Do you have enough bone for all on 4 dental implants?

hi everyone so in this video I want to talk to you about the levels of bone loss that can occur in the top jaw when you're replacing a full set of teeth with dental implants now I want to be clear this doesn't apply to if you're just replacing a couple of teeth here or there and you know you've got the vast majority of your own teeth this is specifically for those situations where either you have no teeth or the TT have are in such bad condition that they need to be removed and quite a typical way of treating these kind of cases or these situations I should say is we're using an awl on for technique or a situating treatment where you remove all the bad teeth you put in the implants and you have a fixed bridge put on the implants on the same day now typically a lot of people who have this treatment have suffered gum disease in the past and they've been told numerous times that the amount of bone isn't enough to have dental implants so this isn't strictly true so in the top jaw there's usually three levels of bone loss or I like to categorize it in my own head in three kind of patterns so for me to explain this pattern I need to show you an x-ray so this is an x-rays called a panoramic x-ray or an OPG or DBT there's a whole bunch of different names for it but this is a really standard dental x-ray it's not a CT scan but it shows us some key parts that we need to look at first of all we can see the bottom off the bone okay so this is if you were to rub it your finger over the gum just underneath the gum this is what you would be feeling the second thing is these kind of dark spaces on the top left and top right these are the air sinuses and these are bits that we should ideally avoid to put our implants in so inside our cheek bones we have air sinuses which are just pockets of air and as you lose teeth these pockets of air get bigger which means you lose bone from the inside without being able to see there any differences if you were to look inside the mouth that's why having proper CT scans and x-rays before any of this kind of treatment is really really important because we don't know where your ear sinuses are now the melt that these air sinuses change or how big they are is really variable among different people so the best-case scenario is where the air science is still really small like in this x-ray and we could effectively place upright implants all the way across the arch without any problems okay this is the gold standard and it happens very rarely now the most common situation is the air sinus does get bigger towards the back of the mouth and then to to have the implants coming out as far back as possible what we do is we angulate the furthermost implants and by angulating them it means that the we can use longer implants engage them in more bone and then we can use more upright systems at the front but it means that where the implants come out is as far back as possible meaning that you can replace the maximum number of teeth using this kind of method of course you could have sinus lifts on both sides and and have upright implants placed there but it's complicating things and with a treatment which is already expensive adding sinus lifts to the the treatment is going to increase cost complexity and time to get your ear end results so the vast majority of people go for a system like all on four which is kind of what I'm describing here now sometimes these air sinuses can get problematically big okay so the the next kind of I'm going to say it's an extreme because it is is where you've hardly got any bone to place your implants in the top jaw now in these situations it doesn't mean you can't have this it just means we've got to change our game plan slightly and use different bone okay so what we would do in this situation is use zygomatic implants now zygoma is this bone which you can feel under the corner of your eye the bit that you cheekbone the bit that sticks out that's your zygomatic bone and it's about five centimeters been four and five centimeters from where we want the implant head be to support a full set of teeth so what we can do is place an implant which goes in through the mouth but engages and gets fixed to the zygomatic bone okay and it on an x-ray it looks like it goes through the sinus but actually there's a little membrane around the on the inside surface of the sinus and we push that membrane so that the implant doesn't actually go in the sinus the membrane goes around the implant and eventually you could get extra bone formation around the the implant there now different surgeons do this in a different way and personally I don't do Saigo matic implants because this is such a rare kind of situation I just don't have enough patience and practice to to confidently give this for my patients so I get a specialist surgeon in who does a lot of these in the situations where my patients might benefit from a psychrometric implant rather than a standard one now there is also a kind of a halfway house between the two because sometimes the air sinus can be a little bit big so that we can't put an implant in at the the ideal angle but there's still a lot of bone around that we can engage so in these situations we do something called a trans sinus implant which effectively means we put the implant in the same way but like we did for the zygomatic implant where we push the membrane up and then put it through the sinus we can use that same kind of technique again the end goal is to get at least four implant heads coming out in the ideal position so that you can have a fixed set of teeth ideally in one day but at least at the end of your treatment plan you'll have a full fixed set of teeth which look great function great and are easy to clean as well okay so if you've been told by your dentist or someone that you know you can't have the this kind of implant treatment because there's no bone they could well be right there they might be saying you know for them to provide that treatment there's enough bone but there are techniques out there and if you see the right person then they are able to point you in the right direction so that you can have that end goal of a fox fixed full set of teeth so I hope you found it useful if you've got any questions comments leave them below and about once a month I do try and get back to everyone if you want to see the kind of stuff that I do I post a lot of it up on Instagram and you can check out my Instagram channel there and again yeah if you've got any questions if you want me to put make a video about a specific kind of topic just put it in the comments below and although I don't get back to absolutely everyone I do read all the comments okay so I'll speak to you soon take care

Channel: Dr Gurs Sehmi

Views: 14,546

Rating: 4.9442511 out of 5

Keywords: Dental Implants, Cosmetic Dentistry, All on 4, All on 6, All on four, Zygomatic Implants, Zygomatic dental implants, Bone graft

Id: RyAeze5GOMo

Length: 7min 15sec (435 seconds)

Published: Mon Jan 14 2019