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Speaker Spotlight – June 2021

Speaker Spotlight with: Dr. Agnes Lai

The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient's attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all."

Dr. Agnes Lai

Bio:

BDS USYD, DCLINDENT (Prosthodontics) USYD, MRACDS (Prosthodontics)

Dr Agnes Lai obtained her Bachelor of Dental Surgery from the University of Sydney (USYD) in 2002, during which she was awarded the G.S CAIRD Scholarship in Prosthetic Dentistry and shared Faculty Research Prize.

After practicing as an intrepid general dentist in Singapore, and metropolitan Sydney, Agnes completed her Doctorate of Clinical Dentistry in Prosthodontics at her alma mater, USYD in 2009, and was admitted as a member in the Royal Australasian College of Dental Surgeons in the same year.

Agnes had been involved with the hypodontia research in Westmead Centre for Oral Health, and  has published her research in human neural adaptation related to an increase in occlusal vertical dimension using fMRI.  She is also a contributor to the textbook “Oral Rehabilitation: A Case-Based Approach.” 

Currently, Agnes practices prosthodontics in private practice at Sydney Prosthodontic Group, Chatswood, as well as a clinical specialist at Westmead Oral Restorative Sciences Department in the Public Sector.  

Agnes had been a past Lecturer of Oral Rehabilitation at USYD where she was involved in both undergraduate and post-graduate teaching of prosthodontics and dental implants.  She has been a past convener of a 5-day Continuing Education Program for Prosthodontics at USYD.   She currently maintains an ongoing Clinical Educator role in the discipline of prosthodontics to Doctorate of Dental Medicine via her role at the teaching hospital.  Agnes has served on the federal executive of the Australian Prosthodontic Society in the past, and is currently serving as a State Representative for the Australian and New Zealand Academy of Prosthodontics.

Her extensive experience in general and specialist practice, locally and overseas, and her friendly approach to patient-care provide our patients the highest quality specialist prosthodontic treatment in a warm, caring manner.  She enjoys teamwork with her patients to rejuvenate, restore and create people’s smiles that is unique and tailored, with a comprehensive approach including mindfulness on aetiology, and recommendations on preventative strategies and risk mitigations.

Agnes is a mother of three delightful daughters and enjoys spending time with her family.  She enjoys cooking, singing, theatre, travel, and playing the piano by leisure.  She was born in Hong Kong and migrated to Australia in her primary years.  Whilst remain fluent in Cantonese, she can also communicate in Mandarin and finds interest in Japanese and French though limited to holiday phrases only.

Publications:

Machado MWallace C, Austin B, Deshpande SLai AWhittle T, and Klineberg. Rehabilitation of ectodermal dysplasia patients presenting with hypodontia: outcomes of implant rehabilitation part 1.  Journal of Prosthodontic Research. 2018 Oct;62(4):473-478. https://doi.org/10.1016/j.jpor.2018.07.001

Lai and Klineberg. Oral stereognostic ability associated with increased vertical dimension, its relevance to satisfaction and adaptation.  Professor Klineberg’s Symposium

Lai and Desai. Cracked Teeth- Cracking Problem in Dentistry (Part 1 to 5). June 2018 Australian Dental Association Online Continuing Education Videos

Lai, Korgaonkar, Gomes, Whittle, Foster, Williams and Klineberg. fMRI Study on Human Subjects with Sudden Occlusal Vertical Dimension Increase, Jacobs Journal of Dentistry and Research 2015 2(2):020. https://jacobspublishers.com/fmri-study-on-human-subjects-with-sudden-occlusal-vertical-dimension-increase/

Chapter contributor to a text book, “ Oral Rehabilitation: A Case-based Approach”, Case 10.3, Case 11.2 and Case 13.2, Wiley-Blackwell Publishing (2010)

You have managed a case where the patient had Amelogenesis Imperfecta. What did you find to be the most challenging aspect of the case and how long was the treatment planning process prior to completion?

The most challenging aspect in these type of cases is patient’s expectations and mindset.  Fortunately, this patient had a very supportive family, both emotionally, psychologically and financially.  He also had an excellent paediatric dentist who provided strong dental awareness and commitment to good oral maintenance of his teeth and future restorations.  All of these helped to finalise our treatment goals and readiness for active treatment and maintenance.  The treatment planning took one appointment, as this patient has had treatment option discussions on multiple occasions with previous dentists throughout his childhood and adolescence; therefore, he came to me with clear directions of his treatment goals.  The design process until completion took 10 appointments over 3-4months.

How do you manage patients that end up needing/ wanting full conventional dentures (without implants) for the first time? Have you had a case where the patient never adapted to the dentures and if so, what did you end up doing instead?

Patients who are about to receive conventional full dentures must understand the relative advantages and disadvantages of the removable prosthesis.  They must also understand how the retention and resistance form and support work, in order to embrace the limitations of function, and the maintenance required.  Like learning to use any apparatus, positive mindset, skill acquisition and adaptation are important elements of the rehabilitation process. Often, by this stage of understanding, the patient will have a good idea of whether or not they will accept conventional dentures. 

In cases where the patient may find adaptation challenging (associated with prosthesis retention), dental implants can be great alternative, especially in cases where patient’s lack the muscular control or coordination for a loose conventional mandibular denture.  Instead, implant retained or supported prosthesis can provide a dramatic improvement in adaptation, as the skill for learning to use them is less demanding.  However, when the adaptation is difficult due to mindset, or other movement disorders, then we may have to work with those challenges more specifically. The solution may not lie with the dental prosthesis design or treatment., but rather with the alignment of the patient’s or family’s expectations and their needs.

Implants are often a replacement option. However, if an implant fails, what would you do? What other replacement options would you offer for a patient who is set on getting implants (i.e., placement of a second implant, bone grafting, etc.)?

Implants or its prosthesis can have complications or fail too.  If an implant fails, that is, loses osseointegration or fails to integrate, it will need to be removed.  The case will have to be restarted and should consider all possible treatment options.  Implant re-treatment may or may not always be possible, and often would require multiple surgical procedures with increasing treatment complexity with the risk of failing again.  If the patient is set on getting implants again, it is important to identify those particular risk factors that can contribute to increase chances of failure.  Where possible, those risk factors should be controlled first. To minimise the occurrence, a history of periodontitis and parafunction must be considered.  Sometimes it is not as straightforward as such, the patient’s level of comprehension to appreciate the complexity of treatment and outcome expectations need to be realistic and on par. An appropriate maintenance schedule or servicing need would also have to be discussed and planned along with case selection, especially patient motivation and suitability. 

What is one thing you want everyone to know about prosthodontics or something you learned during your years that you would like to share with other dental professionals?

Prosthodontics is very rewarding because you help witness the oral rehabilitation process and improvement in the quality of life in your patients.  The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness.  That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.

The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness.  That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.”

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