Finally have a Diastema
Long post warning. I now officially have a diastema, I got it yesterday at my orthodontist appointment. I have been turning my MSE since October 20 and, as of yesterday, November 25, had not seen a diastema. I had heard my suture crack, it felt like I had some expansion back by my molars, and the occlusal X-ray showed a small split in the suture, but I had no diastema.
Yesterday, when Dr. Picard saw that there was still no diastema, she decided to do the bicortical punctures. I have read online a few different protocols for them, I know some orthos do them at the start for guys over 20 years old while others wait to see if expansion can happen without them. Back when I started the treatment I had asked about doing bicortical punctures or some other form of surgical assist at the start, but Dr. Picard wanted to try without them at first.
So I went into the semi-surgery room and got numbed up. Dr. Ting has a video where he does the punctures on an adult male, so I thought I knew what was coming. Dr. Ting did about 10 punctures along the suture. Dr. Ting said he prefers to not use a TAD for the punctures because of the risk of dropping them in the patient’s mouth and them swallowing it. They look small enough to come out the other end easily, but that still wouldn’t be good.
Turns out Dr. Picard had a bit of a different plan, I guess which method you use would depend on how far into the treatment the patient is, plus whatever previous experience the ortho has. She only did three or four holes total, one or two in the palate and two above the front teeth. She started at the back, and screwed a 2mm TAD into my suture somewhere behind the expander. I assume that the screw was just a bit wider than the suture split, so at it was forced in the two sides of the maxilla were pushed apart. I could feel the tension throughout the midface, it was weird. To make sure I didn’t move during the drilling Dr. Picard basically had me in a headlock, it was like Grade 9 gym class all over again. It can sound odd, but it’s way better than me moving at the wrong time. When she was going into the suture at the back she described it as “mushy” which means there is some separation going on.
The front two punctures, above the upper incisors, were way more interesting. The suture was still pretty tight there, which means there was more separation in the back than the front. A lot of other types of expansion only do expansion the front, its’ the V-shaped expansion that MSE avoids. Ron Ead calls it the Pac-man split. So the fact that I got expansion at the back before the front is cool. I don’t know what does that, but it is possible. Somewhere on Youtube (I looked but can’t find it) is a guy who had MARPE and got more expansion in the back than in the front, so it is possible. I had actually thought of that video when I wasn’t seeing a diastema, so I think it’s cool I sort of accurately diagnosed myself.
I don’t remember the exact order of what happened during the frontal punctures, but here’s the gist. Dr. Picard drilled in a 1.6mm TAD in two spots to start the separation. She mentioned that as she drilled the second hole she could she a bit of a bubble coming out of the first, so I wonder what was going on behind my gums. After those two holes were drilled she took a 2mm TAD and began screwing it in. I really felt the pressure. As she was going in, I heard a very audible cracking sound and felt a release of pressure in the front of my mouth. She kept turning and then removed the TAD. I suddenly had a diastema. So there was enough pressure in my face that when the suture fully released a noticeable diastema formed almost immediately. It wasn’t a sharp, immediate crack, it was maybe for like the sound of ripping half-split wood in half sped up a bit, to about .25 seconds.
I was fully numbed up for the punctures, but I had a long drive home and the numbing wore off before I got home. I definitely felt a lot of pain above and behind my upper incisors, in addition to the pain of the drill holes in my gums. So it was like I could pain-feel that my suture is now open.
This morning the pain was more or less gone fully. I turned the expander and it was slightly easier, but still hard on the second half of the turn. I am still on two turns a day. I think I need to start an excel spreadsheet tracker to remember how many turns I have had before I forget.
I wish I could have gotten a video of my anterior suture splitting, apparently the movement of the teeth apart was quite visible. It would also be cool to have that cracking sound recorded. Obviously I can’t go back and get it. I understand that there are obvious issues with letting cameras into a surgery room, but it would be cool to have video of the crack. When I rewatched Dr. Ting’s video of the bicortical punctures I realized that the patient was another orthodontist, maybe that makes the consent/ethics/legal side of videoing easier.
Occlusal X-ray: we see a split in the suture, it just wasn’t evident in my front teeth.
Mouthal selfie: taken after my ortho visit. There is now a small diastema. You can see the drill hole up at the top.
