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At long last, the series of dental procedures to replace my baby tooth have completed.  Last Wednesday, I went in for the final appointment where the dentist set the crown (the artificial tooth) onto the implant. 

About 3 weeks before, I went in to get fitted for the crown.  Unexpectedly, this turned out to be one of the more unpleasant parts of the process.  The main part of this process was taking wax impressions of my teeth that a lab would then be able to manufacture a properly fitting crown.  To do this, they stuck a fairly large wad of the wax impression material into my mouth, had me bite down, and then I had to keep it in place for about 10 minutes or so until it set.

They started off by taking the impression of my upper teeth (the implant is on the bottom).  This was kind of uncomfortable, but not too exceptionally bad.  The worst part was that the wax had a very slight, strangely spicy flavor to it and I found that it kind of burned my lip a bit while it was in place.  While waiting for the impression to set, the staff left me alone in the room and went off to gather supplies and/or tend to other patients.  For some reason, I kind of felt oddly self-conscious during that time.

After the upper impression was completed, they next took a couple X-rays to verify the exact angle and positioning of the implant.  I thought it was interesting, and encouraging, that while reviewing the X-ray, the dentist spontaneously exclaimed that the oral surgeon is “a master”.  Apparently, the implant was very precisely and cleanly positioned, creating a pretty ideal situation for the placement of the crown.

Next, the dentist removed the “healing cap” that had been placed into the implant.  This was actually the first that I had realized that the metal disk-shaped piece that had been in place was actually temporary.  It made a lot of sense, but it was something that I had somehow simply overlooked or misunderstood during the previous appointments.  This cleared up something I had really been wondering about, which was how the crown was going to fit over this disk, which seemed to extend a bit too far past the edge of my other teeth.

Once the healing cap was removed, he placed a fairly large metal piece into the implant that was used as part of the measurement process for the impression of the lower teeth.  I’m not really entirely sure what this actually was, but it was the part that was especially unpleasant.  The reason for this is that the big metal piece prevented me from fully closing my mouth or from putting my teeth together.  This had to remain in place until they completed the impression, which was done in a fairly similar manner to the upper one.

The lower impression was especially rough as it had the same basic problems as the upper one, plus the added discomfort from the metal piece.  At the end of the waiting period while the wax set, the hygienist came in and removed the impression, having to do some maneuvering to pull it out around the metal part that was in the implant.  The dentist then came in and immediately asked her how she got it out without removing the other part first.  He then examined the impression and confirmed that it had been ruined and would have to be redone!  As much as I disliked having to repeat that part of the process, I admit that I actually felt kind of sorry for the hygienist, who both seemed to feel really guilty about the whole thing and also had to endure a pretty strong scolding from the dentist.

Fortunately, for that replacement impression, the dentist came in and removed the impression material himself (after taking out the other instrument) and this one was fine.  The healing cap was put back in after that to keep something in place until the actual crown came back from the lab.  The dentist then pulled out a set of color samples that he matched up to my existing teeth in order to determine the correct shade.  It was actually a tad troubling to discover how yellow my teeth actually are when viewing the color outside my mouth that way, but I guess that comes with age.  The dentist did ask if I had any intention of ever getting my teeth bleached as a factor in deciding whether to go with a somewhat lighter shade.  I decided that wasn’t something I was probably going to ever do, so I went with the exact match.

They told me that it would take about 2 weeks for the crown to come back from the lab and made an appropriate follow-up appointment.  A few days later, they called and told me that the lab had called and said that they would need another week.  Coincidentally, I already had a long-standing appointment scheduled for that week for my six-month cleaning.  They were able to go ahead and schedule me for the appointment slot right after that one to put the crown on.  This worked out well from a scheduling/convenience standpoint, although it resulted in about 2 1/2 hours spent in the dentist’s chair, which is something of an endurance test.

They did the cleaning first, which was very routine, and then moved me to a different examination/procedure room for the crown placement.  The dentist came in and explained that they are usually able to do these without any anesthetic, but he did warn that there can sometimes be some discomfort as the shunt is screwed into the implant.  The reason for this is that the shunt is somewhat thicker than the healing cap, which can cause a bit of pressure due to the compression of the gum tissue.  He said that some anesthetic could be used if I started having enough discomfort to indicate a need, but it never bothered me enough to be necessary.

The process was never especially uncomfortable, but it was fairly time consuming.  The dentist fairly repeatedly had to place the crown on, take various measurements of how the bite lined up, and then remove it and trim it down a bit before trying again.  The measurements were done using small strips of marking paper that would leave guide marks on the crown. The trimming of the crown was done using a dental drill, but thankfully it was all done on the counter and not in my mouth. 

Once he had the sizing correct, he took the crown into another room to polish it up.  I presume this was basically to take away any roughness that was left behind from the trimming process.  He then came in and mixed up some special dental cement that would be used to hold the crown in place.  Once the crown had been cemented in, I then had to bite down on a small Styrofoam cylinder for a few minutes to let the cement harden.  The dentist then gave me a few instructions about how to properly clean the area around the implant/crown and also warned me to be particularly careful during the first 24-hours until the cement fully set.

After about 8 months without a tooth in that spot, having one there again is taking some getting used to.  Initially, I was feeling a bit of pressure against the adjacent teeth and the gums, almost as if I had something stuck between my teeth. That feeling pretty much went away by the next day, probably as the gums and teeth adjusted to having a tooth there again.  The other part that I really have to get used to is that the new tooth is full-sized.  I’ve always had the smaller baby tooth in that spot, so the bigger tooth is a definite change.  Finally, the crown is pretty much completely smooth without the ridges that are typical across the top of a real tooth.  Over the last few days, I’ve had to keep periodically reminding myself that this is normal and doesn’t mean that I have something stuck to my tooth.

The only thing that still is really unresolved at this point is how much all of this is going to cost.  Despite the fact that several months have passed since the implant was done, I still haven’t heard back a final determination of how much the insurance is going to pay and how much I’m going to owe.  It seems that the oral surgeon’s office is being exceptionally patient about that, although I suppose that they are probably used to this process taking a long time.  After the crown was put on, the dentist indicated that they were still waiting for a response from the insurance company on that work as well and that they would bill me once they new the correct amount.

Obviously, this has been a pretty long and difficult ordeal, but I do think I am way better off with this implant than I would have been going with something more routine like a bridge.  Aesthetically, the implant and crown looks pretty much just like a real tooth and, once I get used to the few quirks, I think it will pretty much feel like one as well.