Getting Dental Implant Surgery

Ted Rothstein, DDS

I am an orthodontist practicing here in Brooklyn Heights since 1976. Occasionally I encounter patients who have lost, or will lose, one or more teeth for which I usually recommend replacement with dental implants. Being an orthodontist, I discovered, does not immunize me from dental disease. So when I realized I was going to have to lose two front teeth I decided to take my advice and get two implants.

Over the years I have had multiple dental experiences for cleaning, cavities, caps, extractions and gum surgery. Each of them has left me with a profound appreciation for just how uncomfortable and frightening dental procedures can be. Perhaps my story will help you÷it has helped me.

I am 60 now. About one year ago I began to notice one of my front teeth was loose (the upper left front and the second from the front tooth). On November 9th I went to the periodontist (specialist in gum diseases). He examined me and took some X-rays and recommended that the tooth be removed.

Loathe to let this tooth be taken from my head, I said, "Dr. Joe (he was 75), if I was your FATHER what advice would you give to me then?" He replied, "Leave it alone and forget about it." That was what I wanted to hear.

But my tooth did not forget that something was wrong. It became progressively looser and I was forever wiggling it back and forth, (testing to see if it was becoming more solid in its position). I could not forget it÷not for an instant. So about 3 weeks later I went to another periodontist friend who again examined and X-rayed me. This time he placed a thin pointed ruler down alongside the root of the loose tooth as far down as it would go and took an X-ray with the ruler in place. It went down, down and down until it was almost even with end of the root of my tooth.

The bone between my upper left front tooth and the one next to it had indeed quietly and painlessly vanished into thin air.

"Why not graft new bone into the empty space?" I asked. " Not possible" he shook his head with an aura of authority that could not be dismissed. He left me (I left his office) convinced he was right.

Furthermore, that I would have to lose not just one but both of the teeth.

Resigning myself to the inevitable, about one month later I went to my friend who is a specialist in oral surgery and on January 7th he removed the two loose teeth as easily as you might lift a marshmallow out of a sack of its fellows. I immediately felt is if I was 80 years old. I had this gaping space and sounded worse than Elmer Fudd.

I was a Boy Scout in my younger days, ("Be prepared that's the Boy Scout's marching song, be prepared...") so I had prepared a temporary bridge to fill in the gaping hole between my upper front teeth. (In fact, I prepared two of them). I let Christine, my office manager, bond it on when we got back to the office.

I would later find out that she bonded it on so well that only a pneumatic jackhammer, (the kind they use to break up old streets), could remove it.

When a dental implant fixture is inserted it has to be placed in mature (hard) bone. So I was advised that I would have to wait 10-12 weeks before the bone where the teeth were removed had reformed in the sockets left by removing the two teeth. I decided to allow the fourth-year oral surgical resident at the hospital where I am a staff member to place the implant. On March 7th I took a new X-ray of the site where the teeth had been removed and showed it to the surgery resident (Dr. Ned Nix who will be practicing in San Jose, California starting this June 2000). Dr. Ned said the receptor sites for the dental implants were sufficiently healed (resolidified)and he was prepared to do the surgery for implanting the fixtures. He said he had done about 40 of them altogether.

On April 14, 2000 I went to the St. Luke's Roosevelt Hospital site at 116th St. NYC and Dr. Ned did the implant surgery. Christine came along to assist and take photographs. In fact it was she who was enlisted to remove the temporary bridge she had inadvertently bonded on so well three months back. It took about 30 minutes to remove it (about how long it takes to remove a section of road with a pneumatic jackhammer). I re-bonded the second temporary bridge in place that same day later in the afternoon after the surgery. I bonded it on with LIGHT cement this time because Dr. Ned told me he wanted me to return to his office to examine the surgical wound and remove the 5 stitches he had placed. (Of course I would have to remove the temporary bridge to allow his evaluation of the healing site to be done carefully.)

I am writing this story three days after the surgery was completed, I have no pain at all. The day after the surgery I had taken two Advil and that was the only pain reliever I had needed. Joanne, the expert from the company who manufactures the implant (Nobel Biocare http://www.nobelbiocare.se/international/index.asp) had been present to advise Dr. Ned on the intricacies of the newest model of implant that had been selected for my case. She suggested that I would do best to apply an ice pack to my face for at least six hours after the surgery. I did not heed her advice.

The next day my upper lip was somewhat swollen and had my ego been more fragile I might have preferred not to venture out lest my local public see something amiss attached to my mouth.

However, in my opinion the swelling was minimal. As of today I have removed 3 of the 5 stitches that were placed to re-close the gum where it had been surgically cut open. Those stitches were driving me crazy and I could not help but keep rubbing them with my tongue.

Just about every oral surgeon and some periodontists have the expertise demanded to insert dental implants. I can think of a half dozen between the twenty blocks that separate Park Slope from Brooklyn Heights that can perform this service.

The cost of a single implant, and the prosthetic (false) tooth which is fitted on the implant, ranges from $2,900-$3,600. This method of restoring a missing tooth is very beneficial because it spares the teeth on either side of the empty space from having to be specially sanded/filed, which is a mandatory process when a dentist makes a "bridge" to restore the empty space. In addition, bridges often cause the gums around them to "recede" and require having to be remade every 10-15 years -- not so with implants.

For the next four-six months, the receptor site bone will heal around the newly inserted implant so that the implant fixture and the bone become one. This process is called "Osseo-integration." When it is complete the implant becomes rooted as solid as a rock and the general dentist will be called upon to create the false (prosthetic) tooth upon it.

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