Peter W. Hills Teeth Restoration 1 Peter W. Hills Odyssey to Perfect Teeth! Oct 2008

Peter W. Hills Teeth Restoration 1

Peter W. Hills

Odyssey to Perfect Teeth!Oct 2008


History – Peter’s teeth Subjected to dental treatment in Africa where extraction was better than

the cure! Old dental drilling machines driven by wire pulleys from a slow motor,

with grinding stones – None of todays high speed drills Numbing injections were rare and the whole exercise a dread The mecury amalgam require about 150% larger cavity than the actual

problem in order to secure the filling Peter had rear teeth removed creating large gaps It is understood the rotting teeth and the absence of teeth causes the

jaw bone to waste away. As a result he ate with the front teeth and wore them down; the bottom

ones became so sharp he was always biting his lip Over the years ‘fixes’ were done as problems arose Caps and bridges were installed. On one side it was a ‘bridge too far’

the supporting tooth sheared so it had to come out The front top cap also sheared off at the root and had to be removed.

The bridge was the only solution but if felt horrible In summary Peter’s mouth was a mess with fixes everywhere


Desire Peter investigated the possibility of implants in the UK but then

moved to India for an indeterminate time in 2004 On recommendation, Peter tried two dentists, both were good

but the second, Dr Prafull Sabadra was nearer home. It was an excellent decision; visit www.drsabadra.com

Peter wanted an holistic view taken of his situation, not just a few new teeth to fill the gaps but a long term solution; cosmetics was not the main driver instead the ability to eat properly and be healthy

Dr Sabadra was just the person, it was right up his street. The challenge was to get Peter’s jaw working correctly and establish an even bite. Cosmetics would be a positive spin off

Dr Sabadra proved to be a perfectionist and had experience of complete mouth / teeth restorations


Dr Prafull Sabadra at Work


The Dentist – Dr Prafull Sabadra “Everyone smiles in the same language”

Right from the first year, Prafull scored distinction in all 3 subjects (very rare honour) till the final year his academic excellence is as follows:

Third in Government Dental College and Hospital , Mumbai in final B.D.S examination. Second rank in subject of oral surgery. First rank in subject of Periodontology Third rank in subject of Oral Anatomy and Histology. Gold medal and Colgate merit shield by Indian Society of Periodontology He presented lot of scientific papers and even won the best

presentation award at the Asian Pacific International Dental Congress in 1996.

Dr Sabadra has a private practice dedicated to general dentistry with special attention to aesthetic and cosmetic dentistry since 1997 in Mumbai-INDIA. Due to his excellent clinical knowledge and skills, patients from all over the world visit him and return with satisfied beautiful smiles.

Visit www.drsabadra.com The surgery was state of the art, modern with two operating

rooms Digital x-ray and digital photography available and used Before each patient, the room is sanitised. Dr Sabadra removes

his gloves before going to the next room All instruments are autoclaved and presented in sealed packets

for each patient, obviously standard practice The dental assistants and support staff were responsive and

seem to read the Docs mind for his next need, all goes smoothly Treatments are well scheduled with follow up and even personal

phone calls to enquire if all is well. You feel Prafull is a personal long term friend which he is and will be.

The excellent piped music distracted me from the treatment.


Planning Objectives1.Function-Restoration of bite and the whole jaw working rather just chewing from one side

2.Health – General oral heath. The gums were not right, food did not clear easily from the teeth. Past teeth spacing necessitated using a tooth pick!.

3.Comfort – No longer would I bite the inside mouth, no bridges or uncomfortable gum gaps being impacted.

4.Longevity – Long term correction for more than 15 years expected since a holistic approach was taken.

5.Appearance – All metal free CAD/CAM Lava crowns and bridges making the teeth look natural. Lava had just established their facility in India. This was the first full mouth rehailittation using Lava Crowns & Bridges in India


Planning Objectives1.Function-Restoration of bite and the whole jaw working rather just chewing from one side

2.Health – General oral heath. The gums were not right, food did not clear easily from the teeth. Past teeth spacing necessitated using a tooth pick!.

3.Comfort – No longer would I bite the inside mouth, no bridges or uncomfortable gum gaps being impacted.

4.Longevity – Long term correction for more than 15 years expected since a holistic approach was taken.

5.Appearance – All metal free CAD/CAM Lava crowns and bridges making the teeth look natural. Lava had just established their facility in India. This was the first full mouth rehailittation using Lava Crowns & Bridges in India


Assessment It was obvious to Dr Sabadra that where teeth had been

missing the jaw bone had wasted away This was a problem as there needs to be width and height of

bone to position the teeth on a flat plane upper & lower jaw To establish the quality of bone, both an OPG (36O0 x-ray) and

CAT Scans were done of the upper and lower jaw bones Bone grafting was essential on the upper jaw. This would

involve splitting the jaw, screwing it apart and filling it with bone growing material. After 6 months it would be ready

The lower jaw was also split but with implants and added bone growth material; this would be less of a problem

In all 6 implants are required. They need 4 months to ‘bed-in’ One tooth had virtually turned 900 and another had to be

removed. Some root canals needed to be redone and the few rear teeth remaining needed repairing

The whole process would take almost one year


Preparation The first action was to enable Peter to eat while work was

done on one side of the jaw. Problematic teeth were ground and tidied up with

temporary metal/porcelain caps. The front bottom teeth would be attended to later Many moulds were taken as well as digital x-rays of each

tooth. Checks were made at every stage. As treatment proceeded Dr Sabadra was extremely

thorough and attentive; this built accumulative confidence The temporary teeth were plastic and unfortunately

discoloured easily with Betadine mouth wash etc despite vigorous cleaning

A basic plan of milestones was laid out so that Peter could plan his work load around surgery without to much interruption


Preparation The first action was to enable Peter to eat while work was

done on one side of the jaw. Problematic teeth were ground and tidied up with

temporary metal/porcelain caps. The front bottom teeth would be attended to later Many moulds were taken as well as digital x-rays of each

tooth. Checks were made at every stage. As treatment proceeded Dr Sabadra was extremely

thorough and attentive; this built accumulative confidence The temporary teeth were plastic and unfortunately

discoloured easily with Betadine mouth wash etc despite vigorous cleaning

A basic plan of milestones was laid out so that Peter could plan his work load around surgery without to much interruption


The Patient Age 64 A resident in Mumbai India

which makes it convenient for long term treatment

A few caps and wry smile hides a lot of pain and problems!

Note the gap on the right side. The bottom teeth never show

above the lip but have eroded away.

The enamel is razor sharp


Status & Plan

Peter's RIGHT TOP LEFT TOP

Original 18 R 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

Expectation CR BR BR CR CR IM CR CR CR CR IM IM BR IM CR

N BR BR BR CR CR CR CR CR BR BR BR IM IM

48 R 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

RIGHT BOTTOM LEFT BOTTOM

DATE RIGHT TOP LEFT TOP

STATUS 18 R 17 16 15 14 13 12 11 21 22 23 24 25 26 27 28

01-Oct-07 CR CR CR BR BR BR BR CR CR CR M M M M CR

01-Oct-07 N BR BR CR N CR CR CR N N M N M M

48 R 47 46 45 44 43 42 41 31 32 33 34 35 36 37 38

RIGHT BOTTOM LEFT BOTTOM

LEDGEND` ORIG PLAN

Natural N IM – Implant

CR (Crown) CR CR

Missing Teeth M BR

BR (Bridge) BR


Missing Teeth on One Side Here is the main issue. Peter is sucking in his

cheeks ‘Mind the Gap’ There are no teeth on the

left side which has change the shape of Peter’s face


The teeth have worn and do not lie parallel between upper and lower

It can be seen that the side with teeth slopes Teeth should be flat from front to rear The uneveness required many ‘bite’ trials to get right


Jaw Split and Bone Graft To create the platform for the implants

the jaw needed splitting & filling The operation was done on a Saturday

morning. Dr Sabadra brought in a specialist (Dr

Deshpande) to split the jaw using an ultrasonic saw, all went well

Two ceramic Endopore implants were placed and the centre filled with bone

This picture was taken on the Sunday By Monday the swelling had subsided It was not so painful that a couple of

panadol would not fix The stitches came out in 8 days The bone grafting would take 4-6

months to take effect Later the distancing screw was

removed.


The Old Teeth The lower teeth are mine The upper are temporary caps The erosion on the lower can be

seen Past attempts to fix the erosion

were never permanent as the filling kept coming off

The discolouring is largely due to the temporary teeth.


The Panorex (OPG) X-Ray Three were taken; this

is the final. It shows the implants

from Endopore Canada and Nobel of Sweden

The abutments by Lava were carved on a 3D CNC machine from solid zirconia after the moulds were scanned

The Lava Abutments cover the tooth pegs. On these the pocelain teeth are fused.

The bottom right are yet to have the abutments fitted

This service is now available in Mumbai.


Pete the Peg

I Happened to have my camera handy in the dentist & snapped this portrait

You can see some of the prepped teeth for the new abutments and some fitted loosely

The original teeth after root canal work, when shaped for caps, will discolour; this apparently is normal!

Not a pretty site


The New Teeth Here they are in full glory!

All 26. The only 2 natural teeth are The left teeth are my

uppers. the right the lowers There are several ways to

secure an implant. The left shows external

screws. The holes are temporary filled so that after settling in say 4 months they will be torqued down and invisible permanent filling done

Other implant’s abutments are ‘torqued’ in to secure them in the bone

The abutments with unglazed teeth were fitted in stages to ensure the bite was properly aligned

Only after the bite was perfect wre the teeth glazed


Left Side View Before and After


Plan View Before and After


That Bollywood Set of Teeth I was absolutely delighted as was Dr

Sabadra He reckoned people would die for

teeth such as these! Yes I am very happy with the

outcome, the inconvenience was worth the wait.

In months to come the gums will improve further

Dr Sabadra performed virtually every dental procedure on Peter

Treatment is not finished. For the next 6 months I will sleep with two mouth guards

These will allow the jaw muscle memory to develop as I re-learn to eat with sides of the jaw

The implants will be permanently torqued and screw holes filled to match the teeth colour

The cost was about 25% of that quoted in the UK

Dr Prafull Sabadra the maestro Visit www.drsabadra.com


Before and After Teeth

The top are temp teeth after old caps were removed

The lower gum line was tidied up by cauterising; this will take a while heal and adjust


Peter & Prafull - life long friends


Presentation by Peter W. Hills

The comments and summary are Peter’s experience over 11 months of treatment. While terms may not be strictly accurate they attempt to simplify the technology applied.

Any errors and omissions are regretted.

For further details contact Peter at: [email protected] or [email protected]

© Peter W. Hills 2008

Documents

Peter W. Hills Teeth Restoration 1 Peter W. Hills Odyssey to Perfect Teeth! Oct 2008