The day has finally arrived--it's time to remove my MARPE! In this video I take you along with me during my appointment to get the expander removed. There are some unpleasant surprises along the way...I share some learnings and advice on what to expect after having the expander removed! Full post below:
Removing the MARPE After the initial 1-2 week active expansion, the MARPE is left in for a longer period of time and acts as a retainer. In this time, the space between the now separated halves of the maxilla is filled in with new bone and solidifies. I had my MARPE in for six months before my orthodontists decided it was time to remove it. While the MARPE did not give me any discomfort or pain (in fact, I often forgot it was there!), I was still excited to get it removed and feel the roof of my mouth again. The first step of removal was to unscrew the four mini-implants that were anchoring the MARPE into my maxilla. I was given the numbing shots again so I wouldn't feel the pain of the screws coming out. There was still a lot of pressure and some discomfort. After the screws were out, my orthodontist started prying off my molar bands. They were cemented in so it took a LOT of force to tease them off my teeth. Once they were loose, the whole MARPE was remove from my mouth! It felt SO free and SPACIOUS! Especially because I have such a narrow maxilla AND a 'high'/'v-shaped' palatal vault, my tongue had never been able to comfortably fit into the roof of my mouth. Now, it had so much room! --Trigger warning for anyone prone to claustrophobia & panic attacks--- Installing the TPA I had barely started exploring my newfound freedom when my orthodontist immediately started fitting something new into my mouth - she said it was a trans-palatal wire. I hadn't looked this up at all but assumed since it was just now being introduced to me, that it wasn't that big a deal. When it was fully installed, I naturally relaxed my tongue, expecting it to rest against the roof. About halfway up, my tongue bit a thick metal bar. I noticed that this wire was actually traversing horizontally from molar to molar, completely blocking off access to the upper half of my mouth. Immediately, my body felt ice cold as my claustrophobia set in and I felt a trapping sensation all around me. I know this sounds like an overdramatic reaction, but it was really a huge surprise to me. This bar was preventing me from swallowing properly and my throat was filling up with saliva since I was leaned back in the patient's chair. I've had panic attacks before but this one was quite intense and I burst into tears and started blubbering. My orthodontist, the faculty supervisor and other student orthodontists around me started gathering over and just gawked at me as I fell into this panic. I was trying to tell them--I can't talk, I can't swallow, I can't do anything and I feel trapped. What is this thing in my mouth?! Here's a couple things that I think would have made this less traumatic. Even writing this post over a year later, I can still feel the same sensation of panic--that's saying something. 1) They should have told me before the appointment what exactly a TPA is, feels like, and when it would be installed. 2) Heads up on changes I could expect following the installation 3) How long they typically leave this in Once I had calmed down, the faculty doctor stayed to answer some of the questions I had. My first one was -- how long are you leaving this in? He said ideally for the rest of the treatment, or at a minimum 6-8months. My anxiety climbed. I asked, how long does it take for people to adjust to this and feel normal? He said about two weeks. I asked, are there ANY other options we can consider since I'm having such an intense reaction to it. They said not really. I asked, what happens if we just take it out? He said, there's a risk that we lose some of the width achieved with the MARPE. I told them -- I've been incredibly strong so far and didn't even flinch when they drove 12mm screws into my skull. I said I would give it two weeks to adjust but if it didn't work out we needed to have a plan B. I left in a shock that day. I wasn't able to swallow, chew, talk, or breathe normally because of this device that was inhibiting a basic human reflex (tongue to roof). I felt miserable but decided to do my own research (yet again) to find something that worked for me. I found a couple options with very little effort. 1) Get a custom TPA built using a longer wire that could contour to the shape of my palate 2) Get a removable TPA built that I could wear at night and take out during the day I scheduled a follow up appointment for a week later. During this week, I basically stopped talking because my tongue was so bruised and swollen from hitting the wire constantly. I actually had painful sores. I also lost about 10 pounds in two weeks just because I could barely eat or drink. At my follow up appointment I talked to my orthodontist about the two options. She said the removable TPA would not work as having it out for so long each day created a risk of losing width. She said we could go the custom TPA route but it would take a week to prepare, which I was more than fine with. So they took out the TPA and took a mold of my palate to send to the lab. Installing the custom TPA I returned the following week to have the custom TPA installed. After a few minutes of work, my orthodontist asked how it felt. I asked, how what felt? The new custom-contoured TPA fit my palate SO well that I actually could not feel it at all. I wanted to make sure that the functionality of this TPA was the same and they confirmed it was. I was so incredibly happy and relieved by this. At the same time, I was pretty angry. If this TPA was just as effective but so much more ergonomic and comfortable, why wouldn't they use this in the first place? Was it because of the tiny bit of extra work involved? The biggest takeaway here is that you should NEVER stop being proactive about your treatment. Any time something feels wrong or off, it's your responsibility to speak up. You are not a trained professional and can't tell them if something is the right approach or not, but you can tell them if it doesn't work for you. Ask all the questions you want to. It's your body, and your right to know what's going on.
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After exactly one week of turning my MARPE, I finally saw a diastema (gap) form between my two front teeth!!! This means that the expander was incredibly successful and separated the maxillary bone! Woooohoooo!!
The week leading up to this was pretty eventful; here's a breakdown of my expansion....
***Posts are a bit backlogged, working on catching up! :) ***
It's been a few days since I had the MARPE installed and started the expansion process. I've been instructed to do three consecutive full turns (3/4mm in total) per day, at the same time each day for consistency. I'm expanding for two weeks until my follow up appointment, by which ideally, I'll see a gap called a "diastema" form between my front incisors. It's quite a strange sensation that personally, I didn't get used to....
The big day finally arrived! Yesterday I went to get my MARPE installed. I've been looking forward to this day for nearly five months since I first discovered this device. I was a little nervous but mostly excited to finally start this exciting process and (hopefully) see some dramatic changes.......
I returned from traveling to amazing news- my orthodontist said I am eligible for MARPE to widen my maxilla and correct my posterior crossbite! :) Some things the team considered were my bone density (to see if the suture would cooperate and unlock) and if there was enough space in my palate to fit an expander. My entire orthodontic treatment is estimated to span 2.5-3 years. First up, active palatal expansion using MARPE! Once it achieves the desired width (should take 1 or 2 weeks), it will be left in as a retainer for a few months while the bone heals, and they will install the braces to start aligning my wonky teeth. Further down the line, a combination of TADs and elastics will be used to close the open bite. Of course there will be adjustments along the way, it's very much an observe-and-react process.....
After what felt like the millionth orthodontist telling me surgery was the only option to fix both my problems, I was feeling pretty disappointed. Then it occurred to me that not all orthodontists practice with the latest technologies, instead using only their tried-and-true treatments. It was up to me to catch up on the last 10 years of orthodontic developments and find practitioners who actually used them. Again, I want to stress the importance of using credible sources like studies, papers, and simulations published by universities or orthodontists to find the most accurate information, and consulting with practicing professionals on treatment plans. So began my meticulous, exhausting research....
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