Saturday, October 29, 2011

Appointment 37 and My Provisional Smile

On Monday, October 24th I had my 37th dentist appointment since January 19th. On the agenda for this appointment was my last 3 extractions of the remnants of my 3 front teeth, bone grafts and my first implant placement, and also the immediate delivery of my provisional 5-tooth denture, or "flipper" upon extraction. This would be the first time I saw myself with the appearance of all my front teeth in nearly 14 years, though it was more like 17 since I first began to be self-conscious from cavities and began tightening my lips in all conversations with the world and suppressing my smiles and laughter around 10th and 11th grade.

I can't deny that I wasn't kinda nervous going into this appointment. Many of my actually painful, bloody and intense appointments took place months ago, and though I have not forgotten them, I have been lucky to experience several visits that felt more like art classes that Dr. visits. I also knew that though exciting, seeing myself with a different face after half my life was going to be surreal and awkward and hard to process.
It was a really busy, crowded and more "formal" appointment with a doctor performing the procedures and two students assisting, so this time unfortunately I don't really have many pictures, but I will describe the process as best as I can remember. On some occasions I may be incorrect as to what was actually being done, but I am going to describe what it felt like to me.

 First up we were performing my final 3 extractions on my front teeth numbers 8, 9 and 10. Here is one last "before" picture I took on the way to my appointment:

After 3 or 4 shots, one of which made my eyes water despite my overall fear of needles, including one on the palatal side which always feels awkward, I believe a long incision was made laterally across the gums to sort of create a flap of flesh on either side of my upper jaw bone. Though in the case of my molar extractions there were many times bone had to be filed down in order to get a grip on my fractured roots, great care had to be taken in this case to preserve as much bone and tissue as possible because it is the site of the weakest bone in my mouth and also because it will be visible in my future smile. Amazingly enough, though one of which was surely buried, the first two teeth came out quite effortless and faster than expected. The final one however would introduce me to yet another of my least favorite dental tools/procedures/sensations to add to the list, a perio-tome, which if I had not asked to see it afterward, I would have swore was like 10 times larger.

From what I understand my last root was somewhat stuck, and the perio-tome was basically used like a wedge between the root and the bone in several places to help break it free. I was thinking in terms of my wood-splitting experience as this was going on however, and though I knew we were trying to preserve as much bone as possible, I was envisioning as a much wider wedge that was in fact spitting my jawbone at all 3 tooth sites so as to pry it apart on the end and pull the last root out. I never got to see if there was actually a mini dental "hammer" or what, but it most certainly felt like a nail was being driven about an inch into my skull. It didn't hurt exactly, but because of bone conduction, hearing it reverberated throughout my whole head and it was entirely freaky.

All three teeth were out in probably a half hour though and we could gladly move on!
Next up we would be inserting bone graft material at the site of all 3 extractions. Though I am tentatively scheduled according to my treatment plan to receive a 2 implant-supported FPD (fixed partial denture), the middle site is still important because over time the bone can re-absorb/recede without a tooth in the hole. We want to prevent that hopefully so there's the least amount of gap possible between the bridge and my gums at site 9.

Bone grafts are a little weird. I have never really had any kind of major injury in my life and never had to receive any part of another person's donated body. I had never really imagined even of all those people donating their organs, that a small portion of someone might end up in people's mouths or help others, OR me, smile again. My particular bone grafts came in the form of bone dust that was mixed with water (or saline maybe?) and applied into my root holes after they were fully cleaned with a syringe. It was totally painless. I asked my new student dentist assistant Elif how my living bone could somehow attach to someone else's dead bone and she described it as acting more like a supportive "scaffolding." Perhaps more like a tressle for tomato vines to grow up? A guide? I don't know. I keep making jokes however, wondering whose bone I have in my mouth. Whether it might be some hot girl's pelvis, from the femur or a runner which will make me talk even MORE, or the cranium of a brilliant mathematician or something. Haha. Whoever it is, I am grateful, and I hope their bones and my bones get along.

After this to help guide the tissue to grow back in a more pronounced and uniform way across the formerly sunken in sites of my gums, a collagen membrane was applied covering the holes. It basically looked like a little inch-long piece of scotch tape. This felt particularly weird because Rakhee was using like, a little "spatula" thing to hold all that flesh away from my jawbone while the doctor was applying it. I'm not sure sometimes if my powers of visualization freak me out more that I would be if I was actually watching these procedures done on someone else or what. Upon completion, I received several stitches, and we moved on.

We tried my provisional denture in for the first time to see how it fit and determined that it would need to be modified slightly in order to not interfere with the healing tissue of the extraction sites before the day was over. Then we went to take my 3rd I-cat X-ray thus far to get a better picture of how my bone has healed over the past several months at my extraction sites before beginning my first implant.

The implant actually also went quicker than I thought, though there was one slight snag: my mouth is too small! We would only have time for one implant today, once again beginning the process with an incision at the site of tooth 30--my bottom right first molar. The Dr. then filed down the rounded bone slightly to create more of a broad surface to begin the first of several pilot holes, increasing in size. I asked to see the implant, which was 4.7mms in diameter and 13mms long, or about a half an inch. We continued on with more holes of increasing diameter, I think 3 in all, with the students confirming the angle and "perpendicularity" of the drill from their more advantageous perspectives. We took more X-rays to confirm with some other metal  piece in the hole as a reference, one of which happening to be my least favorite angled X-ray because in order to bite down on it hard enough to hold it in place it supremely cuts into the bottom of my tongue, this time from the taste I think making it bleed. During the final pass with the largest drillbit it was virtually impossible to get started at the correct angle because try as I might I could not open my mouth any further to begin the hole more perpendicular. The implant was screwed in very slowly with a cute little mini-rachet until it was flush with the surface of my jawbone, with each turn making a hard click that also reverberated through my skull. Upon the final X-ray it appears because of my small mouth it went in at a hair less than the ideal angle, but the roots of the adjacent tooth were also a little curved and it seemed actually perfectly in line with tooth 28. It was however, no big deal and will just require a custom abutment, or the joining part between the implant and the crown. More stitches to cover the implant with my gum tissue, my appointment was finally almost over! Today was a total MESS of tools and blood, and this wasn't even all of them used:
6 full carpules of Lidocaine, (3 for upper and 3 for lower) and 3 1/2 hours later, I was almost ready to go home. Rakhee made the modification to my partial and explained I needed to keep it in for 3 days in case of swelling it might not fit again. When it was first put in my mouth I think my tongue was so confused I could barely seem to make the sound of any consonants. It was incredibly disorienting, and I hadn't even seen it yet!

Being under orders not to lift or exercise for a week and under strict dietary limitations so as not to cause complications with the sensitive bone graft sites, I took the next few days off of work to rest and try to get accustomed to the sight of my mouth full of teeth again. This is, in fact, quite harder than it seems most people think. I've spent a lot of time in the mirror just looking at my mouth and making faces and taking pictures and trying to fight my perpetual urge for years of keeping my lips as narrow as possible in all conversation. I have come a long way over the past several months at opening my mouth, both to friends and strangers, wearing my story on my sleeve in regards to what was "missing" from my mouth. It feels like a different story altogether however finding comfort in teeth being put back IN. I posted a few pictures on facebook before I began to awkwardly make my new public debut of this new transitional smile.
A few hours after surgery.

I think some people may have felt that these pictures represented my "big finish" or something at first, and in order to clarify I wanted to also share the following few pictures I did not post on facebook. The teeth in the above pictures are part of a temporary partial denture, kind of like a retainer that just sorta pops in.

I think it kind of looks like an elephant!
It is not what my final smile will look like, and in fact I still have probably 6-8 months and about $12,000 worth of appointments to go. The purpose of this denture is to provide support to my other teeth throughout that time so they do not collapse. I'm sure it also will help to ease the transition in my brain, and also help me eat better once my sutures heal.

I have been wearing this crazy thing for five days now. Though it is getting a little bit more bearable in general, it is still very hard to overcome my public resistance towards speaking with perky enthusiasm and unleashing big smiles. I feel that some people are disappointed in me that I don't outwardly seem "excited enough" yet, but trust me when I say it is not that easy, and that I am working on it.

I have taken a few other pictures after resting and sitting with this new plastic friend for a couple of days that I feel look a little bit more natural to me, or just being playful. Here they are:
This is probably my favorite thus far.

And here is a pic, in case you are wondering, or maybe just because Halloween is around the corner and I have gore on the brain from watching zombie movies, of what is healing slowly behind this surreal new plastic smile:
That's all for now! I have a post-op appointment on November 7th and at that point hope to schedule my next 3 implants for early December providing everything looks good and the implant doctor is available, but now things are kind of a waiting game for me to heal and to raise the remaining $9K for the remaining implants and subsequent crowns to be mounted on them. So I guess it will be nice to have a break from so many appointments and stress over finding rides, though I am honestly going to miss my dentist. I'm sure that sounds crazy to some people! I am going to redirect my energies toward more fundraising events and catching up on a great deal of things I wish to write about in this blog I have been neglecting. Thank you for reading along, though I understand if some of the detail of procedures like in this entry may be monotonous, I am trying to be as thorough as possible in reporting all I remember, all I feel and experience to provide the truest account that I can for all of you wishing to know the story of this transformation. Thanks, as always, for all of your continued support and kind words. It is far from over. I hope to give you more to read really soon! Goodnight.


  1. Fuck yea, dude! It's getting somewhere! So great.

  2. The sepia-toned one (or maybe it's black/white; my monitor does weird things with color sometimes) is my favorite. I think you look super-cute in it.

    Also, a friend of mine just started a cross-country bike adventure and I thought you might be interested -- her kickstarter page (goal met) has the most info. It's here:

    But I think as things go on there will be more blog posts and stuff here:

    And her ride partner is documenting things here:

    Hooray for bicycles, and your progress.

  3. Honestly, you scared me a little, Paul. That looks like a tough and bloody procedure. You are so brave for doing it. Yes, you are from over; but you’ll get there and it will be worth it. :-)

    Nannie Livingstone

  4. Oh boy, that looks so painful. I’m glad it’s over now. But, you know, the pain is worth it! You look so much better now, Paul! I bet you can now smile and have a conversation with full confidence. Take care of that implant and the rest of your teeth. It feels to have a good set of teeth, doesn’t it? :) By the way, how are the implants? Are they still in good condition?

    Gunilla Cameron

  5. With the way you smile on the photos, who would have taught that you have monstrous teeth before? Guh, it must've been a nerve-wracking procedure for you! But, at least, you can now confidently show off your teeth to everyone. Your teeth is not for the Halloween, as you said, anymore. You can now be featured in a smile campaign or toothpaste commercial. :D