How to clean your All on 4 and other Dental Implants

hi everyone how you doing so in this video I'm going to show you what I explain to my 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 which are held on with dental implants which we'll talk about bridges which is a section of teeth on dental implants and most importantly we're going to talk about all on force because this is a question which I get asked quite a lot which is once you've had your oven for you can't remove your teeth how would 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 a single dental implant it has the same kind of philosophy for a full arch there's only slight variation so here we've got a picture of a tooth on a dental implant okay the implants at the bottom here so that's the implant we've got the tooth here okay and in between connecting the tooth and the implant is this bit here and that's called the abutment okay so it's really important to understand these 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 this situation 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 the gum which is going all the way around the tooth and ice implant - it should look like it's naturally coming out of the gun but underneath the surface the attachment of the gum actually goes down the side of the abutment okay and that that's important because the attachment to the the gum the gum to the the implant is right down here somewhere okay it's right near the 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 but maybe once a week I'll 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 gonna highlight the implant tooth is this one here and the guys had a full smile design done with veneers and crowns you had that done about 10-15 years ago this tooth broke so we had to replace it with a dental implants and that's 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 okay and the attachment on what I'm talking about is where the gum and the tooth attached toget to each other with an implant the attachment is much lowered down it's down here somewhere so what you need to do is actually let the floss travel down the side of what you might be the route or down the implant all the way to the bottom and normally this doesn't hurt okay 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 to hurt and it shouldn't bleed and you definitely shouldn't get any white pus coming out out from the neck of the tooth if you're getting any of these things then you should go and check it out have your 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 pass can cause problems around your implant in the long term so these are 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 single teeth how do things change when we've got a bridge so here's a what we call a four-unit bridges for units because it's 40 I've fitted this about a 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 abutments cleaning those in the same way that I've shown you with the floss a second ago but we've also got this contact area where the bridge and the the gum is 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 the next thing I'm going to show you like an awl on four is very similar to this and the way you clean this is very similar to how you clean like an awl on four so let me show you an awl on four case this is this lady had all on four top and bottom she uh I 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 what 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 is with this product okay it's called super floss it's made by or will be in the UK you can buy it from any decent chemist so say boots for example will will have this you can buy it online ok 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 ok and here's just a quick diagram of the three sections first of all the green area that is a slightly firmer like floss ok so it's like philosophize it's made from plastic but it lets you thread the 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 the gum and the last section is just regular floss so you can use this last section who got combination of implants and bridges and all its stuff one piece of super floss it should be able to clean the whole mouth now with the the thermos 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 of showing you how to do it from the outside in and the inside out here and the important thing is once you've threaded it through the cleaning is done with the the Fermi aspect and you have to slide the the foaming 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 start 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 on four is the very last teeth because normally the way I do my own force 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 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 gonna 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 organ for look really really easy and it's not always like this and if you're watching this video and you've had all and 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 four times before they get the hang of using the the super floss properly and when we're planning a normal form 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 and the color 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 by tell how I do that normally but the cleaning is really important because the design of the whole all-on-four needs to be as clean able as possible and if I show you this diagram there the way this diagram works is if say I had an all on floor 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 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 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 we've got 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 firmest 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 knot feather touch but a firm contact all the way around but it's a spot contact all the way out there 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 the difference between an implant bridge like an awl on for and a removable denture differs quite do it 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 dent a patient had had this done by another dentist embarassingly 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 he had these implants place we needed to remake the bridge I'm gonna show you the photo of when I took the implant the bridge off okay and and if you get grossed out he'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 a without it being cleanable and I mean that 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 is doing a fantastic job he's got an electric toothbrush she's got water picks all this stuff but it's not effective as cleaning underneath it the design of the bridge is critical in how well it anyone is going to be able to clean underneath it now I mentioned water picks and water picks are they all good there's nothing better than a mechanical clean okay so if you can floss underneath that I would say that's the gold standard the problem with water picks is that they are they 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 coarse Adele and because course adil 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 - is it can affect the gum around the abutment okay and sometimes you can get a bit of 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 implant 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 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 there so I'm gonna try and do a few more regular videos okay so until next time take care

Channel: Dr Gurs Sehmi

Views: 20,768

Rating: 4.9217877 out of 5

Keywords: dental implant, dental inplant, all on four, all on 4s, cleaning all on 4s, same day teeth, cleaning denture

Id: p2ZabRTW6V4

Length: 16min 17sec (977 seconds)

Published: Thu Jan 16 2020