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:

i-4fcd92de2c684f7fce76717bee601a81-tooth_implant_laden.jpg

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.

Comments

  1. #1 chuck13
    April 29, 2010

    Let me guess – the screw has an unusual, proprietary head design so you can’t do your own maintenance? Those dentists!

    FYI – I have had no major dental issues since I acquired a pyramid shaped toothbrush holder… :)

  2. #2 SplendidMonkey
    April 29, 2010

    Good thing we’re safe here in MN, in AZ Dr. Spanish would be deported. My dentist’s name was Dr. Patch.

    Cool story.

  3. #3 Dwayne Jones
    April 29, 2010

    very nice xray. glad that’s not my head

  4. #4 Harbo
    April 29, 2010

    I can see the chip is in place and we can now take over.

  5. #5 Mike Haubrich
    April 29, 2010

    Did they put a temporary crown on top of it until you get the permanent one?

  6. #6 MadScientist
    April 29, 2010

    Cool – I’m glad it’s you and not me. Now you have double the fun with a swollen leg and a swollen jaw.

  7. #7 MadScientist
    April 29, 2010

    @SplendidMonkey: In one town my dentist was Dr. Capp; current dentist is Dr. Fang (yeah, I know how to pick ‘em). In one town I noticed a physician in the phone book: Dr. Death (that’s ‘deeth’ as in ‘teeth’) – I’ve often wondered how many regular patients he has.

  8. #8 D. C. Sessions
    April 29, 2010

    Love the X-ray. Please consider donating it to WikiMedia — there’s a serious shortage of good x-rays out there which can be used to explain stuff like this.

    FWIW, one of my tibial fracture shots is all over the Net now.

  9. #9 Mark P
    April 29, 2010

    That reminds me of why my brother in law says he found orthopedic surgery to be appealing. He said with all the screws and metal and tools it was like working on cars.

  10. #10 momkat
    April 29, 2010

    It is a cool process, but this is from someone who loves scrubbing in on a C-section and marveling at the wonder that is the contents of the human abdominal cavity. I went with local rather than conscious sedation when I had the implant put in, just so I could tell what the dentist was doing. BTW, you’ll be glad you went with the implant.

  11. #11 megan
    April 29, 2010

    Hey, I’ve had you beat for years. From a martial arts injury to an eyesocket, I’ve had a screw in my head to repair the blown out occipital lobe fracture. Been screwy ever since literally as it messed with my sinus cavity behind it.

  12. #12 DuWayne
    April 29, 2010

    Ahhh, just what you needed – more pain killers…

  13. #13 rob
    April 29, 2010

    can you pick up kqrs with that thing or are you stuck with ks95?

  14. #14 MyStEryPeRsOn
    April 29, 2010

    oooouuucchh

  15. #15 Greg Laden
    April 29, 2010

    D. C. Sessions: I’d be happy to, but I don’t know how.

  16. #16 Lynn Wilhelm
    April 29, 2010

    Wow, first the leg, then the tooth. But what about that festering infection you had to wait to treat–did it hurt? Did you know you had it?

    By the way, my dentist is Dr Beavers.
    His brother and several children are dentists too. All from a farming family in what was once rural NC.

  17. #17 daedalus2u
    April 29, 2010

    The antibacterial mouthwash is problematic. You need to prevent an infection, but you want the biofilm on your tongue to grow back. It is the tongue biofilm that reduces nitrate in saliva to nitrite, and that nitrite (a couple mM/L) is important in anti-bactrial activity both in the mouth and in the gut. At stomach pH the nitrite goes to NO, levels like 100 ppm.

    It is NO from bone strain that regulates the osteoclastic/blastic balance. More NO is better.

  18. #18 Greg Laden
    April 29, 2010

    Biotine!

    Yeah, the infection mostly went away with pills, then he dug the rest out, and now I’ve got more pills.

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