Hi Rodolfo. Thank you for your feedback. I will try! Live surgery videos are pretty hard to make. I have to obtain patient consent, set up my camera, crop, do voiceovers, etc. Also, it has to be a nice case that doesn't take too long and makes for a good presentation. But yeah, I will be doing more of these videos as I come across interesting cases .
Hi Aloha. Back teeth are under lots of pressure since your chewing forces are transferred to them. Therefore, the more implant screws you place, the better the long-term prognosis. For example, if you're missing two back teeth, you should consider placing 2 implant screws to replace them. Now if this was two missing front teeth, one implant screw may have been enough. The same goes for 3 or 4 missing back teeth. I always recommend to have at least 3 roots/implant posts on each side of the mouth to support your bite forces. This means that if you have two missing back teeth on the right side and you have two remaining teeth here, then try to get at least one more dental implant to make it 3 supporting roots/posts on that side. If you have no back teeth at all, then try to get 3 implant screws on each side to handle the bite forces.
The person also will have a lot of implants and own teeth to support jaw bone!!! Was there any infection in teeth and did you do any immediate loaded implants?
Hi Aloha. This patient was not a candidate for immediate load since he has natural teeth on the bottom. Immediate load only works if you have dentures on the opposing arch. Natural teeth put too much forces, and I never recommend immediate loading in such a scenario.
If you are planning on doing full mouth dental implants you can place about 8 to 10 implants per arch, so 16 to 20 total implant screws. Have I done this before? Yes, but over the course of 10-15 years. Patients who gradually replace their missing/infected teeth with dental implants may end up with a dozen or two implants in their mouth over the decades. Now, when a new patient comes to fix their whole mouth, I almost never advise them to put in these many implants. Usually 4 or 6 implant posts is sufficient to restore each arch. That's why we love all-on-4 and all-on-6 so much!
Thanks for watching my video! Feel free to put your questions in the comments below and I'd happily answer them. Want to schedule an appointment to see me? My offices are located in Southern California (Orange County). Click below to schedule an appointment: San Clemente Office: www.oceansightdental.com/book-your-appointment-online/ Newport Beach Office: genuine.dental/
Hi Aloha. There is no need to place crowns on teeth used as anchors for partial dentures. Unless course, there's a medical need for these crowns. In fact, the best teeth to anchor partial dentures are always virgin teeth. These are teeth that have never been worked on before. When should you place crowns on teeth that support partial dentures? When your teeth have extensive cavities, failing fillings, fractures, etc.
Can u use the same implants I have for top snap in denture to upgrade to all on four fixed bridge. Or are they different implants used and placed differently.thanks kate
Hi Kathleen. Thanks for the great question. This is a tricky one. The answer is yes, it can be done, but good luck finding a dentist who's willing to do it! The work is so complicated that frankly, most dentists don't want to bother with it. Here are a few things to watch out for when converting a snap on dentures to all on four permanent teeth: 1. Are the implants strong enough? You need larger implants to support all on four teeth. You can get away with much smaller implants for snap on dentures. If your implants are too tiny, then you may have to add two additional implants and use six implants for your all on four teeth. 2. Do you know the brand of the implants? All on four teeth require a Multiunit Abutment onto which the permanent teeth screw on. Snap on dentures have Zest Locators that lock into the dentures. For this conversion, you need to switch out the Zest locators with the Multiunit abutments. Your dentist needs to know the type of implant (which brand) so that they can order the correct parts (There is a trick if you don't know the brand, contact me and I will share it if anyone is interested!) 3. Price. Patients wrongly assume that since they already have four implants they will get a bargain on the all on four conversion. Unfortunately, this is almost never the case. Most dentists would charge you the full price, or very close to it, to perform this conversion. Why? Because the work is complicated. In fact, I personally would rather do the entire process from scratch than make the conversion. I hope this helps. Feel free to post your X-ray in the comment (Panoramic preferred) or email me, and I can give you a more accurate answer.
What are the criteria for root canals that need extractions. I understand a few reasons but it sounds like if over 20 years old they will probably not last that much longer?? Is that usually the situation with root canals?
Hi Aloha. Great question. Be sure to check out my video on root canals to learn more about them: ua-cam.com/video/Huj13qxxI5w/v-deo.html. With regards to the life span of teeth with root canals, I would categorize them into 3 categories: 1. Root canals that out live the patient: Some patients receive a root canal and the tooth lasts them their entire lifetime. A well performed root canal can indeed last you for the rest of your life. I have patients with 5, 10, or even more root canals and they have never had an issue with any of their root canal teeth. 2. Root canals that fail within a few years/decades: Sometimes a tooth with a root canal does well at the beginning, but it starts to fail after a while. Don't forget, along with removing the nerve, the capillaries are also removed from the tooth when it receives a root canal treatment. Lack of blood flow makes root canal teeth fragile. As a result, the tooth can break after 5, 10, 15 years of use. In my opinion, and most of my colleagues' opinion, these root canals are fair game. You get to keep your teeth for many years, which justifies the costs and effort to save the tooth. The fact that the tooth fails when you're 70 years old, does not mean that you should rush and pull your infected tooth just to avoid getting a root canal treatment. 3. Root canals that fail right away: Although not very common, some root canals just don't work. To be honest, often times this is due to operator error, aka, the dentist performing a substandard root canal treatment. You may have to visit a root canal specialist (an endodontist) to redo or fix your failing root canal. Still, there are occasions where even after performing a beautiful root canal, the tooth still fails within a few months. Why is this? There are various reasons. Sometimes the tooth is so infected that removing the nerve alone won't address the problem. If the bacteria have penetrated beyond the tooth interior, into the gum tissue and jawbone surrounding the tooth, your root canal may not remove the infection and it will recur. Sometimes the tooth roots start separating after the root canal procedure and there's nothing you can do to save your tooth. This usually happens with molar teeth root canals, which have multiple roots. The patients goes to the specialist, gets a beautiful root canal, yet the tooth continues to show signs of abscess and infection because the roots are cracked and separating. These teeth are not salvageable and must be removed ASAP of they will continuously leak infection into your body! Nothing in life is guaranteed, and root canals are no exception. If I do a root canal on a simple tooth that shows little signs of infection, I would give the root canal a 98% prognosis. If however, I have an infected molar tooth which has had chronic infection, then the prognosis would be more like 60 to 70%. Ultimately, it's up to you and your dentist to decide when it makes sense to perform a root canal on the tooth, and when it's best to just cut your losses and remove the tooth. I hope this helped shed some light on life expectancy of a root canal. Best of luck!
Hey doc, can you please do more live videos of surgeries? thanks. really good content!
Hi Rodolfo. Thank you for your feedback. I will try! Live surgery videos are pretty hard to make. I have to obtain patient consent, set up my camera, crop, do voiceovers, etc. Also, it has to be a nice case that doesn't take too long and makes for a good presentation. But yeah, I will be doing more of these videos as I come across interesting cases .
How many implants are needed for back teeth?
If missing two?
If missing three?
And so on.........
Hi Aloha. Back teeth are under lots of pressure since your chewing forces are transferred to them. Therefore, the more implant screws you place, the better the long-term prognosis. For example, if you're missing two back teeth, you should consider placing 2 implant screws to replace them. Now if this was two missing front teeth, one implant screw may have been enough. The same goes for 3 or 4 missing back teeth.
I always recommend to have at least 3 roots/implant posts on each side of the mouth to support your bite forces. This means that if you have two missing back teeth on the right side and you have two remaining teeth here, then try to get at least one more dental implant to make it 3 supporting roots/posts on that side. If you have no back teeth at all, then try to get 3 implant screws on each side to handle the bite forces.
The person also will have a lot of implants and own teeth to support jaw bone!!!
Was there any infection in teeth and did you do any immediate loaded implants?
Hi Aloha. This patient was not a candidate for immediate load since he has natural teeth on the bottom. Immediate load only works if you have dentures on the opposing arch. Natural teeth put too much forces, and I never recommend immediate loading in such a scenario.
What is the most implants and restorations you have doe. On one patient and why instead of all on x?
If you are planning on doing full mouth dental implants you can place about 8 to 10 implants per arch, so 16 to 20 total implant screws. Have I done this before? Yes, but over the course of 10-15 years. Patients who gradually replace their missing/infected teeth with dental implants may end up with a dozen or two implants in their mouth over the decades. Now, when a new patient comes to fix their whole mouth, I almost never advise them to put in these many implants. Usually 4 or 6 implant posts is sufficient to restore each arch. That's why we love all-on-4 and all-on-6 so much!
Thanks for watching my video! Feel free to put your questions in the comments below and I'd happily answer them. Want to schedule an appointment to see me? My offices are located in Southern California (Orange County). Click below to schedule an appointment:
San Clemente Office: www.oceansightdental.com/book-your-appointment-online/
Newport Beach Office: genuine.dental/
Did you have to crown the two canines to support the partial clips?
Hi Aloha. There is no need to place crowns on teeth used as anchors for partial dentures. Unless course, there's a medical need for these crowns. In fact, the best teeth to anchor partial dentures are always virgin teeth. These are teeth that have never been worked on before. When should you place crowns on teeth that support partial dentures? When your teeth have extensive cavities, failing fillings, fractures, etc.
Can u use the same implants I have for top snap in denture to upgrade to all on four fixed bridge. Or are they different implants used and placed differently.thanks kate
Hi Kathleen. Thanks for the great question. This is a tricky one. The answer is yes, it can be done, but good luck finding a dentist who's willing to do it! The work is so complicated that frankly, most dentists don't want to bother with it. Here are a few things to watch out for when converting a snap on dentures to all on four permanent teeth:
1. Are the implants strong enough? You need larger implants to support all on four teeth. You can get away with much smaller implants for snap on dentures. If your implants are too tiny, then you may have to add two additional implants and use six implants for your all on four teeth.
2. Do you know the brand of the implants? All on four teeth require a Multiunit Abutment onto which the permanent teeth screw on. Snap on dentures have Zest Locators that lock into the dentures. For this conversion, you need to switch out the Zest locators with the Multiunit abutments. Your dentist needs to know the type of implant (which brand) so that they can order the correct parts (There is a trick if you don't know the brand, contact me and I will share it if anyone is interested!)
3. Price. Patients wrongly assume that since they already have four implants they will get a bargain on the all on four conversion. Unfortunately, this is almost never the case. Most dentists would charge you the full price, or very close to it, to perform this conversion. Why? Because the work is complicated. In fact, I personally would rather do the entire process from scratch than make the conversion.
I hope this helps. Feel free to post your X-ray in the comment (Panoramic preferred) or email me, and I can give you a more accurate answer.
What are the criteria for root canals that need extractions.
I understand a few reasons but it sounds like if over 20 years old they will probably not last that much longer??
Is that usually the situation with root canals?
Hi Aloha. Great question. Be sure to check out my video on root canals to learn more about them: ua-cam.com/video/Huj13qxxI5w/v-deo.html. With regards to the life span of teeth with root canals, I would categorize them into 3 categories:
1. Root canals that out live the patient: Some patients receive a root canal and the tooth lasts them their entire lifetime. A well performed root canal can indeed last you for the rest of your life. I have patients with 5, 10, or even more root canals and they have never had an issue with any of their root canal teeth.
2. Root canals that fail within a few years/decades: Sometimes a tooth with a root canal does well at the beginning, but it starts to fail after a while. Don't forget, along with removing the nerve, the capillaries are also removed from the tooth when it receives a root canal treatment. Lack of blood flow makes root canal teeth fragile. As a result, the tooth can break after 5, 10, 15 years of use. In my opinion, and most of my colleagues' opinion, these root canals are fair game. You get to keep your teeth for many years, which justifies the costs and effort to save the tooth. The fact that the tooth fails when you're 70 years old, does not mean that you should rush and pull your infected tooth just to avoid getting a root canal treatment.
3. Root canals that fail right away: Although not very common, some root canals just don't work. To be honest, often times this is due to operator error, aka, the dentist performing a substandard root canal treatment. You may have to visit a root canal specialist (an endodontist) to redo or fix your failing root canal. Still, there are occasions where even after performing a beautiful root canal, the tooth still fails within a few months. Why is this? There are various reasons. Sometimes the tooth is so infected that removing the nerve alone won't address the problem. If the bacteria have penetrated beyond the tooth interior, into the gum tissue and jawbone surrounding the tooth, your root canal may not remove the infection and it will recur. Sometimes the tooth roots start separating after the root canal procedure and there's nothing you can do to save your tooth. This usually happens with molar teeth root canals, which have multiple roots. The patients goes to the specialist, gets a beautiful root canal, yet the tooth continues to show signs of abscess and infection because the roots are cracked and separating. These teeth are not salvageable and must be removed ASAP of they will continuously leak infection into your body!
Nothing in life is guaranteed, and root canals are no exception. If I do a root canal on a simple tooth that shows little signs of infection, I would give the root canal a 98% prognosis. If however, I have an infected molar tooth which has had chronic infection, then the prognosis would be more like 60 to 70%. Ultimately, it's up to you and your dentist to decide when it makes sense to perform a root canal on the tooth, and when it's best to just cut your losses and remove the tooth. I hope this helped shed some light on life expectancy of a root canal. Best of luck!