Showed up early to Dr. Graham's office and chilled out in the waiting room for about 20 minutes. No problem as I'm still on vacation. Only thing on my plate was that I was meeting my sister for a shabu shabu dinner. While I'm waiting there, I see a cute, blonde dental assistant working in the operatory. I couldn't tell if she was staring at me or not. I don't know...I've never really felt used to being stared at by girls. Eventually, I go in and get taken into Dr. Graham's office which is on the opposite side of the wall in the waiting room where I was sitting.
A different assistant showed me into the room and laid out the booklets that I later took with me and also laid out the photos that I had taken on Monday. I also got to see the x-rays I had taken which were turned into glossy photos. I was invited by his assistant to read through the booklets while waiting for Dr. Graham, so I did.
This illustration was made from my cephalometric radiograph and gives the measurements that I have for my underbite. I have included it here so you can see just how severe my underbite is. The two molars shown are actually the front molars and the distance between the top and bottom first molars is about 3 millimeters, from what I'm guessing. Most severe underbites cephalometric radiographs that I've seen have the 2 first molars meeting each other midway. From what Dr. Graham says, when the oral maxillofacial surgeon sees this underbite, he's going to go apeshit. Okay, not his exact words, but you can see where this is going. The good thing is that the top teeth are close to being in the position that they're going to need to be, but they're going to have to tweek the bottom teeth - more on that in a few paragraphs.
Within a few minutes, Dr. Graham came in and we started discussing the treatment plan. As it turns out, tooth #6 is not actually located in the facial area of my gingiva (gums) as I'd thought. It turns out that it's located in the palate (roof) of my mouth. This does present a problem - he can save the tooth, but it will add an additional 2 years to my treatment to bring it forward and hook onto it with braces. It would also have to be glued to tooth #5 to make sure that it stayed there. Doing this would also cause a problem with trying to correct my midline which, as you'll see from the panorex radiograph below, is deviated a few millimeters to my right. If I want my midline corrected, I would have to have 4 teeth removed. Originally, I thought that I would have to have my canine teeth removed, but from what Dr. Graham is proposing, I would have 3 of my bicuspids removed - 1 from either quadrant of the mandibular teeth and 1 from the left quadrant of my maxillary teeth. Tooth #11 will be kept and either tooth #4 or #5 will be kept to use as its esthetic replacement.
The only other question that comes in at this point is just which surgeon in the area accepts the Blue Shield of California HMO plan. This is my main concern. Dr. Graham didn't know if the surgeon that he usually refers people to, Dr. Lee, accepts Blue Shield's HMO plan, and it looks like he doesn't. I was recommended to contact Blue Shield and also check with my general dentist to see if they had a list of any OMS's in the area that takes my insurance.
Show up at my regular dentist's office to see if they had any doctors that participated as contractors for my insurance and get told that I would have to go through my primary care provider, Dr. Rita Archer, to get a referral to an oral surgeon that's in my provider group. I tried to get in for an appointment for tomorrow, but Dr. Archer doesn't work on Fridays, it seems. So, I did what I could do and I'll be able to get in on Tuesday to talk with her about this and see if I can get prior approval. After that, I can then get the consult to the oral surgeon and discuss the treatment plan, including removing the teeth.
The good thing about all of this is that if I have the 4 teeth removed, it will lighten up the load of work that will have to be done prior to having my surgery. After removing the teeth, I'll be back in for impressions so they can get everything prepared to have the braces put on.
There is still an additional problem: my upper teeth come into place behind my lower teeth as you'll see from this x-ray. Not only does this result in an open bite up front, it also causes a problem with placing of the brackets for the braces. Most likely, I'll have to have the braces put on the lower arch prior to getting the upper arch put on to change the position of the teeth in the lower arch to make sure I'm not making my braces on the top loose when I bite down.
The good news for today is that from that point, Dr. Graham said that he estimates that I'll be ready for surgery by the end of the year! That works for me - let's get it moving! =)
P.S. Okay, if anyone is reading this in America and is looking to get this covered through their medical insurance/HMO - and medical insurance WILL cover this surgery if it is a medical necessity - check with your Primary Medical Care Provider FIRST! This will save you all kinds of time and running around from one dentist to another only to find out that you're not going to be covered.
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