title: Oral rehabilitation and psychosocial evaluation of a patient with bulimia nervosa following Teeth in a Day® immediate loading protocol.
abstract: OBJECTIVE
  The purpose of this patient report is to accurately portray the clinical experience of treating an active bulimic patient by employing an immediately loaded dental implant protocol to provide the patient with an expedited esthetic and functional result. Implementation of a psychometric component statistically quantifies the psychological effects of the oral rehabilitation.
  
  
  METHODS
  A 34-year-old woman presented with severe dental perimolysis (erosion) resulting from a 28-year history of bulimic behaviors. Clinical and radiographic evaluation of the existing dentition indicated advanced dental erosion and previous restoration attempts in a state of failure. The patient's existing teeth were extracted and treated with full maxillary and mandibular implant-supported prostheses, following the Teeth in a Day® (TIAD) immediate functional loading protocol. Psychometric assessment was conducted through administration of a 20-item questionnaire, as seen in previous literature.
  
  
  RESULTS
  Radiographic and clinical analysis suggested all implant fixtures to be viable and accompanied by normal levels of alveolar bone 7 months into treatment. Questionnaire results at the new-patient presentation (T1) resulted in a composite score of 4.0 (SD = 2.9; P = 0.004), indicating severe body-image dysphoria. At 3 months postoperative (T2), the questionnaire score was 0.4 (SD = -1.7; P = 0.09). The final psychometric questionnaire at 7 months (T3) resulted in a score of 0.5 (SD = -1.5; P = 0.12). The patient was followed for a total of 7 years following implant placement.
  
  
  CONCLUSIONS
  In this patient report, oral rehabilitation using the TIAD protocol provided an expedited and predictable alternative method for restoring functional abilities, esthetics, and self-esteem to a severely depressed bulimic patient. Psychometrically, at the postoperative (T2) and final testing period (T3), the patient's body image profile was no longer considered to be significantly different from established normative values.
authors.affiliation: Private Practice, Fort Washington, Pennsylvania.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Balshi
authors.affiliation: Private Practice, Fort Washington, Pennsylvania.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wolfinger
authors.affiliation: Private Practice, Fort Washington, Pennsylvania.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Alfano
authors.affiliation: Private Practice, Kennett Square, Pennsylvania.
authors.forename: J Neil Della
authors.initials: JN
authors.lastname: Croce
authors.affiliation: Director of Research, Pi Dental Center, Institute for Facial Esthetics, Fort Washington, Pennsylvania; President, CM Prosthetics, Inc., Fort Washington, Pennsylvania.
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Balshi
mesh_terms: D000328:Adult; D002032:Bulimia / Q000150:complications* / Q000523:psychology; D019094:Dental Prosthesis, Implant-Supported; D004955:Esthetics, Dental; D005260:Female; D006801:Humans; D057893:Immediate Dental Implant Loading; D009066:Mouth, Edentulous / Q000534:rehabilitation*; D011594:Psychometrics; D011862:Radiography, Panoramic; D014077:Tooth Erosion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000534:rehabilitation*; D014081:Tooth Extraction