couldn't nail this one

abridged version - endo #26, MB2 canal, calcified, couldn't do it this time, had to send to my endo guy. well, at least i FOUND the MB2, that made me feel better.

rats.

it's just been that kind of day today!

holy crap, is that what i think it is?

so i'm ready to restore my next implant case, a really great one because it's tooth #11 and we've been bleaching him, so i'm all over that procera thing and i'm very excited. implant was placed in a one stage surgery under IV sedation, as this patient has a history of syncopal episodes in the dental chair (and i REALLY can't wait to do the other two lower PFM crowns that are in the treatment plan - i'll just have the paramedics wait by the door).

he's a very nice guy, so we make our chit-chat and i seat him and i have my armamentarium ready to go. it's an anterior tooth, so i'm expecting that the surgeon placed the implant a little further below the crest of bone so we get a nice collar of gingiva to help obtain a aesthetic emergence profile for the crown. now, these healing caps are placed good and tight, so i always tell the patient to expect a little pressure when i'm de-torquing the thing.

"don't worry, the implant isn't going anywhere."

so i use my driver and move counterclockwise, and the patient says, "yikes!" and starts to sweat, his color a little off, too.

"are you okay?"

"yeah, just really dizzy."

crap. so we put him in trendellenberg, give him some cold water, and place a cool, damp washcloth on his head. i'm freaking out, i've never had a patient pass out on me, and i really don't feel like utilizing the info i've learned in my medical emergencies course. not today, anyway.

"wow, that feels great," in response to the cold compress. "you can go ahead, now."

so i'm gently twisting, turning this healing cap and loosening it and i'm thinking, wow, i've never gotten this much resistance before, must be really tight! and i'm turning and turning and finally out it comes, and it's gray and awfully long and i'm like, hey, i've never seen a healing cap like that...wait a minute. after the double take, i realized what it was.

the implant was right there on the tray! i was pulling out the actual fixture!

"um, mr. poor patient, a minor complication here, seems like your implant has fallen out. i'm going to call dr. perio's office and find out what we can do for you."

"yeah, that seems like a complication to me."

we put him in a taxi, given his near-syncopal episode today, and he was accompanied by my office manager and his un-integrated implant. i'll be seeing him in 6 more months, hopefully.

i guess there's a first time for everything, right? i nearly shit a brick today!

My Celebrity Look-alikes

http://www.myheritage.com

time to pat me on the back, no?

so i know it's late and i have to be up and butt-crack of dawn tomorrow morning (when it will be dark when i wake up, dark when i leave, and dark when i arrive at the office, and that blows goats but what can you do?). but i've had a pretty interesting couple of days in the dental department that i'm kind of stoked about and i just wanted to do a cyber pat on my back for several reasons (to offset the fuck up post from a few weeks ago, as we need to strike a balance.)

- surgical extractions, swore i'd never touch 'em again. but something in me changed, and now i'm not afraid to pick up a handpiece or a scalpel and drill some bone to get the tooth out. i used to shy away from root canal treated teeth or anything that had more than one root and/or 50% bone support. but this past week, i did TWO, read that TWO surgical exo's on RCT teeth with no post-op complications thus far. all by myself, not leaving any root tips behind or calling the OS to bail me out. and i got to place sutures, too, which is cool because i kinda dig sewing a little bit. so i'm kind of excited to introduce this new "skill" i've decided to develop into my practice. my next step is to get really, really awesome at cutting flaps so i can start doing some minor perio surgery. but i'll still leave impacted 8's and the implants to the experts.

- endo time (ameloblast, this one's for you!). so my colleague hates, and i mean despises in all senses of the word, doing root canals of any type and refers most of them to our trusty endo specialist downtown. now, he's awesome, hey, he fixed my tooth (more on that later) but as a specialist he does charge quite a bit more and requires payment upfront, and some patients are strapped for cash and are hence hesitant to seek treatment at specialists offices. that combined with the fact that the office manager is putting gentle pressure on all of us to keep more procedures within our practice and the other fact that my endos are actually halfway decent, has driven her to refer some of her cases to me, which makes me feel pretty darn good. until i got a beast of one on saturday. silly me, she sent me this case weeks ago and i (wrongfully) assuming the case was a slam dunk because she referred it to me, never got around to looking at the radiograph until the patient was actually seated in my chair (around 45 minutes late for an hour and a half appointment, i might add). it was then that i discovered that this #36 had had a pulpotomy completed god knows how long ago, but the IRM was shoved all the way down into the pulp chamber sans cotton, and had made it's way down some of the canals. fuck, how am i going to get this crap out? maybe i should send this out. but wait, it's just IRM. let's back out of my comfort zone and see if i can actually pull this off. very slowly and gently, i worked my way into the chamber, flicked off peices of the nasty, old and hard IRM, got to the pulpal floor without perfing, and with a series of very small gates glidden drills and peaso reamers, was able to successfully locate and instrument all four canals. since he was so late, i was only able to complete the pulpectomy, but i set it up so all i have to do is some light rotary instrumentation and obturation when he comes back. that felt really good!

- two porcelain jacket crowns i prepped two weeks ago on #14, 15 were cemented and looked B-E-A-U-T-I-F-U-L. color was perfect, margins were sealed, everything looked nice. the patient was once in the russian army and had dentistry done with no anesthesia, so he was very pleasantly surprised when i completed all the work without hurting him and he left as one very satisfied customer.

i like it when things go my way. really. and just as i am quick to point out my mistakes, i will never hesitate to pat myself on the back.

hurray for me!

we're all grown up!

and i'm not just talking about cookie anymore, either. one of my oldest and dearest friends just gave birth to a beautiful baby boy on february 28! she was my roommate from college, and to think that the girl who i partied with, the girl who's shoulder i cried on and who's puke i cleaned up, the girl who was there the first time i got drunk and stoned (two separate occasions, i might add, and she was there and the supplier for both!), the girl who did a drunken handstand while wearing a skirt before she realized she went commando that night, the girl who i could look at in the morning and just know that she got laid the night before, and the girl who showed our whole campus the video of her skydiving topless, is now a mom. and i couldn't be more proud of and excited for her!

this one kicks off a string of births-to-be and future nuptials. my other old and dear friend (and you know who you are, girlie!) is due in early may, our best man's wife is expecting in july, and several of my hygienists and another doctor i work with are also expecting in the upcoming spring/summer months. there are so many moms-to-be out there! and i also just found out that my other buddy is planning on popping the question to his girlfriend. this was the guy who's toenails i would paint black (okay, he was/is a little strange but that's why i love him so much) and who was the first person to rush to my house to take me out for margaritas when i got my acceptance letter to columbia. he also used to carry his stash in a little kraft macaroni and cheese tin that had all these little cartoon dinosaurs all over it, and now he's going to be a husband and eventually a father. can you imagine!

and it's funny - i don't feel old, i feel TERRIFFIC! as i'm typing this, i realize what great friends i've made and held onto through all these years, and how lucky i am to have them in my life. some of them are quite far away, but only in terms of miles, and i'm so happy for them to be experiencing the tremendous joy that i've already gone through (and hope to be going through again someday soon!). i was the first to get my professional degree, get hitched, have a kid, and buy a house, and all of them were on the sidelines, cheering me on and supporting me as i plowed on. i can't wait to return the favor and i hope i can give at least half as much great friendship as was given to me all these years.

btw, this new little junior is on his way to full fledged stylin'. since i am a wannabe canadian now, i have to spread the cheer to my american family and i blew over $150 at the roots outlet. my friend went crazy for the stuff i got her, and they'll get tons of use out of them if they want to have more (hey, we have a whole bunch of roots stuff waiting for baby #2, good as new).

man, i'm just so giddy!