Featured patient experiences
Featured Case 09/20: COSMETIC JAW SURGERY
- Chad is a 30-year-old who had concerns about his facial appearance.
- In particular, he was not fond of his relatively short and “square” facial shape.
- He wanted to have a smile that was more attractive but not certain what it took to fulfill that desire.
- Chad sought numerous consultations for orthodontics (braces), jaw reconstructive surgery, and facial plastic surgery.
- After seeing multiple specialists, he narrowed his search down to 2 orthodontists and 2 Oral & Maxillofacial Surgeons from which to choose.
- He had no perceptible issues with his bite or chewing ability.
- The other orthodontist and Oral & Maxillofacial team recommended he have braces and lower jaw advancement surgery.
- After numerous consultations, Chad felt comfortable with our recommendations to address his cosmetic request.
- Chad demonstrated what has described as a Brachyfacial (short vertical and square shape) presentation.
- His lower face (below the nose to the chin) was shorter than the midface (between the brows to under the nose).
- He showed very little upper teeth when smiling making him seem aged.
- His teeth and bite appeared very acceptable and stable.
- Computer simulations were performed to give Chad a sense of facial proportions.
- Since his teeth and bite were stable, only minor orthodontic fine-tuning was necessary.
- He needed skeletal and soft tissue solutions to his cosmetic problem.
- Cheiloplasty or lip lift contouring was performed.
- Reconstructive augmentation of his upper jaw was performed to increase vertical length and show the appropriate amount of his upper teeth.
- The upper jaw surgery is known as a Le Forte I osteotomy.
- Reconstructive augmentation of his chin was performed to also increase the vertical dimension.
- This approach to the chin is called a genioplasty via Mandible (lower jaw) inferior border osteotomy.
- All cosmetic jaw surgery was performed inside the mouth so no visible scarring would occur on his face.
- Soft tissue filler was placed to soften the deep fold under his lower lip.
- All procedures were performed as an outpatient in our AAAHC accredited surgery center.
- He was discharged on the morning of surgery to the comfort of his home.
- Chad had a very uneventful recovery.
- He experienced typical facial swelling for about one week.
- He was instructed to stay on a soft diet and non-strenuous activity for 2 weeks.
- He completed orthodontic fine-tuning (braces) within 2 months of his surgical procedure.
- Facial cosmetics is a function of harmony of hard and soft tissues, proportions, and perception.
- Understanding all components of facial anatomy as it relates to aesthetics is paramount to achieving acceptable results.
- Addressing the facial bones along with soft tissues is important to determine the true nature and solution to the condition.
- It is sometimes stated that “there is usually one correct diagnosis but numerous ways in which to approach it”.
- Comprehensively trained Oral & Maxillo-Facial surgeons have unique expertise in treating all aspects of the face.
- A comprehensive approach to, and surgical skill set of the entire face, is integral to our core competence at Inland Institute.
- We are overjoyed to see how pleased Chad felt about his results and overall experience in our practice.
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Experience personalized, comprehensive and a passionate commitment to patient care by
Dr. David Gilbert
Featured Case 08/20:
NO MORE DENTURES – IMMEDIATE TEETH WITH DENTAL IMPLANTS
“My dentures are loose and I cannot eat well nor enjoy food.”
- Ron lost his teeth many years ago and was forced into dentures.
- This was a significant compromise in his general quality of life and confidence.
- Over time the dentures became more loose and ill-fitting.
- Chewing, tasting or enjoying foods, and confidence in social circles were all compromised.
- He had 2 implants placed to help secure the lower denture but that did not resolve the mobility when eating.
- He found himself in a place where his life was significantly impacted.
- He could no longer go to a restaurant and order what he wanted but look for what he could eat with his loose and ill-fitting dentures.
- Healthy teeth maintain the bone and jaw structure.
- When teeth are lost the bone atrophies (shrinks) from a lack of function.
- Dentures rely on the bone (like a saddle) to remain in place but become progressively loose as the bone shrinks.
- Dentures simply sit on the tooth-less gums and cause even more atrophy.
- The only way to maintain the bone is to replace the function within the bone like a tooth root.
- An implant is the only current tooth replacement option that preserves bone.
Implants as a challenge and a solution:
- Implants require sound bone as a foundation for anchoring.
- As the jaw bone shrinks after losing teeth, there is less bone in which to anchor the implants. The loss of bone becomes so extreme, traditional implants are difficult to place as regional nerves (inferior alveolar for lower lip sensation) and the sinuses (air cavities in the upper jaw) are closer to the surface as a result of bone loss.
- This was precisely Ron’s challenge. He had such bone loss that his dentures were too loose and traditional dental implants were nearly impossible.
- Bone graft reconstruction in this type of case can require extensive surgery, a long arduous recovery (6-10 months), and unpredictable long-term success.
- Only after bone healing is implants then considered. The total time for treatment in the bone grafted approach can be 1-2 years.
- Ron had such bone loss that there was insufficient bone above the sensory nerves (inferior alveolar) passing within the lower jaw (pink solid line).
- His 2 lower implants were failing from too much rocking movement of the denture.
- He also had such loss of bone in the posterior upper jaw, that it encroached on the sinuses where little structure remained for implants.
- Typically, implants of about 8-10mm long are desired and should remain 2 mm above the nerve (requiring a total of 10-12 mm above the nerve) for safety and mechanical security.
- Ron had less than 5mm.
- In such cases, implants can be tilted away from the sinuses or the nerves while engaging the remaining bone for stability and support.
- Another novel approach is to use longer implants that traverse the sinuses and fixate into the zygoma or cheekbones.
- These tilted and “zygomatic” implants have been well-established modalities of treatment for the patient with very little bone that requires immediate stability.
- Utilizing these stable graft-less implant techniques, patients can have implants placed and temporary teeth attached the same day.
- Ron had both failing lower implants removed.
- Concurrently, 4 implants were placed in the lower jaw while avoiding the inferior alveolar nerve with tilted posterior implants.
- In the upper jaw, 4 implants were placed in the sound bone anterior to the sinuses.
- In the thin and lower density region of the posterior upper jaw, 2 zygomatic implants were placed.
- All implants were very stable by optimal use of the available bone anatomy.
- No bone graft reconstruction was performed nor indicated.
- Dr. Gilbert performed all surgical procedures on the same day under anesthesia.
- Temporary dental prostheses were attached to the implants on the same day while Ron was comfortably sedated.
- He left our facility with secure and aesthetic teeth that were attached on the very same day as his surgery.
- Ron enjoyed those temporary prostheses (teeth) for 4 months while everything healed very nicely.
- He then saw his restoring dentist who prepared and delivered final implant-retained prostheses.
- This was a true and nearly immediate transformation for Ron.
- Utilizing very specialized surgical techniques, Ron was able to have a solid set of teeth in an extremely expedited manner.
- Extensive experience and a “well-orchestrated” team-approach are critical to the success of these procedures.
- It is a true privilege and honor for our healthcare team to positively impact a patient’s life in a sustainable and predictable way.
- We are are so grateful and thrilled that we were able to restore Ron’s confidence, comfort, and general quality of life.
Missing Teeth? Consider Dental Implants !
Featured Case 07/20: SNORING & SLEEP APNEA
“I snore and my wife cannot sleep”
- Doug is a 37-year-old male with a history of loud snoring.
- He notes that it has affected his wife’s sleep and impacted their relationship.
- He noted having to sleep in another room on many occasions.
- It was his desire to simply decrease his snoring and improve the quality of his wife’s and his lives.
- Snoring is noisy breathing created by air turbulence along with the airway anatomy while you sleep.
- Commonly associated factors include restricted nasal passages, the poor muscle tone of the throat and tongue, large-sized tongue and throat tissue, long soft palate and uvula, excessive alcohol use, and sleep position.
- It is a very common condition that affects both males and females but males are more affected.
- Increasing weight and age are significant factors in addition to deformities of the jaw (retrusive), tongue (large), palate (long), face, and neck (large).
- Although snoring is not a direct health emergency, it most frequently is a nuisance for one’s bed partner and a primary reason for patients seeking care.
- Long-term snoring can affect sleep patterns and may be associated with Obstructive Sleep apnea (disturbances in breathing when asleep).
Exam and Diagnosis:
- Doug underwent a volumetric CT Scan analysis of his airway.
- Following the initial consultation, he also received a formal sleep study (polysomnogram) and was determined to have only very mild sleep apnea.
- His AHI was almost normal. Apnea-Hypopnea Index (AHI) measures sleep apnea severity.
- The AHI is the sum of the number of apneas (pauses in breathing of at least 10 seconds) plus the number of hypopneas (periods of shallow breathing) that occur, on average, each hour.
- Doug was determined to have primary snoring and did not seek nor require any significant treatment of sleep apnea.
- We then performed a complete evaluation of Doug’s airway while he was sedated and asleep.
- This was performed with a tiny (3mm) flexible camera to assess his nose, oral cavity, and throat while sedated to reflect his muscle tone when he sleeps.
- Nasal Septoplasty (correction of the crooked central portion of the nose)
- Bilateral Submucous Turbinectomies (reduction of the lateral portions of the internal nose without incisions)
- Uvuloplatolasty (reduction and reshaping of the uvula and soft palate )
- While snoring may not be perceived as a health problem by most patients, it may be a symptom indicative of the bigger problem of Obstructive Sleep Apnea.
- Proper evaluation and diagnosis must be conducted to differentiate between snoring and obstructive sleep apnea and treatment options designed accordingly.
- Weight reduction and control can be a very helpful adjunct to sustained treatment success.
- In our experience, the biggest problem with snoring lies with the bed partner.
- It is simply torture, to try sleeping next to someone snoring. Snoring impairs the sleep quality of the bed partner and maybe more deleterious on their health.
We were so grateful that Doug was kind enough to share his experience with other patients and even more delighted that we were able to improve the quality of restful sleep for both him and his wife.
Get Better Sleep for You & Your Partner!
David H. Gilbert DDS, MS, MBA, FACS
I love this office! Dr.Gilbert is the kindness
- Jana Q
Doctor Gilbert and his staff are wonderful! I felt at ease when we discussed my condition and the treatment plan was explained in detail. The staff is warm and welcoming and we are grateful for this overall. Thank you Dr. Gilbert and team!
- Isidro H
- Gayle H
- George G
Good experience and good result so far.
- Elizabeth O
Staff and MD have always been very friendly & professional. Several family members have had procedures done & we have all been very pleased w/ our services at this office. I would definitely refer others to Dr. Gilbert.
- Deanna V
Dr. Gilbert is awesome! He thouroughly explained everything & took the time to answer all our questions. All our appointments were right on time. His staff was extremely friendly and professional.
- Michelle F
great staff and very prof. Doctor
- Laura F
So happy that my dentist referred me to Dr.Gilbert
- Lesley R
Very nice visit with no pain or discomfort.
- Donald B
Featured Case 06/20: FACIAL TRAUMA – DOG BITE TO LIP
“I had a dog bite off a piece of my lip”
- Tyler is a 23-year-old gentleman who was at a friend’s place on Halloween night.
- His friend’s dog suddenly bit his lip and face resulting in loss of lower lip tissue and puncture wounds to his face.
- Dr. Gilbert was called to consult and treat his facial injury at a local trauma hospital.
Pre Op Photos:
- The patient was taken to the operating room for cleaning and repairing his wounds.
- He underwent delicate plastic repair of his lower lip to reconstruct the lip muscles, skin, and lip line.
- He was placed on therapeutic and prophylactic antibiotics to combat the potential of infection.
Photos of injury and sutured repair:
- The patient was seen and followed very closely by Dr. Gilbert and his team at Inland Institute.
- Careful attention was paid to care for his wounds, his healing period, and recovery.
Photo of sutures removed and early healing:
- Tyler was very pleased with his healing and final result.
- He proceeded to resume life as usual with virtually no evidence of his injury.
- Facial trauma can present as a result of various mechanisms and present numerous challenges to both the patient and the treatment team.
- Dog bites are dirty wounds filled with very harmful bacteria. Without proper medical and surgical treatment, it can lead to severe and life-threatening infections.
- Tissue loss is a frequent finding with dog bites and reconstruction takes various approaches. It is not unusual to have multiple surgeries after trauma.
- These injuries can be quite dis-figuring. Ultimately, it is the intent of reconstruction to return the patient to as close a pre-trauma condition as possible.
- Surgical Experience (trauma, cosmetic, and reconstructive) and in-depth knowledge of the face, head, and neck are of utmost importance in these cases.
We are so happy that Tyler had a very cosmetic and functionally natural end result after a single surgical intervention.
Pre and Post Op Photos:
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Featured Case 05/20 – CORRECTIVE FACIAL/JAW SURGERY
“I have an underbite and cannot chew my food. It is impossible to bite a sandwich!”
- Joe is a 17+-year-old with a developmental facial and jaw deformity
- He has had progressive challenges eating and speaking
- His mother relates that it is also very socially challenging as a teenager in school.
- He looks forward to looking “normal and being able to eat anything he likes”.
- He was referred by his orthodontists and primary physician for corrective jaw surgery (orthognathic surgery)
Pre Op Photos:
Developmental growth deformities of the face and jaws are fairly common. The 2 most concerning issues for patients are aesthetics and chewing function.
It is not uncommon where the upper jaw (maxilla) or lower jaw (mandible) to grow at different rates to each other. This may produce an underbite (lower jaw ahead of upper jaw/ prognathic), overbite (lower jaw retrusion), or open bite (teeth not touching) mal-occlusion. A bad bite is referred to as a mal-occlusion.
Many cases can be treated by orthodontics (braces) alone but when the jawbones have too much of a discrepancy, corrective jaw surgery may be required. Corrective jaw surgery (orthognathic surgery) almost always goes hand in hand with orthodontics.
- The patient starts with braces, followed by surgery, and then a short period of orthodontic fine-tuning.
- The braces correct the dental discrepancies (crooked teeth) and the surgery corrects the skeletal (jaws, cheeks, nose, etc.) and bite relationship components, to result in balance and harmonious function.
- Surgery is typically planned after major facial growth ceases. (females >15, males >18 years of age).
This treatment approach addresses and optimizes:
- The bite (occlusion)
- The airway (breathing)
- Aesthetics (facial harmony, balance, proportions, and profile)
- Function (chewing/mastication)
All planning is performed using computer-aided diagnostics, design, and manufacturing before embarking on surgery. Surgery is typically performed in a hospital or surgery-center environment under general anesthesia.
Single jaw surgery patients go home the same day and double jaw surgery patients typically stay for about 48 hours before being discharged.
Planning process photos:
- Computerized/digital facial analysis and treatment planning with the fabrication of computer-generated surgical guides.
- Presurgical airway (nose and throat) analysis was performed by using a small guided camera while sedated (naso-pharyngoscopy).
- Upper jaw surgery (Lefort osteotomy)
- Lower jaw surgery (bilateral sagittal split osteotomy)
- Chin augmentation (genioplasty)
- Cheek implant augmentation
- Nasal septoplasty
Post Op Photos:
Admittedly Joe was very self-conscious about his appearance before surgery. It was one of the major driving forces with his decision to have treatment. An interesting concern that may be raised among family members is that they do not want patients to look like a totally different person after surgery. While this surgery is truly transformational, every effort is made to preserve inherent family and patient identity features.
Joe was very pleased with his final aesthetics and functional result. He and his family expressed how much this helped his self-confidence the most, among all the other benefits of this treatment.
Seeing and hearing how much a procedure helps a patient is the best compliment we can receive.
Before & After Photos Photos:
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Featured Case 04/20 – AESTHETIC DENTAL IMPLANT
“I am missing front teeth and want to replace with teeth that look natural”
- John is an active and robust 23-year-old gentleman who never developed his maxillary (upper jaw) lateral incisors.
- He has been wearing a removable retainer to replace his missing teeth.
- He is very concerned about his appearance and requested the best long-term solution to replace his missing teeth.
Maxillary incisors are among the most frequent developmentally missing teeth. As they are in the most visible location, aesthetics are a major concern for patients. When teeth are missing, the bone shrinks (atrophy), and the adjacent teeth drift into the spaces.
Patients have 4 options when missing teeth:
- do nothing,
- removable denture,
- fixed bridge and
- dental implants.
Dental implants are the ONLY option that is considered permanent AND preserve the bone. Dental implants are typically considered when the patient has finished growing (after age 18).
- Dental implants and bone grafting (rebuilding) were surgically performed by Dr. Gilbert.
- Teeth bleaching and implant restorations (crowns) were placed by his dentist.
Final result 5 years after treatment:
- As this patient experience illustrates, dental implants appear natural, aesthetic, and remain healthy well after 5 years.
- We believe that if John maintains good dental hygiene and sees his dentist regularly, he can have these implant “teeth” for the rest of his life.
- It is ultimately most important to us at Inland Institute that our patients have both aesthetic and long-term functional success.
- We were so delighted John had such a remarkable experience with natural replacement of his missing front teeth.
Dr. Gilbert & Team
Missing Teeth? Consider Dental Implants !