Dr. Danielle Larivey is a Full Arch conversion specialist serving San Antonio, Austin, and Houston General Dentists and Surgeons.
We recently sat with Dr. Larivey to understand a little more about her first ever Full Arch Restoration, her motivation for specializing, and the unique qualities and perspectives that she brings to the Digital Ape team of Doctors and technicians.
Danielle’s first patient to accept a Full Arch treatment option
My first Full Arch case was an incredible experience. The patient originally came to our office because one front tooth was chipped, but after talking to him, I realized there was a lot more going on. He seemed deflated in the chair and he expressed that he hadn’t smiled in the past 10-15 years because he was embarrassed. After taking a full set of xrays and performing my exam, I realized he had a ton of failed dentistry. Every other tooth was either endo treated, periodontally involved, abscessed, fractured, carious, or had failed crowns and fillings. Restoratively, I was limited on what treatment I could offer him without concerns for esthetics and long-term prognosis. After discussing all the options available, we collectively decided the Full Arch was the best option for him.
She realized her patient was done visiting the dentist and she was emboldened to offer the treatment.
This patient, in particular, had high dental anxiety, so he was not interested in sitting through appointment after appointment to address each problem with each tooth. He was ready for a more permanent solution that didn’t require so many long, draining visits which also comes at an expense. Sometimes in treatment planning, we have to keep this in mind for our patients and realize if they’ve already spent thousands of dollars on dentistry that keeps failing, we need to consider a different approach to their care.
As a General Dentist, she was the “Bus Driver” on Full Arch cases.
It’s up to the general dentist to really listen to the patient first, know exactly what they’re wanting, what their goals are as far as dental treatment goes, and then it’s up to us to provide different levels of treatment options. We never want to dictate treatment to people. We have to just inform them of what’s happening, give them several different options to choose from and give our professional opinion of what we see lasting the longest, and what would have the best prognosis. So as a general dentist we’re really in charge of not only the diagnosis but also the planning and coordination of treatment with other specialties.
Coordinating her first Full Arch case was eye-opening to all the parts involved.
If we’re delegating the general dentist as the “bus driver,” it’s up to us to find a surgeon that we want to work with, find a lab that we feel comfortable with, and then make the patient’s schedule work with ours, the surgeons, the lab, and the anesthesiologist’s. It’s way more work than I thought it was, but Digital Ape helped immensely in putting that together for me and within 2 weeks we completed the surgery with a fantastic result.
She understands the fears of the General Dentist concerning the Full Arch, because she shared them.
I think the biggest thing that I bring to the table is that I’ve been there as a general dentist. I know exactly what we’re worried about while doing Full Arch cases and what hesitations we have. No doctor ever wants to look dumb or like we don’t know what we’re doing. So to avoid the potential situation that we may not know how to handle, we just don’t offer the treatment. That’s never a good option for your patient who deserves the best care possible. So that helps me relate to the general dentists a little bit better in a clinical setting because I’ve definitely been there before. I know what I thought when I first went into this and how complex and how scary it could be, and how many things could go wrong. However, once you experience the procedure done the right way, and you find the right people to do it with, it really comes together nicely and it’s not as scary as you think.
What can she offer the surgeons?
Surgery day, what I bring to the table is the cross knowledge and the confidence in helping guide them through bone reduction and implant placement. Those are the two major surgical factors that can make or break the restorative side. I also take the restorative nightmares off the surgeons’ shoulders. By helping train the general dentists to maintain and work with the restoration, I alleviate the prosthetic concerns that the surgeon shouldn’t have to deal with in the first place. Sometimes what will happen is the general dentist may not know how to deal with complications so they will just send the patient back to the surgeon. However the surgeon shouldn’t have to manage the restorative complications, so my goal is to keep them free of that.
She thinks in terms of art, not textbooks when restoring a smile.
I love the art of esthetics. Every case is different so our biggest puzzle is customizing a restoration to fit a person’s face and personality. This is not something you just read in a textbook and there’s no instruction manual. It truly is art and that is something I find really intriguing and fun.
She likes to establish a relationship with the patient prior to surgery because she’s the first person they see when they wake up.
The best part of this whole process is meeting someone new and changing their life. At the end of the day, this isn’t just about esthetics and materials and dentistry. It’s about listening to someone’s story and helping to give them the confidence to conquer every endeavor in their life. The moment companies or corporations forget that, is the moment our patients suffer.
Her General Dentists have her cell number.
I think the coolest thing about what we offer is being that resource for the general dentist. We are available for chair-side coaching so we can teach them anything that they want to learn. We can show them exactly how each step is done if they’re interested. We also do that in a way that doesn’t make the patient question their own dentist on their abilities. Our goal is to make this fun for all parties involved. So I love to help make it a pleasant experience any way I can.
In Dental School, a Full Arch was even a little “taboo”. She used to talk people out of a Full Arch.
It’s kind of funny because, in dental school, we’re almost taught the exact opposite of what the Full Arch entails. We’re always taught in dental school, you take a tooth out, you let everything heal for about three or four months, then you put the implant in, then you let that heal for three or four months, and then you put a tooth on top. So the Full Arch was completely opposite and not really emphasized at school.
So when I got into practice and patients would ask me, “what about teeth in a day?” my response used to be “well you’ll get teeth in a day but do they last longer than a day?” Of course, now I know better and laugh at myself for even saying that, but it just shows you how little it was emphasized in school and how scared we were to offer it without any knowledge on how it even works. It’s unfortunate, and one of my goals now would be to make sure dental schools are really informing the students about this procedure and not making it seem so scary for them to offer.
This can be an emotional process for all involved.
My favorite Full Arch moment was when we did a conversion on this older woman and she had a really tough case. Her face was very asymmetric, her bone was really thin, and the surgery was challenging. Capturing the right esthetics was also challenging because she had lost so much vertical and the asymmetries in her face made it easy to throw off your eyes. At the end of surgery, we gave her a mirror and she just started crying. She was so excited to be able to attend her son’s wedding the next week and actually smile for the first time in years. So it made me tear up. I had to turn away and pretend like I was cleaning the counter or something like that so that nobody would see it, but she was so happy. It’s moments like those that make every minute of school, training, and all the years of student loan debt worth it. You have no idea what something like this means to these patients. Their quality of life suffers, they enter states of depression, their health decreases, and they lose all confidence to contribute in their communities. So to give someone their quality of life back is indescribable. I’ll never forget those moments with those patients.