- Hey everyone, how's it going?
So, in this video, let's look at an alternative
for all-on-four.
And, this is a fantastic treatment.
And I've been providing it for a long time.
It's nothing new, but, whereas historically all-on-four
had a lot of advantages.
Namely, if you've got a dentation which can't be repaired,
you can effectively in one treatment session
go from that terrible dentation,
to a really good set of fixed teeth.
And, the alternative to this was normally
to have your teeth removed,
have a removable denture, which is terrible.
Most people absolutely hate this thing
because having an immediate denture,
it may look good, but it just doesn't stick in very well.
But you have this immediate denture
and three months later you can have the implants placed
and then three to six months later,
you can then have either a bridge or an overdenture made.
Now, the option I'm talking about is the overdenture option.
And the difficulty that I have
is that I've never had implants myself.
I can't genuinely recommend one solution over another.
A lot of my patients who have the full arch fix,
like all-on-four and stuff like that, absolutely love it.
But then those guys have never experienced
having a removable overdenture.
Those guys who we provide an overdenture for,
absolutely love it.
Okay?
So, I don't know which is better or which is better for you
if you're thinking about having all-on-four
or anything like that.
The physical differences I can see
between having the overdenture
and the all-on-four is the all-on-four is thinner.
Obviously the all-on-four is fixed, okay?
And for a lot of people, this is a big thing.
Not being able to remove the overdenture.
That's a deal breaker for them.
Now saying this, the overdenture is fixed in really tightly.
It's not going to move.
And last month, I completed a case
where a lady had all-on-four at the top,
but for cleaning purposes she actually preferred the idea
of having the removable overdenture at the bottom.
And, we fitted this thing last month for her
and I saw her for a review yesterday
and I said, you know, what's the difference?
Because I've never had a patient until then
who's combined the two treatments.
And, she, in her own words,
she didn't wanna be filmed on camera
or anything saying this.
But, there was, there was differences.
In terms of once it's in and the end result,
they're very similar, okay?
She didn't find the denture, the overdenture,
obtrusive or overly thick or anything like that.
They were both as sturdy as each other, she felt.
To remove the overdenture did require quite a lot of effort
because there's a lot of different tightness's
that we can provide it at
and we went for a fairly tight one.
The process of having the treatment
was where it differed a lot.
Because for her, what we did,
we took out all of her bottom teeth.
We did her all-on-four on the top
so she had fixed teeth at the top
which looked great, total life changer for her.
But, at the bottom, we took out her bad teeth
and placed the implants,
but we didn't connect the denture.
So she had the removable denture at the bottom,
which was moving around.
She hated it.
It was terrible,
and she told me yesterday that most of the time,
actually in the first three months,
she didn't even bother wearing it.
But then, because we got the implants in early,
after three months,
we were able to connect that removable denture
which she had to the implants
and that made it a bit more sturdy and a bit better.
Then, after the six months we converted everything
to our final restorations and she's really over the moon
with this end result.
Now, this is what it looks like.
In the patient's mouth, the overdenture,
what I'm talking about
is you have these four little black discs
just poking out the gum.
These aren't actually the implants, these are the abutments.
And, on top of these abutments,
that's where the denture will click into.
So you have this faint female component inside the denture.
And that clicks into these.
And you get different tightness's.
And a really well made denture will look
as good as any all-on-four, all right?
It's the same materials.
It's my same lab technician who's doing all of this.
So the looks wise, it's gonna look identical.
Strength wise, it may not be quite as strong
because the all-on-four bridges do have a metal skeleton.
But this metal skeleton adds a lot of cost
to the overall procedure.
The removable denture, I've not had one break yet.
We haven't done tons and tons and tons of them.
But I have seen them break in the past.
And, in addition to this, what we do to you,
because I always try and have her feel safe is,
this lady and everyone who has this,
always gets two dentures.
So if one does break, that they do have a backup
that they can wear while the broken one is being repaired
because nobody wants to be without teeth
for any period of time right?
So what I've done recently,
and I've done this only for two patients so far
and it's worked really well,
is to use the same kinda of all-on-four protocol.
So we take out all of the bad teeth,
we put our implants in and I'll connect the overdenture
to the implants straight away.
And I'm always a little bit scared because in the early days
when implants aren't fully integrated,
they're always prone to,
they're not very good with stresses,
biting stresses so if you stress them straight away
without them all being splinted together
which is what they are in an all-on-four,
in my head it's adding a bit of vulnerability.
But, I've spoken to a lot of dentists,
some guys are doing this
and they're getting really good results with it.
So, we've done this for a few patients,
and what this means is,
that awkward period of having to wear that removable denture
is completely gone.
Because the patient still goes away on the day
with semi fixed teeth.
They can take it out, they can clean it
and then they can put it back and it clicks into position.
It's really, it's really good solution in that sense.
So, I mean cost wise it comes in less
than an all-on-four as well.
Where I normally charge between 15 and 18 thousand
for an all-on-four,
depending on how many implants we're using
and for this solution it comes in nearer 10,000 okay?
so there's a big cost difference there as well.
You still get the two dentures so you have the immediate one
which goes in on the day
which is kind of like a temporary denture
but then after six months
we upgrade that to a permanent denture.
Having an overdenture solution like this,
also has other advantages.
Say one of these implants was to fail,
then what we could do
is just treat that implant in isolation.
We could take that implant out, put a new one in
and then use that same overdenture
which we've already made
and connect this new denture into that.
Okay, that's possible with an all-on-four,
that's not possible.
If an all-on-four implant fails,
what happens is that implant has to first be removed
then the new one goes in,
maybe with or without a healing period.
Depends how it's failed.
And after that we need to construct a brand new bridge
because remember that metal framework is built
to the original implant's set up
so as soon as you put a new implant in,
it's never gonna go in exactly the same place.
There's always gonna be a a bit of movement
and you therefore need a fresh bridge
and that's a lot of expense there as well.
So, I still don't know which is the best one
but from speaking to my patient who has had both options,
there's really not that much difference in it
once you've had the treatment.
Okay, the actual process of the treatment
can be a little bit different when we're doing things
to actually minimize the difference
of that uncomfortable period without any teeth.
If you're really on a budget, there is another option.
And that's to use mini implants.
And I've done another video on mini implants
which you can have a look at, it goes over it
in a bit more detail.
I don't class mini implants as a permanent solution
I do think they're semi permanent
but that's just because they haven't been around
for that long.
But, Straumann do the same overdenture connection
which you can see here in mini implants.
So, you could have that same locking in,
locking in denture on mini implants
and it could last you a long long time
and if one of the mini implants fail,
again it's cheaper to replace a mini implant
than it is to replace a regular implant.
So, I know that if you,
if you're in a situation where you need only teeth replaced
and you go and see a lot of dentists,
most people will recommend the all-on-four
and it's a great treatment option
but I don't think it's the only one.
This other option is still a fantastic treatment option.
Okay, so I hope you got something out of it.
If you did, give it a thumbs up.
If you've got any questions,
comments you can leave them below.
If you wanna find out more about me,
you can find out more about me via my website,
the link's in the description.
Okay, so until next time, take care.