At this point I didn't know what could be done. It was eight days before the appointment and my mind raced this way and that. Would he do "mini implants" that I read about to hold the denture plate in place? Would that really do any good if he did? What about getting new teeth? Was that even possible on such a grand scale?
I was ushered back into a room set up especially for consultations. There was a video monitor connected to a computer with the ability to display computer simulations and photos for various things that dentists do in the deep recesses of their lairs.
Once again Phileas Fogg was set in motion as I went back to my book, but the man who was destined to be a major player in this tale, and from this point on will be referred to as "my dentist", didn't leave me waiting for long before he arrived. He struck me as young, eager, and intelligent. He spied my book reader and was instantly intrigued. He asked me all about it, and how he could download over 17,000 of the finest books ever written for free from Project Gutenberg, and he could store several hundred of his is favorites on a memory stick in the book to carry around with him, with no strain on his back at all.
But that was not why we were there, and soon the conversation moved to dental implants. I asked what he could do for me, because the dentures were not working out as I had hoped. Would he recommend the mini-implants that I had read about?
He said that he would recommend full implants to do the job right. Well, that moved me easily into my next question, "If you are going to do full implants anyway, is it possible to just give me my teeth back?" His response was in the affirmative, but I saw some reticence in his face. Perhaps I was asking too much.
He went on to describe what an implant was. First they drill a hole in the bone and then they screw a metal threaded shaft into the hole. A cap is then placed in the top of the implant sealing things up for 3 months or so while the implant sets up permanent residence like a hobbit in a bony hill. The bone would grow in around the shaft, because the material is "tissue friendly" and not subject to rejection.
Next I learned some unhappy news about the rear teeth that I lost. The reaction of the upper jaw to an extraction is that the bone is eaten away and the sinus works its way down towards the jaw line. It is like an air supported car moving downward to hold a constant distance from the chewing surface. It leaves too little bone to place an implant. Sigh.
But retrieve was then offered. They could go in and lift the sinus back up out of the way and a simulated bone could be inserted to hold it there, and an implant could then be placed. It sure didn't sound pleasant, but it did turn on a light at the end of the tunnel, rather than three of them.
When I left he said he would put together a proposal for me and contact me with what he felt would be the best course of action, and how much it would cost. In the first week of February I had another meeting with my dentist to see what he had cooked up for me. Well, he wanted to do 4 implants on the top to lock in my denture plate and put a fifth in the lower jaw so I could have a molar on the left to match what I had on the right. I was taken aback a bit, disappointed that the tooth replacement idea wasn't feasible, but at least my dentures would work better.
Since my dentist had everything in place the next day for a 5 implant procedure, this threw a monkey wrench into the system a bit. He said he would call me later in the day and let me know if they would have to delay or not.
When he called later in the day, Dotti and I were sitting at a table in the Borders Book Café having a coffee and working on our respective projects; she was working on the web page on her laptop, and I was working on musical chord theory in my notebook. My dentist said that it was "a go" for the next day, and he felt that we should proceed.
I had mixed feelings about that. In a way I was hoping that it would be delayed because I wasn't looking forward to what I knew was coming, or the unknown, about which I had no idea how to feel. Sure it would make things better one day, but tomorrow was going to be trashed pretty well. Still, the decision was made. The big day would start early the next morning.
I brought my book reader with me, but I just didn't have it in me to read. My feelings were bounding all over the place. Dread, anticipation, hope, and fear were all in a wrestling match to see who would take charge of my state. Fortunately the wait was not long.
The young lady who would be assisting the dentist came out and called my name. Well, all the preliminaries were done, now the rubber would meet the road, and the engines were all started and warm already. I felt something like a man might feel walking up the 13 stairs to meet the trap door, but that was mingled in with hope for the future, creating an odd concoction like mixing sweet and sour and gulping it down. But it settled down into resolve finally. I was going to do this and it was going to be okay. (I hoped.)
The walk was a short one down a hall past the restroom, which I would be returning to along the way for an emotional break as much as the normal use one might expect to make of the facility.
Next, about halfway back, was the x-ray alcove with the machine that creates a panoramic view of the entire mouth. I would be back right at the end of the day to get a picture taken of the results.
The setting was not new to me, but it was different. The computer keyboard (is there any part of our lives that is no longer touched by that ubiquitous device?), tables, and the head of the x-ray machine were all covered in plastic, as if a mad scientist were about to set to work with a chainsaw and didn't want anything to get on his stuff. Why would my mind run to such things? Then reason snapped back into place, and it came to me that this was to protect me, not the equipment. Covering everything with plastic allows complete sterilization of the surfaces so that if they touched them and then touched my mouth nothing nasty would be transported to my wounds and then grow there. Still that first impression hung around in my mind for a bit, running from room to room out of sight, and then jumping forward from time to time to say, "Boo!"
I spotted a camera on the table and I had to go and look at it quickly, careful not to touch it. It was a Canon EOS with an interesting flash attachment. The flash was a ring around the lens, covered with a diffusing plastic surface. When it flashed it would send light straight out for a short distance and diffuse it evenly. It was perfect for photographing things going on in a mouth during a dental procedure. Of course that was no coincidence.
The first step was to get my mouth ready for what was to come. The nice dental assistant gave me a small cup with an aqua colored fluid and told me to swish it around inside my mouth for 2 minutes. She pointed to a digital timer mounted on a cabinet and said I could watch it if I chose, but I didn't care really about how much longer I had to keep the fluid in. It wasn't unpleasant, and I knew that things that were unpleasant were not far off. It was about here when my dentist arrived, smiling and enthusiastic.
After I could finally spit the anti-microbial fluid into the sink, he offered a cup of water to me to rinse the taste out if I wanted to. He was professional but very friendly all day long, and that was appreciated! He showed me some of the tools that would be used during the upcoming procedure.
We had to talk about the camera of course, and he said that he would be giving a lecture on this procedure, and the pictures that they would be taking along the way would be used for that talk. This led me to think that he would be extra careful to make everything perfect as we went along, because his peers would be looking at his work and I could tell from speaking with him as much as I had already that he would want to present a very good image, and perhaps add to the knowledge base of others.
It is always great working with a man who is concerned about doing the best possible job at all times. I have seen that difference many times in my various positions in the field of electronics; some men do the job adequately, and some go that extra mile to make sure they do the best that they can do. I felt very comfortable with the fact that my dentist is one of the latter type.
He next took me over to the tray of tools, and pointed out a couple of them as he described what we would be doing. There was a metal mallet a couple of inches long and maybe three-quarters of an inch square at the head, the handle was 6 or 8 inches long it seemed. I asked about that and he said that it would be used to spread the bone out, if the bone turned out to be the right harness to handle it. By tapping a tapered punch into a smaller hole, the bone could be spread enough to accept the implant, and then when it later rebounded, it would grab the implant very securely. If that procedure was not practical, he would have to drill a larger hole and screw the implant in that way. It would still work but would be less secure at first and might take a bit longer to heal up to the right level of stability.
He pointed to the "punch." It was about as long as the hammer was, and the tip looked like the end of a centering punch, and the shaft had a diameter that was in the neighborhood of 1 mm growing only slightly wider from the tip to its widest point. It wasn't like a splitting wedge that would create a huge change in diameter of a hole it was drive into, but would only spread it slightly. I felt a bit better about the mallet than I did when I first spied it.
After taking my denture plate from me and handing it to his assistant, my dentist used his computer monitor to show the panoramic x-ray view they had taken during my last visit, as he explained exactly where we were headed. To start, he was going to place the front two implants. He would work in groups of two on the top, and then do the single on the lower jaw last. The first two had to be perfect because they would be the reference for all the rest of the upper implants. The angle had to be just right, and the location precise. He asked if I liked the way the dentures lined up right to left. I said sure. The dentures always looked good to me, they just never have been comfortable to wear.
He was going to drill a small pilot hole in the bone and check the angle with an x-ray. If it looked good, he would then drill the hole out to the full diameter and place the implant.
"It makes you feel less aware of what is going on, more detached. Some people love it and others don't care for it."
I decided I was on the cruise, I might as well join the shuffleboard game and get the full treatment. "Okay, I'll try it."
The assistant brought up a hose that felt like hard plastic with a sphere with its bottom cut off where my nose went. On one side of the sphere was the feed line, and the draw was on the other. This arrangement was to allow me to be exposed to the N2O, while keeping the dental staff clear. (If something like this isn't used to whisk the gas away, the dentist and others in the room can be exposed, causing intoxication and if repeatedly done, it can actually have permanent damaging effects on the brain.)
When the numbing was on its way towards taking effect, the assistant showed up with my dentures, but they had become transparent, at least that is what it looked like. Apparently they had made a full mold of my denture plate and then poured a plastic model of it in the mold. This was going to be his template for the rest of the day. The plastic was clear and holes had been drilled in the model, which the dentist had positioned and cut during one of the times I was occupied in other matters.
About here they produced a device that looked a bit like a tiny rubber skirt. It had a ring running around where the waistband would have been, and the "skirt" rubber material extended from it for about an inch. The ring was placed inside my mouth and forced in between my lips and my gums. Although I couldn't see myself, it must have looked like a clown's mouth. The skirt protruded out over my lips to protect them and the ring was resistant enough to help hold my mouth open, taking away some of the strain from that process.
He placed the clear plastic model into my mouth and used the holes to mark his starting point, removed the plastic denture, and soon the high pitched whine of the dental drill was heard near my right ear.
The first drilling was what he called a "tissue plug." I remember that my thought was that he was going to cut through the gum and expose the bone beneath so he could proceed farther in another step. But I was wrong, he was through the gum quickly and I could tell that he was continuing on into the bone right away.
I was noticing that the N2O was overpowering me a bit, and I used sign language to ask to have the flow adjusted down. Throughout the day the flow was moved up and down several times. Later, when I got up to use the restroom the hose was put back in place when I returned, but the gas had not been turned back on, and breathing through the nose became very difficult. But that was quickly rectified. I found over time that I didn't feel exactly inebriated by the gas but I did feel detached a bit, and when the flow got too strong I had to breathe through my mouth for a bit to lower the amount of N2O that I was taking in, because it felt like I might black out. I don't know if I really would have, but that is what it felt like.
One time my mouth had a little bit of water in it, mixed with some of the debris being created by the drill, and I held my throat closed so I wouldn't swallow it. That of course kept me from breathing through my mouth, but the flow was a bit high on the gas right then. I was forced to breath through my nose, and it produced an odd feeling as I sort of "floated away" for a moment. I tried holding my breath a bit and breathing less often and that helped a bit, but I finally just swallowed so I could breath through my mouth again, and could ask them to turn down the gas a bit. That only happened once and was quickly rectified.
The dentist applied the whirling bit of his drill, while I listened to the sound that all dental patients have grown to dislike to one degree or another, and time passed. I have to admit that the N2O blurred the time line a bit for me, but he was busy for quite some time before changing tools and then tinkering with the work area. It felt all the world like he was using a pair of needle-nosed pliers to worry a chunk of material out of the way. I did not verify this with him, but I think what happened is that he used a hollow shaft drill to cut around a core of tissue and then did grab it and yanked the core out; he was doing something similar to what they do when they take a core sample from the bottom of the ocean, from the ground, or even from the ice of Greenland. He was definitely pulling on it, and when it gave way the pliers, or whatever tool he was using, came away from the area as if the core had given way under the pulling pressure he had exerted upon it.
It was time for an x-ray. I held the sensor in place as the assistant went and pushed the button. And there was the picture. Two pins were visible. Where did two pins come from? Since the area had been numb I hadn't realized that he had been working on both sides of the front implants and he had already done the core on both implants.
He was very happy with them right off. In fact for all 6 of the top implants he got the angle just right the first time. It wasn't until the last one, the one on the bottom, before he had to adjust the angle a bit after the first x-ray.
Once the angle was tested, he proceeded to ream out the holes to the right diameter. He was very meticulous as he worked, making sure each step was perfect before moving to the next one.
Once he felt that the hole in the bone was just the right size, he grabbed his metal mallet. Yes indeed, it was time for the hammering to begin.
He warned me that he would rap the punch in bursts of 3 strokes. Tap. Tap. Tap. I said, "Okay." What was I going to say, "Nope, sorry; let's wrap up the job and I am going home"?
Here it came, WHAP! WHAP! WHAP! Wow, that was bone jarring.
My dentist could tell that I was not a happy camper at the moment, and he asked me if I were feeling any pain. I replied that I was, and it felt like someone was hitting my head with a mallet. He chuckled at that, and I had to join him, because that is exactly what he was doing. I told him that the hole he was hammering on was feeling no pain and that he should proceed.
I have a neck that is not very forgiving to stresses upon it, so I buried the back of my head into the head rest to direct the force of the blows there rather than having my neck take the force. This gave a solid feel to each and every stroke of the mallet. WHAP! WHAP! WHAP! Seriously, how many strokes will this take? WHAP! WHAP! WHAP! I took a nice deep whiff of the N2O to take my mind off of the festivities. WHAP! WHAP! WHAP! The N2O was helping, because I lost track of how many more times he hit me, and it seemed to be over fairly soon after that.
I was beginning to feel like I was a hunk of wood or a car engine in a shop where drills, hammers, punches and now ratchets were being used on me. I heard the old familiar sound of a wrench turning and then the telltale click, click, click of the counterclockwise return rotation before the force of torque was again applied in the clockwise direction.
I said, "That sounds like a ratchet wrench."
He replied happily, "That is just what it is! And it also measures the amount of torque I am applying."
"That's cool, a torque ratchet wrench!"
Another quality I like about this dentist is that he actually welcomes questions and nearly bubbles over with information whenever queried on a point. If we had of gone to school together, I could see our being good friends. I really like his attitude about learning and sharing ideas.
I later looked one of those wrenches up on the Internet and found that they are calibrated in Newton-centimeters. For us English unit types, a Newton is about a quarter of a pound. (0.225 pounds) and it takes 2.54 centimeters to make an inch. If the wrench were 6 inches long, that would mean that 1 N-cm would occur if the dentist pushed at the end of the handle away from the ratchet end, with a force of about 1/4 ounce. So, a very delicate control is provided to the dentist where he can select just the right amount of force to apply to the screw he is driving into your bone.
I could tell the implants were snug because there was a bit of tightness as he put the last couple turns on each of them. And those implants were done, aside from capping them later.
I had warned them that I would need a restroom break every so often and this proved to be an excellent time for two reasons: it was a great stopping point for the dentist, and I really needed the break. Before leaving, the anesthetic was injected into the right area for the next phase, and then I was given directions to not bite down.
Each time I got up to leave the chair, the assistant pulled the rubber skirt out, and wiped around my mouth, and warned me not to smile out front. (I don't think they wanted me to scare away their patients when they saw those pins sticking down. I threatened on my second trip to tell the waiting people, "For a nominal fee, you too can look like this." )
The assistant walked me to the restroom; I knew the way already, but I appreciated the company because I was not sure how my knees were going to hold up after what I had just gone through. (I had been unable to hold my feet after my first extraction back in 1974, and so I have always watched myself when I stand up after anything serious having gone on in a dental chair.) I was fine and made my way to the restroom without incident.
My dentist had placed the plastic model of my dentures into my mouth right over the pins, and they had slipped right into the holes that had been drilled in the model perfectly. He was very pleased with the placement. The x-ray showed that the implants were perfectly straight and exactly in the right position. The only thing that was abnormal at all was that the left one had intruded into the sinus area just a bit. But since the implant sealed it off, that was probably not something to worry about. All in all, everything was right on schedule. He told me that the first ones had taken longer than the rest of them would because these front ones had to be perfect, and they were.
When the drill spun up I asked him if he were familiar with My Fair Lady, and he said that he was. I told him that the line from Professor Higgins song had come to mind, "I would rather for a dentist to be drilling than to ever let a woman in my life." He chuckled and told me that he had done the play in high school and he played Alfred P. Doolittle. He was doing the song "Get Me to the Church on Time" one time and the words just escaped him for a moment. So, he was stuck making up words as he went along until he could get back on track. It worked out okay though, but was quite embarrassing. He also mentioned that it was fun getting to play a drunk since he had never been drunk. That prompted me to ask him if he were LDS, and he said he was.
A Mormon AsideBack to implants 3 and 4.
At one point I saw a cupboard opened and inside I spied a map showing the western hemisphere and a little mark on the map in southern Mexico on the Pacific side and a note "Here is Dr. G." I had to ask about that. I had already met 3 of the dentists in the office with the same last name, and that name began with "G." The one on the map is the father of my dentist and the brother of the one who did Dotti's work. He has been down in Mexico on a Mormon mission and has been there for 7 months already. I think that he may have been the one who had done some emergency work on my tooth years ago, because none of the ones presently in the office seemed familiar when I met them. Since it had been a couple of years before, I was thinking that my memory was faulty until I learned of the traveling member of the ensemble.
The people in my dentist's office are all LDS (Mormon), and they are clean-cut upright souls. (Dotti was LDS when I met her and I have the highest regard for Mormons. Dotti fit in well with them, because she is a lot like them. It feels a bit like going back to your old hometown for a visit. ) It is a friendly office, very professional, and top of the line in equipment and procedures. They stress furthering their own education to constantly improve. Just seeing what they have done with Dotti's smile is nearly miraculous. These guys are top notch!
- One of the best turns that my last dentist did for me was to send me to this office that one time because one of my teeth was exploding in pain. I had already waited for normal office hours to roll around, since he didn't come in on weekends, but when no one showed up at his office I called his emergency number on his office door. He answered his cell phone up in Canada. He was out of town doing a triathlon event. So, our current dentist office covered my emergency and what a contrast it was. When we finally decided we had to change dentists we had a wonderful choice at out fingertips. I only wish we had done it sooner.
The procedure was similar to the first set of two. He was working on the right side, the side closest to him, which made things easier I would think. I ran into some pain creeping in and he gave me some additional shots. The first one made me wince a bit because it was up under the skin at the roof of my mouth and I wasn't expecting the stab of pain. He said, "Sorry!" And he sounded as if he really meant it. It is only the surprises that normally get me. When I know it's coming it is okay.
There were only a few times where pain popped up like that when he was working, and in each case I pointed out where I was feeling the discomfort from his drill and he nailed the very spot each time perfectly. I could feel the momentary burn of the Novocain for a moment and then all the pain was gone. There really wasn't not a lot of pain during the day. Considering what was going on, I thought that was very well done on his part. But it was a long, tiring, grueling day, and I was being warn down through attrition. My energy reserves were evaporating each hour that went by.
From time to time I would relax my hands and rub them together to keep the circulation going and to relieve stress a bit. Several times along the way when the assistant noticed that she asked if I wanted a blanket because I was cold. Each time I declined. I was very comfortable in the area of my thermal environment, and if all the other areas in my life were as good as that, I would have felt much improved. Alas, we were "breaking the eggs" so we could "make the omelet," and as they say, there is no other way.
One thing that started to get old by this time was the camera. At first it was a minor thing, a brief stop at each of the many steps along the way to get a picture of what was going on. Occasionally it took quite a bit of time and positioning to get just the right shot, and the camera wouldn't focus for the assistant shooting the picture at first and they had to fight with that. As we got towards the end I felt like I was emotionally just barely hanging on for the procedure itself, and I didn't have a lot of extra energy to expend in waiting for pictures to be taken.
Still, I didn't say anything, because I knew that he was going to use the pictures in a lecture, and I would be doing some good perhaps for someone else in the future if something he presented helped another dentist do a better job. And I hadn't forgotten that if he were going to present his performance to his peers in a lecture with pictures, he would have even more of an incentive to do a top notch job.
At one point, when I had asked for another shot, the assistant said, "You must have a really good liver!"
"Why is that?"
"Because it is metabolizing the anesthetic very quickly."
It is always nice to hear good news about my liver but I can think of less stressful tests to run to check it.
When my dentist cranked the third and fourth implants into place I could feel them really snug down. I was a little concerned that when all the anesthetic wore off those two might ache, due to the pressure I was feeling. (But fortunately that turned out not to be the case. )
First off, the upper area was done. The remaining implant was oriented with the lower jaw, not my upper denture. So, the plastic model, after sliding neatly over the 6 pins was removed and set aside for good. My dentist unscrewed the pins from the implants and then screwed a small cap over each one of them, sealing things up. The top six were done.
As the drill was making progress, he warned me that I would probably feel the drill "fall through" at some point. He had talked about that earlier but on the other implants all the bone was new and solid all the way "down." But this one was an old extraction and the bone was different. The surface was hard but down below it was softer. There was a slight feeling of the drill giving way, or "dropping through" near the end, just like he had warned. Soon he had slipped the implant into the hole.
It was time to break out the ratchet. I heard the assistant say the wonderful words to my ears, "Mr. Coon's wife dropped him off and you should give her a call and tell her that we are almost finished."
Of course then a snag was hit. The ratchet never reached snugness. The implant turned and turned, but like a stripped thread it just never tightened up. He called in a fellow implant expert, and discussed whether to go with a larger implant or not. I seem to remember him saying that he was using a "386" (3.86 mm?) and was contemplating going to the larger "476." I am not sure of the numbers but I know that they were close to that. The fellow expert equivocated a bit and the ball was left in my dentist's lap entirely. He decided to go with the bigger implant.
A few minutes later he had ratcheted the smaller implant out and had inserted the larger one. As the ratchet turned it was almost immediately clear that he had made the right choice. The implant snugged right into place just like the other 6 had done. We had joy at last. All that remained was the shouting, and a few odds and ends. The dentist capped off the implant, and the assistant cleaned me up.
One of the more pleasant of these odds and ends was getting that rubber "skirt" out of my mouth. The area inside my mouth where it had been sitting was sore and for days afterwards it was a bit tender. Getting to take that out for a while was one of the things I looked forward to most at my breaks during the day. Now, it was gone for good!
I was led to the x-ray alcove and after playing with the height adjustment and trying to get my head aligned with the mechanism, I was told to "bite down" on this metal piece that had just been covered with a removable plastic sleeve. I thought, "You have to be joking!" I wasn't biting down on anything with those bloody gums. Well, I pretended to bite down and the panoramic x-ray was run.
Back in the dental chair we looked at the x-ray together. The dentist was very happy with the way everything looked and that made me happy too, even as tired as I was.
Dotti, such a beautiful sight to my tired eyes, was standing at the front counter when I came out. I was feeling completely exhausted. My dentist came out with me to make sure I was okay before sending me on my way, and passed the time with Dotti and me for a bit before heading back. Dotti was in the middle of a conversation and I didn't want to interrupt, but I was utterly out of gas. So, I made my way out to the car to wait for her.
Soon Dotti joined me at the car, and she drove me home, swinging by the pharmacy drive-thru on the way home to drop off my prescriptions for my antibiotics and pain meds. She dropped me off at home, got me settled in, and then went back out to take care of a couple of errands and to bring home my prescriptions.
I have a clear memory of the first penicillin pill I took, because the left side of my tongue was dead of feeling. The pill got stuck under my tongue and I thought I had already swallowed it and then when I took another drink of water all at once the pill popped up in my mouth. Wow! Where did that come from?
In the evening my dentist called me up to check on me, and he was happy to hear in my voice that I had bounced back a long ways already.