Dental Implant Procedure

My Dental Implant
This post has nothing to do with myeloma, except that I am able do implants now because I am not (yet) taking any bisphosphonates. I'm writing it here because it was an interesting experience and I want to keep a permanent record of it.

My left lower jaw is running out of teeth. Number 17, the "wisdom tooth," has been gone for 50 years (possibly explaining the lack of wisdom). Number 18, a huge molar, is in place and working, the only remaining chewing surface. Numbers 19 and 20 have been gone for years, and number 21 has been slowly "resorbed" (dissolved from the inside - unusual) over the last five years or so. Today's job one was to remove what was left of number 21, leaving a three-tooth gap. Job two was to insert an implant in place of number 21, and another in the area between numbers 19 and 20.

After the work was done.
Left to right # 21, 20/19, 18
(with xray-opaque metal crown)

My surgeon was Dr. Macmenamen in Stillwater, MN. He told me that if this extraction was required because of infection, we would have to wait four months for the jawbone at tooth 21 to heal before placing the implant. However, because the tooth was not infected and the bone should be clean, he might be able to do an "immmediate" implant, depending on what he actually found when the tooth was removed. Because the bone in positions 19 and 20 was strong and healthy, the doc was certain that he could place that second implant immediately regardless.

We discussed nitrous oxide, "laughing gas," in the initial consult visit and again at the beginning of the second visit. The doctor recommended it as a means of reducing my anxiety during the procedure. I'm more afraid of anesthetics than pain, though, so eventually I declined the nitrous, which turned out to be fine. The only pain was two or three needle pricks (they call them "pinches" these days, don't they) as the novocaine was injected.

The doc first removed the weak tooth, number 21. Though it broke into pieces, he had no trouble getting them out, and was pleased that he had managed it without damaging the bone around the root, as this was important for anchoring the implant. He found no sign of infection, also important, and decided that he could proceed to the immediate implant. I had asked him to talk to me as he worked, so that I would know what was going on, and he did a pretty good job of that, and also responded to frequent questions. I love that.

For the implants, the doc started with a small-diameter "pilot hole" drill bit, then followed that with successively-larger drill bits, each drilling quite slowly and with lots of water irrigation. He explained that the bone is alive, and he wanted to avoid heating it (thus killing it) by taking too much bone at once or with too much speed. I suppose that he drilled with five different sizes or so. He said that the final size was 4.5 mm, roughly two tenths of an inch, and that the threaded titanium implant was slightly larger, for an interference fit. When the hole was prepared, he used his drill at an extremely low speed to screw in the implant until it bottomed out. Both implants seemed to bottom out quite positively, suggesting a nice snug connection between the threads of the implant and the bone.

With the implants in place, he screwed a "healing abutment" into the top of the implant. The gum will grow around that, and four months from now the bone will be firmly grown into the implant's threads and the healing abutment will be replaced with a different abutment designed to support a dental crown. Finally, he took three stitches in the gum with thread designed to dissolve in a few days.  He said that everything had gone very well.

Now it's evening, the novocaine has worn off, I don't taste blood any more, but it still hurts. I'm taking naproxen (Aleve), which does help a lot. Beer helps too, in modest quantity. I'm to take only foods that don't need to be chewed, for a day or two, then soft stuff, described as food that can be cut with a fork. I can't eat anything hard, like nuts, for at least a week.  I'll miss my chunky peanut butter.  I can run, but should be guided by the pain, i.e. don't run if it hurts.

I expect everything to go well, but if not I'll blog.