November 5, 2007
The Mexican Connection - The Story of a Dental Implant

John R. Guthrie

Cervando Mendoza is a man of middle years.  He wears glasses and has an unruly shock of white hair which is parted precisely down the middle. When I first catch a glimpse of him, he’s gloved and masked, busy with the patient in one of his three dental chairs. Dr. Mendoza is a graduate of the dental school of Universidad Autónoma de Baja California and has taken post graduate work in the US and elsewhere. He practices general dentistry, but his special interest is implantology; the replacement of missing teeth with a cosmetically appealing and functional substitute. He’s done over 5,000.

His office is neat, compact, well-organized and spotlessly clean. It has massive picture windows that provide an intriguing view of the busy streets of Tijuana’s financial district. It is located in a combination bank building and parking garage.

He’s cordial enough when my turn comes, his English putting my feeble Spanish to shame. He’s also business-like, intent on the work at hand and efficient in his movements. His hands are as deft, hábil as Mexicans would say, as those of a concert pianist.

He checks out my dentition and nods to his assistant, Abba. She is twenty or so with hair like polished obsidian, eyes expresso dark, focused, but with a pleasant mannerism and a smile that’s better than any billboard for Dr. Mendoza. The sight of her working away recalls for me that the first evidence of dental implants was found in the remains of a young Mayan woman, also a twenty-something. Archeologists working in a 1,400-year-old Honduran tomb found a fragment of her jawbone. Three missing incisors had been replaced with ones carved, interestingly enough, from sea shells. Studies indicated limited growth of bone to the material of the shells, telling the archeologists they had been implanted while the recipient lived.

Dental implants have been attempted repeatedly in modern times, typically using one alloy of steel or another. No matter the skill of the practitioners, they were rejected, cast out by the body as foreign. It remained for Per-Ingvar Brånemark, an orthopedic surgeon and eventually Professor of Anatomy at Sweden’s Gothenburg University to bring dental implants to fruition. He noted that titanium devices were well tolerated by rabbits. Then in the mid-1960’s he carried out the first successful human trials. Bone not only tolerated titanium, but seemed attracted to it and grew around it. Brånemark labeled this remarkable ability of titanium to facilitate bone growth and adherence as “osseointegration.”

Titanium is now used for any of a number of replacement parts; hip joints, jaw     joints, the ball of the shoulder joint, the bearing surface of a knee as well as teeth. In times such as these, titanium has the additional advantage of being non-ferrous. This obviates the risk of setting off the airport magnetometer and thus being beaten about the head and shoulders by terminal security, water-boarded and flown on a chartered plane to Egypt for further interrogation.

Abba interrupts my reverie to make a digital X-ray of the area of the proposed implant. The roof of bone over the upper first molar on the left, number #14 in dental parlance, is also the floor of the maxillary sinus, a recess in the human skull best not penetrated. Dr. Mendoza steps over, gloved hands elevated, and scans the radiograph. He nods, a nod that is at once obeisance to Mdm. Marie Currie, Wilhelm Roentgen, and Henri Becquerel as well as evidence that the boney structure of my upper jaw is of adequate density and thickness to retain an implant.

Abba places a swab saturated with the topical anesthetic benzocaine against the gum, leaving it for several minutes. Then comes the injection. I wince from the sting of the lidocaine. The remainder of the procedure is painless both during and after the surgery. The dental surgeon uses three sterile drill bits, each successively larger, to provide an aperture in the upper jaw bone, the maxilla, for the implant. The drill bits look like what a maker of fine cabinetry might purchase at Home Depot except for the fine serrations on the business end. Using them attached to the dental drill, Dr. Mendoza created the opening, then inserted the threaded implant and seated it firmly with a miniature wrench. The implant itself is titanium alloyed with small amounts of aluminum and vanadium. Then a post is threaded into the recess in the implant and ratcheted down. It is made of a different material than the implant proper, one better suited for the adherence of the crown that will be added later. I note as I rinse my mouth that the rinse water is bottled.

Another X-ray is made to make sure that the implant is properly positioned. I’m asked to remain for a few minutes to insure that I’m steady on my feet. Eventually I stand and pay with my MasterCard as I depart. I’ve saved a substantial amount, more than enough to pay for my pleasant mini-vacation. I’m provided with a copy of my bill and a copy of the record of the procedure. I have my prescription for amoxicillin, an added precaution against post-surgical infection, filled in one of the two pharmacies at street level. In six months I will return and have a permanent porcelain crown placed on the post of the implant.

Is there a downside to all this? Possibly. Just as in New York, Los Angeles or Boston, it’s possible, no matter how flawless the surgeon’s sterile technique, to get a post-surgical infection. This may have varying degrees of consequences. This is not because I’m in Mexico, but because I’ve done something contrary to the laws of the god called nature; get a new tooth when the aging one failed. If nature wanted us to have new teeth as adults, we would grow them all of our lives like our distant cousin the great white shark. Also, an implant, even one constituted of something as congenial as titanium, can be rejected and occasionally is. Though tobacco is not a factor with me, tobacco users have a higher incidence of implant rejection, possibly because of the vasoconstriction caused by nicotine. And it’s possible to be struck by lightning when I emerge from the train in Simi Valley, or to fall down the stairs and break my neck on my return home.

I pick up my bag at my hotel, take a cab to the border and cross on foot (much quicker than riding due to U.S. border security). I feel optimistic about it all, and shortly I experience the immense pleasure that comes at the end of any journey, that of setting foot upon one’s native soil once more.  

With appreciation to:
Cervando Mendoza, DDS and Abba
2034 Benito Juarez St Office 602, 6th Floor
(Between Revolution & Madero Streets)
Dial (011-52664)+ 685-6414
Dial (011-52664)+ 685-2384
Web page: http://www.dentistsmexico.com

Dr. John R. Guthrie practiced family medicine in the Smokey Mountain foothills of Appalachia for years. As an adolescent he was a U.S. Marine infantry rifleman and later served as a physician in the U.S. Navy Reserve. He lives in Southern California and is a writer and social activist.


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