How did your recent adjustment go?

Well, the appointment yesterday was very interesting!

It started very normal. The ortho asked me if my bite had improved since the last adjustment and if more teeth are touching now. I responded that nothing really changed and I still only have contact between my left canines and my left 7s. She reacted surprised and took quite a deep look at my upper teeth and bite. After also studying the notes in my file, she asked, what I think about completely leaving out the upper plate for now and only wearing the lower one, coming back for another appointment one week later. Now it was my turn to be surprised. She explained that she moved my incisors and canines outwards so much that they are starting to flare, yet my bite still isn't improving at all. She wants to let the upper teeth settle for a while to see if that helps.
After taking another look at the upper teeth, she shook her head and adjusted the springs for my 22 and 23 on the upper brace, saying that we can first try pushing out the teeth a little more.

Next was her examining my lower teeth. She noticed that the step from my left first premolar to the canine had become quite large. She explained to me, that the posterior bite-plane together with me clenching quite strongly and wearing the plates religiously way more than most of her patients, could maybe have resulted in my molars intruding. Which interestingly is exactly what I suspected in my last post. I wanted to ask her about this later during the appointment, but she came to the same conclusion beforehand. She fetched my impression model from before I started treatment for comparison. It confirmed not only that my molars intruded, but also that in addition my left lower canine extruded as it was not covered by the bite plane's acrylic. She said that she had never seen such a thing as all of what is happening with my teeth in her career.
She explained that she wants to extend the occlusal coverage to go over all lower teeth including the incisors to prevent any in- or extrusion. However, that will only be possible once my lower teeth are completely finished with the treatment as the acrylic is going to enclose all those teeth, locking them in place.

She went back to my models, the braces and her notes and thought for several minutes. When she came back, she suggested the complete opposite of her first plan: She asked me to only wear the upper plate and completely leave out the lower brace. As the lower left canine is the only tooth touching the upper plate's acrylic, that might result in the tooth intruding again and giving my molars space to come back up. Testing out how my canine interacts with the upper plate without the lower one, we realized that the canine slips to the side. The acrylic where my canine hits is also relatively thin, such that the ortho has concerns about it breaking off.

This was when the ortho decided upon a complete redesign of the plates. My braces will go back to the lab technician. The posterior coverage will be completely removed from my lower plate. The upper plate will gain an anterior bite plate to intrude that canine and give my molars space to erupt again.I took the chance to try and push my luck further. I again asked if it was possible to make the acrylic cover my full palate. This time I also showed her what I mean directly on the braces. I also explained the reason more, that I'd like to try to distribute the pressure of the acrylic more, as the plates had always left marks in the gum of my palate. I don't think that we talked cross points as we did last time, as she asked "The whole palate?", which I confirmed.

After writing down everything, she wanted to perform yet another slight IPR on my bottom incisors. They are getting better, but still have a bit too little space. So we went to the other area with three chairs next to each other, where she stripped away a bit more between all incisors up to the canines. I still can't get used to that feeling and still hate it as much as during the first time.
Then came another set of impressions. Every single time so far, the upper jaw required at least two impressions as my wisdom teeth wouldn't fit properly even on their largest (XL) impression spoon. This time, after three failed attempts by the assistant, the ortho used a bit of wax to increase the length of the spoon. Only then, with the fourth attempt, the impression was finally usable. The ortho checked that the impression of my palate was good as well, a further indication that maybe this time I might finally get full palatal coverage.
After getting fluoride applied for the IPR and making an appointment for Thursday, I was finally done with the appointment. The whole appointment took well over an hour. When I left, there ware at least 5 children with their parents in the waiting room.

All in all quite a rollercoaster of an appointment. I'm super excited for tomorrow and really hoping to finally get full acrylic palatal coverage. I also expect that I'll struggle with lisping for several weeks again.

Wow that upper brace is now enormous with a very thick bite plate!  It is amazing that you can speak at all. I would say that the acrylic goes about twice as far back as that of my recent hawley ( I have no first premolars ) and it is at least double the thickness. And I thought my hawley was fairly bulky. Does the bite plate show beneath your incisors? Is there a danger of this bite plate allowing your molars to erupt further, leaving you with an anterior open bite? Presumably your ortho will be keeping an eye on this.

Fixed braces are very much the normal approach in Europe these days, but quite complex orthodontic work was done with removable braces maybe 40+ years ago so it is interesting to see your ortho having a go at it. If I were in your shoes, I would ask the ortho to finish off with fixed braces anything the removable ones can't  achieve so your teeth are as good as they possibly can be after all this effort. But kudos to you both for using removables.

Those look great!

PPS Why do you have an adams clasp at one side of your upper brace but arrowhead clasps at the other side?

How did your adjustment appointment go?

Remember when I wrote that I find it harder to wear the braces for 12 hours each day than full-time? That will become way easier now.

At my appointment today when I entered the room, the ortho immediately asked if I am able to bite properly again and if all my teeth are touching again. After I answered in the negative, she asked if the bite plate is still opening my bite while I wear it, which I confirmed, stating that it closes during the day again while not wearing the braces. She had a quick glance in my mouth with and without the braces, then with just the top brace in followed by just with the lower plate in. She concluded that the situation with my teeth is geeting too precarious (is this the best translation for the German word "heikel" in this context?). I should stop wearing my braces completely for the next three weeks at which point she wants to see me again. She checked if wearing only either the upper or the lower plate might make sense but decided against it. As I do notice my bite getting better while not wearking the plates, she hopes that my teeth will settle by themselves in that time.
And with that I was on my way again. All in all the whole appointment didn't even take 10 minutes (compared to 20-30 min usually). Definitely my fastest appointment yet.

Welp, I've got fixed braces since Tuesday. Ish.

During my last and this appointment, the ortho studied my models and bite. In the appointment on Tuesday she explained to me that my bite on the right side looks good and has good contact. The left side however is blocked by my second molar. When I had the thick posterior bite plane, my strong clenching resulted in that tooth tilting forward while intruding. Now the forward part is stuck below the cusps of my first molar. This results in the back of the second molar to be raised, blocking my bite. The ortho explained that reversing this is the type of movement that can't be done with removable braces. While I didn't want anything fixed, this can only be fixed with brackets. She needs three brackets, one on the wisdom tooth and one on each molar in my bottom left jaw to upright the second molar. As a consolidation she said that it shouldn't take too long, maybe three or four weeks. Knowing my luck, it'll probably be at least double that.

She continued that my bottom incisors are looking good. With the performed IPR they moved back and straightened just as she wanted. She recommended placing a fixed retainer to finish and stabilize them as soon as possible. However, I'm not fully satisfied with those teeth yet as they started to shift within the last four weeks of not wearing the braces. My left central incisor moved forwards while the right one is rotating inwards. She looked at the models again and confirmed that she can see the rotation and understand that I want that fixed first. It could be corrected with fixed braces in 1-2 weeks and we'd be done with it. But I'm not too keen on that. Three small little brackets (boy was I in for a surprise) on the last three teeth are somewhat acceptable to me as they are required at this point and at least won't be too visible. But if possible I'd still like to avoid brackets on my front teeth. While I think she wasn't happy with that response, she said that my lower removable brace could be used after my molars and bite are fixed. Depending on how well I get along with the brackets, she may or may not keep them on some more time for stabilization. In that case the lower removable brace can be modified to work with the brackets still in place.

Either way, she wants to only tackle one movement at a time now. First the lower molar must be fixed. Only then we're going to correct the lower incisors. Once the permanent retainer is in and my lower jaw finished, we'll get back to the top jaw. Upon the end of the treatment, she suggested a top retainer with full posterior and anterior acrylic coverage as bruxism night guard. That way I likely won't need a permanent retainer for my top jaw. (I was slightly surprised by that statement as she previously vehemently insisted on permanent retainers for both jaws, always citing that removable retainers may not be worn regularly enough. I guess she can see that weartime won't be a problem with me )

After she told me all this, I was somewhat overwhelmed. It wasn't that I didn't expect something like this already. On the contrary. During the week before the appointment I thought about possible treatment continuations myself. The posterior bite plate didn't work as it intruded my molars. The anterior one intruded my incisors too much. Thus, no bite plate it is, accepting some tooth wear until I'm finished with treatment. If my bite problems were due to movements possible with removable plates, they'd self correct or at least get better while not wearing my braces. However, the left side didn't change during the last two weeks. Therefore, the only logical conclusion is that movement is needed which requires fixed brackets. Still, I didn't want that to be the truth and tried to suppress those thoughts. Now with this actually being the reality I was startled.
As I didn't really respond, the ortho asked if she should repeat the treatment steps again. I answered no and summarized: First three molar brackets, then a removable lower plate for the incisors, afterwards a permanent retainer, and finally the upper jaw. She asked if I agree to the proposed treatment or if I want to sleep over it. I concurred that I ultimately kind of expected something like what she explained already. She asked when I'd have time to get the brackets bonded. She usually would have lunch break soon. However, knowing that I need an hour to the practice, she offered to do it right then and there anyway if I have time. I thought about sleeping over it, but decided there was too much of a risk of be chickening out of brackets. So right then and there it was.

I was led to the open treatment area chairs and asked to sit down. While the ortho prepared the brackets, the assistant cleaned, etched and dried the three to-be-bracketed molars. Once done, the ortho placed the brackets one by one, moved them around on each tooth a little and removed excess glue before the assistant cured them. I don't think she got all excess glue away, as I can feel some rough residue in some places. Next, she got a wire and cut off a piece. She said that she won't start me on a rectangular wire. A thin round wire should be plenty of force for the required movement. She started to thread it through my brackets, which surprised me. I'd expect her to lay it into the brackets and fasten it with ligatures, not thread it through them. I also realized that she never asked me about any ligature colour. While I had all of these thoughts floating around, the ortho was close to being done with the archwire, bent its edges in the front and back and clipped off a bit more in the back. During all of that I was incredibly tense and my heart beat very strongly and fast.
Not even ten minutes after sitting down everything was finished. My mouth was as drier than I thought it could get. My tongue, lips and cheeks were incredibly sticky until I wet them again. The chair was raised and I was handed a mirror to look at what had just been done to my teeth. What I saw was way more metal than I expected. It wasn't three small little brackets. It was more like three times a quarter of a molar band with a long tube instead of a small bracket glued to it, which were glued to my teeth. In fact there is less white visible than grey. Three large buccal tubes with hooks instead of three small brackets.
The ortho asked me how it feels apart from something I never wanted to feel. I was frozen from the realization of the large buccal tubes and couldn't formulate anything. She continued and explained that the brackets will feel very rough in the beginning, but the cheeks will eventually get used to it. As I had quite some problems with my cheeks with the removable braces, she gave me two boxes of wax and suggested to use it preemptively to prevent sores in the beginning. She further said that I can pull forward the archwire a bit if it moves back too far. And with that, it was done. I now had fixed brackets.

Parting, the ortho said that she wants to see me again in three weeks at the very latest. If nothing happens, or too much happens, or something weird happens, I should call her immediately for her to decide if I should make an emergency appointment.
The assistant gave me a date and time for my next scheduled appointment and I left.

Once home, I immediately went into the bathroom to look at my mouth in the mirror. The brackets were still just as large as when I left the ortho. Who would have guessed. The bracket on my first molar is straight on the tooth. The one on my second molar is low in the front and goes up towards the back, making the wire apply pressure the opposite way. The bracket on the wisdom tooth is moved towards the front to finish the derotation started with the lower removable brace. The way the brackets are placed and the way the wire is weaving through the tubes makes the teeth look way more out of place than they actually are.
Luckily I realized that even with the large size of the braces, they aren't visible when talking or smiling. Only when I smile wide or laugh, a trained eye can make out a little bit of grey. Also my webcam is low-res enough that even when I pull away my cheek and try to actively expose the brackets nothing can be seen in the pixely mess in meetings. So in that regard, I'm good.

In the beginning my cheeks took everything without any problem. I didn't use any wax during the rest of the day and also decided against using it in the night as I didn't feel anything. What an error that was. While my cheeks didn't hurt during the night itself, they immediately started to hurt in the morning. I've been wearing wax pretty much full-time until yesterday. It's nearly as if the ortho has experience with all that stuff recommending me to use wax immediately...
Honestly using wax doesn't feel much different to a removable brace. Instead of taking out the braces before eating, I need to remove the wax. After eating, I brush my teeth before applying wax instead of putting in the removable plates. Except when everything hurts, I can't just take the brackets out.

Eating didn't really change, except that the brackets are food magnets. As my right teeth are fitting better than the left ones currently, I've primarily been chewing on that side anyway. But even doing that, so much food gets stuck below the brackets and under the wire between the brackets. I'm not even chewing there. How does food even end up there?! Only having three brackets, it's quite easy to clean them though. After eating, I can get out most of the stuck food with my tongue and the rest with a rinse of water.
Brushing is similarly more complicated, but only a little. I can still brush over 90% of my mouth regularly. Only those three teeth require a bit more attention with additional cleaning using an interdental brush.
I can only imagine how much harder all of that is with brackets on every single tooth.

The first night was bad. Not because of pain, but because of the omnipresence of the brackets. Although I expected that fixed brackets might be among the possible outcomes, and agreeing to them, I'm still not fully accepting them. Neither am I really enthusiastic about them, nor am I completely satisfied with the status quo. With that in mind at all times I slept extremely bad and couldn't fall into a deep sleep, always needing to think about what happened that day and what I've gotten myself into.

Regarding pain, apart from my cheeks there wasn't any movement-related pain. My teeth are very sensitive to acids in general (e.g. when I eat lots of fruit or sour gummy bears, my teeth often hurt for some days). With the etching, I had the exact same problem. Although the ortho did apply a layer of fluoride after curing the brackets, even now there is one spot left that's extremely sensitive when I brush my teeth.
While I didn't feel any movement-pain, I did feel some pressure the first few days. Putting some ice cream on the brackets felt like a relieve. It wasn't that I actively felt pressure. It was rather that with cooling the NiTi archwire something I didn't feel beforehand was gone. Like with noise outdoors which suddenly stops. Even if the lawnmower outside doesn't really register, it still feels good when it is finally turned off.

When I wanted to add the appointment to my calender on Thursday, I realized that the appointment wasn't in three weeks time but in four. This was weird as the ortho specifically said she wants to see me the very latest in three weeks. I called the practice, only to find out that they are on vacation in that week, so the appointment in four weeks is correct. I slept over it but it didn't feel right. Even though the practice is closed on Fridays, the ortho said previously that she always answers emails. Thusly, I wrote a mail to ask if I should come back in two weeks time or if the appointment in four weeks is good enough. The ortho answered, asking how much pressure I felt and how much my bite improved already. As she was expecting very quick results, the brackets should have made a significant difference already.
I tried to provide a detailed description, stating that my bite didn't change much. The vertical gap between my first premolars seems to have closed a little, the wisdom tooth is derotating quite nicely and now has contact with the upper one, but I don't see or notice any difference with my molars. The step from my second molar to the first one (where the second one slid below the first) is still higher than on the other side. She responded that in that case I should come in after two weeks time and bring along my removable braces. I'm glad this was her response, as currently I'm in favour of more appointments rather than less. After all it was the long time of seven weeks between two appointments which started all of this mess.

In conclusion, I'm still somewhat dissatisfied with the whole fixed bracket situation. I need them, I agreed to them, I have them, they are there, but that's it. They are exactly how I expected them to be, a bit achy, rough, cheek-penetrating, and one heck of a chore to clean. While I think I can get along with them, and maybe even accept them, I don't think I'll learn to enjoy them. Definitely not in the way that I enjoy removable braces, which I do start to miss the feeling of.
At least I am now able to also experience some of the joys and challenges of fixed brackets. And they will allow me to experience having fixed brackets and removable braces at the same time, which I am very intrigued and excited about.

On Tuesday two weeks ago I had my first adjustment with the three fixed brackets.

Up until that appointment, the brackets still hurt my cheek significantly. Especially the bracket on my wisdom tooth is digging into the cheek. I didn't have a single day where brushing didn't result in some amount blood. I tried using wax, not using wax, different ways of putting on the wax and in the end found a way that it didn't hurt too much and only was slightly unpleasant.
The wire also rotated a few times, especially in the days before the appointment. The ortho showed me how I should rotate it back during the previous appointment as she expected as much.

During the appointment this time, I wasn't invited into the more private room with a single chair. Instead, I was asked to take a seat in one of the three chairs in the open treatment area. This was something I previously feared but luckily was mostly in the private room. However, at this point I've somewhat come to terms that I'm just another patient no other patient cares about. Therefore, while I still like the privacy of the other room a bit more, I was ok with it.
The first action was that the ortho had me bite on a marking foil to check if my bite improved. She said that I still only have the single contact on my left side between my second molars when biting down. When chewing, there is a bit more contact, but only little so far. She asked if anything changed since I wrote the email. I said that not much changed since then, but I feel like the bracket moves the molar lingually a bit, making it have earlier contact with the upper molar.

The ortho clipped off the end of my wire and pulled it out. She asked if what I wrote about the pain I experienced was really true, that I feel more pain when the removable braces are adjusted compared to what I felt with the fixed brackets, a bit in disbelief about that statement. I confirmed that I felt some pressure, but no pain at all.
She decided to skip two wire sizes and tried to insert the wire three sizes up, but she couldn't get it through all tubes yet. Moving one wire down, she was able to fit the wire through all brackets.  The feeling of the wire being inserted and pushed through the tubes was definitely weirdly interesting. She asked me how much pressure I felt. I answered that currently I only feel a little numb pressure and that I'll only be able to tell in a few hours. For comparison she pulled out that wire again and inserted the wire one further size down, the next wire up the line compared to the one I had. She asked me how that felt. My response was that even if she held me at gunpoint I wouldn't be able to tell any difference.
She left in the lower-size wire in as I'll be back in two weeks time anyways so there's no need to possibly torment me with a bigger wire. As I had problems with my cheek, she shortened the wire in the back such that it would end inside the buccal tube on my wisdom tooth, not being able to poke my cheek. This definitely helped. At least I don't need wax anymore. There's still some dull pain every now and again, but scar tissue forming where my wisdom tooth bracket is, definitely helps reduce the constant pain and sensitivity.

The ortho put a bend into the wire between my two molars. She showed me how to derotate the wire if it rotated again like the first wire did.
While the first wire only rotated during the last few days before the next appointment, the bend this time resulted in the wire wanting to rotate at all times. When eating, the wire rotated. When brushing my teeth, the wire rotated. When just sitting around and talking, the wire rotated. I needed to derotate the wire at least five times each day...

Since the ortho is now only focusing on one problem at a time, I noticed some of my other teeth moving back. For example there is a visible gap forming behind my lower left canine. It wasn't there before I started treatment, but I assume it moves forward into the space IPR provided while my incisors are moving forward back to where they came from. This interferes with my upper left canine and lateral incisor, being one of my strongest contact points when biting together strongly. As this makes makes it harder to see improvements in my molar region, the ortho wants to use the removable upper brace to push out the upper two teeth for now.
She inserted the top plate into my mouth and asked where I felt pressure. While the plate fit somewhat, I felt pressure everywhere. The ortho ground away some plastic inside my molars and reduced the pressure exerted by clasps until I didn't feel any immediate pressure anymore. She significantly reduced the anterior bite plate thickness, saying that I need to bite somewhere. If she completely got rid of the bite plate, she worries that me biting on the metal wire of the clasps directly might damage them or my teeth. Additionally, she wants to prevent my lower left canine to extrude too much again. To not intrude my other incisors, she reduced the acrylic as much as possible while still keeping the bite open a little.
After activating the springs in the top, she said that I should wear the plate 12 - 13 hours daily, either throughout the day or also during the night, whatever I wanted. With that, the appointment was done and I was on my way.

I was glad to finally have plastic back in my mouth. I was also happy that I was asked to wear the braces at least half of the day and not only a few hours. I decided that I'll wear them during the evening and night.
Unfortunately, already after the first night when I took out the brace, I noticed that my bite changed for the worse again. It took nearly three hours until my bite was back to the current "normal". I noticed that all of my upper premolars and first molars were a bit sore.
Thus, I scheduled another appointment Thursday.

After I told the ortho about where I felt pressure, she ground away even more of the plastic inside of the premolars and molars. When she was sure that there was no contact between the plastic and those teeth anymore, I still felt a bit of pressure. She said that the only reason left are the wires. After modifying a few holding clasp wires, everything felt good.
She activated the incisor spring a bit more and said that I should wear the upper brace only for 4-6 hours and only during the day. Just as much as is needed to move the two upper front teeth out of the way.

Since then, I tested around a little with how my bite changes while wearing the upper brace. In general it's better than before, but my bite still changes when I wear the plate. After taking out the braces it still takes some time for my bite to go back. However, instantly after taking them out the bite is only a bit off, way less than before Thursday. Wearing the brace during the night (I did one test), it took about two hours for my bite to recover, but the canine doesn't interfere for the rest of the day. Wearing it from lunch until supper it takes about one hour for the bite to settle again, but already in the morning I can feel my canine touching the incisor again. Same thing happens when I wear it from dinner until I go to bed. I'm not sure, but it feels like the molars intrude a little while wearing the plate. I'll discuss during my next appointment tomorrow (well, taking a look at the clock actually today).
I think this, again, may be due to me sucking negative pressure (which I still do subconsciously during the night and when concentrating during the day). As my teeth shifted quite a bit since I last wore the plates, with the modifications the ortho did, the brace doesn't fit snugly against my palate. Instead, there is a millimeter or so of space between the plate and the roof of my mouth. With the negative pressure, I force the plate to be against my palate. The whole brace sits differently and the plastic and wire push differently.

The fixed brackets seem to do their job. The step from my second molar to the first one is gone, which should also mean that the second molar isn't stuck below the cusp of my first molar anymore. I can also chew a bit better on that side. Nevertheless, I don't feel like the tooth contact itself improved much.