This was pierced with a pre-bent needle held in a clamp, followed through with a captive bead ring. This had to be done a second time, when the first one rejected.
The second one only lasted a few months before it got rejected as well, surfacing toward the front. The ring tended to look nasty, with a mucus bubble on it, and it was cleaned for this picture. I also had trouble with it flipping forward, up on the back of my tongue, so I had to literally swallow it down into a more comfortable position. I do not have a gag reflex.