The Innovator: Dr Vijay

By: Ruth Donnelly
Created on 11th October 2010

Who: Dr R P Vijayanarayanan (Dr Vijay)
What: The One Day Smile
Why: From zero to 24 teeth in just eight hours

In this series of articles, Cosmetic Surgery & Aesthetics Guide tells the stories of the men and women who are pushing forward the boundaries of aesthetics. In this issue the spotlight is on Dr Vijay and his One Day Smile protocol

We often print articles in this magazine about how to correct wonky, stained or overcrowded teeth, but have you ever stopped to think about the implications of having no teeth at all? As a general practice dentist, Dr Vijay encountered many such patients and, frustrated at being unable to offer a real solution to the problem, he set about investigating the benefits of implant dentistry, which led him to develop his unique One Day Smile service.

How did you make the move from general practice into implant dentistry?

To be honest, I was ready to quit dentistry all together because I was so dissatisfied. There was always that group of patients who I’d have to turn around to and say, “there’s nothing else I can do for you, other than make you some dentures”. It got me thinking that one day that might happen to me, and if I had to take my teeth out and stick them in a glass at the end of every evening, I would just feel like my life was over.

I just couldn’t believe that there was nothing else we could do for these patients, so I started talking to colleagues in the United States, Germany, Spain – in all these countries, implant dentistry is offered as a mainstream product. And it wasn’t until I started speaking to these guys that I thought: why aren’t we doing this in the UK?

That was the real trigger; it pulled me back from reconsidering my career in dentistry. For me, there was no joy in doing root canal treatments and pulling teeth out. It all has its place, but it didn’t satisfy me, because I wanted to be able to solve any problem anybody had. And implant dentistry allows me to do that.

What decisions did you take to make your practice stand out from the rest?

Everybody does implant dentistry in their own way. I looked at it from the patient perspective – what do they want and what don’t they want – and took away the things they don’t want. Once you’ve made the decision to invest in a new set of teeth, you don’t want to be walking round with dentures for the next six months, you want your new teeth straightaway.

So I knew we needed to be totally focused on implant dentistry, in order to be able to offer as quick and efficient a service as possible. We are a strictly implant only oral reconstruction centre, with our own lab onsite and all the equipment we need, which means we can do things much more smoothly than anyone else.

The other big thing was a fixed pricing policy. Patients want to know exactly what they’ll be paying from the outset, with no hidden costs. So we set up a structure whereby you pay £8,500 per jaw if you have no teeth and £10,500 if you’ve got some teeth, no matter how complex your requirements.

And of course the most important thing is the ability to perform the surgery to a very high standard and to be predictable. Patients are paying a lot of money for this and it needs to be perfect. Which is why I have people like Professor Coulthard on my team – he’s head of oral and maxillofacial surgery at Manchester University and I like to have surgeons of his calibre watching me while I work because I like to be critiqued.

What’s the first step when someone comes to you for a One Day Smile?

The first and most important thing is the consultation. That’s mandatory, because I need to meet the patient and they need to meet me. It’s a trust issue – they have to believe in us. The patient must be suitable, medically and dentally – but 90 per cent of patients are – and I need to be sure that they are going to work with us to achieve the results that we know are possible.

So we spend about an hour in consultation, we take all the necessary x-rays, get all the information we need. And then, assuming they are suitable, I like them to go away and think about it, because it’s a major step. Most of the time they have already made their mind up to do it before they’ve reached the bottom of the stairs, but I encourage them to give it careful consideration, because this is their final set of teeth, we won’t be doing this again.

They need to get their heads around the fact that this isn’t a cost, it’s an investment. To give them their lives back, their selfconfidence. To eat out again, to smile in photographs – all these things that you and I take for granted.

So once the consultation’s done and they want to go ahead, the next step is the pre-op. At this stage I ask them to bring in a photograph of themselves at 21, carefree, with a big grin on their face. This gives me an idea of what they were supposed to look like in the first place. That allows us to start designing what we think they should look like today.

We take some photographs of them as they are now and we’ll take some moulds of the mouth and I hand it all over to the lab. We then sit down with the patient and say, “right, you’ve got completely free artistic licence now. How pretty do you want to look? How white do you want your teeth to be?” It’s a very interactive process. We do offer some guidance, because you have to have the right teeth for your face, but we can do whatever they want.

The pre-op takes about an hour, an hour and a half, and then all that detail goes to the lab. It’s then time to book the patient in for their actual transformation day, and that can literally happen the very next morning, if that’s what they want.

So what happens on the day itself?

The patient arrives at about nine o’clock in the morning and they’re given pre-op medication and prepared for surgery. I don’t believe in keeping a patient sitting in the dentist’s chair for eight hours, so I’ve developed a technique whereby I can reduce the surgery time to one hour per jaw. So if they’re having an upper jaw done, they come into my room at 9:30 and by 10:30 the actual implants are in and they’re back downstairs in a private waiting room.

Once the implants are in, the patient can chill out downstairs in the waiting room, while the lab gets on with modifying the bridge to the new foundation that I’ve given them. And by about halfpast one the patient is brought back in to try on the new bridge.

At this stage, the teeth are done, but they’re set in wax, so we can still make adjustments if needs be. We screw it in and say to the patient: “Is this the smile of your dreams?” If they want any changes we can do that. That process takes about half an hour.

Once the patient is happy with what we’ve done, we take the bridge off again, the patient goes back to the waiting room and the bridge goes back to the lab, where they need about three hours to do the final processing.

Finally, at about half-past five that same day, we’ll do the final fit. That takes roughly five minutes – four screws and it’s in. And then I like to give them an apple and say “bite that”. That’s something most denture wearers haven’t done in a long time, so that’s the bit where they become convinced in their heads that these teeth can do anything my teeth can do.

What sort of impact does implant surgery have on patients’ lives?

It’s quite staggering really. When I was in general practice, no one ever wrote me a card saying “thanks for that filling, it’s changed my life”. But I got a card from a lady yesterday who said she hadn’t enjoyed a meal out with her husband for 32 years, and since her surgery they’ve been out practically every other day.

I had one patient, she was 35 years old, she’d been wearing dentures since she was 17 and she was at her wits’ end, because her boyfriend didn’t know. I can only imagine what it must have been like for her, at 25, in a nightclub on a Friday night, with a set of plastic gnashers in her mouth. Sadly, I couldn’t give her the time back, but I could put her teeth back.

You can’t quantify the freedom you give to people. Implant dentistry has never really been viewed as a life-changing procedure, but it is. The sad thing about edentulism, missing teeth, is that the World Health Organisation recognises it as a disability, but general society just looks on it as some kind of social joke. So it’s a cause of great embarrassment for people and they tend to suffer in silence.

CS&AG