Bite Point

Smudgepots and Ends of Eras

Blackwood, N.J. has excellent childhood memories for me. My grandparents on my Mom's side used to live there when I was very young. They had a great yard. They had a gazebo.  One time a cement truck came and, drum rotating with the apparent precision of the Earth spinning on its axis, poured something for them, probably the base of their gazebo.  I got gum stuck in my hair there and my Mom cut my hair as the only way to clean it up.  And more than once there was roadwork on their street, and they used Smudgepots. 'Toledo Torches', if you wish to employ Google. To my cousin and I- to two five year old boys- the dancing of their flames that never blew out in the wind was pure magic. I've seen the end of a number of eras in my day already, and to most of them I say a heretical good riddance. But I feel privileged to have seen the Smudgepot Era firsthand, and I feel sad that it ended.

Except! Now I own two Smudgepots of my very own. I fill them with Citronella rather than kerosene. And their flames dance merrily yet again, and delight us more than any ridiculous Tiki Torch ever could.

You will see many eras end in your life.  Popular culture saturates us with talk and information on the big ones, the vast sea-changing upheavals in our world that we must continually learn to adapt to and live with.

Then there are the small eras, let us call them micro-eras, that rise and fall around you throughout your life.  Favorite businesses closing.  Telephones changing from rotary to pushbutton to cellular.  The local parade that transitions from marching bands and magnificent John Phillip Sousa marches to just a bland flow of local politicos in late-model cars with obnoxious banners on their sides.  Dental amalgam fillings!  My Smudgepot example may seem a trifle silly to some, but dang it, the sight of a dozen or so Toledo Torches lighting up the familiar streets of home at night was a visceral, magical one.

Take note of the micro-eras that end as you go through life.  Tell your children about them.  Write about them in public.  And, when you can, keep them alive yourself.

On Writing In Public

“Do not stand idly by while your neighbor bleeds.” [Lev.19:16]

This ancient concept suggests a superb use for the newfound freedom we all have now, that blogs have given us, to write in public.  We no longer have to ask for permission from someone to publish something.  How many of you who do something that makes a difference are writing about it, in a public place?  Well.  You can help someone in this way, you know.  My main purpose in writing my blog is to send anticipated, personal, and relevant posts to my existing patients, so that they better understand things that we talk about in the office.

But it's also very popular in India and the Phillippines.  Who knew?

If you are doing something that makes a difference in the world around you, write about it.  The people you already serve will appreciate it, and you will also help others farther afield than you ever imagined.

Oh. Right. The Fear thing.

People who think nothing of jumping out of an airplane with naught between them and a sudden and violent death but some string and a piece of silk are often terrified of saying anything in writing that could be criticized, laughed at, or challenged by the legal department.

Oh, just do it.

Inform. Delight. Solve someone’s problem for them, or answer their question. And then simply let them know that you are eager to solve similar problems for their friends and family. 

"Put Those Teeth Back Where They Belong!"

In our practice, when placing dental implants, the most common scenario is to replace a single missing tooth.  We may extract a failing tooth and place the implant immediately, or we may fill the space where a tooth was missing for years, but looking back over our years of performing surgical placement of implants, I realize that most of our cases have been single tooth restorations.  We refer implant surgery (still doing the restoration of the case here) in cases where the sinuses must be manipulated, where the nerve and vascular canal in the lower jaw is a complication to proper implant placement, and in some cases where multiple teeth in a row are to be replaced.  The reason for referring multiple tooth implants is not so much the number of implants to be placed; rather, it is that the bone has often resorbed or dissolved away after many years of the teeth being missing; this effect is more severe when the span of missing teeth is long than when it is just one tooth wide.  The reason is that teeth (and dental implants, for that matter) are the main reason for the alveolar (tooth-supporting) bone to be there in the first place; take them away and much of the bone in our jaws dissolves away and flattens over time.  Getting this bone back is actually possible with our current technology and it's only going to get better and more predictable in the future.  The specialized techniques are complex and demanding however, and so for cases of extensive bone loss, we refer to our highly trained and trusted periodontists and oral surgeon colleagues.

To place dental implants and even to re-establish the bone that will support them requires one critical thing right at the beginning- the entire team must know precisely where the teeth are going to go.  This may sound elementary, but we dentists have all heard the stories of implants placed in the wrong Zip Codes with no communication between surgeon and general dentist, and then the poor restorative doctor who is trying to create teeth for their patient is forced to create structures that even M.C. Escher never dreamt of in an attempt to make things function well and look reasonably fine.

 

 

The best way to proceed when replacing multiple teeth with implants is to make a temporary removable appliance and create ideal form, function and appearance of the teeth involved.  Then, we can go about making a surgical guide, or stent, based on where those teeth were placed.  This gives the surgeon a very precise idea where to place each implant.  In cases of extensive bone grafting or sinus lifts, if even informs the surgeon about where she needs to regain bone for the patient.

Here is a model of a patient's mouth where some extensive implant-based tooth replacement has beed decided upon on the lower right.  Note how "low" the jaw is in that long span between the remaining teeth.  Bone grafting and implant placement will be complex.

 

Here is the interim removable appliance:

Now that the size, 3-D position, and biting patterns of the teeth have been established, a surgical guide is created, based on all that positional information:

There are holes that accomodate the initial implant placement drills:

 

There is of course a "Fog of War" element here and the surgeon can gain flexibility when needed by removing the inner half of the guide and gaining more freedom of the exact angulation of the implant placement.  Even if this has to be done, we know that each dental implant will be placed well within range of a position that allows a normally shaped human tooth to go above it.

There are also now levels of computer guidance of these techniques that enhance our abilities even further.  What I look forward to in larger cases is some kind of reverse-predictive software that comes up with a very close estimate of where the teeth and bone used to be, before teeth were lost and bone ran away.  This would be especially useful in creating dentures, where there are the fewest remaining anatomical clues as to where the arch of teeth really belongs, for the best esthetic and functional result.  This would be a highly useful tool whether or not dental implants were being used to stabilize full dentures.

If, as a patient, you ever decide to embark on a treatment involving dental implant placement of one or more teeth, make sure that your dental team is planning that treatment very thoroughly, right from the beginning. 

 

You really can't overstate its importance:

 http://www.youtube.com/watch?v=h6ep0hSOvPc

"Holy Molars! Am I ever glad I take care of my teeth!"

"True. You owe your life to dental hygiene. If only more people..."

Yeah. That just might be my favorite 53 seconds of television ever created by mankind...