The Full Mouth Rehabilitation and Psychometric Assessment of a Patient with Bulimia Nervosa Following the Teeth In A Day® Immediate Loading Protocol

Balshi TJ, Wolfinger GJ, Della Croce JN, Balshi SF

Purpose: The purpose of this patient report is to accurately portray the clinical experience of treating an active, bulimic patient utilizing an immediate loading dental implant protocol and implementation of a psychometric component, quantifying the psychological effects of treatment.
Materials and Methods: A 34-year-old female presented with severe dental perimylolysis resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition showed advanced dental erosion and previous attempts of restoration in a state of failure. The patient’s existing teeth were extracted and treated with full maxillary and mandibular implant supported prostheses, following the Teeth in a DayÔ (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature.
Results: Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone seven months into treatment. Questionnaire results at the new patient presentation (T1) resulted in a composite score of 4.0 (SD=2.9; p=0.004), indicating severe body-image dysphoria. At 3 months post-op (T2), the questionnaire score at this time was 0.4 (SD= -1.7; p=0.09). The final psychometric questionnaire at seven months (T3) resulted in a score of 0.5 (SD= -1.5; p=0.12).
Conclusion: In this patient report, oral rehabilitation utilizing the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics and self-esteem to a severely depressed bulimic patient. Psychometrically, at the post-op (T2) and final testing period (T3), the patient was no longer considered to be significantly different from established normative values.

Index words: dental implants, Teeth in a Day, Immediate Loading, Self-Esteem, Psychometric analysis, Bulimia