Meeting Dr Drill - Part 1

[JimsKnight]

It happened many years ago, an action of mis-spent youth and a skateboard resulting in a deadened tooth nerve and a world of hurt for a few days.

Years later it came loose and the tooth was pulled.

The result - A huge gap in my mouth and a lisp! Not what I exactly planned for in lifes rich tapestry.

However the all helpful doc wistfully made up a fake denture and in it went. This was back in Europe but I always felt the need to completly make up for the lost tooth with a full-on implant.

You know the ones, Liam Gallagher had one done when a brawl resulted in him loosing his front tooth, less than a week later he had a titanium implant drilled into his mouth and a shiny new tooth where it's unfortunate predeccessor was.

They are pretty established on the dental scene and most places have them, even in the provincial cities.

Well today I started on the road to getting my very own replacement tooth. Back home the cost would be in the region of 130,000 to 180,000 baht for an implant. But here in Thailand the price is a more reasonable 60,000 to 100,000 baht.

I took the plunge, spoke to the Doc, asked him a bunch of questions, settled on a (rough) price and got booked in.

I make sure I get assurances that if there are any major complications he'll fix them free of charge, just in case.

First came some X-rays, no big deal there, then came the nitty gritty a few days later.

Now getting an impant is no simple process like a filling, but not overly complex either. The (upper) jaw bone may or may not be sufficent to take the implant directly, in which case a bone graft will be required. This sounds pretty drastic but its typically only a small amount (a gram or so in weight). This will add a few thousand baht to the cost. The other factor is time.

Thats right you have to have plenty of time on your hands to get an impant, once the implant is in place the Dentist has to wait 6 months before inserting the replacement tooth into the implant. So the typical 2 weeker tourist will maybe struggle if they are gunning for an implant.

However, shorter courses of treatment are available, but this will cost you more as the Dentist has to use a different type of implant (more sophisticated I guess). For me I opted for the, get-it-done-in-four-months option. This added another few thousand baht to the price.

Well today was D-Day for going under the knife and drill at the surgery.

On walking-in the hospitality factor was laid on, water was brought out but after a short period it was into the surgery proper to meet Dr Drill!

Dr Drill was, as I expected, Chinese Thai. He looked professional and clean-cut and after brief formalities it was down to business.

First came this green cover-thing that obscured most of my vison, at first I didn't really like this as I like to look and see whats going on but I suppose its a comfort-aide for the patient and prevents stuff getting on you etc.

Then came three injections, these didn't really hurt, except the last one in the roof of the mouth. I'm guessing they use ultra-fine needles that don't pierce the skin as much as the wider ones, or maybe I just got lucky?

The local anaesthetic took seconds to take hold, much faster than back home. After rinsing out the Dentist wasted no time, out came the knife and he started cutting back the gum to reveal the bone. This was the most disturbing part, for it took several deep cuts and was pretty crazy. I've had teeth drilled and root canal surgery done, but having the gum deliberately cut back and mildly feeling it was pretty new and radical for me. This was certainly going under the knife alright!

The anaesthetic (still working in) took care of 80% of the pain though and I only felt it a little bit. Dr Drill seems more Willy Wonka than sweeney todd and kept asking if I was alright, did it hurt etc etc.

After a minute of the knife treatment came the grinding part, which took an age. Then the bone graft was applied. This is important as there is a risk of the bone rejected it, hopefully not in my case though...

Then came the drilling for the implant. After a while I settled in, I was a bit apprehensive but not too worried. After this the Implant was inserted and the cut gum was stitched up and I was told to rinse out.

X-rays were taken and I got to take my first look at my new friend...

It looks pretty cool, in a bionic kind-of way I guess, but it is was it is and the titanium means it will anchor a new tooth in rock solid.

Several more appointments with Dr Drill were made to check up on the implants progress, although the implants enjoy a 95 - 97% success rate the implant still needs to be checked for the next 4 months. So its the waiting game now folks. My old denture tooth wouldn't fit in the recess due to the implant. No problem though as Dr Drill lived up to his name and ground the plastic denture down until it fit again!

As personal touch Dr Drill gives me his home phone number, the Willy Wonka treatment continues! Wondering if a golden ticket awaits on my next visit I take it, hoping I don't end up a screaming wreck when the pain-killers wear off or should the implant fail.

This is the cocktail of painkillers, anti-inflammiterys and anti-biotics I've got to take! dam_n, they never mentioned this when I was making my decision to get the implant

They also gave me the name of a powerful antibiotic (as they've run out) from the local pharmacy.

I paid half the 70,000 baht and left the clinic.

So I roll on down there, the numb effects causing a slight drool effect! Like after a filling but more so as he's injected me 3 times!

Shockingly, when i get to the pharmacy the extra antibiotics cost me 1,080 baht! I was a bit miffed but it's not like I can argue really.

But the next time I see Dr Drill I consider buzzing him on this and see if he can weave a discount, afterall, .

So now it's wait out the music to see what next week brings...

PS. The pain for the next 4 hours is nearly unbearable (mostly from the third injection) and the bleeding (from an injection, not the cutting!), while not bad, still is enough to annoy, but the extra painkillers I take help wonderfully though

[JimsKnight]

UPDATE:

Just been for two more appointments with Dr Drill.

Both times the ever helpful doc. took a look at the implant and is happy with its progress.

It's taken to the bone well, the graft is good and there's no pain either

All being well D-Day for the final showdown is in Mid-March time.

As I was leaving an elderly farang lady mooched about outside getting her footware off.

"Seven" said the receptionist chirped up cheekily.

Not quite understanding what she meant I asked her.

"She getting seven implants!" The receptionist giggled.

The pain of just one is enough, imagine seven of the suckers buzzing on in there

LOL.

PS heres the implant in all its glory

Edited January 11, 2009 by JimsKnight

[JimsKnight]

Ok, just went back for what I thought was the last appointment.

Went in, the first thing Dr Drill did was unscrew the implant.

Out it came, no real problems, took about ten or twelve turns so it's nice and secure in there.

Then a dummy implant with a fake tooth was fitted and impressions (top and bottom) were made.

This done the real implant was re-inserted. This hurt a bit as the gum had closed in a bit since it had been removed.

After a minute or two the pain faded though.

Then came the colour matching. For this I had a panoply of plastic toothes with shades from whiter than white to dark tobbaco stains!

Narrowing the colours down to one of two I got some light on the case and finally made my choice.

Dr Drill took a comparison as a second opinion and readily agreed.

All that remains now is for the tooth to be made up and it to be inserted.

Which should be (all being well) in about 2 weeks

[Comehome]

Hi!

I am in exactly the same process.

Will go to see my dentist on friday to have take new imprints for the final implant.

I also had bone grafting and it seems to heal fine.

I don´t want to make you worry but have you checked the brand of your titanium screw properly?

The best ones are the swedish ones however there has been a lot of tv-programs in Sweden regarding two manufacturers.

My dentist in Sweden is teacher in "dental implant" at the School for dentists in Stockholm and he has told me a few things about this.

They only use the screw from Astra tech and Straumann nowadays.

The others are not as good.

Acording to studies in Sweden, the absolut best implant screw is the one from Astra Tech.

The one from Nobel biotech has shown to be not so good. It makes the jawbone "softer" and often the implant needs to be redone within 5-10 years.

Nobel biotechs titanium screw is no longer allowed to be marketed in Sweden, but it is still sold and marketed outside Sweden.

I payed 75000 baht for my implants including all x-rays, medication etc.

Got the Astra tech screw.

Will get my final tooth in june.

Thanks for all the info, it is nice to know what and how other dentists are doing it.

[Comehome]

Hi again!

Need to ask something.

What do you mean when you wrote that Dr. Drill took out the implant?

(Ghaaaa...can understand if that hurt a bit!!!)

Did he take out the screw form your jawbone or do you mean the crown?

thanks,

comehome

[dotcom]

Thanks Jim. Might need this myself one day. Frickin dear. LOL about the pharmacy. You are just as kee neow as I am. Always watching the pennies. Hope it turns out well.

[JimsKnight]

Hi!

I am in exactly the same process.

Will go to see my dentist on friday to have take new imprints for the final implant.

I also had bone grafting and it seems to heal fine.

I don´t want to make you worry but have you checked the brand of your titanium screw properly?

The best ones are the swedish ones however there has been a lot of tv-programs in Sweden regarding two manufacturers.

My dentist in Sweden is teacher in "dental implant" at the School for dentists in Stockholm and he has told me a few things about this.

They only use the screw from Astra tech and Straumann nowadays.

The others are not as good.

Acording to studies in Sweden, the absolut best implant screw is the one from Astra Tech.

The one from Nobel biotech has shown to be not so good. It makes the jawbone "softer" and often the implant needs to be redone within 5-10 years.

Nobel biotechs titanium screw is no longer allowed to be marketed in Sweden, but it is still sold and marketed outside Sweden.

I payed 75000 baht for my implants including all x-rays, medication etc.

Got the Astra tech screw.

Will get my final tooth in june.

Thanks for all the info, it is nice to know what and how other dentists are doing it.

It is 14.5 mil of Swedish Astra Tech implant!

Edited March 22, 2009 by JimsKnight

[JimsKnight]

Hi again!

Need to ask something.

What do you mean when you wrote that Dr. Drill took out the implant?

(Ghaaaa...can understand if that hurt a bit!!!)

Did he take out the screw form your jawbone or do you mean the crown?

thanks,

comehome

He took the outer section AFAIK as the dummy tooth screwed into something solid.

But when he replaced it the gum flap must of moved a touch in the way.

[JimsKnight]

The Final Appointment with Dr Drill

Well the final day of reckoning for the elusive tooth was today and it was an interesting conclusion to the saga.

First thing was a glass of foul-tasting green flavoured water in reception.

Hoping this wasn't some attempt to sedate me I made my way into Dr Drills domain.

Firstly an allen key was unleashed to unscrew the implant cover plug/bolt.

This done a zirconium alloy rod bolt was screwed into its place where the threaded implant was.

This was unpleasant as the area was tender. The implant of course meant it was hollow but not at the edges, nor at the extreme depth of the thing either. Some gum had obviously been keen to re-explore and growth about the 'fringe-zone.'

So he had to root and twinge about somewhat. At first there wasn't enough 'gap' but he made some prods here and there and soon there was enough space for the rod to screw in 100%

Dr Drill was making several precision adjustments using a fine metal probe. Hooked like a scyle, pain images of Dustin Hoffman being put through his paces as the Marathon Man started to take form.

The pain irritation was annoying now, my eyes were glazing with tear-film but the worst was over.

A mini-torque wrench appeared and he manually torqued up the bolt. Giving it a last painless tightening-tweak the part was anchored in to a steel-like consistency.

Now the crown porcelain tooth was slotted over the rod bolt gently.

I was shown it in the mirror to see how it looked prior to afixing.

Colour match was near perfect and it looked good.

I quizzed Dr Drill about the tooth looking slightly angled compared to the real tooth next door but then was reminded the gum would grow to cover the angle up and all tooth looked like that in their natural state.

Inserting the tooth meant the marathon man tool had to be used again.

This wasn't hurtful though but aided the tooths insertion by 'tweezing' aside and away parts of the gum so the tooth could be slotted into place.

The tooth was then 'glued-in' using a plastic resin then, like a model airfix being assembled, Dr Drill held the tooth firmly onto the implant structure with both thumbs.

After a minute a new tool from Dr Drills arsenal was uncovered.

A ‘heat gun’ which used trigger-activated halogen light was buzzed around the tooth, nearly touching it, by the cute dental assistant.

It was bright too. A plastic orange clapper thing was held over it so not to blind or damage the eyes.

A senior assistant took charge after a while held it against the back of the tooth for 3 seconds, just to make sure I guess, I yelped as the heat of it shot up through the crown, rod and implant! Mind a-fizzing like a rocket she removed it quickly again. Obviously satisfying herself that the porcelain was rock steady in there and not going become unstuck.

This done I was told to bite down on this red plastic slide.

Clack!

Feels like I’ve suddenly grown one big tooth!

Dr Drill unleashed his trademark polishing drill. Whzzzzzzzzzzzzzzzzzz.

‘Bite down again’ he said.

'Ok' Clack! But still the bite pattern was uneven.

Whzzzzzzzzzzzzzz.

Third-time lucky I bite down. dam_n this implant feels mean man, like I could bite through a rubber air hose! Not quite jaws out of James Bond, but a level towards it

It was still uneven, but not by much.

I knew that if Dr Drill took off much more of the crown the tooth would stand uneven against the partnering one. Yet to get an even bite on the lower row it would have to be slightly off center otherwise the bite would be wrong.

Fourth time under the drill...

Whzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.

Clack! The bite was good. Not perfect, but nor were both teeth out of level either. Overtime the fine bite margin would even out.

I asked him what the procedure was to remove the tooth if the impant needed removing. The process involved cracking the tooth and discarding it due to the nature of the resin. Then the rod bolt could be accessed. It was trivia I didn’t really need to know, unless the crown was cracked/damaged but I was curious.

It was then explained to me, that a normal tooth has soft tissue between the tooth and the jaw-bone, giving it the slightly 'springy' feeling.

An implant was much more solid with no soft tissues between it and the jawbone. Giving it the dense, inner-hardened feeling.

This was certainly true, it felt wierd, like a different entity to the other teeth; stronger, elitist and yet somehow with more feeling and sensation than I first expected.

Implant details:

Upper - Titanium.

Lower - Gold Alloy

Rod - Zirconium (I think that's how its spelt)

Made in Sweden. Length 14.5 mm

I asked him about polishing procedures. For polishing the crown he advised telling a dentist about the implant. That was he could use an appropriate device not to damage/wear it away.

Some pictures followed for their records including an X-Ray.

No infection, bone growth was present/healed and all that was left were some farewells and making the last payment of 35,000 baht for a job well done!

I took Dr Drills email address just in case of later problems from the implant.

With that done it was time to get used to having a ‘real’ tooth anchored into my mouth for the first time in 2 years

No more worrying about a denture for separate cleaning and food getting stuck behind it, awkward removal when eating tough foods etc

Here’s the story by pictures:

After the first implant stage 4 months ago.

Goodbye to the denture!

Hello to the new tooth!

I recommend Dr Drill and if anyone wants to know more PM me and I’ll give you more details on this.

Edited April 1, 2009 by JimsKnight

[JUDAS]

Don't know whether to thank you Jim or scream. With my fear of dentists that read like a horror novel but it's actually something I'm considering

[simon43]

Jim, what was the reason for choosing this sort of implant, as opposed to a bridge? Years ago, I had 2 bridge molars installed in my upper jaw. (So basically a very good false tooth that is bonded to the tooth that is either side and has a small gap between it and the gum). The dentist told me that these bridges would outlive me - and so far, so good!

I suppose you needed an implant because yours is a visible tooth??

Simon

[taxexile]

i am also wondering why , for just one missing tooth , you were advised to have a complicated expensive implant rather than a simple and relatively inexpensive bridge.

a bridge bonded by means of a thin metal plate to the back of a tooth adjacent to the gap would have been a much easier option , it would have been painless and in most cases aesthetically just as good.

tooth preparation for this kind of bridge is minimal , often not even requiring a local anaesthetic , and there would be no need for antibiotics and painkillers.

from the photos , although they are blurred , it looks like your left central incisor was replaced with the implant.

was there some clinical reason that meant that an implant was the only option?

[JimsKnight]

Dude bridges aren't my thing, I've looked into them and don't like them. Very much a half measure to 3/4 measure.

Yes the tooth was/is a very visible one, being the main ones you see, not the incisor. Contrary to what many say, you can see a bridge as the plate sits at the upper (visible part of the tooth) and Dr Drill would have fck around with a perfectly healthy tooth. Not cool.

The Cons of a bridge:

* Requires removal of adjacent tooth structure to secure bridge in place. (Why I'd want to remove a healthy tooth to have a bridge fitted would be madness.)

* If fit is incorrect, the crown must be re-cast from beginning.

Here's the groovey advantages of an implant:

* Permanent and almost like real tooth (Damned tougher that's for sure!)

* Reduces change of bone loss (cool)

* Can be flossed and maintained same as real tooth (yo)

* No removal of adjacent tooth structure required to secure bridge in place (exactly)

Disadvantages:

* Requires surgery (Dr Drill cometh)

* Additional costs (pay the piper)

* Healing time required (not long, 3 - 6 months, but only painful for a few days tops)

* Rare allergic reaction to metal alloys may occur (you'd have to be very very unlucky).

Source: http://www.bangkokdental.com/EN/services_a...otrecompare.htm

Edited April 2, 2009 by JimsKnight