It’s now April 2013. My most recent visit was a “twofer”.
I was first scheduled to visit the ceramics lab that will make my permanent. (I’d made the same visit in 2009 when I was having other cosmetic work done.) Per the coloring of my teeth, the teeth around #7, and because the tooth is so visible, my visit to the lab means they can take their own photos and plan for the variations.
(In 2009 the first attempt by the lab wasn’t right so I ended up driving to the lab to have them hand-mix and directly apply the coloring to the tooth while it was in my mouth. They then carefully removed it to fire and finish it. Again, as a dental nerd, I thought this was an amazing process!)
Luckily the lab had my prior work documented, which had been in the same area of my mouth. The lab owner took the photos and luckily proclaimed the coloring of my teeth hadn’t really changed so they would just need to duplicate the effort from last time. Yeah!
I then headed to Dr. F. where more impressions both with and without the temp were needed. This meant she had to drill all the resin out of the port to access the screw that was holding the temp in place! Drill, remove cotton, unscrew tooth, take impressions, then put everything back together. Deep sigh.
Because no one would believe me, I had to get a shot of the little dental ratchet!
Luckily, from last time, Dr. F. knew which resins and colorings were needed, so it didn’t take nearly as long!
I’m now scheduled for my permanent at the end of May. However, I think I’m going to delay it :( until the beginning of July when next year’s Flexible Spending Account at work starts over. Big sigh. The temp and permanent crowns alone more than maxed my dental insurance for 2013.
Dr. F says there should only be one more appointment. Then we looked at each other knowing good and well it was unlikely the color would be right on the first try. Thus, I’m definitely planning for 2 more visits! Right now I’m happy enough with the temp so it’s no big deal.
In March 2013 I was finally completely done with periodontist Dr. V and now under the care of only my cosmetic dentist, Dr. F. YEAH! I laid out my proposed timeline and as usual, she was happy to work with me in scheduling specific joint efforts on the same day so I would have fewer 2 hour round-trip drives to make.
In early March 2013 we had impressions made for my temporary crown. About a week later I return for her to remove the healing cap and attach the temp. As usual, I have a high-maintenance mouth.
The temp is usually glued on, but mine had to be screwed in. In cases like this, the access port in the temp (for the screw to attach to the implant) is on the backside of the tooth so there’s no visible points. Nope. Not me. My implant is in at such an angle the temp screw could only be accessed on the front. Sigh.
Once the healing cap was removed (with a screwdriver!), the area was again cleaned and the temp was placed. Dr. F then had to make sure to use the correct sized screw and attachment device. The screw was inserted into the temp and it was tightened by a dental-specific ratchet - no joke! (A photo of this will be in the next post!) Having grown up close to my dad in our garage/barn, I’m happy and comfortable around tools, so I thought this was pretty cool!
A tiny bit of cotton was then placed into the access port on top of the screw to protect it from the resin filling. The filling material was then applied to fill the access port, cover the screw, and give the look of a normal tooth.
Now since temp teeth are made out of a simpler, cheaper material than permanent crowns, there isn’t as many options for the coloring. Add to this the tooth is in the front/visible part of my mouth and my teeth seem to have a bit of color variation, applying the right mix of resins and cosmetic colors is a task. It took over 2 hours on this day, mostly dealing with 3 different attempts at the color. Sigh. But this is why I go to Dr. F., she’s not willing to settle!
The color was not perfect, but I knew it was a temp and it was good enough! Happily I was off to my conference and cruise vacation without that stupid flipper! In the photo below, even close up, I don’t think you can tell it’s a temp (#7). My upper gum didn’t drop like we’d hoped, but since my upper lip covers it even when smiling, Dr. F. felt there was no reason to consider more gum surgery.
(I still took along some dental cement, but never needed it. The screwed-in temp already felt stronger than my natural teeth!)
Very sorry for the extended delay, but the setback from Aug. put me in a long-term bad mood about this entire topic.
After speaking with my cosmetic dentist (Dr. F.) and considering periodontist, Dr. V., already knew my mouth inside and out (literally), I decided to stick with him for the remainder of the procedure.
In early December 2012 I was back in his office, again completely sedated with Halcion and Versed. As soon as I was conscious I made sure the implant had actually gotten placed this time! The implant post had been placed, my gum was sutchered completely closed around the implant, and I was still stuck with that stupid “flipper” for the prosthetic “filler” tooth.
My follow-up one week later passed with only minutes as all was well. I was now to wait another 8 weeks for the gum to heal and the implant to begin integrating with the bone.
While my primary concern was a successful implant, if at all possible, I had a self-imposed timeline set. I was to head off to a professional conference and then continue directly to my “Big Birthday Cruise”. A dream was to have that flipper gone before my travels!
I returned to Dr. V. in Feb. 2013 at which time he basically used a “hole punch” to access the implant post. (No joke. The hole punch, like you’d use for a grommet, looked just like a craft tool my friend bought at Michael’s!) He cleaned around the post and then attached, by literally using a tiny screwdriver, the healing cap.
I was now set to continue to have the bone integrate with the post, while the gum would heal and still allow access to the post. This healing cap was actually cool; I felt like a bad-ass rocker with a metal stud in my mouth!
The morning of Thursday, Aug. 9, 2012, I proceeded to Dr. V’s office for the insertion of the implant post - or so I thought. Per the sedations (Halcion & Versed), I was left with a memory blackout of 6 hours. I remember the traffic on 465 and then nothing until I awoke in BFF’s guest room at 3pm - and considering my memory - that is saying something.
I awoke to learn there was no implant; my driver was given no information about what actually happened during the procedure; and I received no follow-up call. At that point I was only confused and disappointed.
Apparently, there had not been enough bone (either from lack of growth or lack of bone graft material from the initial graft, I still don’t know), so there was not enough for either the needed foundation or cosmetic look to place the implant post. Thus, without my knowledge or consent (!!!), Dr. V simply conducted a second bone graft. I was incredibly angry at this realization. This means I’m back to where I was in April - waiting another 4 months for the bone to grow.
My breaking point, however, was Thursday, Aug. 16, the morning of my follow-up appointment. BFF stated the office had only taken part of the money from my payment envelope. Great, I thought, they must have only charged me a negligible amount for the 2nd bone graft since that had never even been discussed as a possibility in my treatment plan. As I grabbed all of my paperwork and my payment envelope, I discovered that the money taken was added onto my considerable existing credit stemming from the final insurance payment on top of my cash payment in April. All of this meant that not only had there been ZERO communication with me about the procedure, but I had been charged an additional $1100!!!
I was hysterical and definitely should not have been driving. Dr. V was almost entirely unapologetic - seriously - and laid part of the blame on me, having such high expectations for the outcome. (Are you kidding me?!) They also said they fully informed my driver (BFF). Really?! Because my BFF has been my BFF for nearly 20 years, so I’m definitely taking her word that they told her nothing. This entire situation had me in tears the entire day. I still want to talk to my cosmetic dentist, Dr. F, as she referred me to Dr. V. I will probably stay with him only so that he can finish what he started, but I really never want to see him again. Now I have to decide if I will book my (supposed) implant with Dr. V for the end of Dec.
The estimated total completion time to get me to my permanent crown is now around 16? months with an estimated cost of $7000+. Oh, all of the other things I could have used that $ for….
This week (Thurs., Aug. 9, 2012), I go in for my next procedure: the insertion of the actual implant post. After setting aside the flipper, an incision will be made and the implant post will be placed in my newly-grown jaw bone. Dr. V will then stitch it up for healing. I will go home for the same post-op as with the previous extraction and bone graft - icepacks, Vicodin, antibiotics, and Rx mouthwash. I’ll then wait another 3? months for the bone to attach/grow around the implant post. This also means I’m still stuck with the flipper (groan).
Within the past month, I’ve gotten very frustrated, as my perio (Dr. V) and cosmetic dentist (Dr. F) have not been communicating. I’ve gotten different answers as to who is doing the 3rd procedure (abutment), costs, and the new/surprise announcement of a needed 4th procedure! I’ll try to detail some of that later.
Ugh. It’s been 4 months since my first procedure. My lack of writing stems from not wanting to re-live this situation.
That Wednesday morning I took my two Halcion as directed. Remarkably, I didn’t really feel an effect, which is odd, since I’m usually sensitive to meds. The perio, Dr. V, asked if I wanted more meds. Duh - Yes Please! He gave me an injection of Versed and within seconds, I was OUT.
I barely remember him making a comment about the fit of the flipper at the end of the procedure. (We’ll come back to this.) Again, not really remembering this, they apparently got me in a wheelchair to get me out to the car. My brain must have kicked in, because apparently when I got in the car - again having no recollection of this - I hit the OnStar button and programmed my address (that my mom needed, since she’s directionally impaired). Amazing!
I remember none of the hour-plus ride home, only barely staying conscious long enough to get in the house, change clothes, and get in bed. I was out for a few hours and awoke to seeping stitches. Ewww. I immediately drank some Ensure just to get something in my stomach, as I couldn’t eat prior to the procedure and took 1/2 a Vicodin (as I’d never had it before). I was also having to try to get used to the flipper in my mouth, which of course didn’t fit properly per my incision. The flipper made everything even more painful since it was pressing on the incision.
Too soon I realized I should have taken a full Vicodin and started my militant schedule of Vicodin, antibiotic, icepack, and Rx mouthwash. Luckily all of that made me not very hungry.
The next day was the worst for pain. I obviously hadn’t considered my caffeine schedule, as the lack of it and all of this other stuff produced a migraine on Thursday. I knew I needed my Excedrin Migraine pills, but didn’t know if I could take those with the Vicodin. Thus, I had to call Dr. V while he was attending a conference. Nope - can’t take together. So it took a full day without pain pills and 3 migraine pills to deal with my migraine. Meanwhile, my mouth was throbbing. I was so happy to finally get to take a Vicodin that night!
Friday wasn’t getting any better, as this was the day the swelling topped out. My mouth felt HUGE! Luckily for my mouth (but not my waist), ice cream (& lots of it) helped make it feel better. Yet, the flipper was causing the most pain, as it didn’t fit right and was of course putting pressure on the incision. It was bad enough that it was waking me up in the middle of the night - even with the Vicodin. The flipper had to be in to help make the gum form the correct shape. Luckily, after the third day I was permitted to take the flipper out to sleep, which I have done every night since.
I was quite self-conscious going back to work on Monday, as my mouth still felt huge with swelling, but most people couldn’t tell (that much).
At one week I went back for my follow-up. Luckily, I seemed to be healing well, but confirmed the flipper didn’t fit well. That was the part I remember from the procedure; from that first fitting Dr. V demanded the lab make another flipper. So now I was waiting another 2-3 weeks to get the new flipper, which by now I really hated. My speech wasn’t as bad as I thought, but I had to be more conscious when speaking and definitely slow down.
When the new flipper finally arrived (90 minute drive one-way #3), it was like a new day. The new flipper fit great and reminded me of my old high school retainer. There is a “fake” #7 tooth and it has an inner gum plate and then gum “trim” around teeth 5-6 & 8-9, so it basically takes up 1/2 my mouth. Eating is slower, but I easily adapted. The only interesting issues are with pizza; I have to eat it topping side down, otherwise the cheese pulls the flipper away from my gum. Tiny bits of food can also get stuck between the flipper & my gum, but I can easily clean that off with my tongue in private.
While Dr. V didn’t recommend Vitamin D, I’m taking it anyway, as it had previously been prescribed by my regular MD. The bone doesn’t have the same shape as its sister tooth #10, but then again I still don’t have a “tooth” under the gum. So we’ll see.
At my consultation with Dr. F, we confirmed the implant option and I made sure I’d get the same Dr. F “perfectionism” as I received with my cosmetic work. We walked through all of the steps and I was realizing the implant would like a number of procedures and much more time than I anticipated.
Dr. F made my referral to a periodontist she knows quite well, Dr. V. Luckily, Dr. V’s office was willing to work in a consultation with me that same day to save me a trip down to Indy.
The perio office was luckily nearby and the staff was incredibly nice. In speaking with the hygienist/assistant, we went through my history, questions/concerns, and the fact my stitches were still in. One stitch was actually pulling on my gun and causing an open wound. After calling my endo and cancelling my next day’s appointment, the stitches were removed by the perio staff = yay! (Although that quick work meant I don’t have a photo.) Also, they used a relatively new topical numbing agent to remove the stitches; that stuff was amazing. It worked crazy fast, numbed nearly 1/2 my face, and wore office much quicker than normal! It felt so much better to have those stitches out!
As I was worked in between patients, I didn’t have a lot of time with Dr. V, but we had a thorough conversation. I’d done a lot of research, but he filled in many of the gaps. As feared, either per genetics or from the infection, I’d had bone loss around the tooth, which would require a bone graft. The bone graft significantly increased both the cost and treatment time. I was near tears at this point, but there was no time to waste.
Another x-ray was taken, as well as a bite and full-set of impression to create the flipper. Oh, the flipper - the basis of my worries. So here’s the low-down:
This Wednesday, April 11, 2012 I will take some sedation pills and be driven to the periodontist office. At this appointment Dr. V will try to remove/extract the (beautiful, custom-colored) crown on #7 (without breaking it), so we can try to color-match it for my new future permanent crown (again)! Then he will remove the remaining portion of the tooth and clean the socket. Then he will fill it with bone graft material, cover it with a membrane, and stitch it closed. This means I will be without a tooth! I will be given my custom-made flipper with a temporary tooth.
For my post-op (in the most conservative terms) I am not to talk and consume only a cold liquid diet for the first two days. Ugh. (Which is why I’ve been pigging out for two weeks.) The swelling is supposed to max out around day three! I will have a prescription mouth rinse, antibiotic, and Vicodin for pain. Ouch!
Yet, my biggest worry is not being able to speak properly with the flipper, especially in giving my speech at my honors student graduation event in 4 weeks. I will have a follow-up appointment one week after the extraction/bone graft procedure in order to assess my healing as well as make any needed adjustment to the flipper. Oh, and I forgot to mention, I have to wait 3-4 MONTHS for the bone graft material to “grow” and form real bone. I seriously need some “Skele-Gro” from Harry Potter!
Since this tooth is in the front of my mouth, I’m even more self-conscious about judgement from others. So if you are reading this, please take this vulnerability to heart.
Soon after the start of 2012 I noticed a bump above #7, located where the gum connects to the lip. Actually, it looked very much like a pimple. It didn’t hurt, so I didn’t think much about it. Also, I never have gotten canker sores, so I definitely didn’t know what it was. Perhaps I’d gotten some salt under the gum that had annoyed it? So anyway I went about my life.
It never went away.
So I Googled and soon self-diagnosed an “abscess”. I emailed (as always with great detail) my dentist, Dr. F. Almost immediately Dr. F responded that I should contact my endodontist immediately.Oh no.
At the consultation with the endodontist we reviewed the options Dr. F and I had discussed. Most likely there was an infection (even through I was asymptomatic) at the root tip (from a failed root canal) and/or the remaining tooth could be cracked. I had two basic options.
I chose the apicoectomy with the condition an alternative incision (Luebke-Ochsenbein, also known as Semilunar flap) would be used. In this, the incision is made near to the top of the gum so the gum connecting to the tooth (my very expensive, custom-colored crown on #7) is not disturbed. A hole was to be made in order to access, visualize, and remove the root tip.
Per the invasive nature of this procedure, I’ve learned long ago to ask in advance for sedation and post-op med options. So the morning of the procedure (Thursday, March 1, 2012) I went out for breakfast (although my periodontist has contraindicated this) and then took my two Halcion.
Although I was “out of it” I could tell I hadn’t been in the endodontist chair very long. About the only thing I remembered hearing was “crack in tooth”. That was all I needed to hear, as I knew the apicoectomy couldn’t be performed in this case. Worst of all was the realization that the (high expensive) implant was now my only choice. :(
The non-dissolving stitches were applied and I was sent home. The stitches that far up on my gum reminded me of the feel of having my braces back on. Also, for whatever reasons, the stitches extended all the way back to tooth #5! I was scheduled to return on Thursday, March 8, 2012 to have the stitches removed.
Next Wed., March 7, 2012 I was scheduled for a consultation regarding what to do next with my dentist, Dr. F., in Indy. (I didn’t understand why I needed to meet with her - & drive all that way - since we knew what the next step was.)
Here is the “AFTER” picture following work on #5-12! So much better! (Click photo to enlarge.)
Can YOU tell which are crowns and which are natural teeth?! :)
An individualized treatment was developed by Dr. F. (This was far better than the treatment plan from my prior dentist, Dr. A, who proposed 8 crowns for more than $7000!) My summer of 2009 was scheduled around these four post-root canal treatments.
July 8, 2009 - 4 hrs planned (over 5 hours in reality)
- While I had my iPod and the room had a TV, both Dr. F and I had to take a number of breaks on this appointment. It was one of the only times I was nearly at my wits-end at being in the dental chair for that long period of time.
July 29, 2009 - 2 hrs planned
- As a perfectionist, Dr. F was not happy with the color of the crowns for #7 & #10, which was the sole purpose for all of these procedures. Since the permanent crowns were porcelain (vs the heavier/stronger temporary crown material), Dr. F couldn’t try to adjust the color in her office. They would have to be sent back to the special dental ceramics lab. As I needed custom color to match the teeth on either side and the lab was just a couple of miles away, Dr. F put me in my car and sent me to the lab - with my filed-down teeth! All I could think was, “PLEASE do not let me get in a wreck with my teeth looking like this!”
I actually really enjoyed going to the lab and seeing how crowns, partials, etc. were made. (I’m such a geek!) Yet, the best part was the owner of the lab painstakingly created custom colors for my crowns and “painted” them WHILE THEY WERE TEMPORARILY PLACED IN MY MOUTH! That was so cool!
Unfortunately all that meant they had to be re-fired, sealed, polished, etc. So I had to go back home with my temporaries. :(
July 31, 2009 - 1.5 hrs
Aug. 14, 2009 - nearly 3 hrs
After so many hours in the dental chair and happy that Dr. F was willing to settle for nothing less than a superb outcome, my expectations were exceeded! With the final billing totaling over $5000 with nearly $4000 coming from my Flex account and out-of-pocket, I do think it was probably worth it?