When Manfred Helmers walked into my office, he wasn’t sure what to expect. A lifelong fear of dental work—dating back to his childhood in Germany—continued to impact his ability to tolerate oral health treatment. Routine visits were anything but routine to him, and he coped by dosing with anti-anxiety medication. As a result, avoiding oral health professionals was what he did whenever he could. However, at this point in his life, he’d reached a crossroads. Helmers was facing a lot of dental work, which also meant he would have to face his fears.
The Importance of Imaging
I knew implants were going to be a big part of his treatment. The question was, would his remaining teeth be valuable for the bigger picture? The answer turned out to be no. So, imaging really became the key factor in everything: the analysis, the treatment plan and the execution. It was also the key to Helmers accepting the treatment plan. He saw that we had the information we needed to map everything out. Helmers also realized that there would be absolutely no guesswork and that we would account for every possible scenario.
Helmers emphasized to me, though, that we had only one shot for success. That meant one—and only one—surgery for his extractions and the placement of all 10 implants, plus the temporary restorations. Helmers wanted to be asleep during surgery and wake up numb in recovery.
One Option: One Surgery
The request for general anesthesia was hardly a surprise, based on Helmers’ history of sedatives and laughing gas for practically any dental visit. However, the one-surgery stipulation would require a significant amount of upfront planning and collaboration among the team. It would also necessitate a bit of luck. Fortunately for Helmers, CBCT imaging revealed that he had enough bone volume to support the implants, negating the need for an additional bone grafting procedure beforehand where three to four months of healing time would be necessary before placing the implants. That would have foiled our plans for the one-surgery option.
The Treatment Breakdown
In addition to CBCT imaging, the collaborative effort required mounted study models, surgical guides, intraoral scanning and methodical planning between the prosthetic team—Dr. Hartlieb and Dr. Ching—and me. On the day of surgery, a fourth doctor, Dr. Zak Messieha, a dentist anesthesiologist, put Helmers to sleep, and then along with multiple staff members, we started to work. I extracted numbers 6, 12, the root tip of 13, 22, 27 and 28. I then used the surgical guide to place the implants at numbers 3, 5, 7, 10, 12, 14, 20, 23, 26 and 28. I placed the restorative abutments for immediate loading. I also performed socket grafting at numbers 6, 12, 10, 14, 22 and 27. The graft consisted of MinerOss® enhanced with platelet-rich fibrin (PRF). I also placed a Bio-Gide® collagen membrane hydrated with saline. Then Doctors Harley and Ching began their part of the surgery to create the maxillary and mandibular prosthesis. They converted Helmers’ existing denture into a temporary restoration. Helmers woke up in recovery feeling no pain because he was still numb, just as he requested, and he was delighted with the result.
Changing Expectations
When I reflect on this case, I feel a real sense of accomplishment—and not just because we had such an outstanding outcome. I’m still kind of amazed that we successfully convinced a patient with such profound fear to undergo the placement of 10 implants. The key was the imaging technology and the fact that Helmers felt part of the planning process from beginning to end. I think for him the use of technology built the bridge between what we can accomplish in modern dentistry versus what Helmers thought dentistry was all about.
Those interested in seeing how modern technology and decades of experience can change their view on dentistry can call our office at (630) 627-3930.
