Emergency Denture Replacements

The ‘go-to dentist’ for difficult cases comes to the rescue.

Like so many people, David Beeman grew up wanting to see the world. To scratch the itch, he did what his father did and joined the Navy. Now 64, David considers that the best decision he ever made.

“What a great experience,” David enthuses. “I saw it all. I went to Spain, Iceland and Norway just to name a few on the West side of the world, and on the East side, I’ve been to the Philippines, Japan, Hawaii, even Kuwait.

“It was a great time, and a lot of that is because I was fortunate to be selected as part of an aircrew and stationed onboard a couple of aircraft carriers. That’s how I was able to travel so much and have some pretty neat adventures.”

David was assigned to the USS John F. Kennedy and the USS Kitty Hawk. His job aboard those carriers was to repair aircraft electronics.

David did that for the better part of his 21 years in the service. Afterward, he worked with his father on a commercial fishing venture for a few years before retiring for good.

Though grouper and sea bass were among their primary targets, David spent a good part of that time wishing he had caught a better break with his teeth.

“I must have had bad genetics or something because I’ve always had bad teeth,” David remembers. “Eventually, they started to come loose, and a few fell out. I went to a dentist in West Palm Beach, had them all extracted and got dentures.

“A few years ago, I started to have problems with the dentures. They weren’t fitting quite right. One night, I came home after a night of drinking and left them on the couch. That’s when my dog tried wearing them, and that was pretty much it for them.”

In a Bind

The dentures left unwearable by David’s dog were secured by dental implants, which are screw-like bodies implanted into the jawbone, where they become the foundation for replacement teeth.

Replacement teeth can be a crown that is cemented or screwed onto an abutment affixed to the implant, a partial bridge secured by one or more implants, or a full denture fastened to a series of implants.

David’s upper denture was secured by four implants and his lower denture by three. After his dog got a hold of them, though, the dentures were no longer wearable, so David found himself in a bind.

To rectify the problem, David briefly considered traveling to West Palm Beach to see the dentist who made the dentures. Instead, he decided to get them fixed locally by Richard Leong Jr., DDS, PA.

Dr. Leong first saw David in June and vividly remembers him with his dentures virtually in pieces and wondering what, if anything, could be done to restore them.

“He came into the office with these dentures that were not in very good shape at all,” Dr. Leong recalls. “They were cracked and very worn down, and he needed to get new ones. But he also had a problem with one of his implants.

“His dentures had these special attachments, a ball-and-socket type of thing that allowed him to just snap them into place. The issue was that one of the implants was missing a very important piece that the denture attached to. That’s why he was having problems with that denture before his dog got a hold of them.

The dentures were also missing two precision attachments that fit into the implants.

David loves the fit and feel of his new dentures.

“The good news is that he came to the right place because this is what I do,” the doctor asserts. “I’ve been teaching about dental implants for 30 years, and not only can I put in new implants, I can also repair failing or broken implants. I’m the go-to guy for that sort of thing.”

Something New

Dr. Leong realized immediately that salvaging these dentures wasn’t going to be possible. The biggest reason was that the teeth had deteriorated to where they were forging a change in David’s appearance.

“When dentures get worn down and lose their proper height, the wearer loses bone from their jawbone because the top and bottom teeth don’t connect the way they should,” Dr. Leong educates. “The result is what we call a premature aging effect. The wearer looks older because the space between their nose and chin becomes diminished.”

A third of a person’s facial height should come between the nose and chin, but David’s dentures were so worn he had only a fourth of his facial height there, Dr. Leong points out.

“This caused him to look much older than he was,” the doctor continues. “The other thing that happens is that because your face crunches up at the bottom, your lips hang downward. When you put your teeth in, you always look like you’re frowning because your mouth is pointing downward.

“In addition, that downward hang of the lips tends to make you drool out of the side of your mouth. That can lead to yeast infections, and David was experiencing all of that. So, giving him new dentures that alleviate those problems was critical.”

Just as critical was the need to fit David’s new dentures into his established, 20-year-old implants. That proved tricky because several were in need of repair.

In addition to one needing a replacement part that is no longer made, two of the four implants in David’s upper arch had lost so much of the bone supporting them that they were in danger of failing if action wasn’t taken to halt the bone loss.

The loss of bone around those implants was due to the dentures fitting improperly. That was causing an imbalanced occlusion, which is how the top and bottom teeth meet when a person chews or closes the mouth.

The imbalanced occlusion placed excessive pressure on two implants, which caused them to loosen. The solution was to ensure that David’s new dentures had a balanced occlusion.

Tedious Work

Creating a balanced occlusion with a full set of dentures can be a tedious process, Dr. Leong notes, and in David’s case it took three appointments to ensure the correct placement to avoid further bone loss around the compromised implants.

Repairing the implant that was missing a crucial piece also proved to be a bit toilsome. Because that part is no longer made, Dr. Leong had to lean on his experience and expertise and fashion it himself. Then he had to make sure the dentures fit properly.

He did that by creating fittings in the dentures that matched the outmoded ball-and-socket implants. As with balancing the occlusion, this took a few tries, but Dr. Leong eventually delivered the perfect match required to give David the support, function and sustainability that was lacking.

“The fit of my new dentures is superb. It’s even better than it was originally.” – David

“It was a very difficult case, but we worked hard and got it right, and now David has a set of dentures that are strong and have the proper height so that he won’t have that aged look,” Dr. Leong emphasizes. “I think he’s pleased with the result.”

Not only is David pleased that he has proper-fitting dentures, he also is grateful Dr. Leong took the time to address and correct the myriad of problems with his dentures.

“The fit of my new dentures is superb,” David raves. “It’s even better than it was originally, and I thought that fit was pretty good. It just goes to show you how good a dentist Dr. Leong is. He’s really good and very experienced.

“He’s a very dedicated dentist and he puts a lot of care and effort into treating his patients. He’s not going to let you go until everything is exactly how it’s supposed to be. I was fortunate to find him and gladly recommend him to anyone.”

Missing Tooth

Debbie Franqui

The idea first popped into Debbie Franqui’s head a few years ago, when some friends showed up to a crafting workshop drinking beverages out of tumblers they each decorated.

“I thought, Wow, that’s really cool; I need to learn how to make those,” Debbie recalls. “Then a couple of years ago, my daughter got me the special cup turner you need to really do it right for Christmas. It took off from there.”

Oh, it took off all right. Debbie now has 12 cup turners, and she keeps them rolling because her first few custom tumblers created enough demand that she’s turned what was once a spare-time craft into a small side business.

“I’m selling them through a Facebook page right now,” Debbie offers. “They’re double-walled, stainless steel-insulated tumblers that we can decorate just about any way you want, with designs, decals, paint, whatever.”

Debbie, 49, is quite the craftsperson. In addition to making custom-designed tumblers, she also does custom framing at a local craft store. Recently, she sought help from a different kind of craftsman, one who specializes in custom-fitting replacement teeth.

A longtime patient of Dr. Leong’s, Debbie finally decided to resolve a dental issue that dates back more than 20 years to when she passed on having a problem molar repaired and opted instead to have it extracted.

“I was in my early 20s and didn’t have a good job or good insurance, so I couldn’t really afford to get the right dental work when I needed it” Debbie explains. “So, when this top molar became a problem, I just had it pulled.

“I never thought much of it after that, but then Dr. Leong told me it was eventually going to create problems because I still have the bottom molar, but I don’t have the top molar that’s going to hit against it when I chew.”

Debbie faced the likelihood that she would slowly damage several teeth as a result of her irregular bite. Recently, Dr, Leong suggested she finally replace that missing tooth with a dental implant.

Bone Graft Needed

Debbie hadn’t previously been offered that solution. A few years ago, Dr. Leong replaced another failing upper molar with a dental implant. She soon learned, though, that the approach to replacing this one would be different.

“Whenever you’re replacing a missing tooth with a dental implant, it’s very important to make sure that the patient has enough bone to support the implant,”
Dr. Leong informs. “In Debbie’s case, with that first molar, she did not have enough bone.

“After I pulled the tooth, I found that there was a lot of infection in that tooth and it had taken away some of the bone. So, what we did with her that first time was perform a bone graft with a special growth product called platelet rich fibrin.”

Platelet rich fibrin, or PRF, is obtained by drawing blood from the patient’s arm and spinning it in a centrifuge that separates the fibrin clot material, which is high in growth factors, from the rest of the blood.

When mixed with bone graft material, which can be real or synthetic bone, the PRF helps the body grow new bone faster. That new bone also grows stronger around the implant, which is then capped with an abutment and crown.

“I trust (Dr. Leong) because he’s done nothing but great work for all of us.” – Debbie

“Implants normally need to be in place for about six months before enough bone grows around them to support them,” Dr. Leong adds. “But by doing a bone graft with PRF, we can sometimes complete the implant process in three or even two months.”

Bone grafts are not always necessary, but in cases where infection runs deep or teeth have been missing for many years, a graft is often necessary because bone mass deteriorates when there’s no pressure from chewing to stimulate natural bone regeneration.

Dr. Leong was presented with the latter situation when he began the work aimed at replacing Debbie’s upper molar. In this case, however, a simple bone graft wasn’t going to be enough to resolve the problem.

Because she had been missing her tooth in that area for so long, the bone had deteriorated to where Dr. Leong would need to not only use a special implant but also perform a sinus lift before fitting the implant.

Tap, Tap, Tap

Also known as a sinus floor augmentation, a sinus lift is a surgical procedure where the dentist drills through the jawbone and lifts the sinus membrane in a way that creates more space for the bone grafting material and implant.

In treating Debbie, Dr. Leong also added what is known clinically as a guided tissue regeneration barrier to keep soft tissue from growing into the site where the implant was placed.

Dr. Leong further augmented the site with PRF, but in extreme cases such as this, it typically takes about six months for enough bone to grow around the implant to support an abutment and crown. Dr. Leong also used a unique implant.

“Most implants are screwed into the jawbone. In this case we used a smaller implant that has a post that you tap into a cylinder inside the implant,” Dr. Leong adds. “Then, once everything is finished, the more you chew, the tighter that post gets.”

Dr. Leong completed that advanced implant process in February. After spending more than half of her life without a tooth in that space, Debbie says the presence of the new molar felt a little odd at first. She quickly adjusted.

“I definitely babysat that new tooth for a while before chewing on it, but the more I got used to it the more comfortable I felt,” she said. “I feel a whole lot more comfortable now knowing that this is going to help me avoid other problems down the road.

“That’s one of the reasons I really like Dr. Leong. He’s always looking out for his patient’s best interests. In fact, that’s how I ended up going to him in the first place. He was treating my husband before we got married and offered me a free cleaning.

“I’ve been seeing him ever since, and that’s been 15 years now. And all of our kids go to him as well. They really like him, and I trust him because he’s done nothing but great work for all of us. I gladly recommend him to anybody. He’s really great.”

© FHCN article by Roy Cummings. Photos by Jordan Pysz. mkb
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