Doctor Approved

Expertise proves pivotal during difficult dental restoration.

Elective procedures and surgeries are among the many things women are advised to avoid when pregnant. That’s why Magaly Villafradez-Diaz decided a few years ago to wait until after she gave birth to replace a fractured second upper molar.

Magaly Villafradez-Diaz finally had her missing tooth replaced by Dr. Leong, and she was thrilled with the work he did.

Magaly Villafradez-Diaz

“I still don’t know 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 again 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 explains. “But 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 eventually.

“So, after we relocated to Florida, I started looking for a dentist. I needed some general maintenance done. My husband found a dentist in our area whom he was really impressed with.

“My husband found this dentist to be very professional, thoughtful and thorough, and he really liked that he took a lot of time to listen to him. I decided to go see for myself how good this dentist is and see what his plan and recommendations for me would be.”

The dentist Magaly went to see is Richard Leong, Jr., DDS, a general and implant dentist who practices comprehensive, full-treatment dentistry, including full mouth reconstructions. Upon first examining Magaly, Dr. Leong found several issues that needed to be addressed.

A Complicated Case

“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.

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 jawbone 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 happened to be in the back upper left, where 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 educates. “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.

Magaly Villafradez-Diaz finally had her missing tooth replaced by Dr. Leong, and she was thrilled with the work he did.

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

“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.”

Half the Time

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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