Hi, everyone. How are you doing? so in this video, I'm going to show
you what I explained to our patients when they've had dental implant
treatment and how to keep it clean.
We're going to talk about single unit dental implants.
So just individual teeth, which are held on
with dental implants, we are going to talk about bridges, which is
a section of teeth on dental implants.
And most importantly, we're going to talk about all on fours, because
this is a question which I get asked quite a lot, which is
once you've had your all on four you can't remove your teeth, how do
you clean underneath it? Because I think a lot of people understand
that the success of their dental implant treatment, a lot of it is
dependent on how well it's maintained.
So let's first of all, look at a single dental implant.
And because single dental implant has the same kind of philosophy
for a full arch, there's only a slight variation.
So here we've got a picture of a tooth on a
dental implant. OK.
The implants at the bottom here. So that's the
implant. We've got the tooth here.
OK. And in between connecting the tooth and the implant
is this bit here.
And that's called the abutment.
OK.
So it's really important to understand these kind of three sections,
because the implant itself, you can't clean that
it's fully encased in bone or it should be encased in bone,
right in these situations. I'm going to talk about healthy implants.
So if the implants fully encased in bone, you're not going to get to
it. The tooth you can see you can access that with just an
electric toothbrush or really good manual tooth brushing
technique and floss.
You can easily floss the in between the
contacts of the implant tooth with the tooth next door.
But there's a slight difference between implant teeth
and natural teeth. And that is in the abutment
section. So let's zoom into that and let's see what's going on here.
So we've got the gum, which is going all the way around
the tooth and a nice implant tooth should look like it's
naturally coming out of the gum.
But underneath the surface, the attachment of the
gum actually goes down the side of the
abutment. And that's important because the attachment
to the gum the gum to the
implant is right down here somewhere.
Okay. It's right near the neck of the implant.
So this means if you take the tooth off and you take the abutment
out, you've got this nice collar of gum around
which isn't actually attached to anything.
So we've got this collar of gum coming out of
the implant, which needs to be cleaned.
It doesn't need to be cleaned every single day, maybe once a week.
I will show you how that's done. But let me show you a real life
example of a single tooth implant.
So here we've got an implant and I'm going to highlight the
implant tooth, this one here and the
guys had a full small design done with veneers and crowns.
He had that done about 10 or 15 years ago.
This tooth broke. So we had to replace it with a dental implant
and that's what he chose.
So underneath this tooth, we've got the implant and we've got
the abutment all kind of in this kind of direction here.
So we need to be able to clean not
only the tooth and what we can see, but underneath the tooth
and all up this abutment all the way around.
And the easiest way to do this is to use just regular
dental floss. And with a normal tooth,
you would, loop the floss around the side of the tooth going all the
way down as far as it goes.
And it doesn't go very far below the gum line
and that's it. You've cleaned everything.
Now, the reason it doesn't go beyond the gum line is because that's
where the attachment level is. So on a normal tooth, not an implant
tooth on a normal tooth, the attachment
is somewhere here. OK.
And the attachment on what I'm talking about is where
the gum and the tooth attached to each other
with an implant. The attachment is much lower down it's
down here somewhere. So what you need to do is actually let the floss
travel down the side of what you think might be the root or
down the implant all the way to the bottom.
And normally this doesn't hurt.
OK. So this if you've never done this before, the first time you do
it, it may be a little bit uncomfortable, but once you've done it
once or twice, then this shouldn't hurt and
it shouldn't bleed. And you definitely shouldn't get any white pus
coming out from the neck of the tooth.
If you're getting any of these things, then you should go and check
it out. Have the dentist who did the implant, check it all out.
And usually it's quite a simple fix, but an ongoing
low grade infection, which causes inflammation, which causes pus,
can cause problems, around your implant in the long term.
So these little warning signs, which don't hurt, but you should get
them checked out as quickly as possible.
So this is how you clean around a single tooth.
How do things change when we've got a bridge?
So here's a what we call a four unit bridge is four units because
it's 4 teeth. I fitted this about month
ago. And we've got two implants underneath each
side of this bridge. And in the central two teeth, she's got nothing.
And what this means is not only do we have to
worry about the sides of the abutment's
cleaning those in the same way that i have shown you with the floss a
second ago. But we've also got this contact area where
the bridge and the gum is touching.
Now, this bridge is right at the front of the patient's mouth.
And in these situations, I put a
lot of pressure on the gum so
that we can have the gum looking as natural as possible.
Okay. Because it's a really difficult thing to make a bridge
like this at the front of the mouth look natural and it's not
perfect, but it's not bad either.
So this contact area
is going to be really tight and it's going to be quite difficult for
my patient to clean this.
Now, the next thing I'm going to show you like an all on four
is very similar to this. And the way you clean this is very similar
to how you clean like an all on four. So let me show you an all on
four case. This lady had all on four top and
bottom. I can't remember whether she had four, five, six implants at
the top. But it doesn't really matter because it's the principle
which is important.
And what we want to do here is, first
of all, we need to understand where our implants are.
Okay. So we've got let's say argument's sake, we've got eight
implants. It's important to know which tooth is where
the implant is in relation to the tooth so you can
navigate the gap between the implants because that's where we want to
clean. Is the the gap between the implants
and the way we do it is with this product,
it's called Super Floss.
It's made by Oral B in the U.K.
You can buy it from any decent chemist.
So say Boots, for example. Will, we'll have this.
You can buy online.
It's really easy to buy this stuff.
It's it's more expensive than normal floss,
but it's really not that expensive in the whole scheme of things.
So this is really cool because it's got three sections.
Okay. And here's just a quick diagram of the three sections.
First of all, the green area.
That is a slightly firmer like floss.
Okay. So it's like floss. It's made from plastic, but it lets you
thread the super floss through underneath
the bridge.
The next section, which does all of the cleaning.
This is a much more foamy kind of floss.
It's a lot thicker. And because it's foamy, it mechanically
cleans the underside of the bridge and cleans the gum.
And the last section is just regular floss.
So you can use this last section. You got combination of implants and
bridges and all this stuff.
One piece of super floss should be able to clean the whole mouth.
Now, with the firmer section of this super
floss, what you need to do is thread it underneath your bridge
so you can thread it either from the inside out or
the outside in and in different areas.
Different people will find different things which work better for
them. So I've got a video clip was showing
you how to do it from the outside and the inside
out here. And the important thing is, once you've
threaded it through the cleaning, it's done with the foamy
aspect. And you have to slide the the foamy aspect
of the floss all the way from one implant.
So you slide it all the way back and then slide it all the way
forward and side to side.
And that way, you know, you've done the absolute best in terms of
the cleaning. One area which people may forget
on, especially on all four is the very last teeth,
because normally the way I do my
all on fours, we've got the implant coming out.
But then you have a tooth, one tooth behind as well.
And the way to do this is you loop the floss,
just the foamy bit over the back and then you use that
just to clean that last little section.
You can use the same technique to clean under implant bridges.
So that four Unit Bridge, which I showed you earlier on, exactly the
same technique to do that, although it's going to be a lot more
difficult because remember, that bridge has got a lot
of pressure on the gum.
Now, I've made the cleaning this all on four look
really, really easy.
And it's not always like this.
And if your watching this video and you've had all four done and you
can't do this, then I would recommend just seeing the dentist and
talking to them about it, because even with my own patients,
I may see them three or four times before they
get the hang of using the super floss properly.
And when we're planning an all on four,
we have to start with the end result in mind.
Okay. So in terms of aesthetics, aesthetics is what I do all the
time. So we make it look amazing.
I design the smile and the colour of the teeth and the kind of gums
that we have and we do all of that. We plan all of that.
But for something to last a long time,
especially when it comes to implants, we need to consider two things.
One is cleaning and the second is the bite.
Okay, so I'll address the bite.
How I do that normally.
But the cleaning is really important because the design of the whole
all on four needs to be as cleanable as possible.
And if I show you this diagram now, the way this
diagram works is if, say, I had an all on four, for my top teeth
and I cut a section through like that through the middle of
one of these implants, this is what we would see.
And there's three sections here.
We've got the implant here.
Then this little grey bit here, that's the abutment.
This is the gum.
On the actual all on four.
Okay, so the natural gum is the pink bit
at the top. And then this bit where I've marked gum.
That's the fake gum. And then the blue is the tooth.
So if I show you a photo of an all on four this is kind
of what I'm talking about, we've got the implant at the top of the
abutment. We've got our fake gum.
And here you can see this is our transition from
fake gum to natural gum.
Now.
In order for this to be cleanable, in order for my patient to be able
to get a little bit of floss through there, even if it is the
firmer super floss.
And if I just scribble this out for a second
to get it through here, what we need is for
this contact area from here to here to be
as small as possible.
And the way we design it is basically to have a little
of not feather touch, but a firm contact all the way around.
But it's a spot contact all the way around.
If we start wrapping this gum around the
the natural gum more, that makes it almost impossible
to clean. Even with this super floss stuff, it's just impossible
to get that floss underneath and to
clean this effectively.
And that's really where the difference between an implant bridge like
an all on four and a removable denture differs
quite dramatically. So this is our all on four on one
side. If we were to have a removable denture, no implants, just
a normal denture, then we've got our gum.
That's exactly the same.
And our teeth and our denture wraps all the way around
the gum. If we were to do something really
stupid, which is just put an implant in
and screw it in position so the patient isn't able
to remove this by themselves, this would be impossible
to clean.
And I actually had a case where
a patient had had this done by
another dentist.
Embarrassingly, it was in the UK and his bridge actually
kept breaking. He didn't really care about the cleaning underneath
it. He thought he was actually doing a good job.
But he had these implants
placed and we needed to remake the bridge.
Now, I'm gonna show you the photo of when I took the implant,
the bridge off. Okay. And if you get grossed out easily, it's
probably worth skipping over this bit.
But this is what it looked like.
All right.
This is after over a year
in place without it being cleanable.
And I mean, this is real neglect
from the dentist who did this.
All right. Not only was the implant system he used terrible.
It wasn't actually fit for purpose. And I'll make a whole video about
this case because there's a lot we can learn from it.
But because of the shape, because it wraps around
the gum, it's impossible for him to clean it.
Everything that he sees from the outside, he thinks he's doing a
fantastic job. He's got an electric toothbrush, he's got water picks,
all this stuff, but it's not effective at cleaning
underneath it.
The design of the bridge is critical in how
well anyone is going to be able to clean underneath
it. Now, I mentioned
water picks and water picks are good but,
There's nothing better than a mechanical clean.
Okay. So if you can floss underneath then i would say, that's the
gold standard. The problem with water picks is that
they are well, they can be very aggressive.
So if you are using a water pick and I do recommend some of my
patients use water picks, then turn it all the way
down, turn it to its lowest setting and usually you've
got a reservoir with your water pick in that reservoir, half
fill it with water and half fill it with Corsodyl And because
Corsodyl is an antibacterial mouthwash and only use it
once a week.
Okay, I wouldn't recommend using this every single day.
It may make you think that you're doing a good job, but because it's
quite aggressive, what it can do is it can affect
the gum around the abutment.
Okay. And sometimes you can get above gum shrinkage and the metal
abutment is on show.
Most of the time this isn't a problem.
It's more of a cosmetic issue.
But gum is protective around the implants
as well. So you want to maintain as much gum as possible.
So I hope all in all, you found this video useful.
I know. I do get quite a lot of questions about this.
If you have any questions, if you think I've not covered anything,
please leave it in the comments below. If you've got any questions
specifically about implant treatment in general, all on
fours and stuff like that, you can leave it in the comments section.
If you want to find out more about me there's a link to
my website in the in the comments as well.
And you can find out loads of information.
So I'm going to try and do a few more regular videos.
OK. So until next time, take care.