Fake Gums on your Full Set of Dental Implants? (or all on 4)

hey guys how you doing in today's video i'm going to answer a question which i get asked quite a lot and this is if you're having a full set of implants if you're having an all-on-four or whatever it is is it better to have the teeth sitting on your natural gum or is it better to have fake gum now the answer to this like the answer to anything related to implants or cosmetic dentistry is probably not as easy as you might think initially um you see there's five categories for what we call full arch dental treatments and i'm going to explain these five categories to you because the first three relate to how much gum or have you got fake gum or long teeth or what's the kind of design that we have in place there so the the terminology here is slightly complicated but let me help explain it we've got five categories let's call them one to five okay so we've got one two three four five and the first three of these categories relate to fixed sets of teeth okay so what i mean by this is you have the implants placed in the bone and then you have teeth which are not removable by the patient themselves screwed into these implants okay so if we have teeth which are fixed we call this fixed prosthetics so we're going to call number one to three fp for fixed prosthetics one two and three now the other two are removable so we're going to call these removable prosthetics rp for an rp5 okay so let's explain what all of this means so let's look at the fps first of all fp one two and three and the only difference here is what it looks like at the gum level so we have our implants fp1 is those situations where we don't have any false gum and the the teeth are at an average height to width ratio so in ideal aesthetics what we want is the width of the tooth to be about 75 to 80 percent of the height of the tooth okay so i'm really talking about the front and inside the tooth there and the gum level is dictated by wherever your gum level ends up being after you have teeth taken out so remember when you have teeth taken out the gum and the bone shrink away and quite often it goes up up for the the top and and down for the bottom so that's our that we can't really change that okay it's very difficult to change i do doing bone grafts and tissue grafts to increase the height of bone is notoriously very very difficult it's not impossible but it's very difficult now if that's our fixed position of the the gun wherever it ends up once the your teeth are removed we now have to decide how long we want where do we want the incisal edge of the teeth to be and this is related to the the position of the lips actually so in the vast majority of cases we look at the position of the lips we take into account the age and the sex of the patient and that kind of gives us good guideline on where the incisal length should be so ladies will show more tooth than men so they're they're too the visible tooth at rest is going to be longer so their teeth are more visible guys we show less tooth so about millimeter less for the same age group but as we get older men and women will show less and less top tooth and more and more lower teeth so we take all of this into account and that dictates the bottom edge of the teeth so you can see by now we don't actually have a lot of control over the um the bottom edge the incisal edge of the tooth and where the gingival margin are you where the tooth and the gum meets because when we place implants both of these are really out of our control we're trying to make the teeth look right for the patient and we can't change the gum height and we can't change the position of the lips within reason so now we've we've got these two kind of landmarks and that tells us what the height of the tooth is going to be okay now in an fp1 situation there is very little bone loss okay once the teeth come out there's very little bone loss or the teeth have been taken out strategically in implants placed strategically so that you can maintain the look of the gum okay so this is the hardest thing to do is maintain these pink triangles in between the gum we call these the papillae and by taking teeth out selectively not putting all of the implants in at the same time you stand a better chance to maintain the papillae now the only downside for this is you have to start from a situation where you've already got papillae and you don't have aggressive gum disease so if you've got aggressive gum disease already you've lost lots of bone it's going to be very difficult to maintain these papillae so so maybe we should look at another option now the fp1 i'll be honest i've never done one because i just don't think they look very aesthetically pleasing there's no real advantage in my head from a purely clinical and functional point of view why you would want to keep that um keep the papillae keep the uneven gingival architecture you know the the arcs around all of the teeth and why you wouldn't go for something having a fake gum so the fake gum solution is actually fp3 i'm gonna come back to fp2 in a second but fp3 what you do is you accept that you've got bone loss at the top it will go up and you actually quite often remove more bone so we'll remove the bone so that we can hide that transition line between the the denture or the all on four whatever it is and the natural gum and so we hide that up high underneath the lip so it's not visible everything which is visible is now made fake okay so we've got fake gums and fake teeth now the real advantage of this is that we can make this look really really good we can be very natural looking um here are a couple of photos of real cases and all the gum you see here is completely fake now the advantage here is really in the aesthetics because we've got full control of the height width ratio of all of the teeth so you remember i said the the incisal edge is dictated by the the general look of the face of the patient the age the sex all of this kind of stuff and the the gum position is dictated just by the clinical situation how much bone is there and what's the the actual treatment plan now this means we can't get this ideal height width ratio to the teeth and can't have the teeth the ideal length so if we have fake gum we've got complete control we can have the teeth exact height that we want the exact width that we want we can create that perfect smile for for the patient because we don't have the limitations of trying to make the smile fit to wherever the gum line is going to be we can create our own gum line in addition to this we can create very sharp natural youthful looking papillae in between teeth and from an aesthetic point of view this is really important if you if you're trying to achieve that really youthful you know nice smile you're trying to get a smile which which fits you and makes you look good okay because there's certain aspects of a smile which if you get it wrong they can really it can look like dentures and it can make you look quite old which is obviously not what we want to do with these kind of treatments so these are our two examples we've got fp1 and fp3 um fb2 is in the middle so fb2 is if we accept that we don't want fake guns and we are we are happy having abnormally long teeth okay now this sounds a bit weird but in a lot of cases we can get away with this because the we're treating people who don't naturally show a lot of gum okay so if someone doesn't show a lot of gum then there's actually there's no real reason why you would want the aesthetics to be fantastic up near the gum because it's never going to be on show now saying this i've never done a full arch case with extra long teeth okay what we tend to do is maybe bridges and things like that so here's a photo of a guy who who we recently did a lower bridge on and exactly the same situation the bone has been lost over time and that means we ended up having very long looking teeth now in real life this isn't um this isn't obvious because all he shows is about two to three millimeters on the top of the teeth everything else is hidden below the gum so that's what we've got we've got fp1 with no gums average height with ratios everything generally looks good but we're still compromising on papilli we've got fp2 where we have naturally long teeth because the bone has been lost papillae has been lost so the the teeth end up looking longer and we have the fp3 where we've we have fake gum to compensate for all of this bone loss which which either we do as part of the treatment or has happened as part of gum disease now those are our three solutions in terms of fixed prosthetics our two removable prosthetics options are are very similar now both of these will have gums so fake guns and one fp5 is the sorry the rp5 is the one which i do most often which is the the clip-on dentures or the cliff on teeth so you have your implants placed you have what we call locator attachments put into the implants and then the the denture is clicked into the implant okay this is this is different to a normal denture because a normal denture would normally cover the roof of your mouth and they're quite bulky but these tend to be much more slimline dentures which click into the implants now the other way of doing this is having a metal bar which is fixed into the implants okay so this metal bar links all of the implants and in all of the fixed prosthetic stuff the metal bar is within the teeth but here the metal bar is a separate thing and it's screwed into the implant on on its own then the denture is clicked into this metal bar now the difference between the 4 and 5 is a little bit technical it comes from where the support of the teeth is is derived from so with an fp4 where we have the metal bar all of the biting forces are going through the implants when the patient bites there's no pressure on the gum because all of the the biting pressure is transmitted into the bar and then therefore into the um into the implants okay just like a any of the the fixed prosthetic stuff now with the frp5 sorry i always get these kind of mixed up a little bit with the rp5 what we have is the the gum takes some of the loading as well so the denture sits on the gum and is then clicked into the implant so as as you bite there's pressure on the gums and the implants okay whether this really makes a difference i i don't know i imagine it adds a little bit of sensation in terms of how hard you're you're biting on things um but as i say the vast majority of the removable kind of teeth which we do are the rp5 where we have where we don't have a bar okay adding a bar adds a lot of complexity and cost to the treatment and having a bar and then a denture clicking on cost wise would be almost the same as the the fixed teeth so almost every single one of my patients would say well why don't i have fixed because um perception-wise it seems like a better solution so i hope this this video answers the question about you know should you have gums fake gums what are the advantages of fake arms really it's not a kind of a choice it's what is the most appropriate thing for your kind of bone loss or your individual situation some people lose loads of bone when they have their teeth taken out some people hardly lose anything so a lot of this depends on what your individual situation is how your lips frame your smile when you smile widely how much gum do you show and what's the height width ratio of the teeth which are going to be fitted into the into the implants okay so as i say you know i come from an aesthetics background first and then i do do the implants to fit around the aesthetics and for that reason i don't think there's anything which is better looking than having fake gums okay and fake gums have come a long way they don't look like cheap dentures anymore okay you can see from these photos they do look pretty natural in fact i put this uh before and after on on facebook and instagram a little while ago and a lot of people were questioning whether these are actually real or or fake okay so i hope you got something out of it if you did you know give it a thumbs up if you've got questions comments you can leave them down below alright and i will see you in the next video guys take care

Channel: Dr Gurs Sehmi

Views: 10,064

Rating: 4.9829059 out of 5

Keywords: all on 4 implants, all-on-4, all on 4, all on 4 dental implants, dental implants, smile makeover, all on 4 dentures, all on four, dental implant, all on 4 procedure, replace my teeth, replace teeth, oral surgeon, teeth whitening, all on 4 dental implants cost, extreme smile make over, full mouth dental implants, all on four dental implants, cosmetic dentistry, implants, all-on-4 clinical treatment, all-on-4 dental implants treatment, all-on-4 treatment, all-on-4 implants

Id: uLJdhxLO8Bo

Length: 13min 55sec (835 seconds)

Published: Sat Jan 16 2021