Problems with Bone Removal for All-On-4

[@CarmenBocsardi]

Thank you Mr.McFadden for this very informative video! Unfortunately they are only a few honest doctors like you....

[@mcfaddendentalimplantcenter]

Thanks, Carmen. I’m just glad you find my efforts helpful. 😊

[@pavalova53]

What shocked me the most was the examples you showed, being considered "acceptable outcomes." Boggles the mind.

[@davidmcfadden878]

Most patients have no idea what to expect when entering into this procedure. Therefore, they don't know what it should look like after. You would think they would obviously see what we see but most people just see a nice smile and don't see the flawed foundation.

[@aroncarvajal7080]

Thanks Doc McFadden

[@mcfaddendentalimplantcenter]

You’re very welcome. Thanks for watching!

[@marlinfeil6984]

Have you ever looked into the 3 on 6 method, if you have what are your thoughts on this procedure, thanks for your informative videos

[@mcfaddendentalimplantcenter]

3 on 6 are implant bridges. (Three bridges on 6 implants). It’s just become a commonly used term, used for marketing. 😊

[@marlinfeil6984]

In your opinion are 3 on 6 a good option

[@mcfaddendentalimplantcenter]

@@marlinfeil6984, Yes.

[@vickyl2479]

Can you have an dental bridge with Zygomatic implants?

[@mcfaddendentalimplantcenter]

Zygomatic implants are used when there is a severe lack of bone anywhere else. An implant bridge could NOT be fabricated on zygomatic implants.

[@vickyl2479]

Thank you! Can Zygo implants be made of zirconia?

[@kacyeleightly8838]

Thanks for such an informative video! I live about an hour & a half southwest of Houston med center area, so not very close to you. I was wondering if you have anyone you could refer me to in Houston or the surrounding area?

[@mcfaddendentalimplantcenter]

Unfortunately, I do not. I WISH I did!! With that said: I’d be happy to do a Zoom call with you if you’d like. If you can send a current panoramic X-ray or CT scan to my office (send it to [e-mail]), she will forward it to me me, I’ll review it and we can schedule a Zoom consultation. I can at least help guide you through what you need…

[@kacyeleightly8838]

@@mcfaddendentalimplantcenter thanks so much. I had a CT last week, I will ask the DDS office to email it to me and I will forward it and set up a zoom.

[@dknc7393]

That is what I'm afraid of. I'm about to bring my mom to a prosthodontist locally, should I ask them the question, "Are you going to remove bones for the implant?", other implant offices/surgeon we've been to said they will "flatten" the area. But as you, Dr. McFadden, said from an older video, some of these bones once removed, it won't grow back.

[@davidmcfadden878]

In my experience, every All-on-4 office that my offices have visited or been treated at either does not mention "bone removal" or, if they do, they say things like "flatten" the bone. No matter what they say, they are doing "alveoloectomy". In fact, we have patients tell us that they state that they "will NOT' remove bone just to get the patient to sign up for treatment. At many offices the patient doesn't see the doctor until the day of surgery at which point it is too late to ask the question. Because you are researching, I know you want what is best for your mother. TRUST YOUR INSTINCTS !!

[@dknc7393]

@@davidmcfadden878 Thank you Dr. McFadden. Should I make sure the procedure does not have the code D7310, D7311? I recall one of our visited Maxillary Surgery facility had this code D7311 on the option list for upper traditional denture. I googled and some site say it's needed for a larger surface area for the denture to fit better. Is that legitimate? Should I even allow alveoloplasty to be performed?

[@davidmcfadden878]

@@dknc7393 Some will mention those codes and do them, some offices will not even mention the code but still take the bone. If you have dental insurance and they give you a bill those codes may be on it. If you don't have dental insurance you may not see those codes. As you know, I am very much against bone removal. In some patients with very thin bone, bone removal cannot be avoided but that is only about 10% of the patients we see.

[@Roi-h9w]

Are you able to please clarify further about the risks with the bone removal? Do you mean that most patients that their all on 4 treatment completley fails would not be able to wear even traditional dentures because of the removal of the bone?

[@davidmcfadden878]

The amount of bone reduction is extreme. And, unless the patient has a lot of bone to start with, it is often the last chance for anything else in the future. Converting to dentures or implant overdentures would be a serious challenge for anyone with failing All-on-4. Angled implants can't even be used for overdenture abutments. On occasion, there is enough bone left after implant failure to replace the implant(s) but not often. Why would you consider bone removal if it isn't necessary? There is a saying in implant dentistry, "All-on-4 or none-on-3"!

[@Roi-h9w]

Thank you! So basically if I had the all on 4 an my implants did not take ,I would not be able to wear a traditional denture? So only gums left?

[@davidmcfadden878]

You would have to use a lot of denture adhesive but you could likely wear one. People need teeth and find a way.

[@angelaschaefer5883]

Oh my gosh how could any dentist do this to anyone. This is dangerous and immoral. Wanting to have healthy smile not have to wear dentures. Be left with not being able to wear dentures. That is devastating!!

[@davidmcfadden878]

Indeed !

[@renyitang5168]

Hi Doctor, does snap on denture require gross removal of bone?

[@davidmcfadden878]

It does require bone removal but not like All-on-4. There needs to be space for a fairly thick denture (Snap-on denture). Implant bridges are the only prosthesis that does not require bone removal.

[@dknc7393]

Oh, I did not know that! I thought it's All-on-4 that needs to remove more. I guess it makes sense that the snap-on probably need more vertical room for the locator housing that requires more structure and material to keep it in place. Where as All-on-4 the screws are embedded through the prosthetics, thus requires less vertical room.

[@davidmcfadden7927]

Not more but similar... If anything, it's more "who" does it rather than "how much".

[@Ladynipchick2]

I understood that bones are constantly regenerating or rebuilding themselves, and that they do this right over a 10 year period. Surely any shaved jawbone would do some rebuilding over time?

[@mcfaddendentalimplantcenter]

Sadly, it does not.

[@neicycombs3533]

Dr McFadden, I have severe periodontal disease, do you work with patients like me? I was planning on getting all on 4…I am so terrified of all of this. Please respond. Thank you.

[@davidmcfadden878]

Yes. All the time! Here is a link to a similar patient treatment. kzbin.info/www/bejne/fZSud2Sfrt6JgK8

[@darlenedrivera165]

​@David McFadden thank you so much for responding ❤️

[@troymuench1977]

Can you comment on how the fp3 is significantly more esthetic than these fp1 prostheses both to begin with but also over the long term? These fp1s are horribly white, the zeniths are all mismatched, gingiva looks okay now but similar to a maxillary roundhouse bridge we know how it'll end up. I'm playing devil's advocate - we all know that drilling less bone is ideal but honestly I think a complete denture looks better than some of these long toilet bowl flared out FP1 or FP2 cases

[@davidmcfadden878]

Poorly completed or bright white porcelain/ zirconium has never been appealing to me. Like the old "roundhouse bridge" it's all in the hands of the lab technician to make them believable. When the patient allows us to make them something that is not bright white (and, it's not easy to convince patients that bright white is NOT in their best interest), our outcomes are breathtaking. Have a look at our Gallery and you'll see perfectly natural looking outcomes in many cases. And, NO, even a good FP3 can't compare to good FP1 for about a dozen reasons!

[@erinethan6884]

Wow there is a guy on KZbin who got the all on four and he is a mechanic he literally needs to use an air compressor to get out the food that is stuck between the denture and his gum which is always irritated from lodged food. He advised females to get a mini air compressor who have the same prob. He said the water pik and flossing does not remove everything.

[@davidmcfadden7927]

Yep ! Terribly unfortunate for those patients!

[@janeg8274]

Thank you so much for your videos!! I am 63 and due to illness2 years with gastric ulcer disease and so 50k of of implants they want to destroy and put in zirconium all in 4 with 2 terrifying steel bars put up through I guess my sinuses cavity!! I am Terrified!!!

[@davidmcfadden878]

I wish everyone would research like you just did !!

[@janeg8274]

Hi Dr I am in Baton Rouge and I am SO stunned by the information you have in your videos that ZERO very wealthy oral surgeons and dentist have not shared!! I was going to have all on 4 in June But I truly feel you are the one person I can trust!! Is there a way I can contact your office? I have a feeling there is a long wait list but I think it would be worth the trip!!!!!

[@davidmcfadden7927]

Of course !! Thank you for the kind words. We can start with a Zoom call if you'd like. Any chance anyone has a panoramic X-ray you could send me?

[@janeg8274]

@@davidmcfadden7927 yes!!! I thought about that! I will take care of that this week after school! I filled out a form on your web site and wrote way to much… Your office people will die.. I told them I was so sorry!! I know you were just looking for 2 or 3 sentences! Once I get this do I just Fed Ex it to your office??

[@janeg8274]

@@davidmcfadden7927 PS I am Going by the dentist Today( where all of this started” You only have a few teeth so it shouldn’t be a big deal!… Well when you have already put 50k in your mouth all be it from 2000 it is a big deal!… and yes Maybe they all have to go but I just must be sure!!)

[@caliinthevalley24681]

Thank you again for such an informative video! Amazing work.

[@mcfaddendentalimplantcenter]

Thanks! I’m glad you found it helpful!

[@1971TheDon]

Sorry but what you just presented is I think too exaggerated

[@davidmcfadden7927]

Tell us how much bone you remove in your practice.

[@1971TheDon]

@@davidmcfadden7927 yes I remove but all I am saying is your animated presentation is too much presenting bone removal. I remove just enough not to show transition of real gums plus gum prosthesis when patient is doing full smile or like gnarling smile that is why pre photographs are in a full smile and or sort of doing gnarling smile as one of the guides of course ct scan etc should be taken in consideration also. How much bone removal has no definite measurement it will all depend on how you think it will all end up pre surgery. So if you plan with end in mind you can come up with FP1, FP2 and FP3.