Last Monday Karin and I went into Vancouver for my second visit to the dental laboratory. The lab is making the crowns that will be mounted on the dental implants that were placed in my mouth last fall. My first trip to the lab had been for the colour matching, and this appointment was officially a “stain appointment”.

When I arrived, the technician had all six teeth sitting in front of her. Each looked like a pulled tooth without a root and was hollow inside. She used tweezers to hold each one up to my mouth to check the final colour, and had a palette of liquid paints in front of her to touch up the tooth. I had mentioned that they were surprised how white my teeth were last time, thanks to my diligent bleaching and avoidance of staining foods; and this time there were even more surprised that my teeth were now whiter. As a result, the technician had to use an even whiter shade as the final touch up. After painting each one, she put them in little oven to dry the paint; though I have no idea if it was heat, infrared, ultraviolet, or yet another option that dried the paint. I suspect it was just heat from the look of the device.

Just as the previous appointment had been rescheduled to give the lab more time, so had this appointment. I had been told on the phone that it was because of the need to make custom abutments; apparently the original delay had been while they waited for a part to make two custom abutments, but when they had called me last week to re-schedule they had already ended up making four custom abutments and needed an extra few days to make a fifth. I was naturally curious and asked exactly what was an dental abutment. The technicians were quite happy to have someone express an interest in their work, and the woman who was doing the colour matching was joined for the explanation by the technician next to her, who had done a lot of the work on my teeth.

I was shown the mold of my upper arch that had the gums removed and replaced with a pink waxy material. Since my last visit, hollow titaniuml tubes had been added in each tooth’s spot. It was explained to me that these were the abutments, which will be attached to the implants and then have the crown slide over top. Each abutment is shaved to narrow it at the end, almost making a sharp circle at the end. Of the six abutments, they had only been able to use one that was pre-machined, as my bite has my bottom teeth sliding behind my front teeth. Pre-machined abutments that stick straight out would hit my bottom teeth before the crowns were even placed over top, and they therefore had to make abutments that will allow my bottom teeth to slide behind them and the crowns over top without touching. This will be something new for me, as my bottom teeth have always hit my flipper, and my original childhood dentist had gone as far as to shave the top off of one lower canine. I will now have nothing hit when I close my mouth. They assured me when I asked that the custom abutments did not mean that they will be weaker in any way.

Both technicians were surprised when they looked in my mouth at the amount of gum growth as compared to the molds, and so I explained that it appears that I heal too good. Apparently a couple of abutments were very difficult to spot. They also warned me that with this many implants at once and the changes in my mouth both due to time and the pressure of the flipper while I was healing, there is a chance that all the crowns and/or abutments might not fit and I might have to come back again for them to redo some of them.

This afternoon I have an appointment at the 7Oaks Laser Dental Centre here in Abbotsford for Dr. Ajar to attach the crowns. It will be the first time since I was about 10 years old that I will be able to have a full toothed smile without a dental flipper. I guess I’d better go shave so that I can take some before and after pictures.

When I first blogged about my dental implants, I did so largely to let my family and friends know what was going on, as they all knew I was doing multiple trips to the dentist; but I labeled it More Than You Ever Wanted To Know as I did not figure it would be that popular a post for many. Little did I expect that it would draw me quite a few visitors that arrived through search engines, as people looked for information on either dental implants or dental flippers. I’m therefore going to try and update what is happening with my mouth so that people that may be researching can find more details.

Last week we traveled into Vancouver in order that I could visit the dental lab to have my teeth colour matched. In the past when I have had flippers made, including the one I am wearing now, the dentists have done the colour matching in their offices using a set of individual denture teeth that are each one shade darker than the next. Implants are a much more permanent and long lasting option, with the crowns that will be screwed onto the implants lasting approximately 20 years before they must be replaced. Dr. Ajar had informed me that I would need to go into the lab in Vancouver in order that they could colour match me under various lights, as the colour will look different under florescent light, incandescent light, outdoor light, bright sunlight, etc.

I was to have visited the lab several weeks ago, and should have had the crowns installed two days ago. When I did not hear from the lab to schedule the colour match appointment, I had the dental office inquire, and it was revealed that there were delays as a part needed for my crowns had to be ordered from Sweden. There was therefore no rush for the colour matching, and in fact they still did not have the part when I did go in last week.

The technician that examined my teeth did not use various lights as I had been led to believe, but rather had a ring light that appeared to be a full spectrum light. She also had two molds of my upper mouth. One which had pegs sticking out from the location of each implant, each one matching pegs that had been screwed to my implants during the molding. The other mold had the pegs and even the gum removed, and the gums had then been rebuilt using a pink waxy material. She did examine my mouth more, as she said the gums will have retreated a bit more as they further healed.

I have worked hard on getting my teeth cleaner and whiter than they have been in years, and it showed when the technician could not match my teeth from the initial set of shades, and instead had to pull out a small set of extremely white samples. She let me know that she was not matching the surface stains nor the enamel, but rather the dentin underneath. She then took out a piece of paper, drew several large teeth, and shaded with pencil different portions of each tooth to match my teeth, marking each shaded portion with the number of the corresponding colour she had matched. The end result will obviously be quite different from what I am used to; on all my flippers each tooth is one solid colour.

The visit ended with me using my fingers to pry my mouth open as wide as possible in all directions, showing both as much gum and as much teeth as possible; while the tech held the shades she had chosen next to my teeth while she took pictures.

The next step is a second appointment at the lab this coming Tuesday. They told me that the crowns will already be finished at that point, and this is to ensure they match. On the slip they gave me, the upcoming appointment is referred to as a “stain appointment”. I’ll provide an update on that visit.

I started yesterday with a visit to the 7Oaks Laser Dental Centre, where I go every few weeks to see Dr. Ajar, the Oral Surgeon who is fitting me with dental implants. This is my second visit since I last blogged about my dental adventures. I realize that many will not find this of interest, but my family may wish to know the progress, and I’m actually starting to get visitors from Google searches on dental implants.

It seems I heal too well. The last visit was to expose the screws that had been implanted and was awaiting me to grow bone into the threads of the screws. My body accomplished that goal, and also grew bone around several of the screw heads.

After a couple of weeks for the gums to heal so they were stiff to pressure, yesterday was time to go in for the final impressions for the model of my mouth that will be used to make the crowns that will go on the implants. But the night before, I could only count 5 healing abutments, which are the ends that had been placed on the implants during the last visit so the gums would heal with tooth shaped holes. Sure enough, I had overly healthy gums that grew right over the abutment that was supposed to keep such a thing from happening.

This all meant extra work for Dr. Ajar, and extra pain for me; but of course it is good news when you heal better than expected. All that is left now is that I will have to go to the dental lab, which is downtown Vancouver, to have them match my tooth shade. I’ve always had the dentist do that himself, but since this is so permanent, they will apparently be shining a bunch of different lights on me so that they can match my shade in fluorescent light, my shade in sunlight, my shade in incandescent light, etc.; and then average these. Then on March 17th, I return to the dentist’s office for the crowns to be attached.

Well once again I have not posted for a few days, and my excuse this time….

…. dental surgery.

I won’t give you all the gory details, but for you that did not know, I have been working towards correcting issues with my mouth that I have had for most of my life. Part of it stems from a bicycle accident when I was a kid that knocked out my right front tooth the same year it came in as an adult tooth. I blame it on the rural town Abbotsford used to be, as it happened at a major intersection which was at the time gravel. The tooth was put back in with an emergency root canal; but that only lasted a few years. I’ve been wearing a fake tooth since then on what dentist call a flipper; basically it’s a one tooth denture, or more formally it is a removable partial denture. I also chipped the left front tooth, I think it was in a separate incident, but the bottom half of the tooth was fake and needed to be re-done every 10 years or so.

As I kid I told the family dentist that the tooth on the right side of that missing right tooth was slowly rotating and slipping in behind the fake tooth. As new flippers were made as my mouth grew, they allowed a few more millimeters room for it to slip more. The accident also seemed to have stunted it’s growth. He told me, “Don’t worry about it, it will be ground down to a stub to support a bridge once you are old enough”. Once I was old enough (16) and went to him requesting a bridge, he said “That tooth has rotated and moved, you’ll need a couple of years of orthodontics to bring it back into place before we can do a bridge”. He said it not only as if I had never mentioned it, but as if he had not seen it moving. This from the dentist that was doing my exams twice a year.

To complicate things, my mother’s side of the family has an inherited condition (ok, that sounds bad, but I don’t know what else you would call it) whereby we have a few adult teeth missing. It will vary for each person as to which ones they are, and for me it is the two upper canines. Once again, I told the fantastic dentist we had that two of my baby teeth had never fallen out; and in this case he never looked in my mouth, but instead consulted a chart where he had X’d out all of my baby teeth. He showed me this as proof that they had fallen out, despite the fact that he knew my mother had three teeth that had never had the adults form. I’m assuming that she would have told him that her sister and mother were the same. As soon as I was old enough to choose my own dentist, I did, and during the first appointment I was asked if I knew I still had two baby teeth. They could tell as x-rays clearly show there is no root on the teeth nor any bud of an adult tooth under it. In this case, the flipper has helped as it keeps the teeth from wiggling loose and falling out like most baby teeth.

The result of all of this is, of all my top teeth from one canine around to the other, I only had one undamaged, un-stunted, not migrated too much tooth. My strong enamel has been of little help.

Armed with a dental plan and a new dental office that I like and trust, I am finally fixing my mouth. I am going to 7Oaks Laser Dental Centre in the Seven Oaks mall near my home. They are the first dentist I have seen or heard of in some time that only charge the “book rate” for procedures, which is the maximum your health plan will allow when figuring out their portion. Normally if your plan will pay for 85% of procedures, but your dentist charges 50% more than book rate; then you pay 15% + 50% out of your own pocket.

But in spite of their reasonable rates, they are well equipped, well staffed and very professional. In addition, they have on staff a Oral Surgeon, Dr. Amir Ajar, who comes into the office 1 1/2 days a week, visits a few of their affiliate offices also, and then teaches an Vancouver General Hospital, the main teaching hospital in the province. We’re pretty lucky that someone with his credentials comes out as far as Abbotsford; normally one would have to travel into Vancouver proper to see such a specialist. Dr. Ajar is handling the reconstruction of my mouth.

Because I had only one good tooth in the top of my mouth besides the molars, to put in a bridge would require grinding down to stubs the teeth are there plus the first molar on each side, and then using the stubs as anchors to cement an 8 tooth bridge from the first molar around to the other first molar. Even then I would run the risk of breaking one of the few anchor teeth in the bridge, especially since not all were in their proper position or orientation. Also, all bridges and crowns eventually have to be replaced as they are not as strong as real teeth, and prying the bridge off the stubs would involve a lot of risk of breaking an anchor tooth when that time comes. Instead, we agreed that implants would be my best route.

So last fall my four bad teeth and one good one were pulled, and six implants were screwed into the bone. My job since then has been to grow bone around them and into the threads. On Monday I went in and they exposed them, and either this weekend or next I will get the final impressions taken for crowns to be made. Within about a month, I will have the final replacement teeth in place. When they finally need replacing in the future, they can simply be unscrewed from the implants.

I look forward to finally being without a denture and with a straight smile, and Karin looks forward to kissing me without a denture. The one thing I will have to be cautious about is the roof of my mouth; it has been protected by the denture for so long that it has become tender and I easily blister when I don’t have it in place and eat hot food. To make it worse, with the protection of the flipper, I tend to put things in my mouth that would burn the average person’s roof, and so I will have to break that habit or really cause some damage.