyone could see there were a couple of pinpricks of blood on the tip of her tongue.  Alex instintively held up a mirror for her as Dr. Brad said "see Olivia, you are still tongue thrusting.  But that tongue rake will make your tongue behave in no time.  No pain, no gain.  Right?  But while you get used to it I do have an appliance to cover it."  He picked up the acrylic appliance and showed it to her.  He continued "I was going to install your bands next, but let's see how this feels.  Open wide."

Alex moved out of the way as Olivia obeyed.  With her mouth wide, Dr. Brad inserted the plate and said "gently bite down."  As she closed her mouth, he examined it closely.  He said "a perfect fit.  How does it feel now?"

Olivia said "ah fees behah.  Buh ah cah tahk.  Ha ahm ah sposh to live?  Nah un unnshtan meh."

Dr. Andi jumped in and said "Olivia, it will get better.  I promise.  I have a rake and an acrylic plate too.  Thish weekend, practish speaking without the plate.  Be very conscioush to keep your tongue away from the rake.  It will let you know when you don't.  That is why we have them.  Practicsh, practish, practish.  The last thing you want to do right now is speak.  But the main thing you need to do right now is speak.  At night when you sleep, wear the appliance.  Or if you just find yourself pushing against it during the day.  You WILL figure it out.  Use salt water rinses regularly.  And use the plate as needed to give your tongue a break."

Dr. Brad said "or I could just bond the acrylic appliance in place for a few weeks."

Dr. Andi looked at him and said adamantly "no, she will figure it out."

Dr. Andi was still looking at him when he said "no Olivia, she is correct.  You will adjust.  So, let's get your bands installed."

It took nearly another hour to get bands seated and cemented on all of Olivia's teeth.  Once Alex was done she leaned up and said "whoa, I don't know if they invented brackets to make it more comfortable for patients or to save assistants lives." 

Dr. Brad laughed and said "Alex, you did amazing.  Now Olivia, we will not put on an upper archwire yet.  Not until we are done with expansion.  You may notice that your upper four bands do have tongue tamer's on them.  But you might not.  We just don't want your tongue to push above the rake somehow.  But regardless, we are done except for showing you how to turn your expander.  It will be no different than before really.  You just have two screw mechanisms now."  He noticed Dr. Andi looking at him.  He could feel the judgement in her eyes.   He said "you know what, we have done a lot today.  I don't want you to start turning them yet.  How about we give you a week to get used to everything?  Keep wearing your CTO as you have been.  We will be checking on you this week.  But go ahead and plan on coming in this upcoming Saturday for a quick check of everything."  He glanced at the wall and saw it was a few minutes after noon.  He said "I promise your next appointment will only take a few minutes, not a few hours.  And with that, we are done Olivia."

After seeing Olivia out the front door, they watched her walk towards her vehicle on still shaky legs.  Dr. Andi said "that is a lot for a patient, you know that don't you?"

Dr. Brad said "no doubt it is.  But Olivia has always told me that she believes in the most effective treatment protocols for patients.  She doesn't believe in cutting corners.  Surely she wouldn't want it in her own orthodontic treatment.  So who am I to disappoint her?"

Dr. Brad turned to see Andi looked at him intently.  He said "Olivia is not our normal patient."  He gave her a grin and said "speaking of extraordinary patients, since we are all here, why don't I take a look at you Andi?" 

After he had raised her up to a sitting position, Dr. Brad smiled at Dr. Andi and said "clean as a whistle.  And the patient appears to be 100% compliant.  But that would be expected.  You have earned a treat from the treat box."  Dr. Brad gave out a little laugh.

Dr. Andi eyed Dr. Brad cooly.  She said "I have earned a treat.  But not from the treat box.  Smile wide for me Brad."  He just looked at her, unsure of what was going on.  She repeated "Brad, please smile for me." 

He asked "what is this about?"

Dr. Bender said "please just oblige me and smile."

He gave her a smile.

She said "I thought I had noticed it before.  Your 22 to 26 are beginning to shift and crowd.  Swap places with me Brad.  I don't know when you were last examined by another orthodontist, but you are about to be.  And I can already see you need treatment."