- Hey everyone, how are you doing?
So in today's video,
let's look at one possible treatment that you can have
if you've had implant work done
and now we're starting to get recession
around your implants. Okay?
So the kind of stuff which I mean if you've got it,
you'll know all about it is something like this. Okay?
So in this situation, the guy had an implant placed,
must be like 10-15 years ago
and he's a regular attendee at the practice where I work
and he's got this recession around this implant.
So we can see the metal of the implant
or the apartment which is showing through.
It's really clear, really obvious,
but there's no pain and there's no infection.
So that's really, really important
because whenever we do any kind of reconstructive work,
like what I'm going to show you here,
we need to make sure
that there's no infection around the tooth.
So what I mean by that is if there's pus,
if you press it and there's bleeding
or pus that comes out from around this implant,
then that's bad news.
If the implant is moving, again that is bad news.
So I'll do another video in the future
about those kinds of things.
But here is a situation where there's no pain,
the tooth isn't mobile, there's no movement.
If you press it, there's no pain associated with it.
There's no bleeding when he brushes or flosses
or anything like that, there's no bad smells.
So we've just got this recession around this implant.
And to be honest, he wasn't bothered about it.
We've been telling him for years that you know,
"maybe we should do something about it."
But what also is entering into this picture
is this tooth here has a very small root
and that was now starting to become loose.
So we had to take that tooth out
and look at a tooth replacement there
and he thought,
"okay, look, let's now address this front tooth as well."
So I'm going to show you exactly what we did.
Let's look at the problem.
Why did this even happen in the first place?
Because I think 99% of the time,
it's implant placement error.
And remember this was done 15 years ago
or quite a long time ago.
And the implant thinking especially for front teeth
was different back then to what it is now,
because we're seeing
how these implants react with the bone around them.
And what happens,
you always lose more bone from the front of the tooth.
So here we've got my favorite diagram
and if you've seen my implant videos on the front teeth,
you'll recognize this.
But for those guys who haven't,
this is the front of the mouth.
So you look at the tooth from that angle.
This is the roof of the mouth,
was supposed to say roof up there.
So the palette and your tongue would press up against here
if you're pushing up on the roof of your mouth.
And so what we can see is the metal parts here.
The metal of that implant is just showing
at the neck of the tooth.
And the reason this is showing is
when the implant was placed,
this bone was probably something like that.
So again, you have the coverage on the front of the tooth
in the early days and what's happened over time,
it's just shrunk back a little bit.
So when I talk to our patients always say,
we want a millimeter, millimeter and a half,
ideally two millimeters of bone
all the way around this implant. This is the reason
because we know things are going to change over the future
where we're trying to make sure
we've got a beautiful aesthetic appearance,
not just today or for the next five years,
but 15-20 years down the line,
as long as this implant is in the patient's head,
I want it to look amazing.
Anyway, this implant is slightly different
because not only is the placement of it not exactly right.
And it's a really old style implant.
Let me explain some of the differences.
Number one,
the dentist didn't use a drill to place this implant.
So a drill is normally how we do it.
We would make a hole with a surgical drill
then we place our implant as gently screwed into that hole
and that's how implants generally work
in vast majority of cases.
In this case, it was hammered in.
And this sounds like a
really barbaric
and to be honest,
it is pretty barbaric if you see this stuff done.
I've never seen it done live
because hardly anybody does anything like this anymore.
But the rationale back then was, if you hammer it,
what you do is you slip the bone
and that new bone helps keep that front face or bone leads
same front face, which is gone here.(laughs softly)
Another thing is, this implant doesn't have screw threads.
The reason I've drawn these lines like this,
is because it was literally a cylinder like this
with platforms there, all the way across it.
And it definitely was not a screw thread.
The reason this is important is
if we now want to remove this implant,
it becomes an absolute nightmare.
We have to drill a hole bigger than the implant, like that.
So we have to make a much bigger hole in the bone,
which has to heal, it has to fill up with bone
in order to get this implant out.
It's going to turn to a very complicated situation
into a much more complicated situation.
If this had a screw thread,
it'd be much easier to remove an implant like this,
start again, rebuild the bone
and just put the implant in the right place to begin with.
But for these reasons that I've explained just now,
we didn't have that option in this case.
So what do we do? It's kind of damaged limitation.
We want to effectively just cover over the gum.
We want take some gum from somewhere else or anywhere,
depending on the exact situation
and we want to place it on top of that implant.
And that's what I've done here.
You can see here, this is the day of surgery,
all my stitches are in there,
We've taken gum from elsewhere.
We've taken that tooth there,
This is a temporary tooth and this is a bridge.
So this from here to here,
that's all joined as one.
It's just a temporary tooth.
acting ,well, it's just a bridge.
Even the final restoration,
we're not going to put an implant there
because it's too close to this other implant,
which is not great.
The angulation on this other implant is not perfect.
So it'd be much easier, simpler and quicker
just to have a bridge in that position
rather than an implant.
And we're doing a damage limitation at the front
to protect this implant.
You see, it's not only about the aesthetics on this case
because if you look closely, the gum in this area here,
is very white almost. It's a very light pink.
Let's compare that to the gum up here.
And we've got this kind of line
which runs in between the two.
So you've got the very hard gum, which is around the teeth,
then you've got the soft gum, which is higher up.
And the reason the hard gum is the lighter color of pink
is full of this stuff called keratin.
Similar to our nails. It's a very hard material.
And the good thing about that kind of gum is
if we've got keratinized gum to this hard gum
all the way around our implants
it acts like another barrier,
like a really good seal around that barrier.
If we look at the top of this implant here,
we've got a situation where this non keratinized gum
is forming the edge of this
it's up against the implant
because it's gum is not so tight, it kind of just opens it.
It doesn't really create a good seal.
So our problem could potentially get worse in the future.
So our goal for this treatment
isn't only to cover it up for aesthetic reasons,
which to be honest, is a really hard thing to do anyway,
but it's also to create this thick layer of gum
of this keratinized gum
so that our problem doesn't progress.
So again, damage limitation,
let's keep this tooth in as long as possible.
Now the reason this guy didn't really care
about this from aesthetics point of view is his lip line.
It's too low, even if he smiles as wide as he can,
he'll never show the silver of this tooth there.
So it wasn't really high up on his priority list.
Even the cracked veneer, which we can see here,
he'd lived with that for quite a long time,
but now that this other tooth was becoming loose
and we had to address that,
we decided to get everything kind of done all at once.
So we did the surgery and two weeks after surgery,
you can see here, at the point of taking the stitches out,
it's all still a little bit inflamed, It's all a bit red,
but we've managed to cover up the gap,
the silver of that implant pretty nicely.
Actually, you know, it doesn't look bad.
It looks a lot better than it did before. Right?
Now, whenever you do gum work like this, quite often,
two weeks later, it looks amazing, right?
Everything's looking fantastic,
but you need to let it heal for a couple of months
to know if it's actually worked well.
So a couple of months later, this is what it looks like.
So it's not bad. It's still better
than what we had right at the beginning,
but you always get the shrinkage.
Whenever you do a gum transplant
or a change of a graft like we call it,
gum always wants to shrink back a little bit.
And that's what we're seeing here.
But can you see we've got that nice keratinized tissue,
the same color pink all the way around.
So this kind of color is all the way around,
all the way around this implant.
So remember this was one of the things we had for success
as one of our objectives of the treatment,
was to get this really healthy, tight pink gum
all the way around the implant,
which we know is one of the things we were trying to achieve
right at the beginning.
It's one of our markers of success.
So right now he's happy. I'm happy.
If we wanted to improve this further,
we could try doing additional gum surgery,
a similar kind of variation of what we did before,
but he really wasn't too bothered.
He was really happy with this result.
Again from a health point of view,
I know have improved the health of this implant.
From a cosmetic point of view, we've improved it a bit.
But there's still a little bit of metal showing, right?
But anyway,
we also wanted to change the look of the teeth
because he's got all the cracked veneers and everything.
So we made a permanent bridge on one side
we replaced the crown on the implant tooth
and we did the cracked veneer on the other side as well.
So going from the original beginning to the end,
you can see the kind of difference
which we've done for the guy here and the gum graft.
How much of the recession around that implant
we've basically covered up.
Now remember, the whole problem,
the reason this happened in the first place
was the position of the implant wasn't right.
So you're on your back foot from the moment go, right?
You haven't really got any option on what you can do.
Again, the implant which was used
is not the kind of implant we'll use today
because today we almost plan for failure.
We can easily unscrew crowns.
We can remove implants automatically if we have to.
Luckily we don't need to do that too often,
but there are more advantages,
especially if we use a good quality system.
There's plenty of cheap systems out there
which don't have this versatility
and it's like an insurance policy.
If you buy a more expensive implant,
you buy it for some of the features
which you hope you'll never ever need to use.
But if you do need to use them,
at least we've used a good quality implant.
So that's all for this video.
If you want to see my other video
on how we do implants for front teeth
and protecting them from this longterm damage,
I'll put a link here so you can see that
either on the left or the right or something like that.
If you want to find out more about implant treatments,
then subscribe to my channel.
I'm going to try and get more videos out for you
and I hope you got something out of this one.
If you've got questions, comments, leave them below.
I'd love to hear what you say. Take care.