All I want for Christmas…

Well, yesterday was my oral surgery to place my dental implant.

Since this is an extremely long entry, I’m not showing all of it on this main page. Click on the story’s heading (or on the date or comments or see more link below) to read the unabbreviated version.

This entry is non-gory. Jen says it is safe to read it.

Background

First, some background for those who aren’t in the know about my shady past… When I was 13, I flipped over the handlebars of the bike I was riding. Without going into too much detail, I knocked one of my top front teeth out, and knocked the other one loose; after some years of dentistry, the tooth that was completely knocked out was put back in (and I still have it), but the one that came loose could not be saved.

Maryland Bridge

Because of my age at the time, the best course of action for the missing tooth was a temporary false tooth called a Maryland bridge. With the Maryland Bridge (a lower-jaw one is shown at right) a porcelain replacement tooth is cemented to a metal backing (mine was golden!). The backing has two wings which the dentist cements to the adjacent teeth. This is considered to be the most non-invasive form of tooth replacement because there is no surgery and minimal grinding of adjacent teeth. (Fixed bridges are the other solution here, but these require grinding the adjacent teeth down to pegs and fitting a group of three false teeth over the whole thing.) Bridges are good for about 10 years, and I’ve had mine in for at least 13 years. Yesterday’s procedure was brought on by the failure of the Maryland bridge (the cementing came loose on the right wing).

About Dental Implants

Welcome to the new millenium; the gold standard for tooth replacement is no longer a bridge. That meant that I wasn’t going to be replacing the Maryland bridge with a new bridge of any design. The new best solution is called a dental implant. Implants are a two-part tooth replacement that mimic a tooth’s freestanding connection to the jaw bone. They aren’t pleasant to have installed, but they last a lifetime. This beats replacing a bridge every ten years. Though they are expensive, they are more economical in the long run than bridges because of their permanence.

How do implants work? Well, Professor Per-Ingvar Brånemark (Gothenburg University, Sweden) discovered that titanium actually bonds to living bone such that it cannot be removed without a fracture. This process is called osseointegration. It’s now used to anchor not only teeth, but also artificial limbs and implanted hearing aids.

A completed implant restoration is very similar to a shelf attached to a wall and supported by a plastic wall anchor and a screw. Or (for any rock climbers out there) it’s similar to placing a bolt and hanger into a rock face.

The first part of the process (which is what I had done yesterday) involves making a hole in the bone, and screwing in an anchor (see examples and x-ray below). Unlike the wall anchor, this anchor is made of medical-grade titanium which osseointegrates with the jaw.

X-ray of an implant	Two different titanium anchors

Yesterday’s Surgery

The surgery went pretty well. Jen’s suggested that I move my description of it to a pop-up window. It only has a mild illustration of the process so it should be safe for most. (No gory pictures or language.) Click here.

At this point, the implant has been placed, and everything has been closed up over top of it. It is alseep in its little bed in my jaw. Everything is left this way for a long time (in my case 6 months). During this time the implant fuses with the bone. During this time it must be undisturbed so that this fusion can be perfect. At the end of the six months, the surgeon will again open a hole in the gum, and will evaluate the implant. A properly integrated implant should not be movable at all. It should be at one with the jaw bone.

So… how am I doing?

Well, I’m doing about as you would expect the day after someone sliced up my gums to drill into my skull. I was hoping to be feeling much better by mid-day the day after, but I must confess that things are still quite sore.

One problem is that I have an incision right behind my toothline, and this incision is right where my tongue goes to make D and T sounds (go go gadget phonetics). So talking tends to irritate this. I did quite a bit of talking last night (good for boosting spirits) but that probably was not a great idea comfort wise. Anyway, that spot is where most of the discomfort is at the moment.

I think it would be better if it wasn’t a front tooth. Although, I think eating would be much more difficult. Eating has gone okay so far, although I have been exclusively consuming things that I don’t really need to chew. Last night I had chocolate pudding with whipped cream (yum!) and today a minigo, a Yop, and a bowl of corn soup (no solid corn in it). Perhaps tonight I will try a soup that actually has food bits in it (like chicken noodle or something). Or perhaps a chopped-up soft-boiled egg. Since I have no tooth in the front, the site is vulnerable to a piece of carrot getting jammed between the lower teeth and the gum on top. I’d like to avoid that…

I think I’m actually doing quite well in terms of expected recovery, but I’m not moving as fast as I’d like to.

“Flipper” partial denture

I have what dentists call a flipper (see left) as a temporary replacement for my missing tooth. It’s basically like an orthodontic retainer with a fake tooth glued to the front. Those of you who’ve seen me in the last week or so have seen it in. I have to leave the flipper out for two weeks now, so if you see me in the next few weeks I’ll look like a four year old — or a hockey player (is there a difference?). After that I’ll have the flipper through the summer until the next phase of this whole process.

Teething… Again!

Completed Implant

Since this entry is already super-long, I’m going to skim over the details of the next phase a little bit. Let’s just say that all going well, the end result is that a false tooth on a screw will be screwed into the hollow center of the implant, just like a screw being driven into a placed wall anchor.

The final result should look something like the picture shown at right. Implant in bone, tooth screwed into implant. This should be the scenario for me at the end of August.

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› health     2004-01-28 17:58   ...6