This week’s episode of the Any and Everything Series discusses beauty from the inside out, the pursuit of greatness, and shows three Dental Masters of Alexandria patients that exhibit this.

Case 1: Ms. F

Under anesthesia, with an anesthesiologist, I removed all her upper teeth that were failing. There were several failing root canals, cracked teeth, and two severely infected implants, including an older style implant, called a blade implant; I removed all failing teeth, implants, and infection, just in her upper jaw. Then during the same appointment, after all the infection was gone, I used my treatment plan to allow me to contour and shape the bone, graft the bone to rebuild it where infection destroyed healthy bone and placed 6 implants.

After that I connected her long term, computer fabricated temporary, making sure it was in the best place, for ideal healing. 6 months later we took records to finalize and make a ceramic bridge that screws in (She cannot take it out but I can if necessary)
The best part was that she felt as though she had regained her original smile and function, and it felt natural to her.

This is a classic example of dentistry failing a patient. What I mean by this, is the patient is doing everything she can to stay healthy and everything recommended to her, but the dentistry never fixed her concern and reestablished a new normal for her health.

This is why a patient having a full mouth diagnosis, before treatment is ever started is so important.
For ME, whatever dental intervention I am blessed to be part of – my goal is the treatment helps that patient to move forward in his/her smile, health, and functional goals. In many cases I see patients like Mrs. F, that have been on a dental healthcare treadmill; These patients are in constant transition, discomfort, dissatisfaction, and their goal is never being reached or even getting close to the goal.

The dentist must know every patients’ goals through communication and thorough examination. THEN the dentist should come up with a comprehensive plan, together with the patient, regardless of whether everything is being done at one time, or in many cases, in different phases or sections.

Case 2: Mr. I

Overall this young man was healthy but had some slight spacing between his front teeth and he didn’t love the shape of his smile.

We discussed an orthodontic option vs a ceramic veneer option and the patient decided to go with the ceramic Veneer option.

The reason this made the most sense to him and I was his bite was functioning perfectly. Orthodontics could close the space but would require a rigorous plan to do so and keep his bite intact and/or keep the spaces closed.

The spaces existed because there were some slight tooth, shape and size discrepancies AND, simply trying to close the spaces with braces or Invisalign WITHOUT moving his entire bite, in this case, would have had a high risk of a negative outcome. Most likely, one of the three negative results would have occurred:
1. Opening the spaces back up (relapse)
2. Chipping or breaking teeth chip (having the same chewing pattern, but not having enough space to chew in that pattern)
3. The development of TMD – a dysfunction of the chewing muscles and/or joint (this would be called an avoidance chewing pattern, meaning the patient must chew differently, to reach his back teeth and also avoid hitting his front teeth “at the same time, subconsciously”

A combination of two or three of these issues could occur.

So rather than doing full orthodontics that would take a very long time and have more uncertainty, we decided to do four ceramic veneers that required minimal tooth removal, to change the shape and look of his smile.

Although there is always a balanced give and take in treatment since I was able to ensure the veneers were bonded to 100% enamel, his original teeth were not structurally compromised, his chewing pattern remained the same, and his goal was achieved in 3 visits
– 1. We took pictures and digital scans of his teeth to make accurate models for diagnosis and planning)
– 2. We prepared his teeth, from the plan, took records for the lab to make his veneers, and placed temporary veneers using the new shape to test the plan (the patient did not break his temporaries indicating the plan was correct
– 3. Four weeks later, in this case, we bonded the final veneers.

There have been no negative outcomes up to this point; it’s been over a year- depending on which study you read, these veneers should have a 95% success rate at 12-15 years. Nothing is certain, however, if evidence-based principles are used the way I choose to help patients, the longest-lasting results occur

Case 3: Ms. H

This patient is 72 and had a complex medical history involving multiple strokes, and other cardiovascular events, in the past. My anesthesiologist and performed our did diligence; we worked together with the patients’ other doctors, gathering information to determine whether or not the patient was a candidate for outpatient anesthesia, and if so, what type of anesthesia or sedation could safely be performed.

It was determined that the patient was a candidate, and the stress without sedation could be worse in this case. The patient had a high level of dental anxiety and the procedure had a high level of complexity.

The patient was safely and successfully made comfortable by the anesthesiologist and then by myself using the traditional long-lasting numbing techniques.

I created a computer-generated treatment plan treatment to perform guided surgery. On this day we were starting in the patient’s upper jaw. During this process I removed 2 infected implants, one that was placed partially in the maxillary sinus, I removed the infected and broken teeth on her top arch, and I removed all infection. I then repaired and reinforced the patient’s sinus membrane using her blood and certain biological materials. After the sinus was closed and reinforced, I contoured and grafted the bone according to the original plan and placed 6 implants. Then we attached her long term temporary bridge that was milled from our computer-guided smile plan. It was put in the best place for healing function and esthetics.
The after picture is 4 days after her surgery.

Ms. H plans on treating her lower jaw next year. And is doing amazing and healing fantastic.

So for all three cases, there was teamwork involved including the patient, the lab, the computer technicians, the anesthesiologist when necessary, and myself.

“The master in the art of living makes little distinction between his work and his play, his labor and his leisure, his mind and his body, his information and his recreation, his love and his religion. He hardly knows which is which. He simply pursues his vision of excellence at whatever he does, leaving others to decide whether he is working or playing. To him he’s always doing both. ”
― James A. Michener