Dental implants case study

A series of interesting accidents were the start of Trevor’s teeth problems.  He’s a bit of a legend, so he’s the best person to tell his story.  Over to you Trev…

I was only seven years old when it all started.  Trying to get off my bicycle, I fell against my Dad’s sundial knocking the tips from my two front teeth. The school dentist placed silver coloured metal caps over both teeth and my school nickname was immediately ‘silver tooth’.

Many years of journeys to London’s Eastman Dental Hospital eventually lead to the caps being removed and repaired using the latest American bonding process to replace the lost tooth structure.

Unfortunately an accident at school involving a relay baton damaged one tooth which required a new cap. Then a few years later a roller skating incident knocked three teeth in half and more crowns were needed.
That was the end of the accidents, thankfully! But I didn’t help things.  Smoking 40 a day led to a large gap in the crowns and the teeth became loose. I was always very conscious of this - there are very few pictures of me smiling.

In March 2015 one crown fell out whilst I was eating a sandwich at work. My dentist glued the crown back with the words “this could last a day, a week or a month” and suggested a denture. But on being assessed by a periodontist, I was told that a partial plate was not possible as the teeth it would grip to wouldn’t be able to tolerate the pressure and would soon fail too.  At this rate, I was going to end up with no teeth at all.  And with a fairly strong gag reflex a full plate wasn’t an option.  It’s at this point I was referred to Maria Hardman.

Maria says "When I first met Trevor, I was struck by how much tension he carried relating to his teeth. He felt very ashamed about the situation and was being dragged down by it. He was incredibly emotional and it was so apparent that his teeth were supressing his personality.

We had a good chat about the results that can be achieved, the processes required and some of the challenges that one meets along the way. I believe that we have to be open with our patients about the positives and negatives of the process - when you’re dealing with the human body, there are always unknown parameters. Each patient heals differently and experiences the process differently and it is very important to be alert to this at all times.
Periodontal disease and a history of heavy smoking meant that in some respects, Trevor wasn’t a perfect fit for the surgery.  Mindful of these challenges, our pre-operative planning and investigations were exhaustive, as usual. 
On the positive side, a strong gag reflex can mean that denture wearing becomes impossible (and even taking impressions can be challenging).  Dental implants would mean dentures could be completely avoided.  So Trevor was an ideal candidate for the surgery in that respect. "

Trevor continues

Meeting Maria and Sarah was genuinely interesting and their support and advice was second to none.  I was nervous about the whole process and anxious about even going to the consultation, but they totally put me at ease and made everything sound possible and straightforward.
And then I made the worst decision of my life.  I decided to wait.  And the only reason was fear. I don’t really know what I was afraid of, I just couldn’t go ahead with it there and then – I booked in to have the procedure in October – six months away.  But that just resulted in a whole summer of obsessing about my teeth and driving friends and family mad as it was the only thing I could talk about. I swear that suddenly every advert I saw had something to do with teeth.  I’m not making this up – that is what it was like. 
I could only think about my teeth, and my anxiety just had time to grow and grow.  Oh, and a word of advice.  If, like me, you really want this surgery but haven’t the courage to commit, don’t do what I did and spend your time watching re-runs of ‘Botched-up bodies’.  Big mistake.

Maria says "It’s quite normal to feel nervous about having surgery, as all surgery carries an element of risk. 
Trevor was very fearful.  He decided to delay the treatment and go and enjoy his holiday instead. It was apparent what a change the surgery would make to him, but he needed this time to fathom things out.  And that’s absolutely fine.  We never, ever insist on any kind of timetable.
Just be aware that the most common thing implants patients (including Trevor) say to us after surgery is 'I wish I’d done it years ago'…"

Back to Trevor

The day of surgery finally rolled around.  My good mate Gazza drove me to the clinic.  He’s one of my  many friends whose ear I’d been bending all summer with my constant talk of teeth.  When we arrived I got out of the car and walked round to the other side to say thanks.  But he was already pulling away with a cheery “Good luck” leaving me no chance to duck out.
A very kind Sarah met me and immediately helped put me at ease.  Then in turn both the anaesthetist and Maria arrived and did the same. I changed into my gown and the process began.

Maria says "I spoke to Trevor before the anaesthetist sedated him and he was very emotional.  I said “Let’s save that emotion for later when you have new teeth and we’ve changed your life”. "

Trevors recalls

The day passed without me knowing a thing. All I can remember is Maria asking me to open my mouth and I think I swore “It is [BLEEP] open”.  Give me a break – I was sedated.  Maria just laughed and promised she’d heard worse.  That’s it – my only memory of a whole day of complicated surgery. I honestly didn’t feel any pain, and I’m still not sure how that’s possible, but it’s true.
At the end of the process, my brother Mark arrived to take me home.  In the car he said to take a photo and send it to Mum & Dad who were away on holiday and worried about me.  What a great feeling – I’d done it, it was so successful and so easy.  After all those months of feeling so nervous and worried, it was over and being able to send my parents a photo of my new smile was a very emotional moment for me.  Relief, pride, excitement.  It was all swirling around.

Maria says "There’s no doubt this surgery is incredibly emotional for the patient.  But I can’t be drawn into it – I have to stay 100% focused on the job in hand. 
Although most obstacles become apparent in the planning, there can always be surprises on the day, and Trevor’s heavy smoking and periodontal disease meant we couldn’t be absolutely sure about the quality of his bone.  We have to be prepared to adapt, make changes if necessary and have contingencies planned. The health and safety of the patient, and a successful outcome, remain paramount at all times.
It’s only once the teeth are fixed and we step back and look at the patient, do we allow ourselves to relax and enjoy the moment. John Davies (my dental technician who has worked with me on multiple cases) and I shared a glance of gratitude, and we finally handed Trevor the mirror.

When Trevor saw his smile for the first time he had tears in his eyes – it was such an emotional moment for everyone. I often use this photograph when lecturing as it tells such an amazing story."

The final word goes to trevor

As my new teeth have settled in, my confidence and sense of humour have (thankfully) returned.  Not long after the treatment was complete, I was at a company party and asked a woman to dance.  That might sound quite a simple thing, but I wouldn’t have had the confidence to do with my old wonky smile.

I can only thank Maria and her team for their kind treatment and professionalism.  And I must thank my family for all their incredible support, and my friends too for enduring my weird teeth obsession and for remaining friends in spite of it. They know who they are.  Many, many thanks to you all.