By: Jean Johnson for Dental1
Part One | Part Two | Part Three | Part Four | Part Five | Part Six | Part Seven | Part Eight | Part Nine | Part Ten | Part Eleven | Part Twelve | Part Thirteen | Part Fourteen | Part Fifteen
The type of dental implants I have in my jawbone take six months to get established while the bone fuses to the titanium, so there hasn’t been much news since I shared my experiences on Dental1 in Silk and Jazz – A Dental Implant Story. But, as an elderly friend of 99 years says, time goes by…
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Most people have their implants done by oral surgeons or other similar practitioners that specialize in the procedure. Then they go to reconstructive dentists or prosthodontists for their teeth.
Since my prosthodontist specializes in both implants and reconstructive dentistry, I chose to have him do everything.
While some think it is preferable to have implants put in by those who install them quite frequently, my prosthodontist maintains that he does so many of them that he stays well practiced. More significantly, he thinks that since angulations are critical in the final outcome he has more control over the precision required if he is involved in all stages of the dentistry.
I first saw my prosthodontist for what he terms a “limited evaluation” in May 2004. I was all tippy-toes back then – wondering about pain and the extended healing time, not to mention the necessary megabucks and whether I’d ever have to leave the office with gaps in my smile. It was like being a wide-eyed, blushing bride uncertain if she was making the right decision and having to proceed on little more than intuition and trust.
But that’s not really true. Indeed, I had little choice because my mouth was in dire straights – that’s where the blushing part comes in. Between family genetics, a sweet tooth, and less than rigorous oral hygiene in my youth, I’ve financed a number of college educations for dentists’ kids over the years.
Also I lingered way too long in the various family practice offices. Initially, I was simply unaware of dentists that specialize in mouth restoration – prosthodontists – and limped along assuming the family dentists knew what they were doing.
Even after I discovered the world of specialists, I feared the expense. But the penny-wise approach turned out to be pound foolish. My mouth went from bad to worse under care that was not up to the quality I required. Dwindling numbers of teeth had to be bridged and carry the load of the missing ones. More, poorly made crowns lead to further tooth loss and even more bridges.
By the time I reached my prosthodontist’s door I was teetering on the threshold of dentures, a fate I wished to avoid at all costs. Indeed, by the end of 2004, a half a year after I first saw him, he had re-cemented bridges that were hanging on by hook and crook three different occasions.
He was always so nice about it, though. Even when the front crowns came loose. I’d never looked in the mirror before, but under his care somehow I had the nerve. It was pretty bad to see myself looking like a toothless Jack-o-lantern, I admit. But the sight wasn’t nearly as hideous as the image I’d conjured up in my mind. Also, he when he finished he’d say, “There. We have you all put back together.” Everyone would chuckle, and the humiliation of it all somehow had less sting than it had in other dentist’s offices. But more about my prosthodontist’s chair-side manner later.
Between the all the glue jobs, some preliminary bone grafting, a core buildup including pins under a crown that just couldn’t wait, and some stents or guides he would need for installing the actual implants, I was on my way – stepping out into the world of implants with increasing confidence and greater ease. There was even a side trip over to the oral surgeon for a sinus bone graft in November 2004, a procedure not to be underestimated and one that remains so horrifically awful in my mind I’ve yet to pen the details.
Then 2005 rolled in. Throughout the year I had seven implants strategically placed in each quadrant of my jaw, the details of which are covered in Silk and Jazz (silk for the sutures he uses and jazz for the great music he plays in his office courtesy of one of Portland’s commercial-free radio stations).
Now as 2005 is giving way to ‘06, I’m on the last leg of the journey – preparing to have the equivalent of an extraordinarily fine set of custom jewelry installed in my mouth. Instead of a strand of pearls and earrings to match, it will be pearly whites for me.
Initially he has to make some molds since part of the restoration will include adjusting my bite. Apparently when a patient starts getting crowns and bridges, the mouth goes into an overbite that causes the front teeth to flare. So a few weeks before Thanksgiving in I went for the beginning of all that business.
First off was yet another panoramic X-ray. I follow his assistant, her long white lab coat swinging and her high heels quiet on the strip of hallway carpeting. We cover the length of the suite in a half minute and wind up in a small room where the big gray Panorex is mounted to the wall.
“We’ll use this double-sided lead apron since the X-ray goes clear around you,” she said and eased the heft of the protector in place over my shoulders. “Now step in close and bite down on the mouth piece.”
There’s a highly unflattering mirror that you stare into, all the while you’re stretching your neck so the crosshairs of two light beams bisect just below your eye sockets.
“Looks good,” she said. “Now put your tongue on the roof of your mouth and swallow.” The X-ray buzz starts up and a box like affair rotates around my head while she peers in through a protective window.
Once she gets the lead apron off, it’s back down to the other end of the airy, open suite and into one of the aqua dental chairs. (The long room has four chairs with banks of storage units separating them for privacy. The units don’t extend clear to the ceiling so the suite has a spacious feeling to it – like being in a home with high ceilings or something.)
The sky is a brilliant blue against the hillside of alders, the same color of the trapezoid-shape plastic slab into which, once warmed in water, my prosthodonist asks me to bite. After a few seconds, there’s the “open please” complete with the lilt on the end that makes the ordeal seem so very courteous.
He rinses the plastic under cold water to set the impression, and his assistant takes over with her blue paint brush and Vaseline. In small, swift motions, she paints the stuff onto my gums to protect them from whatever brew he has in store next. There’s some more dabbing and peering in from the both of them and the smell of a strong acrylic. Then he starts in with the pink goo, gobbing it around my upper teeth before going full bore and putting a mouth plate full of the stuff into place.
He checks around inside. “Relax your lips, Jean,” he says. I quit horse smiling, and he presses around on the outside of my mouth to smoosh the plastic polymer within into every last crevice. After that, it’s just the waiting, his fingers hooked around my jaw to keep the pressure firm.
It’s odd how time slows when normal activity stops. There we are, the three of us, just waiting. It’s like being on a meditation cushion following your breath. But I’m not in the mood for meditation and am glad that the expansive picture windows lining his third-story suite can always be counted on. Out on the hillside the tattered alder leaves cling to a network of gauzy gray branches. He probably looks too, and I like that.
Indeed, it’s one thing for the patient to be happy in the dental chair, but the real gig in my view is making sure whoever’s doing the work has a spring in their step. I know those windows do a lot for my prosthodontist because he said so. “Yes, the windows are great for the patients, but for us they are even more important since we’re here all the time.”
This first appointment in the restoration phase, doesn’t take long. They mix some more of the pink powder into water and then get a mold of my lowers, clean me up, and I’m gone.
Out under a turquoise sky and off to the bank to square away the big money I’ll need to have in hand once things start getting serious…