New-Age Dentistry

Technological advancements deliver incredible outcomes.

Since 1969, teachers in the city of Chicago, Illinois have gone on strike 11 times and spent more than 100 days walking picket lines in a quest to gain better wages and working conditions. Elaine Hirsch was on the front lines of several of those battles.

Photo by Nerissa Johnson.

Elaine described the dental implant procedure as “incredible and painless.”

Elaine spent 35 years teaching language arts, English and social studies to middle school and elementary school students in the Chicagoland neighborhood of Englewood. She was on strike so many times, she lost count of the work days she lost.

“It was a lot, that I can tell you,” says Elaine, a 72-year-old retiree who moved to the Sunshine State along with her husband a few years ago after the couple spent the first two years of their retirement living in California.

“We followed our son down here,” Elaine says of the decision to move to Florida. “He came down, met the girl of his dreams, got married and since then, they’ve started having babies, so it’s all worked out really well for us.”

Shortly before moving to Florida, Elaine had some dental work done that required further attention. That prompted a search for a new dentist, and when a friend recommended Naved Fatmi, DMD, of Regency Court Dentistry, Elaine followed up with a visit.

“I had an implant put in a couple months before we moved here, and I wanted to follow up on that,” Elaine says. “The other thing is that I have terrible teeth, and at the time, my bottom teeth in particular were giving me some trouble.

“So, I asked a friend if she knew a good dentist, and she highly recommended Dr. Fatmi. She gave him very admirable accolades and went on and on about how wonderful he is. When I met him, I immediately understood why.”

Dr. Fatmi specializes in general, restorative and cosmetic dentistry. At his Boca Raton office, he also offers an array of aesthetic services as he strives to provide patients with enhanced confidence as well as proper dental function.

“I’m thrilled with what a great job Dr. Fatmi did. He’s my hero . . .” Elaine

Upon first meeting Elaine, Dr. Fatmi performed a thorough examination using a 3-D oral scanner. He also took digital impressions and discovered that the problems Elaine was having with her lower arch were largely a result of an aging, failing partial.

He also confirmed Elaine’s assessment of her remaining lower teeth, which he suggested removing as part of a complete restoration plan where her lower arch would be fit with a fixed prosthesis supported by dental implants.

Dental Implantology

Dental implants are root-shaped, screw-like bodies that are surgically placed into the jawbone. Once the implant is in the jawbone, new bone naturally grows around it to form the foundation for an abutment and replacement teeth.

X-ray photo courtesy of Regency Court Dentistry.

This x-ray shows where Elaine’s two implants (left) were placed. The implant on the right has been fit with the abutment.

The replacement teeth can be a single crown that is either cemented to or screwed onto the abutment, a partial bridge that can be affixed to one or more implants or a full prosthesis or denture that can be fastened to a series of implants.

Prior to placing an implant, some patients require a bone grafting procedure designed to enhance the volume of the jawbone so that it can properly support the implant. Elaine, who was missing several of her lower teeth, required this procedure.

“The reason we sometimes need to do a bone-grafting procedure is because, when you lose a tooth, the bone that supported it eventually deteriorates,” Dr. Fatmi explains. “It deteriorates because that bone has nothing to grab onto and no longer has a function.”

The combination of the bone-grafting procedure, which is typically done at the same time the implant is placed, and the placement of the implant stimulates bone regeneration, which results in the creation of a solid foundation for the implant.

The amount of time needed for new bone to grow enough to support an implant is about three months. The implants themselves, meanwhile, need between four and six months to heal to the point where they can properly support a permanent prosthetic.

During that healing period, patients typically wear a temporary prosthetic, which Dr. Fatmi refers to as an immediate prosthesis. In Elaine’s case, that immediate prosthesis was a full lower arch that was screwed into the implants.

All-on-Four

In securing those implants, Dr. Fatmi used the All-on-Four technique in which between four and six implants are placed at different angles to ensure proper function and aesthetics. Elaine was fit with five implants and received her immediate prosthesis the same day.

“A lot of what we did for Elaine could not have been done before, but now, thanks to advances in technology, we were able to take a CT scan of her mouth, digitally scan impressions of her and work with a lab to create an incredible outcome,” Dr. Fatmi says.

“The whole process was incredible and painless,” Elaine enthuses. “Everything was done on a computer first so that my bite would be just right, and when I got the temporary prosthetic, I couldn’t believe how well it fit. It just felt so natural.

“Dr. Fatmi even matched the color of my upper teeth perfectly with it. I’ll get the permanent prosthetic in a few months, but I know it’s going to fit and look great because this one feels great and it’s only a temporary.

“I’m thrilled with what a great job Dr. Fatmi did. He’s my hero because he’s a fabulous person, a fabulous dentist and so conscientious. I definitely recommend him to anyone. He’s just super.”

Tailor Made

Photo by Nerissa Johnson.

Elena is very happy with the personalized care she receives from Dr. Fatmi.

Long before computers became small enough to sit on your lap, Elena Fontanazza worked for IBM, testing and developing many of the systems that allowed Big Blue to become one of the worldwide leaders in modern information technology.

“I was a supervisor working with all the older IBM machines, and I really enjoyed it,” says Elena, a Brooklyn, New York native who later married and moved to Fort Lauderdale, where she became a beautician and eventually a homemaker.

Now 76, Elena also spent some time helping her husband run their family’s jewelry store before retiring about 16 years ago. It wasn’t long after she settled into retirement that Elena found herself back at work, this time fighting oral cancer.

“I had this tiny lump under my tongue, and I needed to have surgery to remove it,” Elena says. “They also had to remove some of my jaw bone, the back four teeth on the bottom left side of my mouth and a portion of the left side of my tongue.”

The portion of Elena’s tongue that was removed included the small membrane that attaches it to the floor of the mouth. To compensate for that loss, Elena’s tongue was attached to the left side of her jaw in a fixed position.

In the wake of her surgery, Elena underwent extensive radiation therapy to ensure the cancer did not return. It hasn’t, but the radiation treatments greatly compromised the structural integrity of her jaw bone and remaining teeth.

Those issues combined to make Elena a challenging case for any dentist to do even the most routine work on her. She learned just how challenging when the passing of her dentist forced her to look for a new one shortly after she recovered from her surgery.

After visiting with several potential replacements, Elena discovered that she would need “something of a specialist” to care for her going forward. The specialist she eventually chose is Dr. Fatmi.

Outside the Box

“With someone like Elena, you need to think outside the box because you are limited in the number of extractions and procedures you can perform. You need to be very careful not to cause the patient any more harm,” Dr. Fatmi explains.

“You can’t just pull a tooth, for example, because the density of the jaw bone is much less than normal as a result of the radiation. Not only that, but her teeth are a little more brittle than usual as well, so all that has to be taken into account.”

Dr. Fatmi did take all of those issues into account immediately upon meeting Elena, who at the time needed a failed upper left second bicuspid replaced and crowns for her upper left lateral incisor, her upper right first molar and her lower right second bicuspid.

She also needed a filling in her lower right wisdom tooth, which Dr. Fatmi chose to keep in an effort to avoid doing further damage to her jaw, as well as a heavy fluoride treatment to reduce the chances of further cavity development.

The biggest challenge Dr. Fatmi faced was in replacing the failed upper left second bicuspid because it required removing the failing tooth – which could cause damage to the already weakened jaw bone – and replacing it with either a bridge or implant.

“She’s absolutely enamored with him because he’s exceptional.” – Paul Fontanazza

Dr. Fatmi’s recommendation, which Elena agreed to, was to replace that tooth with an implant. The implant, he reasoned, would provide more biting power than a bridge, which could damage the support teeth because it would need to be removed regularly for cleaning.

Depending on the patient, an implant needs three to six months to fuse with the bone. That’s why Dr. Fatmi chose to do that procedure first. While Elena’s implant fused, he repaired her other teeth, eventually completing the restoration in about a year.

Since finishing that initial round of work in 2013, Dr. Fatmi has continued to treat Elena regularly, about every three months, providing mostly cleanings and fluoride treatments. He reports that her overall oral health has improved markedly since then and is now sound.

“One of the things we wanted to make sure of with Elena is that she can smile and speak and chew her food properly so that she can feel confident leaving the house and being in a social atmosphere,” Dr. Fatmi states. “We achieved that goal.

“She’s not insecure about leaving the house or speaking to people or about the aesthetics of her situation at all. She’s very happy and in control and says she’s grateful she met us because she was being pushed from doctor to doctor after having her surgery.”

An “Excellent Job”

“Happy” may be an understatement. Elena says Dr. Fatmi has done an “excellent job” of keeping her teeth and gums healthy and has proved to be very conscientious and considerate of her special needs.

“I recommend him to anyone because when I first went to see him, he knew everything my surgeon had done and exactly how to proceed from there,” she says. “And he was very confident he could take care of my situation because he has the right tools and know-how to do it.

“For example, he uses this special x-ray machine that doesn’t give off a lot of radiation. That’s very helpful for me, and it’s things like that that make me feel very comfortable with him. Dr. Fatmi is so good, even my husband is impressed with him.”

“That’s true,” confirms Paul Fontanazza. “Dr. Fatmi is a phenomenal dentist. He’s already saved two of Elena’s teeth, and he completely understands and provides the special care she requires as a result of her surgery. “After we first met Dr. Fatmi, I said to my wife, You’ve got to stick with this guy, and now, she won’t go anywhere else. Her needs are met above and beyond with Dr. Fatmi. She’s absolutely enamored with him because he’s exceptional.”

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