ME: You know what I've been seeing everywhere are those weird little diagrams with those tooth with a screw in them? That go into --

DENTIST'S SECRETARY: An implant.

Yeah, an implant.

Hi-tech dentistry, it's the best way to go.

It just looks so -- like -- wrong. I mean it's like a screw --

Instead of having a root -- you know what, it sounds like. If you wanted to fill in a space like that, before implants you'd wear dentures or a bridge. They were expensive, and people didn't like them because they attach a lot of --

Old age.

Yeah. And plus you know, it's cumbersome, you have to take it out and wash it. The bridge is permanent, but you're taking the teeth on either side of that space and trimming them. You're trimming around, and a little off the top, so that you can have something to sit on it with a floaty tooth. And a bridge, to fill in one tooth, is almost two thousand dollars, where an implant is 27-2800 dollars. A little bit more, but...

Has anybody, um, it's just when I see the image, it's just the wrong way to present it or something? Because it is so robotic or something? It just has that bionic man kinda --

Oh, what's that guy, they guy with the mouth, with all the metal?

Jaws! Yeah. You guys do it a lot, I guess.

Yeah, we've had a few patients. We have a specialist who does the surgical part -- he does the screw, and Dr. X does the crowning part. That's usually about four to six months later. We have to wait until the bone, the bone sort of grows and attaches itself to the screw.

Is there an initial hole made, like you would for a screw?

The surgical procedure is --

Because it sort of has a flat end, it's not one of those pointy screws.

No, it's not. I hope they make an inital hole, otherwise: "Whoops! It went the wrong way!" [laughs] But Dr. Y is excellent.

[Other receptionist comes in.]

Do you find that a little disturbing, the screw going into the mouth like that, the side profile they show?

SECOND RECEPTIONIST: No, not really, I mean...

Hmm. OK.

I mean there's artificial hips and braces...

Yeah, but you don't see those images on ads in the subway. I think this is one of the only cybernetic [laughs] metal thing that that that is in the mass media. Cause they're advertising it. Maybe it's cause I'm a science fiction writer. I'm worried -- first it's the tooth, then it's the jaw, then it's the face --

FIRST RECEPTIONIST: Well, we have people -- we had a gentleman in here a few years ago who had his dentures -- OK, he had a ridge, that's all he had.

He had a gum ridge. An old fella?

Yeah. And he had his dentures -- permanently -- fixed.

Wow.

Screwed into the jaw.

Just 'cause he couldn't be bothered.

And you know, he had the money too. Or if you're missing four or five teeth, then you can get a screw on each side and you're not getting screwed for each, you're getting a unit.

Like getting a cupboard installed.

[Laughs] Exactly.

So did you get married?

Yes!

Yeah!

Yeah, I got married a week ago Monday.

Re-- oh my god. [laughs] You see, I have this weird thing in my mind, I remember you saying you were getting married in late October, and I thought it might have just been this October.

Nope, last year.

Right on. OK, well I guess I'll see you tomorrow.

OK. Bye Jim!

***

Have you seen those -- oh, of course you have. You know those diagrams of tooths, tooths with screws in them.

DENTAL HYGENIST: Implants?

When I see them they don't look very good. They look robotic. Do you ever get people reacting badly to them?

No, not to the diagrams. But they are a little bit robotic. Cause it's actually steel going into your bone.

I've become a little obsessed by them, I'm seeing them everywhere.

Plus they're a big thing right now.

Yeah they seem really popular... kind of weird as well.

It is weird, but it's a good, permanent solution. If you have a missing tooth.

No, I understand, it makes perfect sense -- it makes too much sense. It just looks so extreme.

I think so too. It takes a lot of commitment. Cause we have to really get in there and clean around the crown. They put a post right into your bone, and then they put a crown right on top of the post after. So you have to keep your gums really clean, because if you don't they it starts getting into the bone, and if you lose your bone then you lose your implant.

Wow.

Yeah, the bone can actually go right down. If the bacteria's there? It can eat away at the bone. [laughs] So if you're not gonna take care of your teeth, then you better watch out.

***

DENTIST: --a splint.

For now maybe not. Unless you think it's really necessary.

Necessary for not wearing down your teeth -- absolutely. Depending on what rate they go down -- they're not going to be out of your mouth -- but are they going to be that big, or that big. For 28 you have quite a lot of wear on the front. Musculature -- it's off. There is some movement. It will progress, I just don't know what speed it will progress at.

Can we sort of track it? For the next visit or two?

Sure, absolutely. To track the height of the lower teeth is difficult 'cause you can't count microns of wear. We can track how the jaw is doing, again I can put you on the JV8, that computer we used today.

You know, yesterday I was asking these girls here about these diagrams? Of the implants? I keep seeing them in the subway. The thing I was thinking recently was that if you couldn't read you might actually think that's how your teeth were secured to your jaw normally.

It's really weird. What a horrible way to tell people about what you do!

Yeah yeah! Exactly!

It's really about what the restoration, what you see in the mouth...

Right, from the outside -- from the inside, everything looks grotesque.

I go to lectures all the time on this stuff. What people want to know is that they can eat, that things aren't going to move, that it's better than a denture -- that when they can't have a bridge or any other option that's where they go. What people want to know is what the finished product going to be like.

Is there one guy in Toronto that puts this image out there, or...?

No, there's a lot of guys... We're dentists. We're really technically, scientifically based individuals. Not to mention, usually type As. We want that tech! A lot of us don't understand that -- you're not me. You've got a totally different mindset. I do implants also, but I would never advertise it that way.

How do you put it to patients?

When you can not have a bridge, we now use implants where we place a titanium screw into the bone and build up teeth again so they're as close to your natural teeth as science can possibly provide.

Right.

They are not your natural teeth, though. They do not have that 100 micron flex that natural teeth. So they don't feel completely natural, but they're the best thing that we've got right now.

Titanium eh?

Surgical titanium.

So that's probably the stuff that's used with like hip replacements --

Yeah! Actually, it was a dentist that figured out all that stuff. Cause he was doing some studies on blood vessels and he put that in to keep it open, to be able to look, and when he tried to take it out -- he couldn't! So he started studying that. And he said, "Wait a second, there's some really decent integration going on here."

Right, the bonding...

And he started figuring out how to replace missing ears, and eye sockets, and started getting into all that stuff.

So it bonds with bone? Or with the flesh around it?

With the bone. Actually, they believe the titanium oxide surface that's created on top is where the bonding takes place, not the titanium itself. But because you have mechanical retention in place, and you have such a close fit, that you get what we're after.

I see. Interesting.

What we're going to be doing, sometime in the future -- maybe by the time we're giving it into the big guy -- is we're going to be able to take embryonic cells and reform teeth. Boy, is this a fascinating time. It's really cool.

So there's a vague possibility that teeth could be entirely replaced.

A vague possibility. Right now you can not put it out there.

Of course not, because then all your patients would say "Forget brushing cause ten years from now..."

But think about it, ten years from now, what is that gonna cost you. And what is the success rate going to be? And that's the reality of it. All the new products that come out, you see them break. I try to be in the second or third wave because I've gotta replace them. I used my first porcelin bridge six months ago, even though they've been out for years.

Huh.

OK, we got two fillings done today. Do a little flossing, so all the basics, keep up with it. If the bite feels a little strange, please let me know. It just takes a little adjustment. If it's overly sensitive after four days, give a call. Takes nothing for me to fix it up, costs nothing to you.

OK, thanks.