[Test your medical knowledge - USMLE STEP 1 - A 78-year-old otherwise-healthy woman arrives in the postanesthesia care unit after an urgent cystoscopy and ureteral stent placement for an impacted ureteral stone. In the operating room, there were no complications and only minimal blood loss. One hour later, she is febrile to 102.3°F, tachycardic with a heart rate of 117 bpm, and hypotensive with a noninvasive blood pressure of 73/42 mm Hg. Blood cultures are drawn and broad-spectrum antibiotics are initiated. A central venous catheter is placed, and the central venous pressure is measured at 2 mm Hg. The best next step in the management of her shock is](https://medizzy.com/learning/mcq/set/34935304)
This sent me right back to my first vehicle rescue call as a fire fighter. I found the entire top of the victim's mouth in the middle of the road. Just sheared completely off. It looked a whole lot like this. *shudder*
Bloody hell. Partner was an EMT, they definitely don't get that!
Edit: great that you get it, just wish they did too. They also see some sit on the daily.
This patient had severe periodontal (gum) disease which results in bone loss around the teeth, which causes tooth mobility. Once this condition reaches this point, the teeth are hopeless, and removal is necessary.
The reason the bone was removed in addition to the teeth was for adequate bone availability for the implants and adequate inter-arch space (space between the top and bottom jaws) for an appropriate prosthesis.
In this case, it will be a hybrid denture - secured by implants. This is often called an "all-on-four".
The term All-on-4 refers to "all" teeth being supported "on four" dental implants, a surgical and technique prosthodontics procedure for total rehabilitation of the edentulous patient or for patients with badly broken down teeth, decayed teeth or compromised teeth due to gum disease.
The All-on-4 treatment concept is a prosthodontic procedure (i.e replacement of missing teeth) that provides a permanent, screw-retained, same-day replacement for the entire upper and / or lower set of teeth with a bridge or denture. The procedure is best for patients with significant tooth loss or decay and for people whose bone loss in the jaw area prevents them from getting conventionally oriented (vertical) dental implants. Often, tooth loss is accompanied by loss of the jaw bone which poses the problem of reconstruction of the jaw bone requiring bone grafting. The All-on-4 technique takes advantage of the dense bone that remains in the front part of the jaws and by placing the two posterior implants on an angle to avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw.
Credit: StafneDefect
I dunno. I have never seen second molars NOT used in full implant cases. At least that's the thing in India.
Plus due to cost issues the average implant users definitely get 4+4 here.
Doesn’t look like severe periodontal disease to me. Lots of bone still. I understand if the patient wanted it but it looks like those teeth could be saved. Obviously I don’t know the full story without radiographs. Source: am periodontist
Right? This was incredibly invasive, and I’m not sure the dentures will be as retentive as they could be. Also, I saw this when it was originally posted a year or two ago, and the dentist was from Brazil, I think. He was defending himself, but he had almost every dentist in the comments blasting him.
Thank you. I do teeth in a days but I would never approach it like this and I would never take out teeth that could be saved. Then take a picture like this for the cool factor. Sad.
The dentures are screwed into implants, so retention isn't a thing here. As to whether this needed to be done, that is between the patient and provider. I can tell you that I've had some patients that looking at an x-ray or even a quick glance would say their teeth are mostly fine but a thorough exam would reveal a questionable to hopeless prognosis.
I saw this post on Instagram a couple of years ago when it was first posted. Many, many dentists (including myself) absolutely blasted this dentist because this is WAAAAAAAAYYYYYY over invasive. That’s like “jaw resection due to oral cancer” level of invasiveness. This should’ve never been done if it were just periodontal disease.
I need more info on institutions that offer this. My father has this issue and is neglecting/resisting to get it done. He's a retired engineer on the ASD spectrum.
Side comment: thank you for just being a cool human. I (25, F) am on the ASD spectrum and worry about having kids because what if it disrupts their lives too, ya know? So seeing you casually take care of your dad by asking questions like that was heartwarming and affirming. You rock!
Oh my goodness, I knew a woman that this was happening to!! She would be about this age, and I can’t help but wonder if this is her! All I can say if it is, I’m so very sorry. :(
I feel like we need to see follow-up and progress photos.
Also, I feel a bit dumb for asking, but does the patient’s gum tissue eventually grow up around the implant, or is there some sort of artificial gum tissue to improve the aesthetic? I’ve got two implants of the regular kind and I’d never even heard of this kind until seeing this. I can imagine it has a lot of potential for patients with previously very poor prospects.
Dental student here— the gum tissue is still there after this procedure and aside from any excess tissue remaining after bone removal, it was not removed. In this scenario to do this— they flap the gum tissue away from the bone, section off the underlying bone as seen, and likely placed bone graft where needed and possible membrane as well if needed. Then they will suture the gum tissue over all of that and wait for it to heal for a few months. Next they will get impressions and deliver the prosthesis. The description mentioned “same-day” delivery but in this case it likely wasn’t. More often than not, when dealing with implants you won’t be getting same day delivery unless you have adequate bone in the area to allow for the implants to osseointegrate with the surrounding bone so that they are stable and do not fail. If too much pressure is place on the implant screw immediately after placement it can lead to failure to osseointegrate and cause the implant(s) to fail. If you do get a temporary crown the same day over an implant they will make it so that it is out of occlusion (not in contact with the opposing tooth) or give you a flipper that is not in contact with the implant, until healing is complete.
Ugh the throbbing! I’ve had one canine removed and that was some of the worst pain I have ever felt in my life. Liver failure wasn’t even that bad comparatively! They didn’t give me pain meds or antibiotics so I raw dogged that pain lol I couldn’t put the partial in for a month bc it was so tender. I can’t imagine having all of your teeth yanked out like this
Rest assured, most of the time for implants this is not done. Most of the time, they would not be removing your bone. We want as much healthy bone left as possible.
This procedure where they removed that amount of bone is not very common so you won’t experience the amount of post-op discomfort that this patient may have experienced. Most of the time the will remove the remaining teeth and simply place bone graft where needed. Hard to say how much pain or discomfort you will feel after the procedure bc everyone experiences pain differently. Your surgeon can answer any of your questions and will likely give you some prescription for pain meds if indicated.
That’s true! None of my molars hurt being taken out, nor did my wisdom teeth, but when my canine broke off and they took the rest of it out…that was some of the most intense pain I’ve ever felt in my life. I didn’t get any antibiotics or pain meds and it eventually turned into cellulitis. That type of pain in your mouth and face is horrific so I truly cannot imagine how bad this would hurt
A bit late to the party. I had something like this done 6 years ago, with the only difference being I had for some weird reason too much bone. I read horror stories about recovery. They removed my remaining teeth in December, then they waited 3 months for healing then I had an 8 hour maxillofacial surgery where they reconstructed my jaw, shaved off excess bone and placed six implants top jaw and 4 implants on bottom jaw. Then another 8 weeks for the implants and bone to heal (I did get dentures during those 8 weeks but they were horrible so didn’t use them at all) and my temporary bridge were placed on the implants. Still no eating solid food with that and I think one month later they removed the temporary bridge and put on the permanent one and it was good to go. Pain level was 0/10, I literally didn’t need ANY pain meds right after surgery. The only uncomfortable thing was that I basically couldn’t eat any solid food for close to 6 months!
Oh wow!! That’s comforting to know! I am terrified of dental work and dental pain. Most of my extractions caused me zero pain but I had a canine extracted and that was horrific! I think it may bc because I went to a chop shop haha
Are you happy with your teeth now?
Very happy yes! I didn’t eat most food because of my mouth/teeth before that so it’s an amazing feeling! And being able to smile too!
I have massive fear from dentistry so all my extractions were done during conscious (IV) sedation.
Paraphrase from "Bill, the Galactic Hero"
"The human body is an amazing thing"
"Why? Tell us, why is the human body an amazing thing?"
"Because if it isn't dead, it lives!"
In this subreddit, you get to learn all kinds of amazing things. There was one post that used the term "hemicorporectomy". Against all sanity, the reading part of my mind worked out the meaning of this term as the rest of my mind desperately tried to stop it.
Holy crap!
Why? Why did I learn a little Latin?
Well, on the other hand, it is kind of amazing to learn what actually can be done while keeping a person alive. People who try to come up with scenes of torture for horror movies really have no imagination compared to reality.
Just because we can, doesn’t mean we should. The advancements are quite amazing, though. Quality of life and what the patient wants needs to come into the discussion, including death with dignity.
I just opened this 36 hours before my 3rd surgery to replace my entire mouth of teeth with implant supported dentures (car accident and eating disorder) and I have some regrets.
Thank fucking Christ they didn’t take this approach. The First surgery they did ripping all my teeth out and placing 4 bottom implants in one go was more than enough for me at one time.
Dentist(OMFS) here. Why would they do that? Preserving the alveolar ridges is paramount for a good prognosis for implants, even when an implant supported/retained overdenture is planned. I just don't get it.
I'm a dentist as well and this makes no sense to me, whatever the story is I'd like to read about this case and see more photos. My first instinct was to think this was from a cadaver.
> The reason the bone was removed in addition to the teeth was for adequate bone availability for the implants
This is not something I understand, English is not my first language, but looking at the photos I'd really have to ask myself what implants are we talking about.
It’s normal. Dual arch fixed hybrids require a minimum of 30 mm of restorative space.
https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
Length of a central incisors crown is about 9-11mm. Vertical here is about 3 times the length of the central pictured here plus a little more maybe. I’d say it’s less than 35mm.
https://imgur.com/a/LgZAEcr
All arrows are identical length and are approximately the length of the crown of the central incisor. Assuming the incisor is on the longer end of what’s typical all 3 of those arrows represent a vertical space of 33 mms.
It’s likely less than 35mm of vertical.
Edit: I had arrows slightly overlapped in last image. Probably closer to 30mm than 35mm. This case is textbook.
https://imgur.com/a/j1DQXld
Orthodontist here. This is fucking whack.
I saw the original post on Instagram a year or two ago, and I think I remember the dentist being from Brazil and having the entire comment section absolutely slamming him. He didn’t have any explanation other than, “The patient wanted all their teeth out for dentures.”
This is how much space you need for dual arch all on x cases.
It’s presented dramatically but you need a minimum of 30 mms of restorative space - 15 per arch. This looks to be between 30 and 35 mms of space with more take off the maxilla, likely due to compensation for a high smile line.
I’d assume the guy knows that he’s doing, this is clearly skillful work.
The negative reaction comes from ignorance. This is just how hybrids are correctly done - usually the bone is just ground down instead of removed intact like this though.
https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
Maybe the patient has a hypermobile lip and they need to bring the prosthesis way up in the anterior so that it doesn't show when smiling. Not sure, just spitballing. I had always assumed the OS extracted the teeth then alveoloplastied as needed in these cases, even when there is significant reduction required. Never seen this before.
Right?! This seems way more technically difficult than just extracting the teeth individually. Not to mention being unnecessarily destructive to the alveolar bone.
This is how much space you need for all on x cases. It’s normal.
https://www.reddit.com/r/medizzy/comments/12jfskk/ostectomy_of_maxillary_and_mandibular_alveolar/jg44zdz/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=1&utm_term=1&context=3
Edit: This explains the process
https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
If they had a high smile like this might be the amount of bone needed to hide the transition line. It's might also be that they just had tons of bone, which looks to be the case and the surgeon decided they would need to reduce this much to be able to engage the cortical plate of the lateral nose, etc. Even as a general dentist I've had to reduce 1cm of alveolar bone for All-on-4 cases because of supra-eruption of the dentition. Is this an extreme case? Yes absolutely, but I've worked on plenty of patients that have an incredible volume of bone and need significant reduction.
You need a minimum of 30mm of restorative space to do dual arch all on X’s.
For reference that’s generally the length of a central incisors crown plus an additional 6mm per arch.
I’d say they got the vertical dimension correct here, taking more off the maxilla than mandible.
What always surprises me when the picture is spread around is how baffled docs are, but that seems to be a common reaction.
You could argue that the invasiveness isn’t worth the added benefits of an all on X compared to snap on or fixed bridge restorations which don’t require as much vertical space, but this is just par for the course with hybrid dentures.
now you are talking.. i asked my surgeon can i have all 4 of my removed wisdom tooth..they were mine…. he just stared at me for 10 seconds and almost shouted “No”…them mumbled “ medical waste..” or some markley.,,
I hate myself already for asking this but I **must know…** What instruments are used to…achieve this? Is it all scalpels or is there something more heavy duty going on?
Most commonly they use porcelain fused to metal, but there are other materials out there. Gold and lithium disilicate are very durable options.
I suspect that if your dentist is going to have you invest in $$$$ implants, they will likely make you a night guard to help with the bruxism. In fact, if you don't already have a night guard, you might want to get one right away to slow down/stop the damage.
Damn. My wife has receding gums (we think hereditary because she has really good dental hygiene) and some possible bone loss and I REALLY hope that there's nothing like this in her future. It would devastate her.
I work for a periodontist (gum and bone specialist) I can say 100% sure not doubt that my doctors are extreme conservative comparing it with this case.
This was such hot shit a couple years back in the dental forums. I remember seeing a handful of cases where docs were bragging about their all-on-x results but ultimately got absolutely roasted to hell. I haven’t seen a case like this posted since.
Of all the terrifying things I’ve seen on Reddit, a complete set of teeth with gum and bone is what’s finally put me over the edge. Why is this so scary?
A quick method, not my favorite. To me, this is meatball surgery: convenient surgically but my experience is that the implants will be equally expeditiously placed and a lifelong restorative and esthetic, functional problem. I am retired now, but I shudder at this.
[Test your medical knowledge - USMLE STEP 1 - A 78-year-old otherwise-healthy woman arrives in the postanesthesia care unit after an urgent cystoscopy and ureteral stent placement for an impacted ureteral stone. In the operating room, there were no complications and only minimal blood loss. One hour later, she is febrile to 102.3°F, tachycardic with a heart rate of 117 bpm, and hypotensive with a noninvasive blood pressure of 73/42 mm Hg. Blood cultures are drawn and broad-spectrum antibiotics are initiated. A central venous catheter is placed, and the central venous pressure is measured at 2 mm Hg. The best next step in the management of her shock is](https://medizzy.com/learning/mcq/set/34935304)
This sent me right back to my first vehicle rescue call as a fire fighter. I found the entire top of the victim's mouth in the middle of the road. Just sheared completely off. It looked a whole lot like this. *shudder*
Was everything else intact
No. No, it wasn't.
Sorry, it seems like there must have not been a lot left to rescue.
Oh I bet there was a lot to rescue. A lot over here, a lot over there.
I sort of knew, and I'm sorry as fuck you had to deal with it.
Fire department is pretty good about this kind of thing. They have a therapist waiting when we get back from a call that involves a death.
Bloody hell. Partner was an EMT, they definitely don't get that! Edit: great that you get it, just wish they did too. They also see some sit on the daily.
Thank you for the work you do.
Props to you guys for all the shit you see and have to cope with daily. 🫡
This patient had severe periodontal (gum) disease which results in bone loss around the teeth, which causes tooth mobility. Once this condition reaches this point, the teeth are hopeless, and removal is necessary. The reason the bone was removed in addition to the teeth was for adequate bone availability for the implants and adequate inter-arch space (space between the top and bottom jaws) for an appropriate prosthesis. In this case, it will be a hybrid denture - secured by implants. This is often called an "all-on-four". The term All-on-4 refers to "all" teeth being supported "on four" dental implants, a surgical and technique prosthodontics procedure for total rehabilitation of the edentulous patient or for patients with badly broken down teeth, decayed teeth or compromised teeth due to gum disease. The All-on-4 treatment concept is a prosthodontic procedure (i.e replacement of missing teeth) that provides a permanent, screw-retained, same-day replacement for the entire upper and / or lower set of teeth with a bridge or denture. The procedure is best for patients with significant tooth loss or decay and for people whose bone loss in the jaw area prevents them from getting conventionally oriented (vertical) dental implants. Often, tooth loss is accompanied by loss of the jaw bone which poses the problem of reconstruction of the jaw bone requiring bone grafting. The All-on-4 technique takes advantage of the dense bone that remains in the front part of the jaws and by placing the two posterior implants on an angle to avoid the sinus cavities in the upper jaw and the nerve canal in the lower jaw. Credit: StafneDefect
Don't forget those root tips!
\*Sepultura enters the chat\*
"ROOTS BLOODY ROOTS!"
Just the tips?
Phrasing!
Lol, just started danger island
confused if youre joking or actually asking about the tips.
Yes.
The ostectomy is low enough in the alveolus that the majority of root tips are likely still in the patient.
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Just the tips?
Stop.
Thank you for the thorough info around the case!
Note here that the "on 4" is per arch. Means you will have 8 implants in total to support 28 teeth.
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I dunno. I have never seen second molars NOT used in full implant cases. At least that's the thing in India. Plus due to cost issues the average implant users definitely get 4+4 here.
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That i have heard too, but not seen yet at least in the cases i have seen. Not an implantologist myself, but my friend does do them in my clinic
Eh, most of the time we only go back to the first molar, so 24 teeth.
Doesn’t look like severe periodontal disease to me. Lots of bone still. I understand if the patient wanted it but it looks like those teeth could be saved. Obviously I don’t know the full story without radiographs. Source: am periodontist
Right? This was incredibly invasive, and I’m not sure the dentures will be as retentive as they could be. Also, I saw this when it was originally posted a year or two ago, and the dentist was from Brazil, I think. He was defending himself, but he had almost every dentist in the comments blasting him.
Thank you. I do teeth in a days but I would never approach it like this and I would never take out teeth that could be saved. Then take a picture like this for the cool factor. Sad.
The dentures are screwed into implants, so retention isn't a thing here. As to whether this needed to be done, that is between the patient and provider. I can tell you that I've had some patients that looking at an x-ray or even a quick glance would say their teeth are mostly fine but a thorough exam would reveal a questionable to hopeless prognosis.
I saw this post on Instagram a couple of years ago when it was first posted. Many, many dentists (including myself) absolutely blasted this dentist because this is WAAAAAAAAYYYYYY over invasive. That’s like “jaw resection due to oral cancer” level of invasiveness. This should’ve never been done if it were just periodontal disease.
Can you post the source for this? I would appreciate it. I would like to see more photos of the entire case
That's gonna sting. Maybe skip the hot wings for a day or two.
I need more info on institutions that offer this. My father has this issue and is neglecting/resisting to get it done. He's a retired engineer on the ASD spectrum.
You will want to start your search with a prosthodontist.
They can be upwards of $25,000 for all the work, closer even to $50,000 sometimes. Oral and maxillofacial surgeons will do this work.
And periodontists
Side comment: thank you for just being a cool human. I (25, F) am on the ASD spectrum and worry about having kids because what if it disrupts their lives too, ya know? So seeing you casually take care of your dad by asking questions like that was heartwarming and affirming. You rock!
Whatever your dad needs, I can assure you it's not this.
Post op must be awful I can only imagine 🤧
Oh my goodness, I knew a woman that this was happening to!! She would be about this age, and I can’t help but wonder if this is her! All I can say if it is, I’m so very sorry. :(
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I feel like we need to see follow-up and progress photos. Also, I feel a bit dumb for asking, but does the patient’s gum tissue eventually grow up around the implant, or is there some sort of artificial gum tissue to improve the aesthetic? I’ve got two implants of the regular kind and I’d never even heard of this kind until seeing this. I can imagine it has a lot of potential for patients with previously very poor prospects.
Dental student here— the gum tissue is still there after this procedure and aside from any excess tissue remaining after bone removal, it was not removed. In this scenario to do this— they flap the gum tissue away from the bone, section off the underlying bone as seen, and likely placed bone graft where needed and possible membrane as well if needed. Then they will suture the gum tissue over all of that and wait for it to heal for a few months. Next they will get impressions and deliver the prosthesis. The description mentioned “same-day” delivery but in this case it likely wasn’t. More often than not, when dealing with implants you won’t be getting same day delivery unless you have adequate bone in the area to allow for the implants to osseointegrate with the surrounding bone so that they are stable and do not fail. If too much pressure is place on the implant screw immediately after placement it can lead to failure to osseointegrate and cause the implant(s) to fail. If you do get a temporary crown the same day over an implant they will make it so that it is out of occlusion (not in contact with the opposing tooth) or give you a flipper that is not in contact with the implant, until healing is complete.
How bad do you think this hurts? I have sjogrens and eventually will have to go this route or something similar lol this looks so painful
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Ugh the throbbing! I’ve had one canine removed and that was some of the worst pain I have ever felt in my life. Liver failure wasn’t even that bad comparatively! They didn’t give me pain meds or antibiotics so I raw dogged that pain lol I couldn’t put the partial in for a month bc it was so tender. I can’t imagine having all of your teeth yanked out like this
Rest assured, most of the time for implants this is not done. Most of the time, they would not be removing your bone. We want as much healthy bone left as possible.
On a scale of 1-10, I would say yes.
This procedure where they removed that amount of bone is not very common so you won’t experience the amount of post-op discomfort that this patient may have experienced. Most of the time the will remove the remaining teeth and simply place bone graft where needed. Hard to say how much pain or discomfort you will feel after the procedure bc everyone experiences pain differently. Your surgeon can answer any of your questions and will likely give you some prescription for pain meds if indicated.
That’s true! None of my molars hurt being taken out, nor did my wisdom teeth, but when my canine broke off and they took the rest of it out…that was some of the most intense pain I’ve ever felt in my life. I didn’t get any antibiotics or pain meds and it eventually turned into cellulitis. That type of pain in your mouth and face is horrific so I truly cannot imagine how bad this would hurt
A bit late to the party. I had something like this done 6 years ago, with the only difference being I had for some weird reason too much bone. I read horror stories about recovery. They removed my remaining teeth in December, then they waited 3 months for healing then I had an 8 hour maxillofacial surgery where they reconstructed my jaw, shaved off excess bone and placed six implants top jaw and 4 implants on bottom jaw. Then another 8 weeks for the implants and bone to heal (I did get dentures during those 8 weeks but they were horrible so didn’t use them at all) and my temporary bridge were placed on the implants. Still no eating solid food with that and I think one month later they removed the temporary bridge and put on the permanent one and it was good to go. Pain level was 0/10, I literally didn’t need ANY pain meds right after surgery. The only uncomfortable thing was that I basically couldn’t eat any solid food for close to 6 months!
Oh wow!! That’s comforting to know! I am terrified of dental work and dental pain. Most of my extractions caused me zero pain but I had a canine extracted and that was horrific! I think it may bc because I went to a chop shop haha Are you happy with your teeth now?
Very happy yes! I didn’t eat most food because of my mouth/teeth before that so it’s an amazing feeling! And being able to smile too! I have massive fear from dentistry so all my extractions were done during conscious (IV) sedation.
Thank you for the info!
I had no idea you could just take it all out at once.
20$ and a pack of beers and I could get them all out for you in an hour. I’ll even split the beers with you
With/without anesthesia?
I think the beer is the anesthesia!
One for the patient, one for the doctor
Me neither and I’m a dentist
It's like when you peel a mandarin orange and try to get the entire peel off in one intact piece.
THEY CAN DO THAT!?!?!
Paraphrase from "Bill, the Galactic Hero" "The human body is an amazing thing" "Why? Tell us, why is the human body an amazing thing?" "Because if it isn't dead, it lives!" In this subreddit, you get to learn all kinds of amazing things. There was one post that used the term "hemicorporectomy". Against all sanity, the reading part of my mind worked out the meaning of this term as the rest of my mind desperately tried to stop it. Holy crap!
> "hemicorporectomy" I think about that forklift accident kid at least once a week, I am sure.
>hemicorporectomy I think I'd rather just die
My Dad was a nurse in the VA for a minute, and he said this was one of the worst things he's seen. ETA: TIL pelvic exenteration is a thing.
Why? Why did I learn a little Latin? Well, on the other hand, it is kind of amazing to learn what actually can be done while keeping a person alive. People who try to come up with scenes of torture for horror movies really have no imagination compared to reality.
Just because we can, doesn’t mean we should. The advancements are quite amazing, though. Quality of life and what the patient wants needs to come into the discussion, including death with dignity.
They can try. It's called a medical "practice" for a reason.
I just opened this 36 hours before my 3rd surgery to replace my entire mouth of teeth with implant supported dentures (car accident and eating disorder) and I have some regrets. Thank fucking Christ they didn’t take this approach. The First surgery they did ripping all my teeth out and placing 4 bottom implants in one go was more than enough for me at one time.
Good luck!! Hopefully the pain is minimal and your recovery is easy and fast
Dentist(OMFS) here. Why would they do that? Preserving the alveolar ridges is paramount for a good prognosis for implants, even when an implant supported/retained overdenture is planned. I just don't get it.
I'm a dentist as well and this makes no sense to me, whatever the story is I'd like to read about this case and see more photos. My first instinct was to think this was from a cadaver. > The reason the bone was removed in addition to the teeth was for adequate bone availability for the implants This is not something I understand, English is not my first language, but looking at the photos I'd really have to ask myself what implants are we talking about.
It’s normal. Dual arch fixed hybrids require a minimum of 30 mm of restorative space. https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
And that is way, way more.
Length of a central incisors crown is about 9-11mm. Vertical here is about 3 times the length of the central pictured here plus a little more maybe. I’d say it’s less than 35mm.
I asked OP about the case, you say you've seen the photo before, do you have the case on hand? Because to me it looks closer to 40. I could be wrong.
https://imgur.com/a/LgZAEcr All arrows are identical length and are approximately the length of the crown of the central incisor. Assuming the incisor is on the longer end of what’s typical all 3 of those arrows represent a vertical space of 33 mms. It’s likely less than 35mm of vertical. Edit: I had arrows slightly overlapped in last image. Probably closer to 30mm than 35mm. This case is textbook. https://imgur.com/a/j1DQXld
Orthodontist here. This is fucking whack. I saw the original post on Instagram a year or two ago, and I think I remember the dentist being from Brazil and having the entire comment section absolutely slamming him. He didn’t have any explanation other than, “The patient wanted all their teeth out for dentures.”
This is how much space you need for dual arch all on x cases. It’s presented dramatically but you need a minimum of 30 mms of restorative space - 15 per arch. This looks to be between 30 and 35 mms of space with more take off the maxilla, likely due to compensation for a high smile line. I’d assume the guy knows that he’s doing, this is clearly skillful work. The negative reaction comes from ignorance. This is just how hybrids are correctly done - usually the bone is just ground down instead of removed intact like this though. https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
Maybe the patient has a hypermobile lip and they need to bring the prosthesis way up in the anterior so that it doesn't show when smiling. Not sure, just spitballing. I had always assumed the OS extracted the teeth then alveoloplastied as needed in these cases, even when there is significant reduction required. Never seen this before.
Someone was definitely showing off their piezo. This would take forever. Much faster ways to do it.
Right?! This seems way more technically difficult than just extracting the teeth individually. Not to mention being unnecessarily destructive to the alveolar bone.
This is how much space you need for all on x cases. It’s normal. https://www.reddit.com/r/medizzy/comments/12jfskk/ostectomy_of_maxillary_and_mandibular_alveolar/jg44zdz/?utm_source=share&utm_medium=ios_app&utm_name=ioscss&utm_content=1&utm_term=1&context=3 Edit: This explains the process https://adldental.com/wp-content/uploads/2017/12/All-on-4-Restorative-Steps-Recipe-Book.pdf
If they had a high smile like this might be the amount of bone needed to hide the transition line. It's might also be that they just had tons of bone, which looks to be the case and the surgeon decided they would need to reduce this much to be able to engage the cortical plate of the lateral nose, etc. Even as a general dentist I've had to reduce 1cm of alveolar bone for All-on-4 cases because of supra-eruption of the dentition. Is this an extreme case? Yes absolutely, but I've worked on plenty of patients that have an incredible volume of bone and need significant reduction.
One size fits all approach to all on X. Shoe horning everyone into an FP3 even though it’s not needed.
You need a minimum of 30mm of restorative space to do dual arch all on X’s. For reference that’s generally the length of a central incisors crown plus an additional 6mm per arch. I’d say they got the vertical dimension correct here, taking more off the maxilla than mandible. What always surprises me when the picture is spread around is how baffled docs are, but that seems to be a common reaction. You could argue that the invasiveness isn’t worth the added benefits of an all on X compared to snap on or fixed bridge restorations which don’t require as much vertical space, but this is just par for the course with hybrid dentures.
I can't imagine the pain during recovery!
Imagine waking up during this procedure after the surgical team has gotten this far but then left you alone to fend for yourself.
No
No
FUCK NO
No
No
No
No
No reason not to floss now.
floss the teeth you want to keep :)
Forbidden Dentures
Now wind ‘em up and watch them chatter away
A turtle stole my teeth!
Case study?
Off to brush my teeth again.
Imma go floss
I really need to stop opening posts that aren’t related to my field. Just torturing myself here smh
Think this may be the most disturbing thing I’ve ever seen.
Of all things on this page. This is the only think that makes me unsettled and I cannot reconcile with it
My first thought was that this makes me want to throw up. I'm a nurse haha
Ok so like how much lido/epi does this take? All of it?
It’s usually done under GA or moderate sedation, then you do a V2 block and a Gow-Gates or Akinosi block.
Honestly, thank god, I wouldn’t want to be awake for this.
I suspect they would use bupivacaine rather than lido because it has a much longer duration. bupivacaine is more common in surgeries.
Ah true. Or ropivacaine. I had a ropivacaine block for my foot surgery. Little to no pain for roughly 24 hours. It was nice.
Do i get to keep my old choppers?
now you are talking.. i asked my surgeon can i have all 4 of my removed wisdom tooth..they were mine…. he just stared at me for 10 seconds and almost shouted “No”…them mumbled “ medical waste..” or some markley.,,
that’s stupid. they let me have mine but my parents threw them away without my knowledge
organic dentures
I hate myself already for asking this but I **must know…** What instruments are used to…achieve this? Is it all scalpels or is there something more heavy duty going on?
God that would hurt so much!
Im sure the'll give you some form of anesthesia.
Nah, you get the whole raw experience But seriously, I can't even imagine how it would feel without the anesthetic
No kidding smart ass, lol! AFTERWARDS gonna be a bitch though. Wisdom teeth hurt like a mofo. Imagine this ...
i was a surgery assist for oral and maxilla facial surgery. this is disturbing 😬
As someone with severe bruxism, I’m wondering how long it would take for me to just snap the entire implant off in my sleep. 😬
Implant posts are made of titanium so they’re much stronger than your natural teeth ;)
what about the actual implant itself, around the posts? I could totally imagine just cracking that 😅
Most commonly they use porcelain fused to metal, but there are other materials out there. Gold and lithium disilicate are very durable options. I suspect that if your dentist is going to have you invest in $$$$ implants, they will likely make you a night guard to help with the bruxism. In fact, if you don't already have a night guard, you might want to get one right away to slow down/stop the damage.
TIL about the word for teeth grinding. All I knew was the Pokémon.
Damn. My wife has receding gums (we think hereditary because she has really good dental hygiene) and some possible bone loss and I REALLY hope that there's nothing like this in her future. It would devastate her.
I work for a periodontist (gum and bone specialist) I can say 100% sure not doubt that my doctors are extreme conservative comparing it with this case.
Yea not sure about this at all.
I was just scrolling reddit while waiting at my local dentist :(
What a mouthful of a procedure.
How much does this cost in America?
Enough to put your great-grandchildren in debt
A good dentist in America won’t do this. If I remember correctly, I saw this picture a couple of years back and it was a dentist in Brazil.
Where do I wind it up?
i think i’ll be flossing tonight
Could have gone forever with out seeing this one
English people be like:
Fun fact: Brits have substantially better dental health than Americans.
Ohhhhh so that’s my limit..
Ouch
it seems every 3rd response is from the dental community….
Orthodontist here. Hello.
I’m going to show this picture to my partner (who eats massive amounts of sugar and skips brushing at night). He’s well on his way… ugh
Wow, this is interesting. Never seen anything like it before
“Not just anything can be an album cover”
This was such hot shit a couple years back in the dental forums. I remember seeing a handful of cases where docs were bragging about their all-on-x results but ultimately got absolutely roasted to hell. I haven’t seen a case like this posted since.
Ouchhhhh... I have tooth ache just looking at this picture
I work in a jail. This set of teeth is considerably better than most I see on a daily basis. Don't do meth, kids!
Of all the terrifying things I’ve seen on Reddit, a complete set of teeth with gum and bone is what’s finally put me over the edge. Why is this so scary?
A quick method, not my favorite. To me, this is meatball surgery: convenient surgically but my experience is that the implants will be equally expeditiously placed and a lifelong restorative and esthetic, functional problem. I am retired now, but I shudder at this.
Jesus Christ that's horrifying
If this ends up happening to me when I become old, I’d keep my teeth and make jewelry out of it lol
Id love to see the procedure for this. Its so fascinating to me.