New Teeth Now DENTAL IMPLANTS Webinar – Dr. Harley Richards DDS, January 2020


(Bianca) Good evening everyone welcome to the new
teeth now webinar. My name is Bianca and I’m here with dr. Richards and tonight
we’re going to talk about full mouth implants and all that new teeth now has
to offer. Dr. Richards did you know that it’s been
a whole decade since our last webinar? (Dr. Richards) Since last year yeah yeah absolutely. (Bianca)
So we’ll get to know a little bit about dr. Richards. He’s a board-certified oral
and maxillofacial surgeon since 1982 and has over 40 years of dental implant
experience and is the innovator of new teeth now. (Dr. Richards) That’s right we do this a long time now. And really it’s hard to believe the
years is going by so quick. so if every doctor board-certified not every oral
surgeons board-certified probably a greater majority of Marv not everybody
okay and of course that involves finishing a certified program typically
for five or six years after dental school and then taken out oral and
written examination to become board certified most hospitals now require a
person to be board certified to maintain their staff privileges and as you know
and both dr. Corr Patrick and I are on this staff at Lakeland Regional Medical
Center participate there in the trauma services and so we do a lot of other
things that oral surgeons do other than dental implants we’ll take care of a lot
of broken up people so it’s definitely important when you’re looking for a
facility to have a board-certified surgeon as a matter of fact in that vein
occasionally we will see a person as you know whose health is not good enough to
get clearance to do general anesthesia in our office as an outpatient and we
are able to admit those people to Lakeland Regional Health Medical Center
and we do the new teeth now procedure in the operating room at a hospital so that
they get you know better care they can’t go home they can’t wake up and go home
necessarily so they spend the night in the hospital so that’s just an
additional service that we offer by virtue of being on the staff out of the
hospital so yeah that’s kind of nice for people whose health is kind of on the
borderline for an outpatient procedure yeah that’s awesome
so we’ll jump right into what a hybrid is can you kind of explain the different
parts and pieces in this photo well there’s two types of teeth that
generally would be attached to implants in a fixed fashion in other words fixed
would mean that the teeth do not come in and out that would be removable but most
of what we do is fixed so this is fixed its upper that means it’s the upper jaw
and hybrid a hybrid type of a prosthesis is a prosthesis where the position of
the implants and the position of the teeth are totally disconnected a lot of
the people that have these types of prosthesis have a lot of bone loss and
it would be impossible to place the implants tooth site-specific so it would
be very difficult if not impossible to provide them with crown and bridge type
implant work and so the hybrid type work works very well in those situations
where there’s been a lot of bone loss and you can see in this picture you sort
of have Superman eyes so you’re seeing through the tissue through the bone you
can see the implants there’s six typically with the new teeth now
procedure that we do the upper jaw typically there are six implants and
positions similar to what you see in this illustration the lower is just a
very similar situation typically there are four sometimes five six or seven
implants depending on the available bone depending on the position of the nerve
and the lower jaw and just depending on the amount of the size of the John the
amount of room can’t you can see in this illustration
how the implants are spread out and you can’t really Jam the implants up next to
one another there needs to be a sufficient amount of bone in between the
implants so that bone can be healthy and so this illustration would be sort of a
setup that would be typical standard of care on a worldwide basis for implants
position like that in between the nerve for Raymond where the nerves come out of
the jaw so that would be typical and so we’ll kind of go over then you what we
do here using that procedure so our patients are under general anesthesia so
it’s completely pain-free they go to sleep they wake up and the surgery is
completed the second part of it is we’ll start with extractions if the patient
has teeth they’re extracted and then you would place the implants typically six
on the top four on the bottom and while the patient is asleep the lab upstairs
so we have a lab in house they will take impressions for the lab to when you will
take the impressions would like to customize the teeth right and then when
the patient wakes up after surgery they rest in the private recovery room while
our in-house lab creates the teeth for them and then before they leave the same
day of surgery the teeth are placed in the patient’s mouth and adjusted so they
go home in a temporary set of teeth that’s exactly right
just as you stated it yep and I particularly like this slide because it
shows the business model that we have that Bianca just described where the
surgeon the dental lab the restorative dentist we’re all in this office right
and to make the new teeth now procedure happen it is an interaction of all three
whereas in a standard type business model the person would
go to the surgeon’s office which would be separate from the restorative
doctor’s office and then they would interact with a lab that’s in a
different location and so it’s you just don’t have everything all in one place
and these are sometimes complicated procedures and to have everybody in one
plot in one place on the day of the procedure just takes all the stress off
of everybody because there’s no miscommunication your lines are all
there we can handle if any little issues come up the technicians are there dr.
dibbs the restorative dentist is there and the lab is in-house so we can do
whatever we need to do yeah it’s it’s really amazing yeah great benefit to our
facility and this is our facility so this this is our um it’s quite a big
facility actually yeah it’s pretty big I’d say about 15,000 square feet and you
know it didn’t happen overnight the original facility which you see in the
foreground behind the palms is about 7,500 square feet and that we open that
in 2002 we had a couple of operating rooms and and then over time as we
outgrew that facility we actually had a lot in the back for sale and why are we
glad now that thing doesn’t sell because we put a two-story facility back there
which has two major operating rooms where we do other things other than
dental implants and that upstairs is the prosthetic Center where dr. dibbs our
restorative dentist lives and the laboratory as well so that vacant lot
that we sat on for years has certainly turned out to be a worthwhile situation
now we opened the lab in that other wing in 2013 I mean it is hard to believe
that was six years ago time just has passed quickly so here is Pam she’s one of our patients
at new teeth now and she’s actually also a dental lab technician um so yeah so
she suffered from a lot of dental problems and so we’re just gonna hear a
little bit about her story and why she decided to have new teeth now I am doing
these beautiful makeovers on everybody else but my teeth are a mess and how
good am i how effective am I gonna be with patients with the problems that I’m
having now I would like to be able to look at patients and doctors and
everybody in the face and that’s when I thought I really I gotta do something
and the pain is getting hard because you are in pain when you have not a full
complement of teeth and you try to eat something like a potato chip is like a
exercise and terror you know it hurts I don’t smile I don’t date I have one
granddaughter that’s given me difficult about this she tells me I don’t smile
and then I smiled real big and she now she knows why I don’t smile and that
doesn’t make me feel good I want her to be proud of her grandmother being able
to smile whenever I want to and not have to be guarded is probably gonna be the
best part of it and I know dr. Richards and I know as his team is gonna do a
wonderful job on me and to be able to wake up and smile is gonna be a great
thing you got to see a little bit about Pam and later on we’re gonna hear how
she’s doing now on post surgery and so we’re just gonna answer a few questions
I have coming in yeah one of the viewers asked how do we make sure the
temporomandibular joints are in place after doing so many changes and when a
person is under general anesthesia the muscles are relaxed and so I can
hold the joy manipulate and actually rotate the jaw on the ball and socket
and make sure that the teeth come together
properly while the balls are seated in the socket properly so it’s actually
easier to make sure that the joints are in place when a person is under general
anesthesia because you’re not having to fight the muscles right so that works
out really well there was another question Jason about what time is the
appointment yes and most people get here about 7:15 they will get them checked in
they go back with the anesthetist and you’ll see our anesthetist here a little
bit later in the presentation and anesthetist makes small talk and
interviews the person and reira views the medical history and all the
clearances that we will have obtained prior to this visit and then gets the
person changed and anesthetized and then it’s usually about 8 o’clock and then we
we prep the person and drape them sterile II and so the actual procedure
typically wouldn’t get go until about 8:30 and the atypical double jaw for
seizure will last for hours then all of the records go up to the lab and the
teeth are typically ready around 4 o’clock in the afternoon right so the
person is recovering with either Theresa or Jodi in a private recovery room once
they’re awake their family member comes back if they want them to and if the
family member wants to and then we move them to a treatment room and put the
teeth in so the person is here all day from 7:15 until 4:30 5 o’clock I hope
that answers that there was one other question about the level of pain and I’m
gonna look right in the camera lens and tell you there’s not a lot of pain with
this procedure you’ll hear it from Pam quite a few
people get by taking a combination at I’ll Onam tylenol and ibuprofen together
some people take one or two coatings some take no coding
but typically speaking this is not a procedure that causes a lot of
discomfort Pam and her post-procedure little interview will address that yes
it’s surprising but yeah surprising really not so we’re looking at a slide
of sort of a traditional look post-operative x-ray and you can see how
in the upper those implants on the far left and the far right both top and
bottom are tilted and they’re tilted to avoid anatomical regions and the upper
jaw they’re tilted to avoid the sinus and in the lower jaw they’re tilted to
avoid the nerve once again these are techniques that are employed all around
the world this is just sort of typical traditional right every day
bread-and-butter type stuff and this is for someone who has an adequate amount
above adequate amount of bone so for someone who doesn’t have a lot of bone
like if you the viewers who are watching if you’ve been told that you have no
bone for implants we have a procedure that can actually do that without bone
grafting and those are zygomatic implants so we’ve been doing zygomatic
implants since about 2006 or 7 both dr. Kirkpatrick and I do a lot of zygomatic
implants we do a lot of procedures where a person would get at one zygomatic
implant on each side if they have normal bone in the front they would get
traditional implants in the front and as I go Matic implant on each side in the
back back in the molar area well somehow people find us that have no bone in the
front they have no bone in the back and we do for zygomatic implants and
sometimes find a little bit of bone to put some short implants in in addition
to the zygoma so we do some creative stuff with zygoma is I think our last
count maybe we had done almost just short of to thousands I go manic
implants over the last eight years or so or 10 years maybe 12 years because of
seven and 12 is 19 so we do these routinely some weeks we’ll do
between the two of us we might do 20 is like a mannequin yeah you guys have been
doing them a lot lately seems like lately every every person we do against
the zygomatic implant so we’ve got another slide that’s an illustration and
you can see on the far left there’s bone only for two zygomatic implants on each
side whereas the picture in the middle there’s a little bone up front for one
traditional implant with four zygoma ‘s and the illustration on the right is
like the picture that you saw previously where there are four zygomatic implants
and two traditional implants in the front and I mean if you can do like the
middle picture or the one on the right and get a couple little traditional
implants and to shore up those zygoma ‘s that really is the cat’s meow so to
speak for the person who has nobody yeah every patient is different so it’s just
the matter of the combination of right right and I this term zygoma you can
look at that on the computer but the zygoma bone is this cheek bone and it
forms this the lateral wall of the eye socket sort of a lateral inferior part
of the eye socket and it’s the prominence of your cheek and so when
there’s not enough bone in the rear part of the upper jaw because of the sinus
then rather than do a sinus graft and wait for months and months for the sinus
graph to heal to put implants in we just go to the zygoma implant which does not
require bone grafting they are very stable very predictable and relatively
trouble-free as long as you don’t have sinus disease so for people that have
sinus disease we recognize that we see that on the cat scan and we send those
people to a ear nose and throat doctor to get their sinuses optimized before we
do the zygomatic implants so we actually we got another question and how soon can
you eat normally you know I guess that depends on what you normally
people who have a set of these first set of teeth these acrylic fixed in place
teeth they can eat food such as pasta cooked vegetables fish meat loaf
homemade hamburger patty and so for some people that is normal things that you
would not be able to eat would be Cuban bread pizza crusts hard meat like pork
chops where you got to kind of tear it off and really non it because what will
happen is you’ll break the teeth so the the diet afterwards I would say is
fairly normal it’s just kind of easy to chew normal rather than a hard want you
normal again we tell people if you can cut it with a fork then it’s okay to eat
it but nothing that you really gotta bear down on it would be easy to choose
stuff so that’s your first set of teeth and then six months later once you get
your finals right then you can eat the Apple and the stink and all those things
that are harder to chew okay so let’s look at your team you’ve got a couple
new team members a couple breakout right I have a team dr. Kirkpatrick has a team
and we each have four gals that work with us they’re all very experienced
these ladies play with implants and implant screws and implant teeth and
drivers probably more in one week than most dentists do all year because every
day we’re doing one of these procedures and then every day we’re seeing post-ops
and checking those people and checking screws and parts and pieces and so these
gals I just can’t say enough good about them they can run circles around most
dentist who dabble in implants these gals
they’re smart they’re well-trained because I train them and they they know
what’s going on without them I couldn’t do what I do I can’t say enough good
about these ladies that work for me and work for Dave they’re top-notch
top-shelf and that’s the team that you would see every time you’ve come in or
every time patient would come in the office that’s who don’t see with you so
we’re gonna look a little bit at our anesthetist so we have Jack and Kim they
both have an immense amount of anesthesia experience 30 years over 25
years right so a CRNA is a certified registered nurse anesthetist and they
are all our ends first and then they typically there are ends that did a lot
of critical care medicine and then they go back and they do a three-year
training program for nurses to be trained under the tutelage of an
anesthesiologist to become a certified registered nurse anesthetist and so when
we’re doing general anesthesia we’re concentrating on the procedure and
so the anesthetist does the anesthesia it’s not one of those things where you
know like wisdom teeth where we do a sedation for the patient and take the
teeth out and and I do that with my team when we’re doing these procedures under
general anesthesia it requires an anesthetist to manage the
anesthesia these are as you’ve said highly trained highly you know
experienced people and this is always a good question why so why do we always do
it under general anesthesia why is that’s so much better than IV sedation
well I can do a better job for you for you under general anesthesia
I can clean things up better I can when I’m drilling on the bone which generates
heat I can use a lot of sterile saline coolant without having to worry about
you choking and gagging on something that we’re squirting water into your
mouth while you’re sedated and and have you like swallow down the wrong hold
kind of thing so when you’re under general anesthesia your airway is
totally protected we have a lot of little drivers and screws and pieces and
parts that are going in and out of the mouth you don’t have to worry about
anything dropping down your throat and swallowing it or aspirating it into your
lungs your airway its totally protected and you know if you’re drilling on a
piece of wood at home this is something that a lot I don’t think a lot of
dentists pay attention to at all if you’re drilling on a piece of wood at
home with a drill and you touch that drill it’s hot but it doesn’t matter
because that wood is a dead piece of stuff but when you’re drilling on a
person’s bone now you’re talking about living tissue and living tissue will
only stand so much heat and so when a person is under general anesthesia we
can pour the coolant to the drill and we use a ton of coolant when we’re drilling
and we don’t have to worry about the person choking because we’re squirting
coolant on the drills if a person is sedated now their reflexes are slow and
you’re squirting water into their mouths and they tend to choke and gag and the
general anesthesia allows the surgeon just to forge ahead get the procedure
done quicker the person is totally comfortable it’s like the light went out
and four hours later the light comes on you have no perception of time you’re
done and totally competent right so I cannot say enough good about general
anesthesia since we transition to general anesthesia seven or eight ten
years ago is just made our lives and the lives of our patients who have these
procedures so much better and so much safer so this is dr. dibbs he’s one of our
restorative doctors here and we’re gonna hear him talk a bit about the lab and
what he does and how we all work together 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 and
the other restored of 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 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 so
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 there 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 you got to
see a little bit about the dental lab and this is our in-house dental lab team
those are our master artisans they’re the ones who are working on teeth every
single day and they’re truly amazing and it’s awesome that our we’re sort of like
dr. dibbs can walk across the hall and yep you know work on anything and they
can come and see the patient for different customization options and so
as you’re listening to this and you’ve seen I have a team of people who dr.
Kirkpatrick has a team of people we’ve got anesthetist this is the lab team
just think how many people are involved and pulling this off you got a lot of
people involved with pulling this off in one day
and we do this every day and so this is what we’re set up to do we do 300 of
these a year and it just you know seeing this presentation and seeing these
different teams these surgical teams the anesthesia team the dental lab team the
restorative dentist there’s like 20 people it takes to pull at all yeah so
you know that’s who’s taking care of you and I’ll just show a good comparison so
the final teeth that you get are zirconia which is that top set of teeth
and those are like the strongest material that you can get and those are
resting on a set of upper acrylic teeth so both of these have been worn for five
years and you can like immediately see the difference in the wear and tear of
the acrylic versus the zirconia so that’s why we use our Konya they’re just
a much better material right and then these are our implant coordinators
Shauna and Debbie they are fabulous and they will help you through the whole
process so when you come here for a consultation
that’s who you’re gonna sit down with along with dr. Richards or dr.
Kirkpatrick and they answer all your questions they make sure that your
process is going to go smooth and basically helps you out through the
whole process right and so that’s just two more people at an arm to everybody
else that you’ve seen these are the ladies who interview you they’re the
ones who coordinated the medical clearances all the lab work
EKGs appointments help with finances very knowledgeable they both have many
years of clinical experience both of these ladies both Shauna and Debbie have
been surgical assistants and so they have a depth of knowledge of the entire
thing they’re not just like sales people I mean they really know what’s going on
and your gateway in and your gateway through
and Shawna and Debbie are very friendly and personable and actually kind of
develop relationships with people it’s kind of surprising but you couldn’t have
a nicer couple of gals helping you through the process than these two yeah
they’re great and they also will help any out-of-state patients even like with
smoothing their logistics of traveling too so they’re just helpful with
everything and so at your consultation you will take an open CT scan and that
basically going into the next slide you’ll be able to use that CT scan to
finalize the treatment plan with the doctor right Bianca said some a while
ago about people coming in from out of state and you know we’re beginning to
develop some networks really around the country if you came down here from
Atlanta they probably save a ton of money coming
down to Lakeland to have this done we have restorative dentist in Atlanta who
can do post-op checkups so you don’t have to come back and forth every single
time for a post-op checkup we have a I did a procedure on a guy that lives up
near Richmond Virginia we have a restorative dentist up near Richmond of
Virginia who also can do post-op checkup visits and save people a lot of travel
time so we’re beginning to see more and more people come in from out of the area
because they find that our fees are so much lower than what they get quoted in
some other areas of the country that it’s worth their while to make the
choice to make the trip down here yeah so I guess we’re gonna hear a little bit
about Pam’s after experience yeah so I mean you can already tell she’s smiling
it’s you know this is this was filmed eight days after her surgery so
definitely notice that change only eight days later I had the new teeth now
procedure done days ago oh my god a smile means so much
people do not realize how much it means or how much they miss it till it’s gone
and I missed it so much and I have it back and I love it no swelling no
bruising I think I look pretty good I have a great smile now it was very easy
to do and I feel so much better now I think for some people our age it’s
really hard for us to think about doing something for ourselves on this scale
this is just gonna keep getting better I saw him Sunday I gave him a dazzling
smile and it was nice I think I’ll see him again that is such a nice thing for
a woman my age I just didn’t think I was gonna have these feelings again ever in
my life every day I’m so thankful every morning I get up and go to my bathroom
and look at the mirror and give that little smile and wink because she’s back
so as you can see she is just so like much more confident and she’s you know
getting back on the dating scene and everything so it’s really amazing to see
your transformation a lot of people really do a makeover on themselves and
it’s fun actually to watch that it’s amazing you get to be a part of it oh
yeah yeah hair makeup contact lenses new teeth I mean it’s you know brings the
inner person personality out for sure so we
will kind of see a couple more patients and see their before and afters so this
is Krystal and she had painful loose teeth she was tired of covering her
mouth but now after new teeth now she’s laughing and smiling and talking to new
people and it’s just a whole different lifestyle for her and then this is
Gladys and she’s from Tampa and she had difficulty chewing she had infection and
she had embarrassment with her teeth and she so basically she when she researched
all her options she decided on new teeth now actually specifically because we
placed our patients under general anesthesia and she just looks so much
younger I don’t think yeah you know what you said a lot of people tell me that
the general anesthesia that that was your deciding factor yeah and then this
is Bruce he’s over in Orlando and he also had pain he couldn’t eat the foods
that he loved and that was really important to him so now he can eat you
know everything that he wants and it’s made a big difference in the quality of
his life as well and then finally we have Karen and she’s one of our
out-of-state patients and so she came from Pennsylvania it there wasn’t
actually a lot of facility isn’t even up there to choose from right um so she
decided is better to come down here and she had a lot of teeth issues she had an
upper denture for 15 years her bottom teeth kept shifting and she also had
extreme dental anxiety so we actually interviewed her about a month ago and
she said how like the sound of a dremel would make her completely freaked out
and house xiety but now and she’s here after the
procedure she can hear that and she’s fine
yeah so it’s really amazing how a good experience can fix everything she came
down here by herself yes I mean you talk about that’s something you know she
really wanted it definitely and now she’s completely confident in her job
she has her own YouTube and she’s confident speaking in front of her
audience um so it’s really good we met some incredibly nice nice people
yes so if you are interested I think that it would be great for you to come
give us a call we can answer all of your questions if you want to come in and
schedule a consultation just talk to us give us a phone call well we really want
to help so our number is

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