Saturday, 11 April 2015

Not for Dentistophobes

Oh, hey, in case you forgot, I'm a dentist by profession. Yeah, I know, I don't like it any more than you do. But it pays Bill's bills - most of the time. After all, my writing and painting and cartoons are, in financial terms, a negative income activity. I spend on them and earn nothing.

So, I was placing an implant today. Implants, for those of you who would like to know, are titanium screws placed in the jaw in areas where teeth are missing so that artificial teeth can be attached to them later. It's like replacing a missing tooth with an artificial natural tooth, so that the replacement tooth acts just like the natural tooth, with chewing forces being transferred to the bone rather than distributed to other teeth like in a bridge or to the gum as in a denture.

Since I did one today, and I was in the mood, I photographed most of the procedure for your edification.

The specimen was a 35 year old male from Idaho, wherever that is, called RB. He was in good health, no vices, no allergies, and had had an extraction some six months ago.

In this case I first took impressions and made models on which I took measurements of available space, X rays in which I checked the bone height available, and I decided on placement of a 4 mm diameter implant of 16 mm length. 4 mm is about the minimum diameter that I could have placed for a back tooth, but given the space limitations I could not go for a larger size.

On the X Ray I found a broken root from the extracted tooth (circled).

The old tooth socket shows as a shadow. The bone hasn't grown back fully in it.

Then I tried on a surgical template I'd made from the model in the mouth. It's a plastic cover like a mouth guard which fits over the teeth. The hole (with red surrounding) is one I made after measurements on the model, to indicate the exact spot for drilling for the implant.

Here's the site in the mouth:

If you look closely you'll be able to see a tiny black dot on the gum. That's a puncture wound I made through the template with a graduated probe to mark the spot of the implant and to check the thickness of the gum.

Then with a No 15 Bard Parker knife, commonly called a "scalpel", I cut the gum to raise a flap to expose the bone.

This is the flap, just before raising. You can see where it is from the bleeding line.

Then I removed the broken root and began drilling the implant site. I am not going to show the sequence of drills since it isn't significant, but there are seven of them.

This is the depth guide pin in place, both to check the depth of the preparation and its orientation with the other teeth. In simple terms, I was checking to see if the implant preparation was deep enough and whether it was pointed in the direction I wanted, and not slanted.

I took an X Ray to confirm that it was fine.  Apologies for the blurred quality of this picture, but you can see the essentials. The pin is exactly parallel to the premolar, as planned.

Here's the implant preparation, readied for the placement of the implant. Its outline is distorted by the socket of the broken root impinging on the top.  You can also see the bone of the ridge and the gum flap folded towards the lip side.

Here we go. The implant loaded and ready for insertion. That silver grey screw thing is the implant.

Tightening the implant in place with the implant wrench.

The implant in place with the cover screw affixed and a bone graft analogue placed to fill the socket left by the broken root, which was causing wobbling. The implant is hollow; this cover screw is an object which fills the hollow of the implant and covers the top of it in this case. If I were doing an immediate loading implant, in which a crown were to be fitted on top of it as soon as it was placed, I would not have placed a cover screw. But because the bone around the implant is still weak, I recommend a minimum of six months before the crown's to be fitted. Hence the cove screw.

Here's the X Ray of the implant in place. The white wedge shaped bit sticking out to the left on the top of the implant is the bone graft analogue.

The flap stitched shut by a single black silk suture, which is to be removed in ten days.

Right, that's it for today. Until I disgust you next time!


  1. Actually, that was rather interesting.

  2. OK, had to stop looking at the pictures once you drew blood. WTF is a dude from Idaho doing in a dentist's office in India??

    1. Lots of Westerners get their dental treatment done in India. Places like Goa are full of dentists who cater almost completely to a foreign clientele. The reason? We're

      1. Good and
      2. Cheap.

      I've treated Germans, Afghans, Russians, Brits and French earlier, myself. This is my second American.

  3. What sort of anesthetic do you use? Do you use a face mask with all that bone and blood spraying about? Curious.

    1. Local anaethesia. In this part of the world nobody except an anaestheiologist is allowed to give general anaesthesia, and good thing too.

      Of course I use not just mask, glove etc but an eye shield too.

  4. I agree with Benni... it is rather interesting but unfortunatly I'm one of the many stupid people who have irrational fears of the dentist and to me, this represents the biggest horror story possible. But i have to admit, I never realised people do dental tourism to India. I've heard of people travelling to India for eye surgery, but never dental treatment. My mouth is a ticking time bomb waiting for the crisis.A long time ago I had two front crowns. They are now well past their intended lifespan but the only way I was able to do this in the first place was with an armful of diazepam well in advance of sticking needles in my gum. Turns out jokes on me, crowns don't last a life time and now dentists here are not allowed to administer intraveniuos drugs. Opps... my worse nightmare unfolds, maybe some kind of weird karma going on here. :-).


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