Case Study Review with Kathy Nguyen, DMD

Good morning and welcome to the Shatkin F.I.R.S.T.® Monday morning minute.

Hi, I’m Dr. Todd Shatkin. Good morning and welcome to this Monday morning minute. I’m here with one of our residents, Dr. Kathy Nguyen. Good morning, Kathy. Good morning, Dr. Shatkin.

It’s great to have you here. This is our third weekly program with each of our residents this year. And Kathy, you come from Louisiana, and what in the world brought you to Buffalo?

Well, I’m from Louisiana, but I went to school in Florida. Bradenton, Florida, at Leecom. And then I traveled to Erie for my last year rotation, and I was like, I’m tired of moving. I’m going to move somewhere really close for residency, and Buffalo, when I interviewed here, end up being my favorite spot. I matched as my number one spot.

So Erie, Pennsylvania, is only about an hour from here. So you were used to being in the neighborhood? Yeah. That’s great. How was your experience at Leecom? It was really good. It was a relatively new school, and I didn’t get as much experience I did here, but it was a good foundation for me, for sure.

Good. So, Kathy, you’ve been an amazing resident. You’re doing such a phenomenal job. You’ve got such a great bedside manner with your patients. They all just love you of getting letters from people saying how great you are. When you were finishing up dental school, did you ever think you’d be doing the cases you’re doing here?

Not in a million years. I didn’t even like surgical extractions coming out of dental school, but ever since I’ve been here, I’ve dived right in, and I had such a great support system here that it gave me so much more confidence than I came in here with. How many extractions do you think you’ve done since you’ve been? I’ve done 100, and I’ve been doing full mouth cases. Wow. Yeah.

And then now with the mini implants, tell us about your experience with those. They’re way easier than I thought they were going to be. I mean, I had a little struggle at the beginning, but like I said, with a great support system, I’ve placed over 100, and I have so many more big cases coming up.

Just in six months. You placed over 100 teeth, 100 implants, and over 100 extractions. Now tell us about the case that you’re presenting today. So my case is my first big case. It’s a fix on six. This patient comes in with nothing on his upper arch because he hates his denture, it makes him gag. So we offer him this chance to kind of change that and give him great new teeth. And actually, tomorrow I’ll be cementing that case. Oh, wow. That’s exciting. So I want to see that. I can’t wait. For sure. That’s going to be great.

So, Kathy, something unique about you is you love new restaurants and you love food. Right. Even though you’re tiny, I know you like to eat. So what do you think about the food here in Buffalo?

It’s really good. There’s so many options. I’ve asked all the assistants and they have a whole list. And every week I try a new restaurant. That’s like, my goal. By the end of the year.

Well, you could literally go every day to a new restaurant for sure, because we have more restaurants per capita in Buffalo than they do in New York City. Believe it or not, that’s an interesting statistic here. It’s not always the best healthy food. We have a lot of chicken wings, a lot of pizza places, but I know you’re finding the healthier places and enjoying it here. So your experience in western New York and Buffalo has been great. It’s been really good. Good. I’m so glad.

Well, you’re doing a phenomenal job along with our other two residents, and we’re just excited to have you here and excited to share this case with the viewers. Yeah. It’s been an honor and blessing to be here. Thank you so much. Thank you. It’s great to have you here. We’ll be back with you next on the next Monday Morning Minute. Thanks for listening.

So we have a 72 year old Caucasian male. His chief concern was that he didn’t like his current denture. It makes him gag, and he wants to do something about his missing lower teeth. Dental history? Nothing really crazy, except that his gums bleed while brushing and flossing and he has difficulty chewing. Oral hygiene habits. Brushes once a day, never flosses. And his ultimate goal is being able to smile and chew properly. Medical history he has hypertension, but it is well controlled, as you can see. The medication he’s taking, his average blood pressure range about 134 over 83. And so we put him as a class two extra Ore exam. Nothing abnormal. Intra ore exam. His lower gingiva is slightly tender to touch, and you’ll see why in the next couple of photos. This is his extra oral photos. You can see that he doesn’t wear his denture because his upper lip is sunken in there, but he’s pretty much symmetrical. His nose might be a little crooked, though. Intra oral photos, you can see he’s a dentalist. And the lower teeth, you can see bone loss, periodisease, and even some decay there. Here’s a closer look here.

Teeth 21 to 28 has low prognosis, recurring decay, bone loss. Radiolucency on 23 to 25. And obviously class two mobility. This is a pre op CBCT. You see that it ranges from the cross sectional view, ranges from nine to 15. Just want to point out the two at the end here, that his sinus does run pretty low, so just keep that in mind. So we gave him three treatment plant options that doesn’t have a pallet because he hates his dentures. So we have that removable option, the fix on six, which is that semi removal and the fixed cemented option. And after discussing his finances and different treatment plan options, he decides to do the fix on six on the upper only. And we were able to use his conventional dentures as a temporary, so that saves us some time there. And he got really excited throughout this process. He’s like ready to start the lower as soon as we’re done. So good thing about having a lab across the street, we sent in preliminary impressions and they sent back us a stent that you can see on the left there. And to my knowledge, on the day that I did the surgery, they also sent a report saying that I needed to do a sinus lift on areas number one, number eight by 2 mm using Dr. Shatkin’s sinus lift kit. I’ve never done a sinus lift before, so thanks to Dr. Powers, he was able to help me on that.

So this is the day of the surgery. We did this implant placement. That’s the postop CBCT. And just a little more of a specific view here. Those are all the implants that we place and you can see that the areas one and eight are far from the sinus. And then area five, that’s a good thing about taking a post op CBCT, you see that area number five is a little bit more Buckley. So that day we took it out and just re angled that and then we took a white wax bite. We took the final impression using that, I got a lower wax bite made as well. We marked the midline, marked the high smile line, and then we took a bite registration. And like I said, I used his old dentures that he hated. I cut off the palette. We used the registry to use as a temporary liner for the patient. So that’s what he looked like the day of surgery. This is 2.5 weeks. I saw him last week looking really great.

All his implants are stable, there’s no discomfort, no pain. He’s doing really good with his oral hygiene. You can see in his gingerbread alone that they’re very healthy. And then we had his first try in. So that’s the mounted cast on the left there, put the housings on and then we were able to try in the try in that they made for us. And so, like I said, good thing about having the lab across the I called Kevin over, he’s our fixed prost guy. We did some modification. His lip support, if you can see on that lower left, it looks better with that lip support. He has a class one occlusion. His midline is off though, so we’re going to be able to shift it down zero point 51 mm over. So that’s why there’s a pen mark there. We’re going to bring his teeth down 1 little bit and then we match the mold of his tryin to his dentures and the shade eight one and he loves it. So that’s him with the try in, and he’s really happy with it, and I’m also really happy with it, and so I’m not done with this case, but I look forward to seeing what it will turn out to be. Thank you.