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Radical makeovers of our bodies or our environments have become a fixture of the new century. But many factors can influence any individual's decision to seek out and embrace this dramatic form of self-improvement. In the following case study, the patient had reached mid-life before a dental crisis started him down the path to a profound physical transformation.
For most of his life, Bill had avoided any significant dental problems. He'd never endured chronic tooth pain or the embarrassment of discolored or unsightly teeth; he'd never undergone lengthy treatment.
He did have physical problems, however, including a heart murmur and high blood pressure. Thirty years of smoking more than a pack of cigarettes each day had also compromised his cardiovascular system. At 53, Bill finally underwent a triple-bypass surgery, after which his doctor had prescribed a blood thinner. According to Bill, "the prescribed medications caused a loosening of his teeth," with ensuing bone loss and dental abscesses. As Bill's ability to chew foods deteriorated. he sought advice.
Faced with a diagnosis of periodontally hopeless teeth with advanced mobility, significant bone loss, and poor esthetics, Bill felt torn about what to do. He sought other opinions. Three years after his heart surgery, Bill returned to Pi Dental Center for another comprehensive prosthodontic evaluation. His prosthodontist recommended extraction of all of his teeth, while his periodontist suggested that a few teeth might be saved and used to fabricate a tooth-supported restoration.
Due to the advanced bone loss and tooth mobility, Bill was told that conventional treatment would be too unpredictable. He opted to have all his teeth removed. Since he felt that financial restraints wouldn't permit him to replace all his teeth with implants immediately, Bill chose, instead, to receive Teeth in a DayTM in his lower jaw, while having a denture created for the upper jaw.
At the time of extraction, all the soft tissue and abscesses were removed from the tooth sockets. Seven Brånemark implants (Nobel Biocare, Yorba Linda, California) were then immediately placed in the lower jaw, and a Teeth in a DayTM prosthesis was created to fit on top of them. Bill went home that day wearing an immediate complete upper denture. In the days that followed, he reported very little pain or discomfort and only minimal swelling. Three months later, he received permanent versions of both the denture and the implant-supported prosthesis.
"The lower jaw restoration felt just like my own teeth," Bill recounts. "I was thrilled." In fact, he felt so enthusiastic about the initial change in his appearance that he consulted a plastic surgeon. He had become dissatisfied with excess facial tissue that he felt made him look tired and older than his years. He subsequently had a face lift, brow lift and eye lid lift, along with placement of a chin implant to enhance his jaw line.
Although delighted with his new appearance and implant-supported teeth, Bill found the upper denture to be uncomfortable despite numerous adjustments and efforts to reline it. He finally concluded that replacing the upper denture with implant-supported teeth was no longer something he could regard as a luxury; it had become a necessity. A new Nobel Biocare surgical protocol Teeth in an HourTM had just become available. This type of treatment allows patients to receive their implants and new teeth in about 35 minutes, versus the two to three hours required by the Teeth in a DayTM procedure. Moreover, the patient leaves the prosthodontic office with a reinforced definitive prosthesis. This is all made possible due to the use of pre-surgical three-dimensional computer planning that allows for the fabrication of a highly precise definitive restoration in advance of the surgery.
Informed about this opportunity, Bill was eager to proceed. Since his upper denture looked good, an impression of it was made, and a clear copy of it was fabricated. Numerous radio-opaque markers were then placed within the clear denture. With that denture in the mouth, a CT scan was taken. Another scan was taken of the clear denture itself.
Working on a computer, these scans were aligned using the radio-opaque markers, and the surgeon determined exactly how the implants needed to be placed in order to achieve the best possible esthetic result. This information was then sent by modem to Nobel Biocare in Sweden where a computer guided the machining of a surgical guide that would help guarantee proper implant placement.
On the day of surgery, 20cc of blood were drawn and platelet-rich plasma (PRP, Harvest Technology) was harvested from the blood. Applying the platelet-rich plasma to the surgical area has been shown to expedite healing. Six small receptor sites were then precisely created in the upper jaw, exactly where the surgical guide dictated that they be positioned. Five 13mm-long Brånemark implants and one 15mm-long Brånemark implant were coated with the platelet-rich plasma and placed into the surgical site. Abutments were connected to the implants, and the carbon fiber-reinforced acrylic prosthesis that was created in advance was screwed into place on the abutments. The post-operative instructions given were the same as those that Bill had received after his Teeth in a DayTM procedure. These included using ice for the first 40 hours and sticking to a moderately soft diet for a 12-week period. In addition, Bill was provided with antibiotics, pain medications, and steroids. The following day, he reported only the mildest discomfort and no swelling. When compared to those receiving implants placed following a standard protocol, patients receiving Nobel Biocare’s Teeth in an HourTM typically exhibit very little to no pain or discomfort. This is due to the brevity of the surgical procedure and the fact that the gum tissue is subjected to minimal trauma during placement of the Brånemark implants.
Today Bill, who enjoys an active lifestyle, professes to be "awed" by the outcome of his surgeries. "I always wanted to look like Don Johnson," he confides. He smiles the smile of a man who has achieved a dream.