Hi, everyone. How we doing?
So today,
let's talk about all
on four treatments.
It's something
which we've covered
a lot on this channel.
And let me talk you through
six things,
which I think
a lot of people don't expect
when they're starting
to go down this journey.
So my name is Gurs.
I'm a cosmetic and implant
dentist based in the UK,
and we do a lot of all
on four treatments.
All on four treatment
is essentially a treatment
for those people
whose teeth are in
such a bad condition
that we have to remove everything,
put implants in
and give a solid set of teeth
and we do it all in one day.
Okay.
That's
most of the appeal of this treatment
is that all
the problems are solved in one day.
The reality isn’t that simple.
But most of the treatment is done
in one session. Okay?
And this video is all about
what happens in that session
and the following weeks
after that session.
Now, on the day of treatment,
there is a whole load of stuff
which needs to happen. Okay.
And it takes time.
So typically, if I'm doing a case
and we've just got to say
just the top teeth
will start at 9:00
and usually be
finishing off about 1:00,
something like that.
But we often book a little bit longer
because sometimes
we can have unexpected things happen.
We need to change a game plan
and things
drag out a little bit longer.
If we're doing top and bottom
in the same day,
we usually finish about three
between three and 4:00.
Now, the thing to bear in mind here
is that
especially if you're having sedation
to calm your nerves down
during this treatment,
the advice
is not to eat the night before.
So you have this period
of fasting before treatment
and you can't eat
during the appointment.
Okay, So you're going to be hungry.
It's a long day
and some of my patients
have been a bit grumpy afterwards
and it's been because
they haven't eaten,
which is reasonable.
I get a bit grumpy
when I haven't eaten as well.
Now to compound this,
you're not doing a lot.
Okay?
Now, a couple of times a year
I will actually do a deliberate fast
for health reasons
and it's difficult to do.
But what makes a lot
easier is concentrating
on other things,
you know, trying to distract yourself.
But if you're in the dental chair
and you are having this stuff done,
there's nothing to distract you.
So it can be quite a difficult day,
you know,
in terms of the length of the day.
And weirdly,
if you're just sitting there
having this treatment
done, it's really tiring as well.
Okay, So just be prepared for this.
Don't think it's a walk
in the park mentally, okay?
Because mentally
it can be quite draining.
Now, once
the treatment is said
and done, you're going to leave
with a set of temporary teeth.
These temporary teeth
are really there to hold and connect
all of the implants together. Okay.
And that's how this treatment works.
That's the secret sauce.
All the implants stuck together
so we can give you teeth,
which you can kind of chew
on straight away.
And one thing
that a lot of people comment on
is the thickness of these things.
Okay?
From the outside,
they look very nice,
but from the inside
there's a lump of plastic there.
And that lump of plastic
is going to be there
for the next 3 to 6 months,
depending on how quickly
your dentist will go
and put the final teeth on.
Now, the reason it's there is
the temporaries are made from plastic,
and plastic gets
all of its strength from thickness.
It's not going to be like this
for the final set of teeth
because typically the final sets
have either a metal skeleton
or they're just made from
a different material,
for example, zirconia.
And that material
can be a lot thinner.
And the thickness of the temporaries
is going to cause an issue
with speaking.
Okay, a lot of people will be lisping
and they'll just find this
plastic thing quite annoying.
That's not quite as annoying
as having a denture,
which covers the roof of your mouth.
But still,
you know, you're going through
a lot of treatment.
It's very expensive.
And some people might see this
as a bit of a drawback is a drawback,
but it's a limitation of
that phase of treatment
and the materials used
in that phase of treatment.
Now, a lot of these points
I'm going to talk about
are related to the temporaries,
okay, we've spoken about
the feeling of the temporaries
and next thing to bear in
mind is the look of the temporaries.
Quite often
when people come
and see us, the look of their teeth
is really not very good.
And if you look at all of the before
and afters,
the before and afters are fantastic.
It's a dramatic improvement.
But don't expect
that perfect smile on the temporaries
we've put temporaries
in for our patients
and the midline
has been off to one side.
Some of the teeth
are longer on one side
than they are on the other.
Sometimes the smile
is more full on one side
than than the other.
Okay, all of these things can happen.
We do aim
for absolute perfection
on the temporaries
because it makes our job a lot easier
as we move forward
to make the actual final restorations.
But because we are almost guessing on
what the smile should look like,
sometimes the teeth can be long,
they can be short,
they can be off to the side.
You know,
all of these minor
things can happen in the temporaries.
Point number four is to do
with the strength of the temporaries.
A minute ago
I told you that the temporaries
get their strength from
the thickness of the material,
even with this thickness,
we can still get problems with teeth
pinging off the temporaries.
Again, this is,
I'm going to say, moderately common.
Let's say maybe 10% of the cases
that we do have this,
but it's far more common
if we have implants in the lower
jaw as well.
Okay.
So two implants
against implants, top and bottom
and the reason
is, implants
don't have any kind of sensors to
to tell you how hard you're biting
if you had just implants at the top
and natural teeth to the bottom,
your bottom teeth have these sensors
and you can tell
if you're biting too hard.
Now, if you've got implants
against implants
just randomly,
a tooth can can chip off.
It can be when you're eating
something really soft,
it can happen
in the middle of the night
when people kind of
grind their teeth together. Okay.
And more often than not, it's
a front tooth that breaks. Okay.
When this happens,
it's is distressful.
And we want to
just sort the problem out
as quickly as possible.
Now, if this happens, it's
usually an easy ish fix. Okay.
Unless your temporaries
are broken like this,
which is a much more complicated fix,
but a single tooth here
and there can effectively
be glued back on
not with superglue
we use proper stuff, you know,
which is dentally safe,
but in essence,
this is what we are doing once
a tooth breaks, once
a temporary breaks
is a bit more likely to break again,
we're never at 100% strength.
So it is a case of
just doing a patch up job
until we get to the point
where we're doing
the final restorations.
Now, in cases where people have had
quite large breakages
in their temporaries,
we do have an option to make
a new set of temporaries
once the final teeth have been made.
This this gives
you the added advantage that
if something were to happen
with your final teeth,
which occasionally can
you do have a spare set
that you can go in
for a short period of time
while the final ones
are being replaced?
Point number five is how many teeth
you get on your all on four,
whether it's your temporary teeth
or your final teeth.
This is largely dictated
by how far back
we can get the furthest implant.
Now, if you look at an X-ray
on a typical
all on four
you'll notice that the implants
at the back are slanted forward.
Now, the reason for
this is we have an air sinus
which we want to try and avoid
the air sinus is different sizes
in different people.
So the amount of bone
we have going back
stops in different positions
for different people,
and that's
what dictates
where the final position
of the last tooth can be.
I'd say
the most common number of teeth
to have on a set of all
and for a standard,
all four is ten teeth.
So that's five
teeth each side of the midline.
Now some people have
really wide smiles
and if we just did
ten teeth
you'd be able to see the
the gap behind these teeth.
Now, for these people,
there are other options.
There's other types of implants.
We can use something
called a Pterygoid implant,
which goes really far back.
And that will give
a full set of teeth.
Now, if we can't put the implant
far back enough because of the sinus,
we have the option of
a Zygomatic implant.
Now this is a bit of a specialist
implants and not everybody will do it.
Even the Pterygoid requires
quite advanced implant skills,
but a Zygomatic implant engages
different bone.
Okay,
so we're not worried about the sinus.
It kind of goes past the sinus.
It goes next to it
and engages a little bit higher up.
So this, again, is one of those
get out of jail cards
where if we can't give a decent number
of teeth at the front,
we have options going back,
even for those people
who've got large
sinuses and not enough
traditional bone
where we would put our implants
point number
six is related to the final
set of teeth actually, so
they may not look
exactly like your favorite
before and after photo.
And the reason for this
is that everybody is different.
A couple of years ago,
we had a lady
who had all on four treatment
done at the top,
and there was a gap between her
teeth at the top and bottom.
Okay, not a vertical gap.
So they were closing,
they were overlapping,
but it was more of a
a kind of a horizontal gap.
Her top teeth were more forward
than her lower teeth.
And this is appropriate
for those people
whose skeletons have this
we call an anterior posterior
discrepancy. Okay.
Some people's
jaws are just not aligned
top and bottom on top of each other.
Okay.
In fact, only 70% of people
have this pattern.
The other 30% have either
the top jaw is forward
or their bottom jaw is forward
or some kind of variation of those.
So if the jaws are not directly
on top of each other,
the teeth are unlikely
to be on top of each other perfectly.
Okay. It's only a small discrepancy.
We can camouflage it,
but if it's a kind of a larger
discrepancy,
then the teeth are not going
to be perfectly on top of each other.
Now, there is a lot that we can do
to customize your smile
to make it perfect for yourselves.
That's important to realize
that there are limitations
on the esthetics.
We will try our best to make the smile
look absolutely perfect for you,
and we'll listen to you in
trying to achieve your goals.
And in terms of the way
things look, in terms of esthetics,
I tend to kind of just take control.
Initially, do what I think looks good,
and then we take feedback
from our patients, you know,
if they think
that the teeth are too wide,
too small, too long, too short,
we listen to that as well.
And then together
we reach that end result.
But sometimes,
just due to the nature of implant
treatments,
some modifications
may not be possible,
which means you may need to compromise
on small things here and there.
It's impossible to explain all of your
individual possible limitations
because there are so many.
And this brings me on
to point number seven,
which is a bonus point,
which is just expect the unexpected.
I've had patients come in
and tell me that
because of their
all on four treatment,
they've started to salivate too much
or they salivate too little,
or they get
electric shocks from
one implant occasionally
or something in their area.
Some people tell me
they get sensitivity from an implant,
which from a biological standpoint
is actually impossible.
So there is stuff which can happen
which nobody is expecting.
But usually the
consequence of this stuff
is an annoyance rather than something
which is completely debilitating.
So even though
the results of this treatment
look absolutely fantastic,
it looks like natural teeth.
The take home
message here is
they are not natural teeth.
So we have to understand this
and appreciate this.
Yes, it's a lot of money.
Yes, it's
going to take a lot a long time,
even though the treatment says
teeth in a day.
But if you're realistic,
if you're going in this
with an open mind,
if you realize where you came for
and all you're expecting
is a dramatic improvement,
I think you're going to be really,
really happy with the end
result that you get
from this kind of treatment.
If you want to find out more
about how I do the treatment
and the exact process
which goes on in the day,
I have got a video about this
and I'll put it on the screen
so you can just link
straight to that video now.