A combination dental and facial aesthetic case

Step into the light: special feature

A combination dental and facial aesthetic case Tracey Bell shares a case study where by combining dental treatment with facial aesthetics increased confidence in her patient

When I first met Caroline, she was miserable about her ill-fitting 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 the some of the trials that had befallen her and how she has stopped focusing on herself. I could see that, but 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 choices that they may not realise 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 to 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 augmenta74

tion 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 on 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 illfitting dentures on the upper and two remaining teeth, which she just did not want to let go of on the lower.

Like many patients, the history revealed that she had her top teeth removed in her twenties, 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 due to her embarrassment at having dentures and the fear 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 and the main pointer that resulted in our conversa-

tions 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 and the ageing appearance.

Assessment was taken with radiographs and a treatment plan was devised to produce a full upper denture as although the ridge was relatively flat – I felt fitting a good denture could be obtained.

A decision was made regarding the lower denture to extract the remaining two teeth allow healing for eight weeks and to place a single Straumann implant in order to give retention.

Full bone grafting was discussed with the patient but due to the fact that Caroline was a carer, helper, mother and busy woman – this would not fit into her life.

Diagnostically – stents were made primarily for implant placement on the lower and the immediate addition of the two remaining teeth to her existing denture completed.

Whilst allowing for healing – special trays, bite registration were produced and an intermediate denture with increased vertical dimension improved colour and facial support produced.

The results on increase in vertical dimension 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 was allowing Caroline to adapt to her new look and tolerate the increase in vertical dimension.

Private Dentistry January 2009

Patient: Caroline

Before

Before

After

Twenty years ago I was confident, attractive, had the world at my feet and 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 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 past and it was one of those moments of truth, whilst visiting Tracey Bell’s that made my engine re-ignite and it made me stop and think. I’d had dentures all my life and I hated them, but over the years my mouth had changed shape and they didn’t fit at all, but you know what, I hadn’t noticed until then, I had just come to accept the way they were.

Tracey came in to the room and asked how I was, I replied ‘OK’. On reflection Tracey is a very good judge of character and 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

whilst 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, firstly I understand how you feel, truly, and I empathise because life can be very tough, but you know what 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 and 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, so where did I begin, my mouth of course. The single most thing that I had hated, 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 tenfold. I could smile, laugh and eat and they didn’t move. –

‘wow’ I thought. The lovely picture Tracey said and now for the ‘frame’ – my lips and soft tissue around my lips were transformed in to 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 the 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.

On reflection, my looks 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 newfound ‘get up and go’ and my smiling on the inside and outside feeling has had an effect on him?

My life has changed, thanks to Tracey Bell.

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Private Dentistry January 2009

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The ‘look’ I admit took some convincing simply because she had looked at the same disappearing mouth, elongated chin and lack of soft tissue support that had appeared over 20 years.

With the positive support of her family, digital photographs and encouragement of our staff her confidence in her new look escalated.

The use of an intermediate set of dentures allowed the practitioner to assess, vertical dimension change, aesthetic adjustment and allow the patient to adapt, try and be part of the overall facial and dental enhancement – which she truly did become.

new denture was planned, the client had ‘grown to love’ her new look that it was we decided to simply adapt the existing denture to the single implant that was to be retained by a single attachment.

This procedure resulted in simply three visits in order to adopt and refit the denture to the implant and to adapt and extend the existing denture.

The case demonstrates a simple solution that has been adapted to clinical situation and also the patient lifestyle.

The implant retained lower denture has been in place over one year along with the upper existing full denture.

Maintenance is simply review and cleaning of the lower implant and the patient has been informed that the attachment within the denture may require replacing in a year.

The biggest asset is the smile and confidence a simple procedure has brought to the patient as she attends.

She is no longer embarrassed about wearing dentures but in a way is ‘almost proud’. PD

Implant placement In this case the only solution we could find was the use of a single implant.

Not conventional but practical for a clinical situation where the client seeks and improvement but in a compromised clinical situation and the patients available time.

A single implant was placed in the 3,4 region in a single visit and allowed to heal. After eight weeks, although a

Comments to pd@fmc.co.uk Dr Tracey Bell is founder and CEO of TRACEY BELL, formerly APt. An accomplished cosmetic dentist and aesthetic physician, Dr Bell started her first dental practice, Craigend Dental, in the Isle of Man in 1995 the practice grew and six years later she expanded into aesthetic medicine, launching The Kensington Clinic next door to her dental practice. Both flourished and having seen how one business complemented the other, she launched what she termed her ‘body shop for the 21st century’.

The first TRACEY BELL clinic was opened in Douglas, Isle of Man in October 2006, then in June 2007 TRACEY BELL launched a 7,000 square foot Medical Spa in Liverpool city centre, offering dental, non-surgical, laser, spa, hair, body shaping, SkinScription and mineral make-up treatments… more Tracey Bell sites across the UK are planned for the future. Dr Bell is recognised by both the dental and aesthetic industry as a practitioner of international standing and inspirational speaker noted for her motivational and authoritative presentations.

Private Dentistry January 2009

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