FACIAL AESTHETICS
A combination dental and facial aesthetic case Tracey Bell presents a case study where the patient’s confidence was boosted by combining dental treatment with facial aesthetics Dr Tracey Bell is founder and CEO of TRACEY BELL. A cosmetic dentist and aesthetic physician, Dr Bell started her first dental practice, Craigend Dental, in the Isle of Man in 1995. Six years later she expanded into aesthetic medicine, launching The Kensington Clinic next door to her dental practice. The first TRACEY BELL clinic, her ‘body shop for the 21st century’, was opened in Douglas, Isle of Man, in October 2006, then in June 2007 she launched a 7,000 sq ft medical spa in Liverpool, offering dental, non-surgical, laser, spa, hair, body shaping, SkinScription and mineral make-up treatments. Dr Bell is recognised by both the dental and aesthetic industry as a practitioner of international standing and is an inspirational speaker noted for her motivational and authoritative presentations.
xx | Irish Dentist | April 2009
When I first met Caroline, she was miserable about her illfitting dentures, which she had been wearing for a quite a while but had more or less resigned herself to. It seemed like a physical reflection of how she felt on the inside, because some of the trials that had befallen her had stopped her focusing on herself. Rather than just ‘fixing’ her dentures for her, I listened to her and began to understand about the kind of person that Caroline was and how she felt about herself. You cannot force change upon people, but you can educate them and give them options that they may not have realised were available. If someone begins to feel confident in you as a dentist and aesthetic practitioner, they begin to feel more confident themselves, which can help them to make informed decisions and start believing that change can happen. Caroline had a smile makeover using dental implants and new dentures. Once she had the perfect picture, she was motivated to get the beautiful frame for that picture. When I talk to my patients I don’t judge them; I gain their trust and ask them to show me what bothers them. Often the solution is not extreme, but a
combination of natural and subtle enhancements that when all put together have an amazing effect on how someone looks and feels. Caroline’s combined aesthetic treatments consist of a SkinScription chemical skin peel, a little Botox in the glabellas and forehead, lip enhancement with Restylane Lipp, lower face and upper lip area rejuvenation with Restylane Vital, and cheek augmentation with Restylane. The results speak for themselves and Caroline’s account of what happened to her is highly emotive and I would imagine that many people out there will relate very strongly to how she felt. As a dentist and aesthetic practitioner I run my business based upon education, ethics and evidence-based results. I listen to my patients, I educate my patients and when I treat them I use only the very best treatments and products that are going to produce the best results for them, and it’s so rewarding!
Caroline’s case Caroline presented with severely ill-fitting dentures on the upper and two remaining teeth that she just did not want to let go of on the lower. Like many patients, her history revealed that she had
her top teeth removed in her 20s due to ‘gum disease’ and pregnancy, followed by the lower posterior teeth – leaving only the lower anteriors, which had gradually ‘dropped’ out over the years. She was embarrassed at having dentures and afraid of losing the remaining teeth, which was inevitable. The result was a ‘flabby upper ridge’ with no bone and a lower ridge with the two remaining teeth that had a little bone.
History A thorough clinical examination and patient history was taken. The main issue that led to our conversations over two visits was the actual embarrassment Caroline felt about having dentures. This had resulted in a denture with severe wear and the resultant loss in vertical dimension and lip support, as well as an ageing appearance. Radiographs were taken and a treatment plan was devised to produce a full upper denture, because although the ridge was relatively flat, I felt a goodfitting denture could be obtained. When it came to the lower denture, a decision was made to extract the remaining two
www.IrishDentist.ie
Caroline’s story
Before
After
After
Twenty years ago I was confident and attractive. I had the world at my feet, four beautiful children, a good husband and a highly successful florist business. I’d always had a sense of pride; I enjoyed taking care of myself, looked good and enjoyed life. Ten years ago that all changed when my husband had a serious accident; my life fell into what seemed like a black hole and my priorities changed. It seemed as if overnight my confidence disappeared, along with my life, beauty and looks. With my husband requiring constant care, not only did my domestic and home life change but also my social and emotional life. Years passed and it was one of those moments of truth, while visiting Tracey Bell, that made me stop and think. I’d had dentures all my adult life and I hated them. Over the years my mouth had changed shape and the dentures didn’t fit at all but I just hadn’t noticed until then. I had just come to accept the way they were. When Tracey came into the room and asked how I was, I replied ‘okay’. Upon reflection, Tracey is a very good judge of character; she smiled at me and said: ‘Come on Caroline, how’s life? Tell me.’ Well, half an hour later she knew it all. My last eight years spilled out while I was sitting in her
dental chair. Why? Because I could tell she cared. She said little, listened very attentively and, at the end, picked up my hand and said: ‘You know what Caroline – I’ve got just two things to say. I understand how you feel, truly, and I empathise because life can be very tough, but you know life is too short and only you can make that change. I can help you, but you also have to help yourself’. I realised that I had gone to Tracey with the problem of my teeth and mouth because, yes they were ugly and it did bother me, but what Tracey also realised, without me telling her, was that I was lacking in confidence and assertion. By giving me the opportunity and the push to talk to her, I was able to pinpoint those physical signs and get them out in the open. And so I began my reinvention. Where did I start? My mouth, of course. It was the thing that I had hated the most: the lines, the teeth, the loss of my luscious lips that many years ago had kissed the man I loved and married. So the magic of Tracey began with her team. My smile was transformed with dental implants and new dentures – the confidence I gained from this alone was 10-fold. I could smile, laugh and eat and they didn’t move. ‘Wow’, I thought.
I had the lovely picture Tracey had said was possible and now it was time for the ‘frame’ – my lips and soft tissue around my lips were transformed into a frame that houses a masterpiece. With the use of Restylane for the lips and Vital for the fine lines, my lips were restored to their original plumpness. I caught my reflection in a shop window and smiled – ‘not bad’, I thought. Things were improving! From then on I was transformed, peeled and my skin was improved. A little Botox in the brow and eye area and then my cheeks, something I would never have thought about before. But with the right education and treatments, my confidence grew and my personal metamorphosis continued. Looking back, my appearance changed with my circumstances, state of mind and age. I didn’t like what I saw in the mirror and my confidence dropped and stayed there for years. Tracey Bell and her team resurrected that confidence and the physical change has resulted in an emotional change for me. What is also strange is that my husband has improved as I have. Could it be that my new-found ‘get up and go’ and my smiling on both the inside and outside has had an effect on him? My life has changed, thanks to Tracey Bell.
www.IrishDentist.ie
April 2009 | Irish Dentist | xx
FACIAL AESTHETICS
teeth, allow healing for eight weeks and then place a single Straumann implant in order to provide retention. Full bone grafting was discussed with the patient but because Caroline is a carer, helper, mother and, in general, a busy woman, this would not fit into her life. Stents were made, primarily for implant placement on the lower, while the immediate addition of two teeth to her existing denture was completed. For the duration of the time we allowed for healing, an intermediate denture with increased vertical dimension, improved colour and facial support was produced. The vertical dimension was increased by almost 10mm, a flange was added bucally to the upper denture, and the teeth positioned into almost an original position. The biggest challenge in all of this was getting Caroline to adapt to her new look and tolerate the increase in vertical dimension. The ‘look’, I admit, took some convincing, simply because she had watched the disappearing mouth, elongated chin and lack of soft tissue support progress over the last 20 years. With the positive support of her family, digital photographs and the encouragement of our staff, Caroline’s confidence in her new look steadily grew. The use of an intermediate set of dentures allowed the practitioner to assess the case, change the vertical dimension and make aesthetic adjustments. It also gave the patient time to adapt and feel truly comfortable with the overall facial and dental enhancement.
Implant placement In this case the only solution we could find was the use of a single implant. This is not conventional but was practical for this clinical situation, where the client sought an improvement but in a compromised clinical situation xx | Irish Dentist | April 2009
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
and with the patient having limited time available for the treatment. A single implant was placed in the |3,4 region in a single visit and allowed to heal. After eight weeks, although a new denture was planned, the client had grown to love her new look as it was, so we decided simply to adapt the existing denture to the single implant, which was to be retained by a single attachment.
This procedure required just three visits in order to adapt, extend and refit the denture to the implant. This case demonstrates a simple solution that was adapted to suit the clinical situation and the patient’s lifestyle. The implant-retained lower denture has been in place for over a year, along with the upper existing full denture.
Maintenance is simply to review and clean the lower implant, and the patient has been informed that the attachment within the denture may require replacing in a year. This treatment has eliminated the patient’s embarrassment she felt as a result of having to wear a denture and her confidence in that smile is now her biggest asset. www.IrishDentist.ie