Bad News-Gum Graft and Dehiscence
I have been more or less silent for a while about how things are going with my expansion. That is in part because I have been waiting, covid has bunged up the hospital system and it takes months to get a date set up for surgery. There has also been some uncertainly about what course of treatment I will use to finish the expansion, and I don’t want to write too much about things that are up in the air. But now I have some firm news.
Yesterday I saw my periodontist, and I now need gum grafts on my upper left molar. The Hyrax expander pushed it out of the alveolar bone to the point where it has dehiscence, which is a fancy term for being partially out of the bone. Google “dehiscence” and you’ll see plenty of images. This means a few things. First, the tooth cannot take any more outward pressure. Any expansion will have to be done without using that tooth as an anchor for tooth-borne expansion. In other words, no more Hyrax. It also means that I need a gum graft, which requires six months of healing before any treatment resumes. My gum graft is scheduled for November 17, although I am on a waitlist. So I will have no surgery before May 2022 while my mouth heals. And now I am googling the long-term consequences of dehiscence for tooth and gum health. Yay.
More and more I feel like good periodontists are the unsung heroes of these online adult expansion forums. A few weeks ago I got a call from my oral surgeon’s office to set up a SARPE surgery for late October. I was uncomfortable doing anything before making sure my rogue tooth was fine. I have been wearing a retainer since my Hyrax was taken out in March, and the retainer was trimmed to allow for regression of the first molar to bring it back it.
Over almost six months it has barely come in, and I have had regular pain above that tooth, plus occasional pain above the other upper left molars and premolars. In particular I have pain at the apex of where the gum meets the tooth. So I contacted my periodontist, who said she would get my records and see if I was fine. A few days later she contacted me and said she had looked at my X-Rays she got from my dentist. She said everything looked fine and I was in shape to resume orthodontic treatment.
I didn’t believe that. I trust her, but something felt off. Then I realized that she had gotten X-rays from my dentist, which were taken before the Hyrax. I contacted her about that, so she got my CBCT from my ortho that was taken after my Hyrax expansion. She quickly set up an appointment to see me. I had panoramic X-rays taken yesterday, and when she saw those and saw my poor tooth she was very clear that I was not ready for surgery or more expansion because of the dehiscence. The take away lesson is BE YOUR OWN LAWYER. Argue your own case. Trust your gut.
If you look at the last tooth visible (my cheek covers the last two) you will see the recession from the dehiscence. The gum line is much higher than the other teeth, and the slightly yellow root is exposed. All the yellow-ish portion should be covered with gum, but it has receded by 3 or 4mm. I think I may contact my periodontist’s office for the panoramic X-rays, I want to see what they look like.
So now I have to postpone my surgery and get a gum graft. Woo. Hoo. I do not in any way regret doing MSE, but I wish I had not agreed to the Hyrax.
