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

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Presentation on theme: "Peter W. Hills Teeth Restoration 1 Peter W. Hills Odyssey to Perfect Teeth! Oct 2008."— Presentation transcript:

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

2 Peter W. Hills Teeth Restoration 2 History – Peters 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 Peters mouth was a mess with fixes everywhere

3 Peter W. Hills Teeth Restoration 3 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 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 Peters 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

4 Peter W. Hills Teeth Restoration 4 Dr Prafull Sabadra at Work

5 Peter W. Hills Teeth Restoration 5 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 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 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.

6 Peter W. Hills Teeth Restoration 6 Planning Objectives 1.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

7 Peter W. Hills Teeth Restoration 7 Planning Objectives 1.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

8 Peter W. Hills Teeth Restoration 8 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 (36O 0 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 90 0 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

9 Peter W. Hills Teeth Restoration 9 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

10 Peter W. Hills Teeth Restoration 10 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

11 Peter W. Hills Teeth Restoration 11 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

12 Peter W. Hills Teeth Restoration 12 Status & Plan Peter'sRIGHT TOPLEFT TOP Original 18R Expectation CRBR CR IM CR IM BRIMCR NBR CR BR IM 48R RIGHT BOTTOMLEFT BOTTOM DATERIGHT TOPLEFT TOP STATUS 18R Oct-07 CR BR CR MM M M 01-Oct-07 NBR CRN NNMNMM 48R RIGHT BOTTOMLEFT BOTTOM LEDGEND`ORIGPLAN NaturalN IM – Implant CR (Crown)CR Missing TeethMBR BR (Bridge)BR

13 Peter W. Hills Teeth Restoration 13 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 Peters face

14 Peter W. Hills Teeth Restoration 14 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

15 Peter W. Hills Teeth Restoration 15 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.

16 Peter W. Hills Teeth Restoration 16 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.

17 Peter W. Hills Teeth Restoration 17 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.

18 Peter W. Hills Teeth Restoration 18 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

19 Peter W. Hills Teeth Restoration 19 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 implants 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

20 Peter W. Hills Teeth Restoration 20 Left Side View Before and After

21 Peter W. Hills Teeth Restoration 21 Plan View Before and After

22 Peter W. Hills Teeth Restoration 22 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

23 Peter W. Hills Teeth Restoration 23 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

24 Peter W. Hills Teeth Restoration 24 Peter & Prafull - life long friends

25 Peter W. Hills Teeth Restoration 25 Presentation by Peter W. Hills The comments and summary are Peters 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: or © Peter W. Hills 2008


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