Complications with all-on-4 dental implant procedure.

[Music] okay so let's take a look at the different types of patients for an implant reconstructive procedure so the patients are kind of into two different three different categories we have the patients who have periodontal disease where their bone and the tissue is inflamed and the teeth have to be removed and then also we have patients who have decay where the teeth can't be saved due to breakdown of the dentition itself and then three are biomechanical issues meaning they've lost their molars and so now all of a sudden the forces are transferred to the front of the jaw where and the wear and tear on those front teeth is taking its toll usually it's a combination of the three where you've got periodontal disease involved you have decay and biomechanical issues the goal is to restore their mouth back to normal natural function to where they can chew and eat as they did prior to losing their teeth and also restoring those teeth to the beautiful aesthetics that their teeth were prior to the decay and also the periodontal disease and so those are our goals in restoring a patient who has lost teeth broken down their mouth is breaking down or broken down and we're having to reconstruct their mouth back to perfection and so let's take a look at this case so this is a patient who has all three of these factors you'll notice that there's decay periodontal disease and also they're missing teeth and so the the wear and tear on the insulin the the incisal edge of their tooth or teeth is now to the point where everything has to be removed and so if we look at here we have the before photo where you can see all of these things going on but take a look at the after and i don't want to get into all the details of the reconstruction of this case because it can be quite involved in every single patient requires a personal approach to reconstructing their mouth but let's take a look at his after photo and you can see how we have now restored facial aesthetics his smile vertical dimension how the how the jaws relate to each other so all of those things are now restored and they're permanently attached to his mouth so he can chew and eat and smile and not have to worry about his teeth like he did previously the goal will be to have him develop habits that can maintain these so that he doesn't have any of these issues in the in the future okay so that's the first type of patient where the patient uh just needs all of their teeth removed and basically a fresh start which is a wonderful thing about dental implants it's basically like our third set of teeth because you know we have our baby teeth and then our permanent teeth and when those go now all of a sudden either you're in dentures or you get implants now let's take a look a look at this other case similar situation she's got periodontal disease not as bad as the first case decay but this is an absolute case of biomechanics if you look at this picture this photo you can see the wear and tear of her front teeth because she's lost her molars those teeth have just worn down and they have done every they've worked hard to try to get her through normal natural function of chewing and eating but now they're just like okay i give up and they want out and you can see look at the beautiful aesthetics of these teeth we have restored now the function of her entire mouth with zirconius so fixed zirconia prosthesis on the upper and the lower and and we can see now her after smiling shot and look at how it just transforms her face and how beautiful she looks now with her smile restored so these are the patients who come to me and they need their mouth reconstructed and we just it's kind of like i'm starting with a clean slate so to speak and then there's the category of patients who have already gone through the process and these are the ones i feel most for because they've already they've tried they've taken the initiative they've gone and they've had the work done and so but it didn't work out for them so let's take a look at this patient here who she had this work done at a previous office and about a year later everything started to fall apart and this is why i am so adamant about you know if you're having this procedure done all on four is really not for anybody it's a procedure that was developed in order to kind of simplify the surgical process without really thinking about the prosthetic or the biomechanics of how the mouth is supposed to work and so you'll notice here she's missing a whole section of teeth in in her mouth and this was a case that was done recently it wasn't that long ago and so take a look on in the inside of the mouth you can see you know she's got implants but the prosthesis has failed so the implants themselves have not failed but the distribution of those implants where they're placed in relation to the prosthesis or the teeth is not accurate and as a result again she's chewing on her front teeth she's having to use the prosthesis like she did before she lost her teeth and just all the forces are in the front and that's why i don't like the all-on-four procedure because all of the implants are concentrated in the front of the jaw both the top and the bottom and then they angle the implants at extreme angles and so that implant distribution is not favorable to long-term success so you can see here this is a complete catastrophic failure the case has to be redone it can't be repaired or fixed and so what we did was we went ahead and we placed additional implants so that we could give her that support in the back of the jaw and take the load off the front of the jaw here's the prosthesis out of the mouth and you'll notice here there is a big cantilever off the back side or they stay away from the first and second molars and they don't include those molars in the bridge or in the prosthesis which is crazy because we need those molars because it puts so much load on our front teeth when we don't have the support in the back of the jaw again this is why i do not like the all-on-four procedure because biomechanically it simply does not make sense the surgeon usually there's two doctors involved in the process the surgeon will place the implants in the pre-maxilla in the front of the upper jaw and not place any implants in the back of the jaw and then the restorative doctor is basically kind of dependent on the position of those implants but what they do is they'll remove a two usually the mole well definitely the molars the first or second molars take it out of the equation so out of the bridge itself and now you're chewing again on your front teeth putting implants in the back of the jaw having an implant in those first or second molar positions now all of a sudden you've changed the dynamics of the bridge you've changed the dynamics of how this functions and you can see that the bridge is broken here and so now let's take a look at her after photo and you can see now we have restored her back to normal natural function aesthetically it looks beautiful but more importantly the back of the jaw now has the proper number of teeth that she had prior to losing her teeth and this is why i do i love the all-on-six procedure because we restore the patient's mouth back to the original state before they lost their teeth and so the all on six allows us to have proper implant distribution so that the biomechanics and how the case functions is more favorable so that the load factors are not so out of whack that it causes the prosthesis to fail or implants to fail so these are patients who have been through the process and now having to go through it again let's take a look at this x right here this is actually a case that a patient went through the process we had to actually remove all of these implants because there was peri-implantitis there was bone loss around each of the implants so i had to take the implants out put in all new implants and make her new prosthesis if you could if you haven't been through the process or if you're considering the process i mean this doubles the cost of the case or because we're having to do it again and this patient had paid once before but notice the distribution of implants you can see with the all on six i have implants placed six of them very evenly and it goes to the back of the jaw so that the patient can now chew on the back and have support by implants in that area versus the all on four everything is concentrated in the front of the jaw so this is a great example of an x-ray that demonstrates how the difference between the on four versus the all on six okay here's another case a patient had all on four upper and lower and not only did the prosthetics fail but all of the implants failed and you can see in this x-ray there's kind of we had to place additional implants in the patient's mouth but it was just a mess we had to regenerate the bone we had to do all kinds of stuff in order to get the patient implants again because they didn't want to end up in a denture because that's why they went through this process to begin with they wanted implants they wanted teeth that were permanent and they did not want to be in a denture but and they went through that process but unfortunately the materials that the doctor used were were not great and so as a result a few years later they ended up back in my chair where they were having to redo the entire case and so this x-ray it demonstrates you know kind of an image of the patient went through the process and now is going through it again so here's another patient who same thing had had the had lots of implants different implants from different manufacturers different doctors and she was always directed by her general dentist who would send her to a surgeon he would place a certain type of implant a few years later they would do another extraction graft implant and then this guy would place another brand or type of implant and then ultimately ended up in my office and you can see here's the before photo so take a look at this the bridge is falling apart but look at this metal here look at how it's tarnished it's actually there you know so the type of material used on the framework underneath the bridge who knows what that is i mean whether she's getting like a galvanic shock a reaction and a chronic one by the way because there's it's chronically you know with galvanic shock you get this chronic kind of electrocution in the mouth because it's an it's a wet or aqueous environment and so any sort of metal reacts very is very reactive in the mouth because it is a wet environment and so and of course the the prosthesis is falling apart she does have periodontal disease she's got all kinds of stuff going on and so this case has to be redone and so and that's exactly what we did we went ahead and we took out the prosthesis we had to remove two implants and place new implants and reconstruct her entire mouth but take a look at the after photo and you can see her mouth is now relaxed her face is relaxed her lips are relaxed when she smiles it looks natural but more importantly the way it functions and even more important than that is the fact that it's it's secure long term because the position of her implants now are such that biomechanically this will work out perfectly and so and look take a look at the prosthetics itself so this is a zirconia prosthesis so this is a a prosthesis or a bridge that we do here at trust implants we don't use any titanium frameworks or hybrids or plastic or any of that stuff we only use zirconia why because i want my cases to last i want this to last the rest of this patient's life and more importantly it protects their investment it's an expensive procedure i don't care how you do it who does it or how you do it there's costs involved and so the type of implants we use the materials that we use help to protect the patient's mouth so they don't have to go through this process again once we do a case here that's it they don't have to deal with any issues in the future and just take a look at the difference in the prosthetics so here's a case that we had to take out and redo and look how dirty and how tarnished this metal is so this patient had no idea the type of metal that was put in her mouth on this hybrid so this is a hybrid of some sort of metal and plastic of course the plastic broke off the metal piece and now she's left to have to redo this case and so and you can see that you can see how tarnished the metal is you can see where it's broken you can also see how much debris is collected to this framework and with zirconia you don't get that sort of collection of debris it kind of pushes the debris away it does not adhere like a pla plastic adheres a lot of debris titanium a little bit less or whatever this metal is a little less but zirconia is much much less than either and so that's another reason why i like to use zirconia because it does not adhere bacteria plaque or any you know any of the things that can cause problems with your implants or the bridge itself and look at the so let's get into the details of the prosthetics so if we were to you know magnify where the gum tissue and the implant and the prosthesis all meet together that area has to be very precise and the materials in that area it's the most important part because that is where problems can arise it's not necessarily at the edge of the front tooth it's down deep where the implant and the prosthesis and the in the tissue all meet and so that's where that in the materials used in the k in your case or in a case are very important you saw on this slide on the previous slide how the tarnished slash you know all the debris that was collecting there but i can guarantee you with with this slide here you could if i were to take this out after a year it would look much different than a titanium framework so these are all factors that have to be considered when doing these sort of cases and you don't as a patient you don't know that there's no way for you to know what materials are being used in your mouth what implants are being used what brand of implants and then what type of prosthetics what are the materials that are attaching the prosthesis to the implant and vice versa so and these are important topics they're important factors that really nobody's talking about all they're talking about is doing all on four and we can do all on four and you come in and you go out in the day and you're happy and you're good to go but that's really not the case it is very much more technical and involved than just going in putting in four implants and coming out with the new smile so it's critically important the materials the type of implant the type of prosthetics the type of graft material that the doctor uses you know like these images here showing patients who have already gone through the process and now having to go through it again take a look at these images and you can see how there was no rhyme or reason no planning the doctors were just putting in implants all over the place and now the patient suffers because they have to go through it again so my advice is to before you go through the process in reconstructing your mouth with dental implants visit trustingplants.com to gain some information follow us on youtube at trust implants watch the videos and develop enough information so that when you go in for a consultation you can be armed with the information that you need so that the outcomes will be as you expect remember you won't know what the final prosthesis or teeth feel like until it's done there's no way to know that in order to minimize complications down the road make sure and do yourself a favor and get enough information so that when you go in for the procedure you know exactly what materials are being used and you have an idea what the outcome will be i'm dr willardson visit us at trustinplants.com and subscribe to trust implants on youtube [Music] you

Channel: Trust IMPLANTS

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Id: L7TRrjuhcks

Length: 17min 11sec (1031 seconds)

Published: Sat Mar 13 2021