Renovation Reality

Expertise pivotal during difficult restoration.

tense, two-week stay on alert in the Mediterranean Sea awaiting the outcome of the Cuban Missile Crisis and a couple of trips to the South China Sea during the Vietnam War highlighted Charles Davis’ ten-year career in the United States Navy.

“I worked electronics maintenance on the planes that flew off two aircraft carriers,” Charles says of his Naval duties. “I was on the Forrestal during

Photos by Nerissa Johnson.

Charles served ten years
in the US Navy aboard
two aircraft carriers.

the Cuba crisis. We were in the Mediterranean at the time and woke up one morning with four Russian boats around us.

“I was on the Ranger for the two tours of Vietnam I did. Our squadron was the one that ran all the photo reconnaissance missions over Hanoi and places like that. I eventually got out of the Navy after ten years because I was tired of going to Vietnam.”

Charles left with enough experience to forge a career servicing planes for one of the country’s biggest commercial carriers. He has since retired and moved from Denver, Colorado to Florida, where he recently chose to correct a longstanding dental issue.

“About thirty years ago, I had to have all my bottom teeth, except for the six in the front, pulled out,” Charles explains. “They gave me a partial for

each side where they’d pulled the teeth, but the partials never fit or looked right.

“The way they fit was the biggest problem – especially when I ate. It got so bad that after a while, I just stopped wearing them when I ate. I still ate whatever I wanted, but I had to eat in the middle of my mouth like a chipmunk. That was a little time-consuming.

And I was always self-conscious about not having those teeth, so I finally decided to find out if there was anything else that could be done about them. What got me going was this article I read in Florida Health Care News.”

The article Charles read was about Richard Leong, Jr., DDS, a general and implant dentist who practices comprehensive, full-treatment dentistry, including full mouth reconstructions, at his offices in Melbourne.

A strong recommendation from a friend further steered Charles in the direction of Dr. Leong, whose work on Charles began six months ago with a thorough examination that revealed yet another challenging dental issue.

The Implant Option

“In addition to having lost the teeth on either side of the six teeth that remained on the bottom front, Charles had a lot of cavities and some abscesses in those six remaining bottom teeth,” Dr. Leong reveals.

“One of the first things we had to decide then was whether he wanted to keep those teeth and repair them or pull them and go with a full denture on the bottom. Because he already had a full upper denture, that was one of the options I presented to him.”

That option was actually one of several Dr. Leong presented to Charles, who eventually decided to have Dr. Leong restore his six existing teeth while he replaced the missing teeth on his lower arch with bridges secured by dental implants.

Implants are screw-like posts that are surgically placed into the jawbone to serve as the foundation for replacement teeth. After they are placed in the jaw, dental implants fuse over time with the jawbone and become a solid unit with the bone.

Once they are secure in the jaw, implants are capped with an abutment that is topped with a crown for a single tooth or a bridge or dentures when replacing several teeth. When secured by implants, bridges and dentures don’t slip or move when patients speak and eat.

In order to be seated securely in the jaw, implants require the jawbone to be of a certain density to support them. Dr. Leong’s examination of Charles revealed he lacked the requisite bone density, but that did not prohibit Charles from getting implants.

By using implants that are designed specifically for patients who have very little jaw bone, such as Charles, Dr. Leong was able to grant Charles’ wish for implant-secured bridges on either side of his remaining six teeth.

“When a person doesn’t have enough bone to support implants, it is customary to do a bone graft to increase the bone density,” Dr. Leong educates. “In Charles’ case, however, we were able to fit him with specially designed implants.

“The implants used actually do their own bone graft. When placed, a special drill is used in creating the space for the implant that actually harvests the bone. The harvested bone is put back on top of the implant.

“It’s a fantastic technique, in part because we’re using the patient’s own bone, which is always best, and because it’s bone from the jawbone rather than from the hip, which is another place where we can get bone if we need it.”

Taking Out the Guesswork

In creating the environment for Charles’ new bridges, Dr. Leong placed three implants on each side of Charles’ lower jaw. Because of the lack of bone, he used implants that are smaller than normal but can still withstand the normal pressures of chewing once secured.

The time required for the implants to fuse with the bone is approximately three months. While waiting for the implants to fuse, Dr. Leong repaired the cavities and cleared the abscesses in Charles’ remaining lower teeth.

He then took on the task of completing the implant process, which always begins with a series of steps taken to ensure the patient’s bite is properly reproportioned so that chewing happens naturally.

“You don’t start out just guessing where the bite should be,” Dr. Leong notes. “You have to take measurements and do computerized mock-ups and special procedures to make sure the upper jaw is aligned with the skull and lower jaw.

“Temporary teeth are for the patient to be sure they can accommodate their new bite. There’s a lot to it, but that planning is what determines the placement and angle of the implant and assures we get the perfect outcome we want.”

Charles’ outcome was even greater than he expected and hoped for. The work on him was completed this past spring, and he says he now feels confident while eating and smiling for the first time in years.

“I’m very happy with my new teeth,” he says. “My wife and everyone else tell me my teeth look great, and I agree with them. I really love the way they look, and I’m eating normally again, using all my teeth.

“As for Dr. Leong, he’s a real professional. He’s very business-like and very good. I never felt any pain during the whole process, so I really liked that. I was so impressed with him that I’ve already told some friends about him, and I will continue to do so.”

Doctor Approved

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.

“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, I waited until after we relocated to Florida. I first started looking for a dentist because I needed some general maintenance done. By then, my husband found a dentist in our area whom he was really impressed with.

“He 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 was and see what his plan and recommendations for me would be.”

The dentist Magaly went to see is Dr. Leong, who found several issues that needed to be addressed when he first examined her.

A Complicated Case

Photos by Nerissa Johnson.

Magaly Villafradez-Diaz

“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.

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 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 part of the 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 part of the 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.

“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 in March 2018. 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, the procedure can be accelerated and the new tooth put 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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