Florida Dental Implants New Teeth Now Webinar – Dr Harley Richards, July 2019


(Bianca) Good evening everyone welcome to the new teeth now webinar. My name is Bianca and I’m here with Dr. Richards. Thank you for
tuning in to the webinar tonight. We are so happy to have you. And tonight we’re
going to talk about full mouth implants and all that new teeth now has to offer.
So if you’re joining us with through GoToWebinar there should be a chat box
in the lower right hand corner of your screen.
You can type in questions that we can answer live and if you don’t see the
chat box there should be a little orange arrow that you can click to open up the
chat box and then if you are watching on facebook welcome. You can also send your
questions through there. So Dr. Richards how was your fourth of July. (Dr. Richards) My Fourth of July was wonderful how was yours? (Bianca) It was pretty good I had a good time. (Dr. Richards) Good fantastic. It was nice being off for a few days and taking it easy. So we’ve
been doing these webinars for a number of years and we have received a lot of
good feedback. So Dr. Kirkpatrick and I are gonna continue to do these
informational webinars. These webinars are broadcast out of our office in
Lakeland Florida. The New Teeth Now Dental office in Lakeland Florida and that’s
our only location. We’re centrally located in Florida about halfway between
Orlando and Tampa and makes it a really nice destination type of situation for
people that want to come from longer distances. We’ve had people from New York recently. Chicago, Alaska coming from all over and they always enjoy coming to the
Central Florida area. Just a little bit about me this is not about me it’s about
new teeth now but I’m a Lakeland native. I came back and started my practice in
1980. You’re going on 40 years now and it just so happens that I got into the
oral surgery business and the dental implant business at sort of the birth of
modern implants in the United States. Back in the late 70s we were doing
various types of implants. Ramus frames and other non precision type root form
implants but when the brand mark system was introduced into the United States
back in about 83 we began doing these full arch fixed cases and when I tell
people that they’re always shocked that these cases, these types of procedures
these full arch procedures have been done since the early 80s and it’s just
recently with a lot of people advertising about this that the public
is certainly becoming more aware of these procedures. So just a little bit of
background there we can kind of get right into the to the meat of things
here. Was there anything Bianca going to add
there>? (Bianca) No I just wanted to go right in and let’s talk a little bit
about what the upper and lower hybrids look like. (Dr. Richards) Okay.At New Teeth Now basically
what we’re talking about is providing for our patients a full arch of teeth.
Either the upper, the lower or both on the same day that they have the
procedure. So typically a person would come in around 7:00 or 7:15. They’d be
placed under general anesthesia by one of our nurse anesthetist. The procedure
would be performed as I said either the upper arch the lower arch are both. f
it’s both arches, typically we would be wrapping that up at 12:30. The laboratory
which is also on-site, would have the first set of teeth ready by about 3:30
or 4:00 and we would put those into the person’s mouth and then they would go
home. And of course there’d be follow-up visits
after that until they had healed and get their final teeth after about six months.
And we’ll talk later about why we do it that way. There are other people around
the country who like to provide the final teeth immediately and we’ve done
that and there are some problems with that approach to this particular problem
and I’ll be happy to talk about the various things that we have run into and
why we do things the way that we do them here at new teeth now. (Bianca) So we’ll get into,
here’s a picture of what the lower hybrid will look like and then going
into kind of what the steps for treatment are would you kind of explain
a little? (Dr. Richards) Right. Right. A few years ago we did things more traditionally way back
probably in the 2006 time period 2005 2006. We had a more traditional flow
where we were depending on a dentist who would send the patient to us and then we
would do the work and they would go back to the dentist office and then then we
would all interface with a outside commercial dental laboratory and that
worked well for a number of years but as we became busier and busier and busier
with the caseload couldn’t be managed and so we had to make changes in our
business model and in our facility to accommodate our own dentist and to
accommodate our own in-house commercial dental laboratory to be able to service
us and so we went from as you see on this slide the traditional flow to the
next slide which is the new teeth now all in one day all in one office concept
where the anesthesia, the implants are placed all of the impressions are done
here by the surgeons. The lab work is done here by our lab
and then the teeth are placed in the mouth by either the surgeon or our
dentist. And so we’ve taken the three-ring circus where you have the
dentist and you have the surgeon and you have the patient and then they kind of
intersect and we have one circle and it’s much more efficient and
communication is much better and it works very well particularly in these
complicated type situations. (Bianca) Here is a look at our facility so our surgeon
restorative doctor and the lab is all right here. (Dr. Richards) And our anesthesia department. (Bianca)
Yes. This is Crystal and we are gonna show a little bit about her in a video.
(Crystal) Before new teeth now I was in a lot of pain. My teeth were all loose. I was
losing them one at a time. That’s what made me pick up the phone and call new
teeth now. My first appointment I was very nervous but Dr. Richards and the
staff and everyone there made me feel so welcome. The day of surgery I can’t say
that I was nervous I have to say that I was excited. I was gonna wake up and not
have those teeth anymore and not have the pain anymore. I was really ready to
get it done. My recovery after new teeth now was so easy. Now I have the best time
with my grandchildren. I take them to park. So I laugh. I smile. I talk to people.
It’s just a whole different lifestyle and I would recommend anyone that’s
going through pain or having teeth problems to go visit Dr. Richards. it
makes me feel wonderful to know that I finally have a pretty smile after all
these years and I get to show people who I really am because I have a beautiful
smile. So crystal had a wonderful, wonderful experience as you can see. If
you are live on Facebook watching live on
Facebook right now you are able to send messages to us that we can answer during
the webinar. So just to let you know about that. Now let’s talk a little bit
about zygomas which is something that new teeth now it specializes in. (Dr. Richards) Zygomatic implants are used in situations where there’s not enough bone
in the rear. The back. Whatever term you want to use. The posterior. The molar area
part of the upper jaw. So frequently, when teeth are missing the sinuses will
enlarge and the sinus drops down and there’s no bone. And so the person is
faced with the dilemma of doing a sinus bone graft or doing something like zygomatic
implants. And up to once again about that 2006 time period I did the traditional
sinus lifts and bone grafts and waited months and months, sometimes 18 to 20
months to get enough bone to put implants in and I had a failure. I had a
patient that had a miserable failure back in oh six oh seven and I had
grafted her sinuses twice and they just failed to form any bone. So I
went looking for a solution which I ended up at an international conference
in Las Vegas in May of 2007 and I heard a guy named Ed Petrosyan out of the
Pacific Northwest talk about zygomatic implants and I said that’s what I need
to be able to do. And so I made some arrangements. I got scheduled up with a
surgeon up in Mississauga Canada Toronto,
Leslie David went up. Spent a couple of days with her and I was like the first
assistant putting in three or four zygomatic implants and I came home I did
mine first – the next day. So I started doing zygomatic implants around 07
and Bruce and I were counting up I think between Dr. Kirkpatrick and myself and
he came to zygomatics through a a different track. So it’s just sort of
coincidental that you know he and I have kind of come together and we both became
very experienced in the zygomatic implant placement. And I think we’ve done
over, over 1,500 zygomatic implants. (Bianca) It’s amazing. (Dr. Richards) Since around those ’07, ’08. Yeah, it’s, it’s a
bunch. More than it. As a matter of fact we purchase more zygomatic implants than
anybody else in the country. So we place more zygomatic implants than anybody
else in the country. So we’re kind of known for that and we advertise that
widely. Actually nationwide and people come here for that reason because they
have been told they don’t have bone or they have failed bone grafts. I’ve taken
care of two other people from other surgeons that have had failed bone
grafts and zygomatic implants kind of saved the day. Kind of the Mickey Mouse
of implants. But they’re very good. This particular slide, are the viewers seeing
this one? This particular slide shows a person with enough bone to have
traditional implants in the front part of the upper jaw and then zygomatic
implants and the rear portion of the upper jaw. There are other situations
where there’s no bone in the front and there is no bone in the back so that
they have zygomatic implants in the front and the back and there would be
four zygomatic implants rather than two and I think we have some slides of that. One of our viewers has a
question. Yeah. You know the Sjogren’s syndrome basically dries up your saliva
and if you have no saliva then you can develop rampant tooth decay. And I have
done probably a dozen patients with Sjogren’s syndrome over over my time
practice and course implants do not develop tooth decay and you know, so they
do work very well to the viewer who asked that question they do work very
well in a environment where there’s a lack of saliva for that reason but, I
think we have a couple other slides on zygomatic implants. You can see on the
left slide there are four zygomatic implants two on the left two on the
right. One more in the anterior and one in the posterior and that’s, that’s common. I’m
doing one of those tomorrow and Thursday. This middle slide shows two zygomatic
implants on the left, two zygomatic implants on the right and a couple
of traditional short implants right in the middle. And excuse me the one on the
left in to have a single traditional implant, a little shorty right in the
middle. So anytime we can combine short implants in the front or even in the
pterygoid region which is way posterior. Anytime that we can do that to
supplement the zygomatic implants we do that and finally the slide on the right
shows a situation where there is just four zygomatic implants and these these
cases what these people have to understand and what we tell them is I
mean they are at the end of their rope they’re hanging on to the last night
before they fall and there is nowhere else for these people to go bone
grafting in that situation is difficult and unpredictable takes a long time
whereas for zygomatic implants in the hands of a trained qualified surgeon can
be inserted and the teeth done the same day same process and they can have all
of that and walk out of this office with a fixed non removable set of teeth
the same day as opposed to months and months and months
of healing and bone grafting and all that which may or may not work so I mean
it’s like a no-brainer situation with that I don’t know if you’ve counted
recently but one of our viewers wants to know how many is I call my implants you
placed I think it well we looked last week actually and I’ve done I think it’s
eight hundred so quite a few yeah I think David underdone
maybe just a shade more than I have I’ve done about eight hundred piece done
about almost nine hundred and we had about sixteen or seventeen hundred
something like that we had a bunch antibiotics yes whether it’s a single
implant a double triple full mouth single jaw we do preoperative you know
antibiotics on our full mouth cases we give a large dose of intravenous
antibiotics during and after before the IV is removed later in the day and the
other question I have here that we’ll just go ahead and answer now what type
of care to implants and the teeth need well basically they need the same kind
of care that your teeth me and that my teeth need which is a toothbrush
Waterpik and dental floss which is what I do every day and that’s what a person
would do with a set of these teeth that are fixed in their mouth they would
brush them with a toothbrush and use a water pick and I describe that is that’s
sort of like a pressure cleaner any of the food that would get trapped between
the teeth and the gums that kind of takes care of that and then use either
dental floss or little brushes and that’s what you do typical recovery time from a full mouth
reconstruction it kind of depends on what you’re intending to do
I’ve had some people play golf the next day I’ve had other people say you know
it was 2-3 days before they felt like playing golf but the recovery time is
typically 2 or 3 days I’d say had people go to work the next day after having a
full upper or lower it’s not unusual so where were we
listen back to those x-ray pictures one thing I’d like to comment on is our
process and one thing that I keep repeating and I would like to keep
repeating because I’ve been doing this a long time this would be my 40th year in
practice this year and I’ve been doing these implant full-mouth things since 83
so I got a few years under my belt in about 15,000 implants so I’ve done a few
probably haven’t seen everything but I’ve seen a lot and I have done teeth in
a day I’ve done teeth in 3 days I’ve done teeth in a week a couple of weeks
I’ve backed up and and that’s the final teeth now I’ve done the final teeth in a
day with a very close relationship with the lam final teeth in three days final
teeth in a week and a couple of weeks done all of that and what I have found
is that you know the people forget about the implants because when they look in
the mirror they don’t see the implants they see their teeth and when other
people look at them they see their teeth and so the teeth have to look good they
have to like their teeth and they have to feel good in their mouth and they
have to be able to speak and enunciate words they have to be able to talk
without spitting out of their mouth and you know there’s all sorts of little in
your window and so what we found out early on is if you do the final tea
and then you have to do make changes and it’s frequent to have to make changes
that you then you got to back up and you know remake the final teeth again so we
learned a long time ago that making the final teeth too early is not the right
way to go so many people want to change the teeth they go yeah I made a mistake
I want a pointer there’s never a person that wants some darker and so you know
they want a whiter they made a mistake are they are they’re you know not big
enough or they’re too big and variably there’s a considerable number of people
now when we make that first set of teeth and then six months later when they’re
getting their final teeth they want to change the teeth so by making a
temporary set of teeth at first they literally get to test drive that set of
teeth and from a cosmetic standpoint what
their friends see what their family sees what they see when they look in the
mirror are the teeth and so that’s a big deal
now secondarily after the procedure there can be swelling and then shrinkage
when there’s some shrinkage you get these big gaps opening up between the
teeth and the gums and so once again if they’re in their final teeth and you’ve
got you know somebody that’s a long ways away that becomes a problem because now
you got to see them again and do all that to add material here and there so
we prefer that the person who’s in New York they go home with teeth that they
know are temporary and then they know that if gaps open up or if they want to
change their teeth that they can do all that when our restorative dentist dr.
dibbs makes their final teeth right the other thing is no matter how good we are
there will be some implants that fail to bond or you might even get a little
infection or something and by holding off and waiting to do the final teeth
for several months we get to make sure that all the
implants are safe and secure and fully bonded so those three reasons so the
person gets the teeth they like so that we make sure the teeth follow the
contours of the gum tissue so there are no big openings and we make sure all the
implants are healed before we put the zirconia teeth on the implants and
that’s those three concepts are really important for you as the viewers to
understand because I can tell you that with 35 years of experience in doing
this and probably Lord knows how many of these cases five thousand six thousand
who knows so can you tell us a bit about the difference with many implants and
traditional implants well mini implants are very small and they’re typically
inserted into narrow ridges and first of all we don’t do many implants mini
implants are typically intended to hold a removable denture and so in our new
teeth now process our patients get fixed bridge work and so we need implants that
are strong that are sturdy that are placed into good bone so that these
implants can support a fixed bridge not a removable denture so many implants
really don’t have a place in the new teeth now protocol okay all right so why
don’t you tell us a little bit about your wonderful team that you work with I
do have a wonderful team these gals are all hard-working gowns and we have a lot
of fun during the day the four of these gals they probably take out and put back
more of these hybrid restorations and fiddle around with implants parts and
pieces then probably most of all the Denniston state
of Florida combined I mean they and they you know these and this is true probably
for any oral surgeons team of women I mean or or even guys I shouldn’t be
saying just women because there are male surgical assistants but I would say in
our profession in oral surgery when you you’ve got these gals they’re extremely
knowledgeable they have knowledge about all of these dental implants they have
knowledge about Anatomy about particularly about anesthesia and so a
lot of these ladies that work for all of these oral surgeons across the country
they are smart cookies and heart and hard workers you got to respect them
that’s awesome we have a question here well you could have this procedure if
you have if you can get a medical clearance because we’re going to put you
under general anesthesia to do the procedure and I can promise you you will
not have any myoclonic jerks under general anesthesia so you know the issue
is you know why do you have those and there’s there a medical condition that
would preclude you from being able to being able to have an anesthetic okay
and speaking of anesthesia this is our anesthesia team yep you have Jack Daniel
and Kim Sheree yeah who else can have an anesthetist named Jack Daniel I mean
come on okay make that up it’s actually Patrick
Jack Daniel but anyway Jack and Kim have been working for us for a number of
years they’re both certified registered nurse anesthetist and they provide our
anesthesia services so that we dr. Kirkpatrick and I can concentrate on
what we’re doing about doing the procedure and while we’re talking about
anesthesia we’re talking about general anesthesia we’re not talking about IV
sedation we’re not talking about Twilight sleep whatever that
we put a breathing tube down and you are asleep just like at an outpatient
surgery center and the benefits are many number one as the surgeon I can move on
through the procedure and do something in three hours that might take a person
under IV sedation for four and a half hours because you have to stop for them
to take a break and they’re choking and you know they need to rest and you know
they can’t breathe and this and the other so general anesthesia because the
person is totally asleep the airway is totally protected the little tube has a
balloon on the end and then we can pack gauze on the back of the tongue and it
doesn’t choke the person because they’re asleep
and so we can irrigate when we’re drilling we use a lot of sterile saline
irrigation we can irrigate the person is not going to choke her gag because
they’re asleep and if you’ve been to sleep and probably a lot of people
watching this and then this in my age bracket the age bracket the people
watching this have been to put to sleep for something a colonoscopy or they’ve
had an operation or something and the nice thing is the light switch gets
turned off at about eight o’clock and then it’s like the light switch gets
turned on at 12 o’clock and you’re done and so general anesthesia is a wonderful
thing now that being said and when you consider the age bracket of the people
that we work on I mean we’re not talking about 20 and 30 year olds here typically
I mean our typical clients are 60s 70s and 80s so we get a lot of questions
about that how do we handle that well we get medical clearance azan everybody
everybody even a young person who say in their 40s if they’re healthy we still
get a cardiogram a basic metabolic profile and bloodwork and so we are
extremely careful and cautious with our general anesthesia and you know first
and foremost we don’t want to do anything to harm anybody and we’ve never
had a problem with anybody in the office and that’s because we pick and choose
but occasionally we put somebody into Lakeland Regional Medical Center to do
the new teeth mount procedure because they are their physician advises that
they’re not a good candidate for an outpatient procedure they need to have
an in need to do an inpatient so we get a lot of questions about the anesthesia
and how we manage that and that pretty much sums it up right there so what is
happening during surgery in the on-site dental lab during the surgery yeah
they’re probably up there drinking coffee and doughnuts because they’re
they get fired up after the surgery so during the surgery I take impressions of
the implants inside of a denture which is similar to this denture but we make
special dentures and so the special dentures that we make are surgical
guides and bone trimming guides and we take the impressions inside of the
denture so then at the end of the procedure those records go upstairs and
those records are combined with the records that dr. dibbs took before the
procedure and using that then the lab creates the first set of teeth these
acrylic temporary bridges and so the upper one looks like this it’s a
horseshoe it doesn’t have a palate and although this is a zirconia one it still
is the same the first set of teeth is the same as the zirconia it’s just the
material that it’s made of so the upper has no palate and then on the backside
of each of the teeth whether it’s upper or lower are these titanium cylinders in
the teeth and these titanium cylinders set on the implants and there
are little screw holes you probably cannot see those but there are a little
screw holes through the teeth where the little driver is introduced to tighten
the screws that hold the teeth down to the implants and so in the lab all the
action starts after the surgery otherwise they probably have you know
policemen up there so we have two restorative doctors dr. Neff Allah and
dr. dibbs and we’ll learn a little bit about dr. dibbs here one of the things
that really sets Florida dental implants apart from other offices that are doing
full mouth implant reconstruction I have my own laboratory here on site that
myself from the other restorative doctors are able to use this is
invaluable having the ability to work so closely with my lab gives me the ability
to better help my patients with the emotional side of it as well a large
number of the patients that come to us for treatment have had severe dental
problems for many many many years sometimes dating back to childhood
because of the emotional concerns that they have
we really have to spend the time with the patient that you can’t rush anything
and we need to have an ample opportunity to have questions asked and answered
having my own laboratory here on site this is invaluable not only in terms of
having the control over the quality of the product that we’re making and the
but the ability to if I’ve got a question with the patient about can we
make this change is this going to be feasible I can go across the hall get
one of my lab technicians and all of my lab technicians have been doing this for
many many years bring them across the hall and they can talk to the patient
themselves so they’re so we eliminate the need for me to try to interpret the
patient’s concerns and questions and needs in a phone call or in a note they
can speak directly to the patient it was so important to me to have everything
under one roof there’s no waiting that is the advantage of having the lab
on-site and they are so proud of their work that they come out to see the
product these are not regular people with regular jobs these are master
artisans that create they truly are artists and they’re creating beautiful
smiles it’s like nothing I’ve ever experienced and I don’t know of any
other office that’s like this so dr. Richards what do our restorative doctors
do with patients well the the restorative doctor plays a important
role in this overall process you know this this process this new teeth now
process it’s a team effort it takes a combined effort of the restorative
dentist dr. dibbs and dr. new follow it takes the laboratory team it takes the
surgical team it takes the anesthesia team it takes
the implant treatment coordinator who coordinates all the medical clearances
and deals with all the financial issues so when you consider how many people are
involved to make this happen I mean it’s really kind of mind-boggling that that
we’ve been able to put all that together but but that’s how that works so but the
question was what do the restorative dentist do well specifically they see
all of these patients before the procedure so for instance a person might
come in and see me or see dr. Kirkpatrick and let’s say they talk to
the coordinator and they say okay I’m good to go where do we do next but
what we do next is we see dr. dibbs or doctor in the fall and when they are
interviewed by dr. dibbs or doctor navab they get more information they those two
dentists they do a thorough exam they talk about teeth and the size and the
shape and the color and then the prosthesis and show them examples and
take impressions they take pictures they take all the records so all of that’s
very important so that the person before they have anything done they’ve heard
from the surgeon the surgeons end of things they’ve heard from the
restorative dentist that end of things so that you’ve got a really a complete
picture of the entire process they know how long it’s going to take they know
how many visits they’re gonna be I mean our patients are really informed before
they it’s not like they jump into something uninformed right so and the
restorative dentist play a big part of that so here is a really interesting
picture tell us a little bit about the difference between these two teeth so
the the teeth here are about five years old
and the top is a zirconia with porcelain porcelain saying porcelain glaze and the
teeth underneath our acrylic base with denture teeth set into the acrylic base
and so you’re dealing with acrylic which still some doctors provide the acrylic
as the final restoration but it is certainly not durable as can be seen
here the acrylic is porous it accumulates stain and debris it is more
prone to breakage it is more difficult to keep it clean whereas glazed
porcelain or glazed porcelain stain is not porous it’s easy to clean it does
not absorb stains and odors so it’s much more hygienic and durable and the teeth
would the porcelain certainly reflect light more like natural teeth and it
looks much more natural so here are implant coordinators and these are two
Shauna and Debby who you would meet with if you came in for a consultation and
they both of these ladies have been with us a long time twenty years and both
have surgical backgrounds in other words they have both been oral surgery
surgical assistants so then they know a lot I mean they really know a lot and so
so they’re able to talk to people on the phone and we know that the information
people on the phone are given is very accurate
when when it comes from our people here and I just I can’t say enough about
Shauna and Debbie can’t say enough good about and this is what our CT scans look
like so this is something that you would have when coming into a consultation
right right we pretty much do a CT scan on everyone mm-hmm you know look at the
bone from different angles and different perspectives like this this picture just
shows there are different angles and perspectives that we can look at the
bone compared to a traditional radiograph which provides limited visibility and limited and look you know
you can’t analyze where the bone is on a traditional radiograph all right
this is Bruce Cerny do I know well actually lives close to us down
here and Bruce had some advanced periodontal disease and we got Bruce
fixed up at Scully maybe three four or five years ago now and I know he was a
happy camper after that it looks amazing that transformation is just incredible did you guys have a video with Bruce or
now this this is a lady from Poinciana she was funny this way she didn’t want
to smile either and when she came in one of the first thing she said was she goes
I don’t want to be on your website and she goes where is the man that I talked
to about getting a video and she was a pleasant gallant she certainly liked the
smile after she was after her treatment was wrapped up
look at she’s on the website now big change
definitely it’s very common to see when their mouth and facial appearance
changes that their hair changes that their clothing changes I don’t know that
I’ve seen a spouse change at the end people you know they’re they come out of
their shell for sure their personality changes and it’s as I told someone after
listening to who was at Ted we were listening to Pam’s video and I was
telling someone that after listening to pam pam is one of her lab technicians
after listening to her video that is almost a humbling experience to know
that what we do can do so much for the complete person and something that we
take so lightly something we do I do this every day and I don’t think that
much of it I think it’s nice that I can do that for people and that we have the
experience to do that but when you hear a person on the receiving end talk about
what it’s done to their life and they’re not talking about eating and their teeth
and stuff like that I mean they’re talking about their life change their
social life everything it really is yummy it’s a humbling experience it
really is if you are interested in learning more we want to talk to you so
please reach out please give us a call schedule a consultation we want you to
do your research to learn all that you can so you can feel well informed and
confident and ready to go with with this procedure so we look
forward to speaking with all of you and we thank you all for joining us tonight
thank you dr. Richards for taking the time to be here with us and we hope that
everyone has a good evening if you would like to view more informational videos
on new teeth now please click the subscribe button here thanks
for watching

Author: Kevin Mason

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