Hi, everyone. How you doing?
My name's
Gur’s I'm a cosmetic implant
dentist based near London in the UK.
And today
let's talk about
if you can have implants,
if you've got 80% bone loss.
So somebody recently
did contact the practice
and they said,
hey, look, I've been told
I've got 80% bone loss.
Can I have dental implants?
And the answer is yes,
but it's complicated.
Okay, let me explain.
So let's start
with what a tooth
looks like, tooth and the bone around it,
what it all looks like in perfect health.
There's a couple of important markers
which we need to think about.
First of all,
there's a visible part of the teeth
and let's call the tooth
and the gum meets,
let's call that the neck.
And then underneath we've got the roots
and then we've got the bone
which surrounds the root.
And then we've got the gum
which surrounds the bone.
And what happens is,
if this tooth is affected
with gum disease, then chances are
the gum
disease is going to cause inflammation
around the neck of the tooth.
Okay, just in the gum.
And then
the bone is going to think, whoa,
I don't want to be anywhere near
an infected area.
And then it's going to shrink back.
Quite often when you have bone
loss, you get recession.
And recession is where the gum line
doesn't perfectly match
the neck of the tooth.
In fact, some of the root is on show
and in these situations
you can see that the is recession
because the root is a slightly
more yellow color
than the actual tooth itself.
Now this is often accompanied
with a redness in the gums
and when you brush the gums
and you know, quite
thoroughly brush them,
they will start to bleed.
Okay, we don't want bleeding gums
and we don't want to brush it
gently because outcomes of bleeding,
I think that's the wrong thing to do,
but that's a topic for another video.
So we know that there's bone loss,
but as dentists
we need a way to figure out
how much bone has actually been lost.
What are our reference points now?
When you were 18
and this tooth was perfect health,
then the bone would have been maybe
two or three millimeters
below the actual gum line,
and the gum line would be
at the neck of the tooth.
So we know that as a reference point,
we can take an X-ray
and we can see
the neck of the tooth on on a tooth.
No matter how much bone loss we've got,
then we we estimate the
the the level of the bone on the X-ray.
We can see that
and we can say as a percentage, okay,
how much bone has been lost in this case?
In this case,
the patient called up,
said he'd been told about 80%.
And what's also very important
to understand is,
is that 80% just on one tooth
or is it 80% everywhere?
Because that's going to completely change
our treatment plan.
When a tooth is lost,
about 80% of the bone
surrounding it, chances
are it's going to be loose
and it can be painful
and there's no treatment
that's going to successfully rebuild
that amount of bone loss.
So the tooth has to come out,
which is
why our patient
was asking about dental implants.
So we also have to pay a lot of attention
to the fact that there is bone
loss around this tooth
no matter how much,
because bone
loss tells us
that we have active disease.
Okay, there's a number.
There's only a few
ways that you can get bone
loss related to the jawbone
and the two most common are tooth loss.
The case is
your tooth is removed, you lose bone,
but also gum disease.
I think this is just super prevalent
and we can't put implants in
if there is gum disease.
Even if you're having an implant here
and the gum disease is down
here, it's going to travel,
it's going to affect the implant,
the implants are going to fail
and it's going to be a complete
waste of time and money.
And no one is happy at the end of that.
So we have to have
the gum disease controlled
in our practice.
This typically means seeing our gum
specialist a periodontist
for a couple of sessions.
They will give us the all clear
and then I can start planning
all the implant work.
Now let's say it's 80% bone loss around
one or two teeth.
What are our options in this scenario?
Well, it's actually quite easy
because once the gums have healed, once
the teeth have been removed
and the gums,
if healed, will will take a CT
scan, we'll see how much bone is there.
And it might be possible
that we can rebuild the bone
or maybe just stick in the gum,
depending on the situation.
And we can then place our dental implants
and know that we've got
a good chance of long term success
because of the gum disease
being controlled
before we've started anything.
Now, this is a long process.
As soon as we start
talking bone grafting,
we're talking
another 6 to 9 months
on top of our treatment plan. Okay.
Especially with a complex grafting,
I'm not talking about
if we did a little bit of grafting,
then often it doesn't at any time.
But in situations
where we've lost a lot of bone,
quite often
we'll do the bone grafting first,
then come back to it
after a number of months
after the bone is healed,
and then we can place our implant
tissue grafts, whatever
we need to do to get to the end results
at that stage.
Now, what's different
is if
all of the teeth have about 80% bone loss
and this means all of the teeth
need to come out.
And you can imagine losing
80% of bone on one tooth
is a different amount of bone
loss compared to 80% everywhere.
So 80% everywhere
is typically those situations
where we take the teeth out
and the patient can have dentures
or use implants in some way.
All on four or click in teeth,
whatever it takes
to secure a full set of teeth.
Now let's let's take all four
for example,
because I know a lot of patients,
a lot of people who watch these
these videos are interested
in this kind of treatment.
The thing with all four implants is
they are not placed
where the teeth used to be.
Okay.
Let's take a look at this CT scan.
Okay.
This X-ray where you can see that
I've planned
eight implants,
but the patient has
some of their own teeth.
Now,
if you
look at the position of their own teeth,
which all have bone loss, by the way,
you know,
the implant almost starts
where the teeth finish. Okay.
And that's that's deliberate
because we're not engaging
in that infected bone.
A lot of these people who have
this 80% bone loss, well,
all of them have gum disease.
So we need to remove the teeth,
removing the teeth,
remove the source of the gum
disease, the infection.
So we
we know we've got rid
of the source of infection.
We spend a lot of time cleaning out the
the the bone as well.
And then we put our implants in.
So we've got
relatively clean site
for the implants to go in.
We also cut off a few millimeters of bone
so that we've got fresh bone
to put our implants in.
Okay.
This has a number of esthetic advantages
for this kind of treatment as well. So
in answer to
the patient, you said,
you know, it's 80% bone loss.
Can I have implants?
Chances are, yes, you can.
Okay.
Everybody's bone
pattern is slightly different.
And it may be
that you've lost so much bone
that we can't place normal for implants
and you have to consider
Zygomatic, Pterygoid
or other implants,
all these kind of different variations,
but all of these solutions are designed
to be a workaround for those people
who have lost an extreme amount of bone
through gum disease.
So the general principles
of this treatment or any treatment in
any form of medicine is really number one
control the the disease here
with gum disease,
we have to kind of address
the root cause problem first.
And then once we've stabilized that,
we can do the rebuild project.
And it just so happens to be in an all
in four kind of procedure.
All of that is done
in one main procedure. Okay.
But if it's just a couple of teeth,
there's a whole
different process involved.
So I hope this video been been useful.
I hope it's
answered some people's questions
because I'm sure that other people
are thinking the same,
even though this one guy called us up.
If you've got questions or comments
leave them below,
I do read
most of them
and I answer the ones that I can.
Okay, guys, until next time. Take care.