My Tooth Implant
Short Version
I had my right front tooth extracted. Now I have an implant around which my bone is healing for the next few months. After that, I'll have a shiny new tooth.
Long Version
For several years my right front tooth ("crazy number eight") would sometimes ache at the root, and a few years ago I noticed that there was some inflammation of the gum above the tooth (not directly above; a bit higher). My dentist at the time said it was a fistula and said it would be a good idea for me to go someplace else to check it out, but I didn't.
Diagnosis and plan
More recently when the tooth started bothering me, I went to my current dentist's office to check it out. They said that there was significant resorption of the root and that I would probably have to get the tooth extracted. They also helped me set up an appointment with the endodontist, who would be able to determine whether the tooth could be saved with a root canal. He said that he didn't think he could do it well; if he did a root canal, he figured it would keep getting infected. Instead, he recommended I get the tooth extracted and get an implant to replace it.
Random tangential complaint: communicating with the endodontist was pretty slow, though I did eventually get the important information out of him. He tried to simplify his explanations, despite the fact that (a) I obviously wanted more details (he'd say "what you call a 'fistula' older people would call a 'gum boil'") and (b) his simplification amounted to repeatedly drawing a parallel with other parts of the body, as if nobody without a dental degree could understand the concept of an infection in part of the the mouth.
Why extract it if it wasn't bothering me too much? Because the tooth was getting infected, and the infection was eating away at the bone surrounding the root of the tooth. Since that bone is what supports an implant, the likelihood of success of an implant would drop off if I didn't do it soon.
Why an implant instead of a bridge? Every dentist I talked to about this problem would look at my x-rays, and then promptly ask if I'd had some trauma to the tooth. I didn't, as far as I know. But if there was some trauma to the tooth, it may have affected adjacent teeth as well. A bridge would require shaving down the adjacent teeth a bit, and then those teeth would have to bear the load of the missing tooth. If they already had some damage, that would be a bad idea. Anyway, my upper right canine (number 6) is way out of line (see pictures below), so stressing tooth number 7 isn't a good idea.
So I set up an appointment with Dr. Rene Ghotanian to make a plan for what to do. After a quick review, it seemed like the extraction/implant approach was the only reasonable way to go. But to make sure we had a good understanding of the extent of the bone damage and the shape of the fistula, Dr. G asked me to go to a nearby dental imaging place to get a CAT scan (I'm also a "Dr. G", but for the duration of this page, "Dr. G" will refer to Rene Ghotanian). Aside from that, the CAT scan also (a) was really awesome, and (b) showed that my wisdom teeth were really close to my mandibular nerve. This meant that so long as they aren't causing any problems, it's best to leave my wisdom teeth alone, since extracting them risks permanently damaging the nerve. Incidentally, several months earlier, Dr. G had given me the same advice about my wisdom teeth, but without the extra knowledge about their proximity to the mandibular nerve.
Dr. G did an awesome job of explaining everything I wanted to know. Though I'm sure he goes through the same spiel about extractions and implants quite often, I felt like he [Todo: resume here]
Ordinarily (e.g. for a molar), the extraction/implant plan would be roughly as follows.
- . Extract the tooth and
- . fosd