If you do not enjoy medical photographs, do not look below the fold.
As some of you will recall, a couple of weeks into this knee-damage shtick, I was munching on a dried prune and a molar came clean off it’s root on my lower left mandible. It turned out to be a crown that had lost its nail, as it were, and was deposed. Following this, there was a period of uncertainty and confusion which finally led to today, when Dr. Spanish, Amanda’s family dentist, started the process of tooth implantation. The roots of this tooth were too far gone to allow a new crown, and the choices were between bridge and implant, with implant being the clear preference for several reasons.
Have a look at this x-ray, taken right after today’s work:
This is my left jaw. To the left, mostly off-camera, is a premolar. Center-right you can see an obvious molar with some fillings. To the left of this molar is what appears to be … and in fact, for all practical purposes, is … a lag bolt. Well, technically, a lag screw, but one without a point. To the left of the screw is a dark area shaped like a cup. The location of the cup shaped area and the screw is where the roots of a molar previously located here sat.
In today’s procedure, the roots were removed. This involved cutting the root structure into two parts, then easily yanking out out the medial (to your left) roots and somewhat more cumbersomely extracting the distal (to your right) roots. There was a lot of prying and tugging but no swearing or sweating, so I guess it went OK.
The medial roots (left side) were largely rotted away, as was some nearby bone, because of an infection that festered at this location while we busied ourselves waiting for dental insurance issues to be straightened out. Because of the extra bone destruction in this area, additional work was needed (which I assume the insurance company will not be paying in full for, which kinda makes me want to sue them). This consisted of a bone tissue implant. The bone implant is actually a mushy liquid with sterilized bone tissue, which will encourage my own osteotic cells to extend their clastic/blastic activities into this cavity more quickly than they otherwise might.
The root to the right side of the photo, where the bolt now sits, were in great shape as was the surrounding bone. So, Dr. Spanish got out his tap and die set and installed a set of threads in my freakin jaw. That actually hurt a bit, and involved a machine that sounded like a cement tamper and vibrated like an L-11011 jumbo jet on a short runway.
Then he put the screw in. That was funny. It was done with a standard Sears Craftsmen ratchet wrench, and when he didn’t have the correct size bit, his assistant had to run out to her car and borrow one from her tool kit. You can never find the most common wrench sizes because they are always being used.
OK, OK, I’m kidding about the ratchet wrench, but only a little. He really did use one of those wrenches … where you turn the handle to twist the nut, then you turn it the other way to ratchet it back, then twist again, etc. etc. Crank crank crank crank. I was worried that he was going to over tighten. “Check the torque on that thing, will ya?” I was yelling, but it came out like “Ek e or o a in, eh eh?” and he said “I know. It could have been warmer, but in the sun it was nice.” Crank crank crank crank. Like a hundred times.
Anyway, when that was done, a few stitches went in, and Dr. Spanish sent me off with a fresh supply of icky mouth wash, scripts for antibiotics and pain killers, and a wadge off cotton surgical sponges to help control the bleeding.
The injected pain control liquid has now worn off, and my jaw feels like two people were standing on it for an hour. Because they were. In the end, I was very positively impressed with Dr. Spanish and his assistant. I think they did an excellent job, they worked quickly but carefully, and Dr. Spanish clearly has the touch one needs to do this kind of brutal yet finely tuned work.
In four months I go back to get a crown put on that lag bolt.