My Implant Journey - Leonie Watson

To me, it’s more than just a smile. This was one of the best decisions I have ever made; and even though it was a really long process I have no regrets. Don’t get me wrong I was so grateful to have been given dentures at 5 years old, however I always struggled with them – not always physically, but mentally.

Why I wanted the implants

I was always self-conscious and worried about my dentures falling out. Most of us want perfect teeth, it’s one of the first things you notice about someone – their greeting is usually a smile. There’s a stereotype that only old people wear dentures and that made me even more self-conscious to talk about them, but anyone can wear dentures, not just because we don’t look after our teeth but for medical reasons. The psychological impact of dentures and their impact on day-to-day life is often underestimated.  Not being able to eat certain foods, the fear of them moving or falling out, or avoiding a full smile in photos because of my slanted teeth. For me, growing up felt slightly harder as the dentures were always a bit of a burden.

As a young child, I struggled at school when others had said that the tooth fairy visited them or asking me how many wobbly teeth I had. The answer was none, it was hard to deal with, and I didn’t understand why. I worried about taking my teeth out at sleepovers and I’d wake up before everyone else to put them in. My parents were amazing and did everything they could to try and help me, sometimes I would get a visit from the tooth fairy even if I didn’t leave anything under my pillow.

The team at Bristol Dental Hospital under Dr Rebecca John, also supported me by making my dentures gappy when I was little and asking me how I wanted to look so I could fit in. They never forced me to do anything that I wasn’t comfortable with, and I was always involved in every decision. My first set of dentures at 5 years old were both top and bottom, but I couldn’t tolerate the lower one – I absolutely hated it in fact (I tactically lost it at school – sorry Rebecca, although I do feel for the cleaners who may have found it and wondered what on earth it was). I finally wore a bottom denture when I was 11 and I was more confident by then. The intervening time you couldn’t really see my bottom teeth, so I wasn’t too bothered. It did make eating certain foods slightly more challenging, but I knew what I could eat and that was fine with me.

“It was this care and empathy as a child that helped direct me towards a career in dentistry, to give back to people who may be going through similar things to me.”

Leonie

Living with ED

All the procedures and treatment I have had has helped build my resilience and made me who I am today; I have never let ED stop me from doing anything. For example, I wanted to play rugby and so I was given a custom-made mouth guard; there are always ways around barriers – rather than sitting on the sidelines I just had to find them, and learnt that from a young age, I would never let anything stop me. As well as rugby I’ve played netball, lacrosse, swimming, rowing, hockey and climbing. Sometimes ED made things harder, but I learnt to persevere and not let what other people said about me bother me (too much). I noticed the comments about how I am different – but that is what makes me me.

The implant process

Implants were the goal for the Bristol team from about age 9. All procedures, including extractions and braces, were lining up to give me a permanent smile. At 17, my cone beam scan checked if I had enough jawbone for implants. Many with my condition don’t and need a graft. Although COVID delayed the results for over a year, I was still determined to carry on and I knew that treatment couldn’t start until around 20, as you need to wait for your head to stop growing. By then, I had moved to Newcastle for university and switching from Bristol, where I’d been treated since age 3, to Newcastle Dental Hospital was daunting. However, meeting my team of Professor Durham, Dr. Desai, Mrs. Corson and Dr Holliday reassured me.

The scan showed I lacked sufficient bone in both jaws for implants, so a plan was made for a bone graft in the top jaw and to work with the bottom jaw’s limited bone, despite the risk of failure. Lower implants were tricky due to limited space and interfering blood vessels and nerves.

After discussing several bone graft options, with Professor Durham, I chose Maxgraft (an allograft), a relatively new 3D-printed human bone technology. I was one of three patients to try it at Newcastle. The 3D printed graft was taken from my cone beam scan, creating two pieces of Maxgraft that were screwed in place and my gums stitched up over the top. It was quick and caused pain in just one site (rather than 2 if I had opted for the other option). Post-surgery, my upper lip felt strange due to the new bone support, but I adapted in a few weeks. The hardest part was not eating solid food, relying on ready-break, soup, and liquid painkillers. After a week, I resumed eating slowly and felt much better after the stitches were removed. My top tip is 6+ Calpol, as swallowing painkillers was really hard!

Self-conscious about not having top teeth, I was worried but only had a week without them. The dental team were amazing, providing retainer-like dentures that didn’t irritate the surgery site. Later, I received a new, more comfortable denture whilst the graft took. 6 months later I went back in for the operation with Dr Desai and Professor Durham to put the screws in, which meant both my top and bottom jaw would be painful, but it was also a chance for the surgeons to see if the bone graft had fused and if any of it had reabsorbed.  

Anesthetic with very sore jaws, some strong painkillers helped with the initial pain, but the swollen mouth was very uncomfortable. In my top jaw I couldn’t even tell I had had screws put in, but in the bottom jaw I could see the healing abutments they had put in and it was much more painful. My saviour was yoghurt pouches – I probably ate about 5 of them a day; they were the best thing to eat as I could squeeze them into my mouth and didn’t have to chew.

After a week, things started to feel more normal, and I was bored of eating soft foods so I tried eating a Chinese takeaway but could only eat it in tiny mouthfuls which didn’t make it very enjoyable, but I knew I was improving. Healing from this second operation felt faster as I knew what was coming and I was feeling back to normal after 2 weeks. The stitches were the worst part, if you knocked one slightly there was shooting pain, it wasn’t a nice feeling but luckily, they came out after 10 days.

4 months later the next operation with Dr Holliday exposed the screws and added healing abutments on my implants under local anaesthetic. I didn’t feel pain, but I could feel the work being done, which was interesting. There were several dentists watching my procedure, making me feel important, as it’s uncommon for someone my age to undergo this treatment. I have always liked knowing that I have helped people learn by watching what treatment I have done.

After my gums healed, I moved to restorative with Mrs Corson, where we took many, many impressions over the next few months (and I am used to impressions), leading to my first set of temporary implants. They were like the final set but could be fiddled with. I got them two days before my 22nd birthday, which felt like a present. Having them fitted was a huge milestone; it was the first time I didn’t need to worry about dentures. Initially sore, they soon felt great, and I just couldn’t stop smiling. That night, I realised it was the first time I brushed my front teeth and had the roof of my mouth exposed; it is little things like this you don’t realise until you’ve had the surgery. Food also tasted and felt so different, for years all the sensors in the roof of my mouth were covered by my denture.

Over the next few months there were lots of visits with Mrs. Corson to fiddle around with how they looked and fitted to my gums which is vital for me being able to keep them clean. Mrs. Corson worked closely with the lab technicians who were making them, checking the detail every time with the technicians’ input.   Once satisfied, final impressions were taken. In about three weeks, the final implants were ready. The temporaries were replaced, and the new implants fit perfectly. After some adjustments, I left with my new teeth, smiling non-stop. I haven’t stopped smiling since; something such as permanent teeth has made a huge change to my confidence, and I have never been happier. I am so happy I had this procedure done even though it was lengthy and involved lots of poking prodding and sometimes pain.

The Clinical—Margret Corson and Hannah Desai

Dental implants are seemingly everywhere. Fast makeovers, “Turkey teeth”, and overnight treatments with beautiful on-screen results flood targeted advertising and social media feeds. While these may look great, the reality of dental implants is demanding in terms of time, resources, and maintenance. These factors should all be fully considered before embarking on a long journey that doesn’t necessarily guarantee results.

In the case of Ectodermal Dysplasia, implant treatment presents particular challenges because if teeth are missing from birth, the bone that would normally surround them is also absent.

Planning for implants always starts with the ideal tooth position or smile design that the patient desires before working backwards to assess whether there is sufficient bone available beneath these proposed implant positions. The available bone volume can then be evaluated using a 3D scan.

When there is insufficient bone, grafting can be considered, but it is not always possible. Sources of bone include animal sources (xenograft), synthetic bone (alloplastic), and human bone, either from the patient themselves (autograft) or another human (allograft). Often, an additional barrier or membrane is placed over the bone graft for initial protection; this can be synthetic, animal, or human in origin. The bone graft then needs to develop a blood supply and be ‘accepted’ by the body to survive.

A relatively new source of bone grafts that we have recently used at Newcastle Dental Hospital is donor human bone allografts. The bone is harvested from hip replacements by a company in Germany. Using the 3D scan, we can ‘design’ the ideal shape to create the bone volume for an implant, which is moulded using a CAD CAM computer system. Unfortunately, Brexit has added to the cost, as this now also incurs an import charge! Part of the procedure with our Trust has involved greenlighting a limited number of these grafts, so this option may not be available in all parts of the country.

Choosing an allograft means accepting that, although the bone has been sterilised, quality controlled, and no longer contains any living cells from the donor, it has come from another person. This might not be acceptable to everyone.

The engineered bone is held in place with screws and left to heal. After a bone graft, it is normal to experience some pain, swelling, bleeding, or bruising, and there is a risk of infection that could necessitate removal. During the early healing phase, pressure should not be placed on the graft, meaning there is often a week or two without a denture. The bone graft typically takes 4 to 5 months to fuse with the patient’s own bone, thereby increasing the bone volume.

Ideally, if bone is present in sufficient quantity and quality, the dental implants can be screwed into the planned positions, followed by a further healing phase of four months while the implants integrate with the surrounding bone. This process is known as integration.

Finally, the endpoint can be visualised, and once the implants are uncovered, temporary crowns or bridges can be screwed into place. We work closely with our laboratory staff to ensure that the shape and colour of the new teeth are optimised and that the patient is happy with both the appearance and function, and, importantly, can clean effectively around their new implant-retained teeth. Once everyone is satisfied, the final implant crowns and bridges can be made and secured in place.