All on 4 - What to Expect

hi everyone my name is Gareth and I'm a cosmetic and dental implant dentist and I want to make a video to help people who are considering an all on for treatment or a treatment where you're going in having all your bad teeth removed having implants placed and leaving with a full smile all in one day it's commonly called all-on-four although technically that's a no-bail by okay term for it sometimes it's called teeth in a day fasten fix and every single implant company seems to have their own name for the same treatment so the important thing to understand is there's a number of ways of actually providing this treatment and the way that I do it may not be exactly the same as the way your dentist does it but they'll probably be a similar kind of outline to the overall treatment and even myself I've changed the way that I do this treatment from 2 3 years ago to how we're doing it today and even today every single time we're doing it we make slight refinements in trying to improve the what we call the patient journey how the patient is experiencing the treatment and the outcomes we want to minimize complications and when it comes to complications on this all on for kind of treatment I'll make a whole separate video about that and hopefully I can get that shot and edited and out in the next couple of weeks hopefully so let's break my treatment sequence down into 3 kind of sections first of all after my patient has decided yes you know this is the kind of treatment that they want to do they've weighed out all their options all their alternative options as well then we'll have one or two sessions for planning ok and the way I plan it I'm primarily a cosmetic dentist who does implant surgery rather than an implant dentist who does this all and for treatment so I look at everything mainly from a cosmetic point of view my patients are generally come in for an improvement in the appearance of their smile so I'll aesthetically plan the mckay's we have to look at the lip support because quite often with a lot of missing teeth you lose a lot of lip to sports so to rejuvenate the whole smile we have to fill the the smile up and sub caught the lips that's important we have to have the width of the smile right for that person we have to have the bottom edge of the teeth following what we call the smile line so there's a nice gentle arc going upwards and there's a whole bunch of other things that I'll take into account while planning the case now quite often if my patient has a lot of their own teeth but they are in really bad condition it's really difficult to do this planning stage because you cannot try in the the set of teeth if you're in a situation where you've got none of your own teeth then it's easy will have trying's what we call waxed rinds where the whole smile is built up in wax so we can visualize what the temporary teeth you get on the day are actually going to look like so from experience me in my lab we have a way of communicating with photos I'll drawl over them and tell them where I want the the bottom edge of the teeth to be where on the top edge to be how I want them inclined front to back and how wide we want the smile so we'll take all of this into account and my lab will prepare a full set of effectively they're just plastic dentures so on the treatment day will convert the dentures into or call an implant supported bridge so that's the first couple of sessions sorted out okay they're normally about half an hour to an hour each and we'll take all of our based on records and do all of this preliminary work obviously we'll take our CT scan right at the beginning to assess the bone level like and then plan how many implants we're going to use I can see is the bone density good or is it going to be a bit tricky and just get as much background information before we pick up scalpel next once we've done all of this we're getting ready for the main event okay so the main event starts at nine o'clock in the morning and were usually out of the surgery by about three o'clock okay and I tend not to do top and bottom at the same time so if my patient is having top and bottom treatment done normally have the top teeth done and then two weeks later we'll have an appointment to do the bottom teeth okay so a little bit easier for for my patient it's a little bit stress reduction from a clinical point of view I only need to worry about one set of teeth so normally let's let's say we're working on the top teeth the procedure is pretty much the same for the bottom with a small variation so we'll first of all go through all of our consents all the paperwork you know all the the bad stuff that can happen with this treatment even though he's spoken about it before on the day of treatment it's always a good idea just to refresh everyone's mind to say hey look bad things can happen sometimes the implants don't work sometimes the bone is too soft we've got a whole list of stuff that we would go through then we there's some medications typically for this kind of treatment we will have painkillers okay usually just ibuprofen we will give antibiotics typically amoxicillin which is a broad-spectrum antibiotic for those people who are allergic to that there's other ones that we can give and quite often I'll give some steroid called dexamethasone and that helps keep the swelling down it's not essential and this is something I've built into the protocol probably about a year ago next after we've done the medications everyone knows what's going on we'll all scrub up the whole team we'll scrub up that means we're working in an aseptic environment which is as clean as we can possibly have in a dental surgery and we'll have the patient all completely numb so they don't feel it I think we give the anaesthetic about 10-15 minutes to work because I don't want my patients to feel a thing and after that's happened we'll make our first cut okay so I've got a way that we do this the cuts main the patient doesn't feel anything and quite often there's a level of infection these teeth have usually been affected by gum disease quite a lot so the first 20 minutes is removal of all of the bad teeth and all the scar tissue around these teeth all the infected bone and all the infected gum okay because remember we want to keep our site where we're putting these implants as clean as possible if you're in a situation and you've got really the bad gum disease and there's only happened once or twice in the last year then I might suggest that we phase one just take out the teeth and then a few months later we'll put the implants in then but in the vast majority of cases we can open up take the bad teeth out level the bone clean it all up and start with our implants I always work with the back two implants first they'll go in at usually at an angle so that we avoid hitting their sinuses at the top or at the bottom we avoid the bitter nerve that runs which we want to avoid and then once we've got those implants in then my front two implants are pretty straightforward they'll just go in and then we put what we call the abutments little connector rods on top of the implants tighten them all down and then we put something else over the top of it and then stitch up okay so this is the worst part of the treatment for most people this is the bit that they're scared of the most in reality they don't feel anything if it's starting to to ache a little bit when I'm working then we just top up the anaesthetic you shouldn't feel anything in terms of time remember my patients came in at nine o'clock in the morning and by about 11 o'clock we finished all our stitches okay so from this point onwards it really doesn't matter if my patient is numb or not because we're not going to do anything that's going to actually hurt it's really just screwing and unscrewing things on top of the implants and we need to do this maybe about three or four times I'll have my lab technician in who's going to help me convert that denture which we made at the beginning into our bridge work that's going to be fixed into our implants so we have to do a few things we have to record the bite we have to adjust the denture there's a lot of adjustments going on but a lot it's not in the mouth it's all done on the the chair side then we try it into the mouth and then you have two more adjustments from here on from 11 o'clock until about three o'clock is how long it takes for us to process this denture and by process what I mean is the connections put in which fit your implants perfectly this is a really critical part of this treatment and when I get implant failures and they do happen occasionally quite often it's because there has been some error at this stage not the surgical bit which we did in the morning it's usually at this stage now every time we get an implant failure we look at why did it happen and try and modify our process to make sure that never happens again and that's that's been working quite well for us these days we hardly get any issues with this treatment so by about three o'clock usually between 2:00 and 3:00 depending the house smoothly everything goes the my patients ready to leave okay so from 11:00 till about 2:00 or 3:00 o'clock we'll say if they came in with someone they can come into the room it's quite chilled out from this point to having the final teeth fitted once we fit the final teeth I have to double triple check that the bite is as even as possible on all of the teeth and that when my patients moving around and when they're chewing their the top teeth aren't restricting the bite of the lower teeth okay in my complications video I'll show you what happens when I didn't do this okay and once there was an oversight and it was a pretty dramatic failure but we had a happy ending nothing too bad happened so that's it afterwards the day after the most common thing that people experience is swelling okay there's usually not much discomfort okay maybe a little bit sometimes maybe they have to take an over proofing or something like that but usually it's looks worse than it is and swelling is by far the biggest thing that that people experience now bruising is on an individual level some people can have a lot of bruising some people can have black eyes some people can have this massive bruise which travels down their neck it doesn't hurt but it looks terrible so I do warn my patients just that's going to happen and for about ten percent of people that is what happens but it's nothing to be worried about and it's all just fades by itself within about a week two weeks after surgery will always involve our patients in the kind of stitches I used don't dissolve by themselves so we have to take those out this is about a 15 20 minute appointment we'll take the bridge off make sure everything is nice and clean underneath there if it's not I'll educate my patient on how to clean the latif so that they can do a good job at home and we'll take the stitches out and pop the bridge back in okay and we just leave it then pretty much for for about six months the only time I invite my patients in again and again is if the cleaning isn't good enough I need to work with them to help them to be able to clean more effectively under this bridge after the six months and we're happy that the implants are fully integrated into the bone there's not going to be any more movement in the gum now we start the process of making the final set of teeth on the implants and this is really there's no anesthetics involved it's just screwing and unscrewing things we it's very similar to having a denture made will take moulds of the teeth then we'll take more moulds of your teeth then we'll record your bite in different ways then we'll have chances to try and what the final smile would look like we can change the shape of the teeth we can change the color of the teeth we can change how long the teeth are we can improve or reduce the amount of lip support that we need all customized to that individual patient and once we're happy with what the smile looks like in works I'm happy with the way that the teeth actually biting together then we process it and the next time my patient has a final set of teeth made in a strong material designed to last many many years and then a week later we'll invite them back in just to review make sure everything is okay as long as the cleaning is good and my patient is one-hundred isn't happy will then set them off on a kind of a recall where I'll see them probably once a year take x-rays take the bridge off make sure cleaning is good and put everything back together again okay so if you are considering this kind of treatment I hope you this video useful remember not everybody does it in exactly the same way everyone's got their own preferences and variations on it but this is the kind of way that I found works really well in in my clinic and even for the dentist who refer to how have me do the implants and they can do the final bridge afterwards this is literally how we we all work in pretty much the same same kind of way okay so as always questions comments you can pop them below this video I'll try and get back to to everyone and I hope you have a great day if there is anything I can help you with pop it into questions and if in and if enough people ask for it I might make a video of it okay so take care

Channel: Dr Gurs Sehmi

Views: 20,072

Rating: 4.9130435 out of 5

Keywords: Dental Implants, All on 4, Cosmetic Dentistry, Implants for top teeth, Implants for bottom teeth, Full set of implants, full set of dental implants

Id: oy1WlUt9PIk

Length: 13min 58sec (838 seconds)

Published: Fri May 10 2019