Will ALL-ON-4 Dental implants last Forever?

[Music] okay guys within implant dentistry i'm gonna talk specifically about all on four dental implants okay now to help this make sense i'm going to tell you basically what all on four dental implants means the surgery is the same no matter what type of bridge you put on top we typically are going to see four implants in the maxillary bone or mandibular bone and then you're going to have a connection into one device the device is going to replace the patient's teeth and gums this is why we call it all on four meaning teeth and gums all the smile and the teeth on four implants it doesn't matter if you use five six or seven implants the concept of all on four is basically this you're going to build on at least four implants because that's what you need to have a good strong device two implants in the back two implants in the front just like you'd have to have on a chair that's the stability anterior stability and posterior stability and then you're going to build some sort of device on top of it okay that said let's talk about the most common device that's made within all on four dental implants what you're looking at are the components for a titanium bridge which is often called a hybrid bridge okay so there's really three different components the first component is a titanium bar this is what you'll see is a naked titanium bar it's a big one because when i was doing these often i would make these very very strong and you'll see this is very very thick this is probably twice as thick as most other doctors out there okay either way that's where the strength comes from okay so you have a titanium substructure on the bottom and then you're going to put pink over the top of it you can see pink here there's a bar within it and i wanted to kind of use this representation this is acrylic okay and if i squirt a little bit of uh monomer right here this will turn into liquid and that liquid will turn into basically the same thing that we do our nails with okay and so you have a titanium base and then you have a acrylic support around it and then you have denture teeth on top okay so again what you see here's all those put together you have you can see the titanium you have the acrylic and then dent your teeth on top this device can look very beautiful i mean this is why i did so many of these for so many years but what made me transition and stop doing this device is because after about three to five years what happens is teeth where you can see these teeth have ridges and they're rugged so the patient can eat what happens is that the teeth wear down and then as a teeth wear down in the back uh what happens is that you have teeth that start to break in the front so here's an example of an actual patient came into my office this week okay and this is uh what's happened if you look from the back side you see how flat those teeth are okay so again comparing these you can see these have mountains and valleys and this one here is flat so these teeth wear down everybody's different but usually after about three to five years you start to see enough wear in the back teeth that what happens is you start to have teeth break off in the front why is that well i'm gonna use this as kind of an example here but let's say this is the bottom and here's the top what happens is that the teeth are made to glide over the top of each other and so as the back teeth move past each other the valleys and the mountains the terrain basically pushes the anterior teeth the front teeth up over the top so now so it doesn't hit okay but let's say we reverse it here if we don't have it what happens is it's so flat that now the teeth in the front are colliding with the bottom teeth and so ultimately what happens is you have teeth breaking off like he's here okay and what's hard is that even though as a doctor we tell our patients that this is something that's going to happen patients get frustrated because it's it's a lot of money even for the titanium and to have problems like this they just kind of forget that you you talked about it um and so they start to come in for these repairs and after you know second or third repair in five years they start thinking okay was there something better out there and that's where we move into other devices like the zirconia but i just wanted to kind of help you understand that the other thing that i i want you to notice this is again this is an actual device that we fabricated here about five years old if you look really close in here you can see how the cell is darkening around the teeth that's because as time goes on acrylic absorbs water and so it basically there's a staining that happens in between these teeth just because acrylic by nature is going to absorb stuff and so and this patient has been pretty good with cleanings and we've been telling him uh that he needs to make sure that he brushes the teeth to keep him as clean as possible but that's why he has to come in and he doesn't want to miss his appointments because he's going to get you know that brown uh that brown staining in between his teeth now one thing that you have to do with these devices and patients struggle with this too is if you're going to have a titanium all-on-four bridge made it's so critical that you use a night guard an eye guard at least at night will protect your teeth from grinding together okay and they won't flatten out as quickly and so and for some reason it's really hard for patients to wear those night guards um you'll notice like this is nice and flat in here and that's what you want to see underneath this type of device um we were working on this earlier so you can see where we've used it with the bird butt at the end of the day that is a an example of a titanium bridge that with the problems you see facing again wearing down to the back teeth you see breakage in the front because as the back as the bottom and the top teeth as they collide it'll pop these teeth off if the back teeth have been worn okay i like to use the example like a door stop if you don't have a door stop and you swing the door open it makes a hole in the wall well the back teeth on the bottom and the top the the door stop is the is the mountains and the valleys so as the teeth come together they they create a rise so the anterior teeth can't touch and they can't break in a sense okay all right so let's move to something that's better than okay so just a quick recap all on four dental implants one of the one of the devices that we make still and it's still the most commonly made device in the country and in the world is a titanium substructure with denture teeth and acrylic and it makes a beautiful result but the result doesn't last as long because the teeth do wear okay so let's move to something better so if we move up here we'll see the next generation what's better so zirconia device you'll see a couple examples here the zirconia device is made out of zirconia which first comes in these big pucks okay and then as we put a design at the design of the teeth in there it's milled out all one piece all right and so you'll see this is actually the piece that was put in here and so this is just milled out actually today okay and what you'll notice is that this this zircon is the same one that i was using uh as an example in the last video it was a live video i was showing some of the design critical design features but if we look at this this is all one piece now this looks really big it is actually that's going to shrink down to something like this okay or something like this it's significantly larger why is that because when zirconia comes in a big puck initially like this what happens is that it actually is going to um it's actually going to be really fragile like right now if i if i cranked on this this would break really easily because it has kind of a chalky feel to it the reason why that is is because that's laser coney is before it's heated up what makes zirconium so strong is that we put it into a sintering oven which basically means it's a oven used in the lab that gets very very very hot and it stays in this heat for 13 hours okay and it goes to the cycles of heating up and then cooling down and when that happens this device goes from here to here so it actually shrinks and becomes very very very hard and so when it comes out it's also still white and then we start to paint the gums on top of it so the gums are customized we put some finishing polishes and we basically paint the teeth to look very very natural and again here's just a couple examples of some zirconias that we've done okay and this light might be a little bright but uh i mean we have we have tons of different examples i'll just show you you know here's an example here that has been polished find another one here here's another example of one that is really really bright maybe a little bright for a lot of people but really really gorgeous [Music] here's another example each one is different because they're made for patients and they the oldest the shades they change as far as the gums the shade changes with relation to uh the teeth the gums everything is is different because they're always customized specifically for each patient okay so again um what's what's what do all these have in common though is that they all are zirconi devices and they all are super super strong and what you'll notice with these is that uh you're not going to have the same problems because the teeth are all one piece that it's all carved out it's like you know if you think about it this is like a tree when it's all one piece um the strength is never broken something can't debond and so unlike the titanium where you have three pieces that are glued together and you always have these types of breakages you don't see the breakages with this you don't see the teeth wear down in the back also and the staining as far as staining between this if you're to fill it's heavy but it also feels like glass okay um super super smooth um on the surface underneath the touch of the gums it's it's very glassy and so the nice thing about that is that you just aren't going to have food getting caught in there and adhering to it like you do with these types of devices you know these types of devices this this type of acrylic is the same acrylic that uh dentures are made out of whereas this this is a ceramic and it's it's just a fantastic device i love it because patients do so well when it comes to cleaning but you'll notice that every single device here is customized you'll see different teeth you know size teeth i mean this is pretty dramatic right the difference between these two this one is for a big uh you know i think six and a half foot uh tongan and this is a a little uh female white lady and uh you can tell there's a big difference between the two and so but um i love i love this device because it is something that i believe will last a lifetime um i believe that if taken care of um and maintenance is done on it what is the biggest thing that i see that if there is a problem that happens with these types of devices what is it well for me in my practice the biggest problem that i see is that uh patients do so well they often don't want to come back for cleanings and why are cleaning so important well cleanings are more than just a cleaning it's actually a maintenance visit where we are looking at the uh well you look at the bone you look at the gums you look at the screws of the implant and you check the health of each of these because if you see a little bit of bone loss then there has to be a reason that's happening if you see a little bit of gum tissue irritation and maybe there's some food getting caught when you make some modifications if there is a screw that is loose perhaps the patient is biting or colliding in the teeth in the back and we need to adjust it these teeth don't wear down and so what happens is the vibrations are transferred to the screw and the screw can loosen up so i still recommend the patients get a uh a night guard for these and i give night guards to all my patients um but uh but at the end of the day i love these devices um we still do these every once in a while um they're indicated for certain uh and patients that are very rare in my practice for the most part we have tried to get it so that these uh are primarily 99 what we do here okay people are saying that i never talked about price but let's just talk price i wasn't planning on this but you know depending where you are in the united states this titanium device could go from anywhere from 15 to you know 20 000 to even 25 000 uh you know per arch so top and bottom when we jump into zirconia now within the country you're looking at closer to twenty to thirty thousand dollars per arch okay and again why is it different in every practice because some places are very very uh some places are very competitive um some doctors they they use materials that are cheaper than others like this is a zirconia that's out of germany um it's not it's not cheap but you can buy cheaper materials from all over the world there's there's a coney out of china and that's one thing i get concerned about when patients tell me about these prices that are so low it's it's scary because you know oftentimes they don't know what materials are being put in their mouth and some things can look beautiful for the short run but the long run they start to break and have problems and so definitely ask lots of questions but i hope this answers some questions out there about what is the difference between titanium implants titanium bridge implants and all on four zirconia implants and this will be helpful as you're trying to decide ask lots of questions let me just say one more thing too i can't stop i just love this stuff but this bridge that you see here that's titanium they can make this also out of other materials there's a there's a material called trainia there's a material called pectin there's a material called i believe it's such a trini pectin trilor and these are all sub structures that are used to put something over the top of it so you can use uh you can use other things besides denture teeth you can actually take like a printed material like this here and you can put over the top of that okay and so this this material here is something that can help lower the price also but again these softer materials just like the denture teeth are going to wear and so there's nothing wrong with doctors giving options that aren't as strong my biggest my biggest petition is that patients just need to be informed and they need to understand what are the differences of these because if they're thinking this device is going to last forever and they give you something like this there's no way these teeth are going to flatten down and now the device or sorry the the bar or the bridge the substructure underneath that can last longer you know that that can last a lifetime but it's you know these materials can only endure so much uh force before they're going to start to wear down like you see right here these are not cheap teeth i mean these are the most expensive teeth you can buy but yet no matter what you're going to have patients that are going to wear that down and when they start to wear you know even these types of devices here that looks they look gorgeous all these things look gorgeous um at the end of the day if the teeth so that in a device like this where you have denture teeth as the top um they're going to break off but in this device what's going to happen is the back is going to wear down and then you're going to start to wear the front and this will start to flatten out just like you see in the natural dentition just like you see with your regular teeth your teeth start to get squared up so again ask lots of questions the doctor that you're intending to have this done interview lots of doctors i think you should know what types of materials if they're going to have these devices made in outside of the office what lab is using what lab they're using and even calling that lab and asking where their materials are ordered from is this uh are these are these devices being made out of materials that are fda approved um are they are they used are they being bought from china or from other parts of the world again no knock on other countries it's just that you have to be aware of what type of materials are being used because all things are not equal you can see here all these you see like three or four different types of materials here they all look look beautiful they will all wear differently and so if you're thinking this is a forever device you you could be very very disappointed with the outcome so i hope this video serves you i appreciate you guys watching all my videos please subscribe i'm trying this year to put more content out than i have in the past six years and so please please ask questions and tell me what you want to hear about what questions do you have what what other videos would you like to see me produce to help you get better informed i love what i do keep watching thank you so much god bless

Channel: Dream Dental Implant Center

Views: 6,486

Rating: 4.9487181 out of 5

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Id: vySz0eub6w4

Length: 17min 22sec (1042 seconds)

Published: Sun Apr 18 2021