Shadow Day with Dr. Folson

On Thursday I had the privilege to shadow Dr. Folson at his private practice. He specializes in periodontics and dental implant surgery. The concentration of periodontics focuses on the surrounding framework of the teeth. Before I begin describing the steps of the surgery, I must say that I had a fantastic day watching Dr. Folson work. He answered all of my questions very throughly and made sure that I was able to learn as much as I could. All of the staff were extremely welcoming and encouraging which I appreciated immensely. 

To begin the surgery Dr. Folson took preliminary X-rays to map out how he was going to approach the problem tooth. Next, the patient was administered local anesthetic to numb the right side of the mouth. Once the patient was completely numb, Dr. Folson began to extract the lower right bicuspid. The crown of this tooth was broken and the integrity of the tooth was compromised, so putting in a dental implant was the best solution. To achieve a better angle, for the whole surgery, Dr. Folson cut a flap of gum from the front to the lower right bicuspid. Most of the time he would not have to cut such a long layer, but the right lower molar had weak gum tissue and he did not want to disturb the area. After the tooth came out, he began preparing the tooth socket for drilling. He explained that you want to start off with a much more narrow drill and gradually get larger as you fit the screw into the socket. If you drill too shallow then the implant will stick out too much, but if you drill too far into the jaw bone then you can hit the nerve located in the jaw bone, causing a permanent tingling sensation in the patient. To avoid both of these problems, Dr. Folson uses the X-rays and computer software to measure exactly how far he needs to drill as well as which drill head to use.

Dental Drill

Various Drill Heads

Then Dr. Folson inserted the screw into the drilled socket shown in the image below. 

Screw, abutment and crown

Once he ensured that the fit was correct, he put a temporary cap on the screw while the implant heals. Implants can take months at a time to recover. Dr. Folson then used a bone graft in the surrounding portion of the implant before suturing the flap of gum he cut back into place. For the bone graft he used LifeNet mineralized bone granules shown below. 

Mineralized Bone Granules

For the sutures, Dr. Folson used PTFE sutures instead of black silk sutures because the surrounding tissue responds well and deters bacterial growth. These sutures can stay in a patients mouth for longer periods of time as well due to their biocompatibily.

PTFE suture

Dr. Folson gave me a copy of the before and after X-rays of the implant. 

Before is on the left
After is on the right 

I learned so much observing the procedure and I had so much fun. Below is a picture of Dr. Folson, the patient and myself after the surgery.

A special thanks to Liz!