Model Makeover

Full-mouth restoration restores function, beauty.

He really cares about people and treats you like a human being, not like you’re a patient or a client. - Alfred

He really cares about people and treats you like a human being, not like you’re a patient or a client. – Alfred

 

The shelves of the entertainment center in the living room of Alfred DeSimone’s Melbourne home are filled with scale models that Alfred painstakingly built with his own hands. We say painstakingly because these are not just any ordinary models.

Built almost entirely of raw materials such as wood and cardboard, the models were made from scratch, not a commercial kit, with Alfred often guided by nothing more than a picture he found in a book or on the internet.

“I recently started concentrating on making models of things from the Old West,” Alfred elaborates. “I built a stage coach, a covered wagon and one of those old horse- or hand-drawn, hand-pump firetrucks. 

“For the stage coach, I had to create somewhere between 125 and 150 pieces, all by hand. God gave me the smarts and skill to do this, and it’s something I really enjoy because I love working with my hands. Right now, I’m building a Ford Model A.”

Alfred, 81, picked up the hobby shortly after he retired from a career in which he also worked with his hands, first as a pipe fitter and later as a homebuilder and remodeler. 

Recently, Alfred learned that his smile needed to be remodeled.

Truth is, Alfred’s smile had been in need of remodeling for years. While raising his family, he’d sacrificed his dental health to such a degree that he had lost several teeth, mostly lower molars, and could only chew with his front teeth.

“My teeth were in pretty bad shape,” Alfred admits. “I was at a point where, even if I was just brushing my teeth, I’d feel a little sensation. I was also having trouble eating anything that had any crunch to it.

“I like crunchy things like celery and peanuts, but for a long time, I had to make sure everything was cooked. I couldn’t just chomp into a carrot or anything. I had to make sure it was cooked so that it was soft enough to chew.”

Despite eating mostly soft foods, the stress of chewing almost exclusively with his front teeth began to peak about a year ago, when a left front tooth broke. That forced a search for a dentist who could repair the problem.

Inspired by an article he read in Brevard Health Care News, Alfred chose Richard Leong Jr., DDS, P.A.

“My daughter lives in Georgia, and she was helping me by searching for dentists in my area,” Alfred explains. “After I read the article, I sent it to her, and when she read it she said, Dad, you’re going to see Dr. Leong.”

A Helping Hand 

As with all of his patients, Dr. Leong’s initial examination of Alfred was comprehensive, including a visual exam, a full set of dental x-rays, a CT scan and an oral cancer screening.

After reviewing the images, Dr. Leong put together various treatment plans. Eager to help her father resolve his vast dental issues, Alfred’s daughter asked to be a part of the discussion regarding which plan to choose.

“I did a personal conference with Alfred in my office and brought her in on a Zoom call on the computer,” Dr. Leong explains. “By doing that, she was able to see all the x-rays, scans and photographs just as Alfred was.

“She was part of the decision-making process right from the very start, and it was very apparent to me how much she loves her father because she really wanted to help him. She wanted to make sure we did the best we could for him.”

That required much more than simply repairing Alfred’s broken tooth. As Dr. Leong explained, it would include replacing Alfred’s missing teeth and a full restoration of the existing teeth. Even his bite had to be altered.

“He had a lot of problems, not the least of which was that his existing teeth had moved into the empty spaces around them and were either too short, too long or crooked,” Dr. Leong reports. “The only way to put new teeth in was to change his bite.

“He also had a lot of tartar on his teeth and a lot of gum disease. In addition, because he was using his front teeth to chew so much, those teeth were all breaking down. Some of them had actually become loose.”

Alfred and his daughter wanted to resolve all those issues, so they chose the most extensive option, one that called for the bite to be reestablished, the existing teeth to be restored and the missing teeth to be replaced with bridges.

A Healthy Foundation 

To ensure a healthy foundation for those changes, the project began with a gum treatment and thorough cleaning of Alfred’s existing teeth. Dr. Leong then went to work repairing the broken tooth. That required the doctor to lean on his experience and expertise.

“I know of an old technique where we put a dental implant through the middle of the tooth,” Dr. Leong explains. “It’s called an endodontic implant. By using this technique, I was able to save the tooth.

“A lot of dentists would simply pull that tooth and either put in a bridge or replace it with a standard implant and crown it. But that would take almost a year to do when you factor in the time needed for the implant to fuse with the jawbone.

“So I chose this older technique where you perform a root canal and insert the implant through the root and into the jawbone. Then you use the implant as the core for the restoration and finish it off by putting a crown on it.”

Once the front tooth had been restored, Dr. Leong went to work altering Alfred’s bite. He did that by reshaping his existing teeth and placing crowns on them. The size and shape of each crown was determined by a digital mock-up of his teeth.

“Alfred was going to be fit with bridges, so in altering his bite, I had to be make sure the supporting teeth were just the right size and shape and could tolerate the stress the bridges would put on them,” Dr. Leong details.

“Getting those details just right requires taking impressions and a lot of very precise measurements. Once that’s done, I send the impressions and measurements off to a laboratory, where they create the virtual mock-up of the teeth.”

The mock-up is used as the guide to make temporary bridges that are worn for about two weeks to determine whether the patient can adjust to the changes in the bite. If not, alterations can be made so that the patient feels comfortable with the bite.

Alfred required several alterations. Now he’s equally comfortable with the vastly improved function and aesthetic appearance the remodeling job provided him.

“Dr. Leong did a beautiful job,” Alfred enthuses. “My teeth look great, and I can eat anything I want now, even peanuts. Some people might not think that’s a big deal, but you never know how much you appreciate some things until you can’t have them anymore.

“That’s how it was for me, but Dr. Leong took care of everything. And I mean it when I say that I cannot say enough good things about that man. He’s got a lot of heart, and over the four months that he was fixing me up, we actually became quite good friends.”

In fact, after all of the work was completed, Dr. Leong took Alfred and Alfred’s daughter out to dinner. Alfred says the outing was another example of the personal approach Dr. Leong takes in caring for patients.

“He really cares about people and treats you like a human being, not like you’re a patient or a client,” Alfred says. “And the people he’s got working for him are the same way. They are really fine people, second to none.

“That’s why I’ve already sent some friends to see him. I told them, Go see Dr. Leong because you are going to be very satisfied, and you won’t feel like you’re in a dentist’s office because they treat you so well.

The Dentist’s Dentist

Of the 35 years that Gene List, DDS, devoted to practicing dentistry, two stand out: when he was practicing in Busan, South Korea, and answered a much higher calling.

“While I was in college, I met a young man who had escaped from North Korea,” Dr. List relates. “Through him, I was later introduced to the president of the hospital and the medical school in Busan.

“The president later asked me if I was interested in doing something other than just practicing dentistry. I told him I was, and so together with my wife and young children, I traveled to Busan and opened a teaching clinic in the hospital there.”

That extended visit to Busan was part of a mission trip sponsored by the Orthodox Presbyterian Church. Several years later, Dr. List made another mission trip, this time to London, where he worked with refugees and their families.

Now retired, Dr. List remains active in the church and works as a missionary. On several trips, he’s traveled alongside his close friend, Dr. Leong. 

Not long ago, Dr. List found himself in need of Dr. Leong’s services.

“It was probably about a year ago that I realized I was having some pain in a couple of teeth where another dentist attempted to do root canals,” Dr. List explains. “I knew what the issue was, but I don’t generally diagnose myself, so I went to see Dr. Leong.”

Dr. Leong quickly confirmed Dr. List’s belief that the root canals failed and informed him the teeth needed to be removed. He also discovered another issue that promised to make the job of replacing the failing teeth a bit more complicated than usual.

“Dr. List takes great care of his teeth, but like a lot of people, he has a hereditary propensity toward gum problems,” Dr. Leong explains. “When you have gum disease, you also lose bone, and that was part of the problem I found with Dr. List.

“He was having trouble with two teeth, a lower left molar and an upper right premolar. Both had inadequate bone, so to replace the teeth I needed to do a bone graft and fit him with special dental implants made for low-bone situations.”

Replacement Roots 

Dental implants are screw-like bodies surgically seated in the jawbone as replacements for the roots of missing teeth. Once an implant is in place, new bone naturally grows around it to form the foundation for an abutment and replacement teeth.

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

Dr. List is no stranger to the technology. He fit “hundreds of patients with dental implants” before he stopped practicing 20 years ago but acknowledges that the technology has changed remarkably since then.

“We worked off two-dimensional x-rays, and it was more like a hunt-and-peck process,” Dr. List shares. “You’d make an incision and take a little bone away. Then you’d back off, take another x-ray, then go back in and take a little more bone away.

“You kept taking the x-rays because you had to know how far you could go before you did damage to the nerve. But now, Dr. Leong has a very modern radiographic system that allows him to examine and premeasure everything before he even makes an incision.”

Using that system, Dr. Leong began the process of replacing Dr. List’s failing teeth by taking a CT scan. It was through the imaging that he discovered the lack of bone and realized a graft was required before seating the implants.

Designed to add bone where it has been lost, grafts can be completed using cadaver bone, a synthetic substitute or bone material taken from the patient. Dr. Leong used a synthetic substitute to treat Dr. List.

In addition, he added a blood product called platelet rich fibrin to speed up the bone-growing process. Platelet rich fibrin is obtained by drawing the patient’s blood and spinning it in a centrifuge that separates the fibrin clot material, which is high in growth factors.

“When you mix the platelet rich fibrin with the bone grafting material, you get a much better bone graft,” Dr. Leong educates. “But for treating Dr. List’s upper right premolar, I had to take some extra steps using some of the latest techniques.”

Stronger, Faster Growth 

One technique involved the use of special barriers designed to protect the bone graft. If soft tissue, which grows faster than bone, gets into the bone, the graft can be compromised and the bone will not be as strong as it needs to be to secure the implant.

To keep that from happening, Dr. Leong used guided tissue regeneration, where he uses barriers that last as much as six months. That allows more bone to grow stronger where the graft is done.

“I also fit Dr. List with special smaller implants that work well with less bone,” Dr. Leong reveals. “These implants have better engineering and better shaping. All of this allows the implants to be seated sooner than normal.

“After doing the bone graft, I usually wait about six months to seat the implants. But thanks to these advanced accelerated techniques, we were able to place the implants in about half that time.”

Dr. Leong began his treatment of Dr. List early last summer. By late December, the bone grafts and a gum graft on the upper right premolar were established and both implants were seated. Today, Dr. List is enjoying the benefits of Dr. Leong’s work.

“I don’t know if I’m a very good patient, but I do know that Dr. Leong is an exceptional dentist,” Dr. List exudes. “Thanks to him, this problem has been resolved and my teeth are very sound. I can chew and bite with no problem at all and with no pain.

“As I said, Dr. Leong is exceptional, top of the class, and he has all the tools necessary to do the best job possible. He does implants quite well, and that’s why I went to see him. He’s among the best at what he does, and I gladly recommend him.”

© FHCN article by Roy Cummings. Alfred’s photo by Jordan Pysz. Dr. List photo courtesy of Gene List. mkb
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