Quitting Controlled-Arch Braces [AGGA 2.5-year update]

Hi friends! Today I bring you the news that after 1.5 years in controlled-arch braces (CAB), and over 2.5 years since beginning my AGGA journey, I have decided to quit CAB.

It’s not quite as dramatic as it sounds – I do have to finish up treatment somehow, after all – but this decision did come about in concert with a decline in confidence with the CAB process in general, so I want to share my rationale and current thoughts.

If you’d rather watch/listen to my updates, you can check out the two videos at the bottom of the post. (As a reminder, I do try to post updates to YouTube regularly, and I’m usually a bit delayed posting them to the blog, so subscribe on YouTube if you want to see updates right away.) I also linked all my AGGA update posts/videos to date at the bottom of this post.

Here’s a quick recap of my AGGA experience up to this point for those of you who may not want to read back through almost 3 years of update posts:

I started AGGA May 22, 2019, and finished (and moved onto CAB) on June 9, 2020
My first AGGA broke around November 2019, so I was in a retainer for a month while they made me a new one, which means I averaged just under 1mm of expansion per month
Final measurements were 10mm gaps on both sides
We finished pulling the premolars forward (the first step in CAB) in August 2021, so that process took just over a year
My gaps after that process were about 7mm on both sides, so I lost about 3mm of space somewhere along the line. One of the things that made me lose confidence in my dentist a bit was that he just kind of stepped over that observation, and they wouldn’t have even measured my gaps if I hadn’t asked. So I wonder whether there’s a bit of tactical ignorance/denial as far as relapse/expansion loss during the CAB phase.
Finally, as I shared in my last post, a CBCT scan showed that I did not have enough room for implants below the surface of the gaps, since the roots of the teeth on either side were in the way. This was a huge shock and disappointment, since I had been banking on doing implants, but my dentist was very confident in his recommendation to simply complete treatment by pulling the molars forward. I decided to trust him, and we started the process of pulling the molars forward.

The below two videos pick up from there. To summarize what I talk about:

Almost immediately, my upper front teeth felt like they were being pulled back. My front teeth started hitting end-to-end* when I would bite or talk. I felt like I was losing all my hard-won AGGA progress.
I also had some concerns about my midline and felt like all my front teeth had been slowly shifting to the right, but my dentist did not seem concerned.
After posting the “Moving Molars” video sharing these concerns, a helpful commenter shared that he had quit CAB for similar reasons, and was now planning to finish treatment with an orthodontist using TADs (temporary anchorage devices – screws in the bone) to pull the molars forward rather than using the front teeth as anchors.
This prompted me to get a second opinion from an orthodontist, who immediately agreed that my front teeth would likely retract significantly if I continued using them to pull the molars forward.
When asked, he said he could use TADs to move my molars forward, but that his recommendation would be to do implants in the gaps like I was initially planning.
He seemed totally confident in his ability to move the roots out of the way and open the gaps a bit more if necessary, and agreed to take on my case.
We cut the power chains to my molars right there in the office the day of my consultation.
I shared my decision with my dentist, and he was totally cool about it. It remains to be seen whether he’s fair in refunding me for the part of the treatment we did not complete together.
I went back to my new orthodontist to have my old braces removed, and new ones put on. He uses Damon braces, which supposedly somehow have expansion/torqueing forces built into the wires. He explained that these forces would replace the ART (anterior root torqueing spring) that I had in before, which was supposed to tilt my front teeth outwards (giving me more space and improving aesthetics).
He put the brackets on my teeth at appropriate angles such that as they straighten out under the forces of the wire, the roots will pivot out of the way of the gaps.
Almost immediately, my teeth felt better in the new braces. Not only are the braces smoother and lower profile (so more comfortable), my front teeth stopped hitting end-to-end, and I felt like I regained some of the space I had lost. Obviously this change couldn’t have reflected any true expansion that quickly, but I’m taking it as a good sign that we’re now moving in the right direction, instead of the wrong one.

And that brings us to today! Overall, I feel very optimistic (and quite relieved) about this change of plan, and my orthodontist and I seem to be on exactly the same page. He’s adamant about not retracting me in any direction, and giving me as much expansion as he can manage, including some lateral expansion for a broader smile (with the aid of the Damon braces).

One thing that I found very interesting was that he actually sees a fair few AGGA patients come to him for consults, and he turns many of them away because he doesn’t feel comfortable with the state of their teeth (most notably, many from New York AGGA dentists). But he said that my dentist had done good work and he thinks I’m in good shape, so he was happy to take on my case and help me out.

The downsides? He estimates I’ll probably be in braces for another year (which will mean this whole process will have taken 3.5 years…), and I’ll be out significantly more money finishing up this way (with the additional treatment expenses, plus the cost of the implants) vs. if I’d stayed with my dentist (no additional cost).

But time and money have lost all meaning during this hellish vortex of ongoing orthodontic torture, so who cares?

(Kidding. But time and money do have a way of becoming less of a concern once you reach the level of sunk costs that I’ve now reached, so I’ve simply accepted these new hits and trust that one day, I will in fact be finished.)

*Of interest – I randomly stumbled upon this video on YouTube of another girl around my age who seems to also have experienced her front teeth beginning to hit end-to-end after starting to pull molars forward. As of this writing on 11 Jan 2022, it sounds like her remaining CAB treatment is on hold, so I’ll be interested to see how she progresses once she starts attempting to move molars forward again.