What are dental implants like?
October 29, 2010 9:07 PM   Subscribe

I'm getting dental implants. Walk me through this.

I still have two baby teeth (bottom front) that don't have adult teeth under them. After a few years without seeing the dentist (I am 22 now), I pulled all my courage together and saw one last week. He said the same thing my pediatric dentist said years ago: I need two implants, and they need to happen soon. The teeth are no good, and could fall out.

Okay, it's a necessary medical procedure. Regardless, I am panicking and terrified.

What I know:
-He'll do a local anesthetic
-This will put me in debt for the next two years
-There will be drilling, into my bone
-I'll get some temporary crowns before the permanent ones in a few months
-I won't be able to bite into much until I get the permanent ones - he mentioned not being able to bite into a piece of bread(?)
-I am already considering canceling the surgery because hey, if my teeth fall out, then at least I don't have to pay for the extraction! And I can continue putting off the surgery.

One thing that helps my anxiety is knowing what will happen, and how I might feel. Any experiences with dental surgery, specifically implants, and especially if you have dental anxiety, appreciated.

(Also - is that last bullet point really a horrible idea?)
posted by quadrilaterals to Health & Fitness (22 answers total) 8 users marked this as a favorite
My mom had an implant done last year and didn't mention any problems eating. Neither did my friend, who also had one in the last year. My mom just had a local, my friend was completely sedated. Is that an option for you? Can you find a new dentist who will put you under or at least prescribe you some Valium or Ativan for the procedure?
posted by elsietheeel at 9:27 PM on October 29, 2010

Best answer: yeah, you can't skip the surgery, because having unfilled gaps messes up the rest of your teeth - i.e. they spread out to fill the horizontal space.

implants are no big deal at all, in fact they rock, because they last forever. you won't feel the drilling, and you'll have pain killers for afterwards. trust me, this is a good thing.
posted by facetious at 9:29 PM on October 29, 2010

Speaking as someone who put off major dental work for about 30 years because I was a bit phobic about dental work... let me say... DO IT !
posted by HuronBob at 9:35 PM on October 29, 2010 [1 favorite]

Best answer: If they fall out you will maybe end up with some kind of underlying bone damage in your jaw, which will require a bone graft before the implants. Which, in turn, will cost even more money.

Is there any reason you can't just get a bridge in front? I lost a bottom front tooth to a rogue piece of popcorn and subsequent abscess, and since I have an apparently tiny jaw, an implant wouldn't fit. I have a marilyn bridge and don't really have much trouble eating with it aside from my own nervousness about biting into really crunchy stuffs.

Anyway, I think his comment about the temporary crowns and eating is because it will actually be a flipper tooth and not an actual crown attached to anything. These look like single tooth dentures and are really annoying to eat with.

I have a couple of implants in the back left side of my mouth that were super traumatic, but that was mostly due to bad infection/abscess/bone graft madness. If your jawbone is relatively healthy it should not be a big deal.

stupid fucking teeth why you do this.
posted by elizardbits at 9:37 PM on October 29, 2010

Best answer: I don't have experience with dental implants, but I have experience with having to deal with emergency dental procedures, so let me answer your question in the last bullet point.

If your teeth fall out, you're right, you won't have to pay for extraction. However, what you gain by going through the surgery is control over when it happens. You now know what it costs, that you can afford it, and that your dentist can take care of it within a specific time frame.

If you wait, your teeth could fall out when you don't have the money to pay to fix it, meaning you'd be walking around with two missing teeth. In a few years, it might be more expensive, too.

If you wait, your preferred dentist might not have an opening to see you for several weeks, which means, again, you'll be walking around with two missing teeth.

If you wait, your teeth could fall out at a bad or embarrassing time, like when you're making out with someone you've had your eye on for a while or during a business meeting with an important client. (Or, when you're making out with your clients...)

I just think that it'd be must worse for your anxiety to have absolutely no control over when you can address this problem.
posted by MegoSteve at 9:43 PM on October 29, 2010

Best answer: Listen, dentistry doesn't freak me out at all. I go all the time. No problems. But when I had my wisdom teeth taken out, I was knocked out cold. I don't wanna know what they were doing, it took 45 minutes and a lot of tooth crunching, so it wasn't easy, but I was none the wiser. I woke up happy as a drunk clam.

I would absolutely not do this without being knocked out cold. You have obviously had this procedure explained to you, and no wonder you're nervous if all they're using is local anesthetic. Find yourself a dentist who does sedation dentistry. They are amazingly easy to find, because a lot of people are terrified of dentists.

You'll be knocked right out, they'll do all the hardware, and you won't know anything happened at all.
posted by sanka at 9:43 PM on October 29, 2010 [2 favorites]

I had a fuck-ton of dental surgery, culminating with an implant, back when I was a teenager (and the crust of the earth was still warm). It really ain't that bad. The temporary crown does kind of suck - mainly the anxiety about having one of your choppers made out of something so flimsy. Once you get the permanent one in there, you'll think it looks like utter crap for a few weeks until the trauma your gums went through calms down. After that, it'll look and function both splendidly. I had the crown wiggle loose from its metal post once; after ten minutes in the dentist's office, it was cemented back in place and has stayed there for a decade-plus.

Do it, man. There ain't a ton of pain (mainly discomfort and awkwardness) and you'll be part cyborg when it's over 'n done with. Oh, yeah: and your mouth will thank you for it.
posted by julthumbscrew at 9:45 PM on October 29, 2010 [1 favorite]

Best answer: IANAD, but these are based on conversations with dentists, hygienists, and lab technicians.

Most of the stories I've heard from people who've had dental implants have expressed no regrets with their decision. The implants are like their real teeth, and they don't have to take care of it in any special way beyond the typical day-to-day brushing and flossing (versus a bridge, for example).

The drilling into the bone of your lower jaw is to install the posts the permanent crowns will attach to. These are the implants. These metal posts will fuse with the bone in a few months and you'll get nice shiny new teeth to install. Depending on your dentist, he may or may not install the implants the same day as the extraction of your baby teeth. If he does not, you'll have to wait for the extraction surgery to heal before the posts are installed.

If you're numbed properly, you shouldn't feel any pain. You might feel some pressure, like someone pushing their finger on your body, but it shouldn't hurt. You'll definitely *hear* the drill, but that's about as uncomfortable as it should get.

During the first few days you'll probably feel some discomfort, a dull ache, and possibly some swelling as your mouth heals. You might be prescribed some painkillers, but some people just take ibuprofen or other OTC anti-inflammatory. I'm not sure when you'll actually get the temporary crowns, so you might have a toothless gap, or maybe a temporary retainer-type of appliance to "fill in" the empty space.

Your alternatives, if you choose not to proceed with the dentist-recommended implants, might include a bridge. This is usually cheaper, but it involves grinding down the two "good" teeth adjacent to the gap in order to cement the bridge. You didn't mention if the two baby teeth are together or not; if together you'll likely have a 4-unit bridge, but if not you're looking at 2 3-unit bridges.

Lastly, you could do nothing and let the teeth fall out, and if you leave the empty space there you possibly risk bone loss which would lessen your opportunity to get implants later on, or it would become a more-expensive and more-involved procedure.
posted by CancerMan at 9:47 PM on October 29, 2010 [1 favorite]

I have a little bit of a dental phobia, so take this with a grain of salt.

This sounds like an important and necessary procedure.

If you are contemplating avoiding it, I think you need to find a different dentist, who can work with your anxieties, and certainly give you options for local v. general anesthetic.
posted by freshwater at 10:26 PM on October 29, 2010 [1 favorite]

I think you should get a second opinion. My mother is nearly 60 and still has a retained front baby tooth. Did the dentist give you any explanation as to why the teeth are going to fall out? It's true that baby teeth don't have the strong roots permanent teeth do, but if I were you I would want an explanation why these teeth are supposed to fall out in the near future, since obviously they've already stayed a lot longer than most baby teeth.
posted by Violet Hour at 11:04 PM on October 29, 2010

I think you should get a second opinion too. I had four retained baby teeth. I did have them extracted, but didn't have implants or any sort of replacements. My other teeth have spread over the years and partially filled the gaps. But there is still a half-tooth-sized gap in each of the four places, which are not visible unless I open my mouth really wide. (They are the fifth tooth from the front in each case, so maybe yours are more visible).

I have never had any problems with the gaps.

The extraction itself was unpleasant (four teeth!) and the healing process was uncomfortable, but not unbearable. I had to eat soft food for a week or so, and over the next couple of months bits of tooth/bone made their way to the surface of the gap, so that was a bit painful too.

I bet none of it is as bad as you are imagining it to be, though.
posted by lollusc at 11:22 PM on October 29, 2010

Oh, and my dentist's reasoning for the extraction was not that they would fall out, but actually the opposite: he said they would sink into the gums, and eventually might fuse to the bone, which would make extraction more difficult in the future than it was at that time.

So again, I think you might want a second opinion on this.
posted by lollusc at 11:23 PM on October 29, 2010

Best answer: I had the same (rare) two front, lower teeth missing as you! At age 16 it was diagnosed, and at 17 I had them pulled. They then went on to put (which was new at the time) a Maryland Bridge (aka acid etch bridge) . The benefit of the bridge, at the time, was that neither teeth on either side of the gap needed to be crowned, (like a traditional bridge).

About 10 years later, I had to have it removed for orthodontics as an adult. The initial cementing was great--they had trouble removing it! After the braces were removed, I got a replacement bridge. It never stayed in longer than 2 yrs. at a time. I always had fear that I would aspirate it in the middle of the night, or when I was in Germany I was afraid to bite into tasty pretzels for fear it would come off. I avoided apples. I had nightmares about it. This went on for a long time.

Nearly 4 yrs. ago I finally got around to doing an implant. I say "a" and not implants because I didn't have enough space for two implants. Instead, they put one implant in, and it has what looks like another tooth right next to it.

I didn't find it a very difficult procedure. I was taken by my husband to the office, and just about an hour before the procedure I took (per my prescription) a sleeping pill and a sedative. The procedure was a fog.

I'm glad I did it. You are young. This is part of dental maintenance. They are in the front of your mouth. Invest in yourself!

Please feel free to MeMail me.
posted by 6:1 at 12:50 AM on October 30, 2010

I have implants and I agree wholeheartedly with, Be drugged. It's not painful, it's just uncomfortable -- bright lights and noisy/crunchy sounds and digging and strangers rooting around in your head, literally. I had a very light IV sedative, fell under when they were putting the gown around me and woke up when it was over, feeling like I'd had a great power nap. My mouth was minorly sore. I had no trouble eating the next day, although obviously I stayed away from that part of my mouth for a while, naturally. Don't let your teeth fall out by themselves, stick with what the pros are telling you on this.
posted by thinkpiece at 6:25 AM on October 30, 2010

Best answer: I am in the midst of the implant process. I can't bite into a piece of bread (or an apple) but I can still cut one up and eat it. The first few days are the worst because you will be swollen from the work and imagine it will be that way forever. It won't. The swelling goes away and with the exception of not biting into large things, I can eat almost normally. Wearing the flipper is annoying but I'm getting increasingly used to it over time. I'm going out to a fancy restaurant next week. Two weeks later, I'm getting extractions for 3 more implants. It's not the teeth that are the problem, but the underlying bone structure. Repeated infection makes the bone withdraw and eventually, the teeth have nothing to hold them. So, why not wait until "eventually?" Because, with too much bone loss, there's insufficient remaining structure to hold the bone grafts to build the jaw back up and in that case you can't even get implants in that area.

Know also that I was absolutely traumatized at first to hear that perfectly good teeth will be pulled (not to mention the expense). I walked into the dentist with one problem and was told I had all these others of which I was unaware. I needed some time to adjust. I mention this because you should know that however it feels now, you get used to the situation and it becomes more tolerable.
posted by Obscure Reference at 6:39 AM on October 30, 2010

I have implants for my top two teeth. It took 18 months to get the process done, and having been through a hammer and chisel into my top jawbone under local, I highly recommend a general anesthetic. :) The flipper/denture kind of sucked, and made me self-conscious, but I got over it. I'd have been much less concerned about it if it hadn't been those two very obvious teeth.

That said, even friends in dental residency programs didn't realize it. They look great, work great, and (apart from cost) really do have zero drawbacks.
posted by kcm at 6:57 AM on October 30, 2010

I should also say that it took 18 months because it was a result of traumatic injury, so removing the old tooth fragments and the resultant healing process was almost half of that time. I also needed to have my jawbone ridge widened (ergo the hammer+chisel), so that was another few months.
posted by kcm at 6:59 AM on October 30, 2010

Best answer: I got dental implants a little over 10 years ago -- started the process when I was 19 and finished up right after I turned 21, but I had a lot more extensive work done than you. I have three implants on my upper jaw holding a bridge of nine teeth total. (Basically, I had your exact problem except with most of the teeth in my upper jaw.)

As far as the procedure: I was put under a general anesthetic (on three different occasions), and I wouldn't really want to have it done any other way. This is mainly because when I woke up there was kind of (what looked to me) a lot of blood all over the place. Most of it was on that paper sheet they put over you, but some had spattered on my clothes as well. I'm not sure what was going on when I was under, but I think I would have been freaked out with whatever it was even if I couldn't feel it. Suffice it to say, having metal drilled into your jaw is not a gentle procedure.

The temporary crowns: They were kind of half-assed and didn't really look very good. Yours will probably be less visible because of only two teeth and on your bottom jaw.

On not getting the surgery: your other options are to get a partial denture or a bridge, and there's nothing wrong with either of those two. (I had a partial from the time I was three, it wasn't a huge deal.) You definitely want to put something there, though, because the teeth around the space can move to fill in the gap in a surprisingly short time, making it harder to fix later.

After the surgery: There was surprisingly little pain. I mean, yes, there was some, but I had been prescribed some pretty powerful painkillers which totally took care of it. I didn't even need to finish the bottle.

In the long run: If your teeth look good and nothing goes wrong, implants can be great. They're like your real teeth and you never have to think about them again. If something does go wrong -- the implant gets infected or the teeth look wrong or something, it is way more expensive to fix. In retrospect, I would have gotten a bridge rather than them implants since I have been unhappy with the way the teeth look but keep putting off getting them fixed due to the cost, which would not have been as much of an issue with a less complicated solution. Since you have only two teeth to worry about though, I think the risks of it turning out not so well are much lower.
posted by frobozz at 8:31 AM on October 30, 2010

He said the same thing my pediatric dentist said years ago: I need two implants, and they need to happen soon.

Just want to address this: both my pediatric and adult dentists up until the time I got the implants were very careful to explain to me all the options (dentures, bridgework, implants) many times before doing the implants and made sure that was exactly what I wanted (and at the time, it was). If your dentist is only telling you about implants, or seems to be trying too much to sway your opinion in favor of them, I would visit another dentist.
posted by frobozz at 8:39 AM on October 30, 2010

Best answer: I have two dental implants, only on the top jaw (next to those big front teeth). Here's my story, hopefully some of it is helpful.

I was diagnosed with the weird baby tooth thing when I was 13, but had to wait until I was 21 to get the surgery (my jaw bone wasn't developed enough).

At the initial consultation, the surgeon took x rays and looked at my teeth (it was then when he told me I needed braces -- again -- to make room for the implants). Fast forward one year:

I had a total of two surgeries. Number one was drilling the titanium pegs into my jaw (they're so much shorter than you imagine... More like carpentry nuts than pegs). I was completely out for this surgery and they sewed my gums over the "nuts" before I woke up. I had to wear this dorky clear retainer thing with two face teeth in it for the next three months, while the doctors waited to see if my body "took" to the first surgery.

Three months later I went back to the surgeon to have the "nuts" exposed. I was only frozen for this part, and it was the worst sensation ever. No pain, but the sensation of them cutting through the gums to expose the metal bits was awful. At the end, they screwed longer pegs to the nuts (for the crown to attach).

After this, I headed to another dentist to get my temporary crowns. For six months, they had these lame-ass teeth attached to the pegs. I was in university at the time, and I remember them falling out/breaking at least once per month (once during a class presentation). The dentist was quite a distance away from the campus, so this 6 months was the worst part of the whole process.

I have the final crowns in now, have for the past three-ish years. No issues at all with breaking/falling out. The only thing that really bugs me is that the fake teeth are a permanent colour. So no whiting strips, etc.

I've never regretted getting it done. Even though it took forever and a buttload of money, it's worth it.
posted by Cat Face at 9:56 AM on October 30, 2010

Response by poster: You guys are great. I'm going to get a second opinion, and at least see about twilight sedation or a general before going ahead with the implants. I am also now convinced that "just letting them fall out" is a baaaad idea. I'll be back in this thread whenever I can't sleep for the anxiety!
posted by quadrilaterals at 1:30 PM on October 30, 2010

as an adjunct: a frozen pack of peas (or lima beans, or something similar) is your friend! keep ice on the area after the surgery to prevent swelling & bruising. the first time i had an extraction done (two teeth next to each other) my jaw swelled so much that it was almost to my shoulder. a friend thought i'd been in a car wreck. it was not. pretty. the culprit was less the surgery than my lack of follow-through with the ice packs. (i took pain meds & went to bed when i got home instead of switching out my ice pack every 20 min or so (20 min on, 20 min off, that is.)) the next extraction, i had an elastic headband that i used to secure the frozen peas to my jaw--yeah, it looked mega-goofy but it worked & it left my hands free to cruise the internet. almost *no* swelling & bruising!

i've had 3 implants lower right back jaw, and just had a post set for lower left eye tooth implant. my mouth is in better shape than it's been for ... many years ... and i don't regret it one bit. yeah, it's costly, but it's also permanent (if you take care of it). well worth the money. split the cost over the next 60 or so years & it comes out to be pretty damn inexpensive.

good luck!
posted by msconduct at 8:27 AM on October 31, 2010

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