Hi, everyone.
Today, let's talk about all on 4 treatment,
and if you were going to have it,
how long can you expect it to last?
My name is Gurs I'm a cosmetic
and implant dentist based in Marlow in near London,
and we do a fair bit of treatment
where we're replacing a full set of teeth on implants .
If you were going to go down
this route, if you were going to spend
all this money,
go through the surgery and have all of this done.
How long would it last?
Okay.
A lot of my patients want to know this,
and I deliberately give them a vague answer and say
it'll be kind of decades.
A lot of this depends on how well you maintain it and also
what are the kind of problems which you could get.
Now let's make some assumptions off the bat.
Number one, let's assume the treatment was done properly.
Well, I mean by
this is the implants are fully encased in bone
and we've got a good amount of healthy gum
around these implants.
And next, let's assume
that we're not talking about some kind of traumatic
event like a car crash smashing implants out, OK?
It's very rare.
And obviously that's going to cause
a failure of our implants or teeth or whatever.
Now, when we come to complications,
let's call it complications rather than failures,
because I think complications happen first
and then it can potentially lead to failure.
The most common
complication is stuff happening with the teeth.
OK, so not necessarily the implants themselves,
but the teeth
teeth can chip off the bridge can sometimes brake in sections.
But these things are actually very easy to fix
because if it's all been, if the treatment's been done
properly,
you should have screw
holes with the implant so you can just unscrew
the whole lot.
Send it back to the lab.
The lab can fix, repair, you know, do whatever they need to,
and you can have the the teeth back to normal, back to
a kind of full strength again.
It's when things start to go wrong around the implants.
That's when things get a little bit more complicated.
Now, the big thing which can happen around implants
is that we get bone loss and gum disease around implants
in the same way that you get it around natural teeth.
And the truth is,
the vast majority of people who we do this treatment for
have preexisting gum disease, and that's why their teeth
got so bad.
Teeth start to get spaced out that become come loose.
The bite becomes very deep, and that these are all signs
that there's a lot of gum disease going on.
So we know that the patient is susceptible to gum disease.
When we do the treatment,
we physically remove all the infected tissue,
put the implants in and we have a second chance.
But implants can get
gum disease in the same way that teeth can get gum disease.
So we have to look at this in in three kind of phases.
Okay, number one, let's look at our patients themselves.
We know they're susceptible.
But are there any habits which are not going to work
in their favor? Like most notably, smoking, smoking
we know is linked to come disease.
Another thing which is kind of 50/50 is diabetes.
The reason I say 50/50 is that uncontrolled diabetes.
OK, so poorly controlled with your blood sugars up and down
all the time
that is going to affect wound healing is going
to make you more susceptible to gum disease
and is going to increase the chance of getting bone
infections and bone disease around implants.
Then there's a whole bunch of other things
which affects gums, and ultimately
it will affect implants, you know, for example, stress.
OK, we know these things affect the the health of the tissues
around the teeth.
So if you're a heavy smoker,
if you've got uncontrolled diabetes,
if you're not cleaning very well,
but the cleaning or come to in a second.
These are all things which is going to shorten
the lifespan of any implants, whether it's all of
or anything else.
The second thing we can look at in terms
of how long these things are going to last
is the quality of gum around the implants.
OK, so with our mouths, we've got two types of gum.
OK, we've got the gum, which is a kind of around the bone.
This is a hard gum.
Okay?
And it's got something in it called keratin keratin
a very hard material.
And then we've got the gum, which almost is like
your cheek. It's very soft and elastic.
You can just pull it.
So that has no keratin in it.
What we want is a good amount of this hard
gum around the implants.
We know that this gum will protect
the implants in the long term, whereas the stretchy gum
that's going to just shrink away, okay, over time,
because it's not, it's not tight enough.
Can't really create that bacteria seal
to help protect the implant, which is underneath the bone
or inside the bone.
Now, some people I have seen are using water picks
and really aggressive things,
you know, water picks on a high setting,
and these things are quite aggressive.
Around the implants and what this does is
it does push the gum away, so my patients who have
water picks,
I tell them to
no one turn it all the way down to almost zero.
Okay, the lowest power setting that you can use.
But secondly, fill it with 50% water, a 50%
corsadyl, and maybe only use it twice or three times a week.
We want to minimize the trauma, but we also want to maximize
the cleaning around the implants as well
in case a bit of a balance.
So if you don't have good quality gum
or if you're too aggressive with the brushing again
is going to cause issues with the whole
all on four at a later date.
Now, the third thing to look at isn't
really anything to do with the patient.
OK, well,
it kind of is, but it's how well your teeth are being
cleaned, how well the old for is actually being cleaned.
And I'm not talking about the brushing on the outside.
Okay, because anybody can do that
and you should have been doing that since age six
when your adult teeth come out.
Actually, before then, you know,
when when teeth come out, they should be clean.
So everybody's used to doing that.
But I'm talking about the junction between the gum
and the teeth. Okay.
This is where the implants are,
and if damage is going to happen,
this is where it's going to start.
And what I recommend for our patients is that we use
a single tufted, long handled type brush.
And that's the
most effective way that I've seen people
get underneath the bridge and you need to get underneath
it all.
Now, the only way our patients are able to clean
is if we design cleaning effectively end
at the beginning.
OK, so we want a nice flat platform.
Sometimes we create a gap between the gum in the teeth,
but we always create a way of cleaning.
OK, if there's no physical gap, you can push it
and it's tiny bit uncomfortable when you're pushing it,
but you'll be able to get the brush all the way through.
I think this is really important.
I know a lot of dentists or some dentists,
they prefer to have zero gap and have their teeth
put a little bit of pressure on the gum.
And this can work, but I just prefer to be able to clean it
every single day.
OK, that way you're sure that you know
everything is nice and clean
and you don't want to put pressure on gums as well.
That's that's probably not a great idea in the long term.
So if you're cleaning well, if you're cleaning effectively,
it's going to
definitely increase
the lifespan of our implants and therefore are all in
full bridge.
If you're not cleaning well
and the only way you really know is by taking the whole
bridge off
and the way we do with
our patients is we'll see them for a review,
take the pressure off and see what it looks like underneath.
And sometimes it's it's not clean at all.
So we really need to work hard
to find a way that our patients are able to clean.
Okay?
And there's no silver bullet on this one.
Most people will have a slight variation
in what they find useful.
Some people will use super floss.
Some people will use these brushes that I've mentioned
and water picks.
All these kind of stuff are available.
It's about finding the best one for your situation.
Now there are other things
that we can think about in implant design,
using a half polished and half roughened implants
so that if we do get an implant,
if you get bone loss around an implant is easy to maintain.
It's all of these things are available,
but they're kind of like an insurance policy.
And I haven't used it on every single case
because there's only certain
types of implants which have this feature.
Those things can buy you extra time if you've got
bone loss around an implant.
But if we can control all of these factors,
if we can tip
all of these factors in our favor a little bit,
it's going to have a dramatic effect on the long
term health of your organ for and it's going to push
any more complex treatment further down the line.
Okay. And that's really what we're what we're trying to do.
Once you have bone loss around all four,
it becomes very difficult.
You start running out of options,
you know,
maybe you can have all
fall down again,
but you know, you cut the expense
and the going through the whole procedure.
You've got all of that to deal with
and that's assuming you have enough bone.
If you don't have enough bone, then are we looking
at in zygomatic implants, which adds a different level
of complexity into the whole procedure?
Okay, so I hope you got something out of it
if you're considering this kind of treatment,
it's a fantastic, life changing treatment.
And if you look after it like you would,
you know,
if you brought a brand new Bentley,
I'm sure most people would look after that quite well.
You know, it's the same kind of thing, right?
Take care of it, and it will last you a really long time.
That's it for today.
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I will see you next time. Take care.