I recently found myself in a situation with which many of you are faced. A tooth was causing me discomfort, so I scheduled an appointment with Dr. John to have it checked out. His diagnosis was a diseased tooth that had progressed beyond treatment. What do you do when a tooth must be extracted? Although we at the Nase Dental Group believe in treating all teeth in order to save them, there are the occasional teeth that cannot be fixed. Sometimes even hygienists have problems like that; we weren't always hygienists!

If a tooth is lost, the absolute best treatment is to fill the space in a way to preserve the function of the surrounding teeth. In certain cases a fixed bridge may be recommended. The bridge can be placed in the area by grinding down the teeth on either side of the space and making a three-unit bridge that has a fake tooth in the middle that fills in the space. Another option available is a titanium implant. Although this is a little more expensive, it is the most permanent way to fill in a space left by a missing tooth without altering the teeth on either side of the space.

With my options before me, I consulted with Dr. John and Dr. Spampata at Oral and Maxillofacial Surgical Associates (O.M.S.A.) in Harleysville. I concluded that I wanted to have the best possible treatment for my situation. I decided that an implant would be best for me as the teeth on either side of the problem tooth are still in good shape and my gums are healthy.

Since I know we have recommended implants to some of you, I thought it might interest you to share in my experience as I go through the steps of have my implant placed and restored. The next step for me was to have the problem tooth extracted.

The last time I had an extraction was at least 10 years ago when I had my wisdom teeth removed. I don't remember much about it though. This time, I was going to be fully awake and I was a little nervous. I saw Dr. Spampata at O.M.S.A. to have the tooth removed. He anesthetized the area very well. He was extremely gentle with the needle and made sure the area was very, very numb before beginning. Dr. Spampata and Elaine, his nurse, worked quite hard at extracting my tooth, which in spite of not being very healthy, did not want to "go quietly". They told me this after the procedure was completed. I can honestly say that the only thing I felt was a very slight pressure as the doctor was dislodging the tooth. I didn't even realize the tooth was out until they told me. They said that previous implant patients have said that having the implant placed feels similar to the extraction. If this is true, I won't have any problems!

After Dr. Spampata extracted the tooth, he cleaned out the area of infection. Then he filled in the empty socket with granules of synthetic bone. This is done to help the bone fill in the socket more completely. A resorbable membrane was then placed over top of the granules to help hold them in place. Dr. Spampata then stitched the gums closed over the membrane. When the numbing wore off, I had some discomfort but it wasn't anything that ibuprofen couldn't take care of. I did have some minor swelling the second day after surgery.

My next step now is to have an implant consultation with O.M.S.A. They will explain to me all that will be involved in placing my implant after the area is fully healed and the socket is filled in with bone. To ensure plenty of time for this to happen, the doctor will wait about 4 months before placing the implant.

After the titanium "root" is placed and has had time to fuse with the bone in my jaw, we will make plans to have Dr. John place a crown on top of the implant. Then it will feel like I have my own natural tooth again. This is just a simplified version of what will happen. I will write the details of each step as they happen. If you have any questions, please ask me.

In my last update, I was awaiting the osseointegration of the new titanium implant that was surgically placed in the upper right side of my jaw. Quite a lot of time has passed since then so I will give a review of what has happened since.

A waiting period of approximately four months is necessary to give adequate time for the jaw bone to "fuse" to the titanium implant. I waited about five months all the while keeping alert for any pain and/or mobility which are usually signs of a "failing" implant. During this waiting period I had no pain or discomfort whatsoever. Had it not been for the empty space where my tooth had been I have could almost forgotten that the implant was even there at all.

Dr. John started procedures for placing the prosthetic tooth, or crown, on top of my implant. To do this he had to numb my gum tissues and make an incision to expose the top of the implant. (This sounds worse than it actually is. With the anesthesia I felt no pain at all and I even went right back to work that same afternoon.) Once the implant was exposed, Dr. John took the healing screw off to check the implant for movement. Think of the healing screw as a sort of screw cap on a soda bottle. It is there to keep the contents of the implant covered until ready for use. My implant had successfully osseointegrated; there was no movement and no pain felt by this patient! Dr. John then placed a healing abutment on top of the implant and sutured the tissues around it. This helped my gum tissues heal in such a way that they would form a little collar of gum tissue around my eventual crown to give the appearance of a natural tooth. Once again the healing period was uneventful.

A month later I was ready for my " new tooth." A crown that fits on an implant must be even more exact than a crown that fits on a prepared natural tooth. This is because it is actually screwed on to the implant and the "holes" need to be lined up precisely. Creating the model that the lab uses to fabricate the crown is quite an involved process for the doctor. The impression must show the lab exactly how the location and angle of the "hole" must be in the fabricated tooth. Of course this whole process is much more complicated than I have described it here.

Finally, less than a month later, my tooth was back from the lab. Dr. John unscrewed the healing abutment and screwed the new crown in place using special instruments made just for this purpose. The crown was left in place for about two weeks with the screw hole left open just in case Dr. John needed to remove it for any reason. Once we determined that it was a perfect fit he filled the hole in with a plastic material and sealed it.

So now I once again have a full complement of teeth. The entire process, from the extraction of the diseased tooth to the placement of the crown on my implant, took 12 months. Of those 12 months the implant procedure from start to finish was 7 months. My implant tooth functions as well as, and probably better than, several of my other teeth. Unlike the diseased tooth it replaced, I am never even aware of it being there. My chewing ability on the right side is superior to the left due 100% to my molar implant. The best part is that, unlike a crown on a natural tooth, an implant is permanent. Implants are not subject to bone loss from gum disease and, because it is titanium, it will never become infected or decayed. Would I do it again? Absolutely, but I will definitely try to keep my natural teeth healthy as an alternative!