A Whole New Look

Comprehensive treatment plan restores aesthetically pleasing, functional smile.

New York City native Louis Rodriguez finished his career as a laundry manager in style. After serving two hospitals in that capacity, he spent his last 18 years in the industry running the laundry service at the famous Fontainebleau® Hotel on Miami Beach.

 Louis Rodriguez and Magaly Villafradez-Diaz went to see Dr. Leong for their dental issues and came away with beautiful, new smiles.

The result of Louis’ dental restoration was a dream smile

“It’s a special place,” the 75-year-old Palm Bay resident says of the Fontainebleau. “I especially like the beach there. It’s beautiful.”

For years, Louis wished he could have said the same about his smile. Unfortunately, the loss of several back teeth and some extensive wear on many of his remaining teeth left Louis with a smile he was not eager to show off.

Those same issues were also causing Louis a lot of pain. When he ate, for example, his upper front teeth would become very sore. He was also experiencing a lot of pain in the gums behind his upper front teeth.

It was that pain that recently sent Louis in search of a dentist who could help him with the problem. The search ended one day late last year while Louis was waiting to be seen for a checkup by his primary care physician.

“I was in the waiting room reading a newspaper, Florida Health Care News, and I saw this article about a dentist that was nearby,” Louis recounts. “I knew I had to do something about this problem I was having, so I decided to go see him.”

The dentist Louis read about is Richard Leong, Jr., DDS, a general and implant dentist who practices comprehensive, full-treatment dentistry, including full mouth reconstructions. Upon first examining Louis, Dr. Leong immediately discovered the cause of his discomfort.

“It was a bite problem,” Dr. Leong reveals. “Because he was missing a lot of back teeth, when he bit down, his upper front teeth were coming down over his lower front teeth, and that was causing a scissoring-like action on the gums behind his front teeth. That had caused his jaw and some remaining teeth to shift, which resulted in some bone loss in the jaw area where teeth were missing.

“That’s why he was experiencing so much pain with his gums and his teeth. He came in thinking there was something wrong with his teeth and that he needed them taken out, but I told him that wasn’t necessary, that what we needed to do was fix his bite.”

Pleased to hear that he didn’t need to have his front teeth removed, Louis agreed to have Dr. Leong correct his bite. That work began with Dr. Leong doing a comprehensive evaluation of Louis’ mouth, after which Dr. Leong came up with a treatment plan.

The treatment plan was extensive. It included some standard dental work to fill several cavities and periodontal treatments to correct some advanced gum disease. When that work was completed, Dr. Leong began the difficult task of correcting Louis’ bite.

“The jaw bone is meant to have roots in it, and when those roots are there, they stimulate bone growth,” Dr. Leong educates. “When there are no roots, the opposite happens, and the jaw bone slowly shrinks away.

“That was part of the problem Louis was having, so I told him, We first have to determine where the upper and lower jaws should meet so that we have a goal of where to put all the new teeth. Then, we can talk about how we’re going to replace the missing teeth.”

Step by Step

To determine where the upper and lower jaws should meet, Dr. Leong studied photographs, x-rays and a CT scan of Louis’ jaw and ran several computerized tests to help create a temporary, plastic denture that included wax teeth.

“The teeth are in wax, so we can move them,” Dr. Leong informs. “That’s how we set up the bite to see if the patient can tolerate it the way it should be and likes the way it looks and feels. We do that using special instruments called articulators.

“With the articulators, we can simulate the bite. It allows me to show the patient how the new teeth will feel in the mouth. Through that, we determine whether the jaw joints and the muscles associated with the jaw joints can tolerate the new bite.

“The reason we do that is because over the years, the jaw joints and muscles have become used to a different position. All we’re doing is moving the bite back to where it used to be, but we need to make sure it can handle being there.

“It’s a big step and after we took that step with Louis, he was no longer hitting his upper teeth with his lower teeth and biting into his gums. We could see right away that he was pleased because he said, Wow, this is like having new teeth. I’m going to like this.”

Once Dr. Leong determined exactly what physical changes needed to be made to correct Louis’ bite, the next step was to discuss with Louis how best to replace the teeth that were missing so that he could properly execute the plan.

Louis went into the process thinking he would replace his teeth with partial dentures, but he eventually settled on implant-secured bridges in the areas where he was missing multiple teeth, and implants capped with crowns in the areas where he was missing single teeth.

Implants are screw-like posts that are surgically placed into the jawbone to serve as the foundation for replacement teeth such as crowns or dentures. When secured by implants, dentures don’t slip or move; they stay in place when patients speak and eat.

In making his decision to go with implants, Louis agreed to become the patient in a teaching video for Dr. Leong, who is also an adjunct professor at the Florida Institute of Technology, where he teaches the dental aspect of biomedical engineering.

Louis’ reward included being fit with three dental implants – one in the upper left, where he was missing a couple of teeth and needed a bridge, and two in the lower right, where he was also missing several teeth and needed a bridge.

Because he still had existing teeth strong enough to support the implant-secured bridge in the upper left, Dr. Leong placed an implant there and fit the bridge on the same day. The other bridge required a wait for the implant to fuse to the jawbone.

“It takes up to six months for implants to become secure in the jaw, so we usually can’t fit a patient with a bridge right away,” Dr. Leong notes. “But if there are adjacent teeth that can support the implant and make it steady, we can fit the bridge right away.

“In Louis’ case, he was able to use that bridge on the upper left right away because it was going to be supported by the teeth adjacent to the bridge. He did, however, need to wait a few months before we could fit the bridge on the lower right side.”

That wait was predicated on the fact that Louis had no adjacent teeth to support a bridge in that area. The time Louis spent waiting for the bridge was not wasted, because Dr. Leong used that time to repair all of Louis’ remaining damaged teeth.

By the time the restoration project was completed, Louis had received two implant-supported bridges and had more than a dozen other teeth repaired and crowned. The result was a smile and comfort level Louis had previously only dreamed of.

“I couldn’t be happier with the way everything has turned out,” Louis enthuses. “I don’t have any more pain in my teeth or gums when I eat, and my new teeth all look beautiful. Now, I just go for regular cleanings and checkups.”

Doctor Approved

Magaly Villafradez-Diaz decided a few years ago to wait until after she gave birth to replace a fractured second upper molar. Pregnant women are advised to avoid elective procedures and surgeries when pregnant.

“I have no idea how it happened, but there were fractures in the root of that molar, so they had to take the tooth out,” Magaly explains. “The next step was to get a dental implant to replace the tooth, but I was pregnant at the time, so I decided to wait.”

And wait she did. A rheumatologist then working in Dothan, Alabama, Magaly waited nearly three years before she inquired about the possibility of replacing that missing molar, in part because the gap was not in her smile line.

“It’s one of the last teeth, and because you can’t see it, you think it’s not a problem,” Magaly relates. “Being in the medical field, I know you have a specific number of teeth for a reason, so I knew I needed to have it checked out sooner rather than later.

“I started looking for a dentist as soon as we relocated to Florida. My husband found a dentist in our area whom he was really impressed with. He found him to be very professional, thoughtful and thorough, and he really liked that he took the time to listen to him. I decided to go see for myself how good this dentist is and see what his plan and recommendations would be.”

The dentist Magaly went to see is Dr. Leong. Upon first examining Magaly, Dr. Leong found several issues that needed to be addressed.

A Difficult Spot

“When Magaly first came to me, she had some periodontal problems and she needed a crown, but the main reason she came to me was to have that missing molar replaced using a dental implant,” Dr. Leong informs.

 Magaly Villafradez-Diaz went to see Dr. Leong for their dental issues and came away with beautiful, new smiles.

As a doctor, Magaly lauds the professional work of Dr. Leong.

Dental implants are screw-like bodies that are surgically placed into the jawbone. The implant supports an abutment, which screws onto the implant, and a crown that is cemented on top of the abutment.

Implant surgery is considered routine, but Magaly’s case was a complicated one, the complications stemming largely from the fact that she waited so long to have the tooth replaced.

“When a tooth is missing for a long period of time, there is no reason for the jaw bone to stay there anymore, so that part of the jawbone just shrinks away, naturally,” Dr. Leong educates. “That was part of the problem. The other problem was the location of the missing tooth.

“This tooth was in the back upper left. There was very little bone left between the roof of the mouth and the sinus, which meant I would need to lift up the floor of the sinus and add, or graft in, more bone in order to place the implant.

“She had even more complications than that because she also had a vertical shelf of bone that was right in the sinus where I needed to place the implant. That made it almost impossible for me to place an implant there.

“The good news is that I specialize in difficult cases. That’s why people come to me. I also do a lot of teaching, including teaching the placement of dental implants, and my residents refer a lot of difficult cases to me, so this was typical of what I see.”

After learning of the difficulties Dr. Leong faced in treating her, Magaly agreed to go ahead with the implant surgery. That surgery began with Dr. Leong removing the vertical shelf of bone that was blocking the area where the implant needed to be placed.

Once Dr. Leong completed that task, his next step was to create a support system for the implant. He accomplished that by mixing a blood derivative called platelet-rich fibrin with synthetic bone grafting material that grows over time into supportive bone structure.

“To obtain the platelet-rich fibrin, blood is taken from the patient’s arm and put in a centrifuge that forms a product that contains concentrated growth factors,” Dr. Leong describes. “It is then mixed with the bone graft material to expedite new bone growth.”

It typically takes about six months for new bone to grow strong enough to support an implant. The addition of the platelet-rich fibrin speeds up that process and allows for the implant to be seated at the same time the bone graft is done.

“By adding the platelet-rich fibrin, we actually save about six months of time because we can place the implant at the same time,” Dr. Leong explains. “Then, over the course of the next six months, the new bone grows and matures faster around the implant.”

Fast-Track It

Dr. Leong completed the first phase of the implant procedure, which included capping the implant with a healing abutment, during a single visit one day last March. He finished the project in September after first testing the strength of the newly developed bone.

“We have instruments now that can measure the maturity of the bone that’s surrounding the implant,” Dr. Leong says. “The instruments work on the principles of magnetism and actually measure the density of the bone and the solidity of the bone around the implant.

“With this and other newer techniques, I can sometimes accelerate the procedure and put the new tooth in about two months after placing the implant. I couldn’t do that in this case because she had absolutely no bone left, but I have done it before.”

Considering all the work that had to be done and the complicated nature of her case, Magaly says she was elated to have completed the process in just six months. And she lauds Dr. Leong for what she describes as exceptional work.

“Certainly, there were a lot of complications. But in the end, everything went very well,” she says. “And the new tooth is working great. It feels fantastic, like a real tooth, very functional and secure, the way it should be.

“Overall, I am very, very happy with the surgery and with Dr. Leong. He was extremely receptive and professional. I definitely recommend him because the treatment I received was excellent, just what you want when you’re a patient.”

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