Clean-Up Duty

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.

Photo by Nerissa Johnson.

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, Brevard 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’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 problem with Louis’ bite stemmed from the absence of several teeth in the back on both the lower left and right sides of his mouth. 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.
“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.

Case Study

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 have 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, he next had 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, have 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, however, 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.”

Lasting Impression

It was more than 30 years ago, while still living in her native New England, that Jeanne Miller lost five good teeth as part of the process required to have a cyst removed from her mouth. In time, Jeanne received a partial denture to take the place of the teeth that were removed.
That partial never really sat well with Jeanne, however. The fit was off ever so slightly, and over the years, it caused the roof of her mouth to become inflamed from irritation. The irritation resulted in a lot of pain and discomfort, which prompted Jeanne to begin looking for an alternative to the partial.
“My search eventually led me to dental implants, and I was immediately intrigued by everything I read about them,” Jeanne says. “Finally, after my husband and I moved to Florida in 1986, I started looking for a dentist who could place implants. That’s how I found Dr. Leong.”
When he first examined Jeanne, Dr. Leong discovered more than just an ill-fitting partial. He also discovered that over the years, Jeanne had developed some gum disease, had several crooked teeth that needed to be straightened and was suffering from temporomandibular joint disease, or TMJ.
“TMJ occurs where the joints connect to the jaw,” Dr. Leong explains. “There was clicking where her upper and lower jaws met. Correcting the problem with her jaw and correcting the crooked teeth became my first priority because her teeth needed to be in the correct position for the implants to work properly.”
Dr. Leong attacked the problem by first treating Jeanne with dental splints to correct her TMJ and braces to straighten and properly position her teeth. In addition, he treated her gum disease with laser therapy in preparation for the implants.
“The objective was to give her a bite that was stable and more functional,” Dr. Leong reports. “Once we achieved that objective and had the teeth in the proper position with healthy gums, I was able to move forward to determine the probability of her receiving dental implants.”

Implant Options

Dental implants come in two sizes: standard and mini, the latter of which is a smaller-in-diameter implant that can sometimes be used when a patient no longer has enough bone left to support standard implants.
“If all a patient needs is to get the denture to stay in place, smaller implants are ideal,” Dr. Leong continues. “They are typically for patients who do not need bone grafting done.”
The smaller implants can support single crowns as well as a small bridge or partial denture. There are a lot of uses for these smaller implants if used correctly and if there is a sufficient amount of bone intact.
“When the process is completed with precision, people can retain the denture immediately,” Dr. Leong educates. “They can walk out of an appointment, and the denture is securely in place. It’s really amazing.
“But there needs to be adequate bone, healthy gums and a proper bite first. Patients need to have a proper overall environment in their mouth in order for implants to be successful.”
Once Jeanne’s teeth were properly aligned and the implants were secure in the jawbone, Dr. Leong placed implant-
supported bridges on both the top and bottom of her mouth. Dr. Leong says he also had to repair some of the prior work Jeanne had done over the years.
“It’s common to have to do some repair work over time,” Dr. Leong says. “Nothing lasts forever. Jeanne later developed acid reflux, which damaged some of her teeth. Because of that, I had to redo her lower right bridge.
“Since I first saw her many years ago, Jeanne has been a real trooper and a loyal patient. She’s had substantial work done to her smile, and she’s really come a long way. You name it, she’s had it done.”

Patient and Doctor Loyalty

For more than three decades now, Jeanne has driven 40 miles each way from her home in Titusville to the office of Dr. Leong in Melbourne. She wouldn’t have it any other way. Her dedication to Dr. Leong and his practice stems from his commitment to provide top-notch care to his patients.
“I’ve had a lot of dental work done over the years, from bridges to crowns and everything in between,” Jeanne says. “Dr. Leong is like a good friend. He’s reliable, and I can talk to him about anything. We’ve developed that trusting relationship over the years. He’s the best there is, hands down,” she says. “He’s not just a dentist, he is a true friend.”

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