Ep. 54: All-on-4 vs. All-on-6: What Actually Matters?

Part 10:00

This is Beyond the Arches, where full-arch dentistry meets real talk. Let's get into it. Welcome back to Beyond the Arches. My name is Erica, and today I'm joined by Dr. Daniel Noorthoek. Hello. And Nadia. Hello. Hi, guys. So today we're going to be chatting about All-on-4 versus All-on-6. This is kind of a hot topic, especially something that we see in our consultations. Some people are like,

▶what is All-on-4? What is All-on-6? So Dr. Dan is here to break it down for us today. I'm here to break it down, but also you guys are here to help break it down. Absolutely. I think that rather than just pigeonhole us into All-on-4 versus All-on-6, we should break out just more of the All-on-X conversation. When I first started doing these full-arch cases, or actually even before I did any, it was All-on-4 was all it was called. And that's, as I know it, that was pretty much all that was...

was ever done was four. It was a concept that we've talked about before that was pretty much made for, in the hopes that denture wearers would have something to stabilize. You could use implants for denture wearers to stabilize a denture, a hybrid denture. Like an over-denture, snap-in denture. No, this is for a screw dent. Oh. And they created, kind of created by a guy named Paolo Malo, with no... No bell, random mark implants. And it was for people that didn't have any bone. And they actually thought, I think I've mentioned this before in the podcast, they thought that they were just going to get swarmed by patients who were dentures, and that wanted this, that wanted some screwed-in teeth. And they actually found out, and we see it as well, that denture wearers are sort of hard to convert. A lot of them are, once they're in a denture, and they're kind of through the painful part of...

▶The reality that something's removable, they kind of get through it and comfortable enough where they don't really seek getting it messed with. So, interesting thing that they learned that we still see true today. Most of our patients are end-of-life dentition, if you will. But anyway, I digress. And it was meant for... Really, the process was sort of described and created for people that didn't have any bone thickness. Length, etc. And it turns out that it works really well for people that do have bone and don't have bone. And then just really in the last 10 to 15 years, I'd say, is where the whole all-on-X versus what number of implants kind of got broken down. Nadia, can you give us some insight on what it was when you've sort of started, and where we are today, and how you've seen it sort of evolve?

Over the last decade? When I started with you, you always placed like five or six. And now you just placed four. I've seen... I don't see much of a difference as far as like final prosthetics or temporary prosthetics when it comes to four or six. I do get that question a lot. Like sometimes patients will ask me, what is all-on-four? And I'm like, I don't know. We do hybrids here. Like this is done in one. So, it's kind of a hard question to ask because I don't know whether people exactly what they do. But from what I've seen, I mean, typically it's either four or six.

Yeah. Well, there was a period... Do you remember when I went through five? Sometimes five. All the time. I see some of your five patients. Like I think 2019, you were placing five. Yeah, that's... Yes. I went six, then five, then four. Yeah. There's a couple reasons for it. First off, I started with six because...

Part 24:04

That felt good. And I didn't have a lot of experience or training in doing these cases to start with. So, putting extra screws was, you know... When you say felt good, like what do you mean? Like you just felt like... More secure. Yeah. More like, oh, I'm doing something that's unique for the patient. There's kind of two things that I notice as a common trend when I start to talk to a person that doesn't... A periodontist who's very good. Let's just use Dr. Lindsay as an example.

The two big things that I hear them talk about is, yeah, I would do those cases if, you know, as long as the protocol allowed for doing more implants. Because logically, they're thinking more is better. And then, also with Dr. Lindsay, the other thing that I hear commonly, and this is a separate podcast topic, but is, yeah, if they could just figure out how to make a set of teeth that didn't require the bone reduction. Mm-hmm. Very, very common for very initial new people. There's... Different surgeons are going to remove different amount of bone. And there is not... You do not need to destroy the bone. It's more of like a fingernail clipping than anything. There are surgeons out there that do all on X that destroy any hope that a patient may have. But there are ways to sort of minimally get away with it, to appropriately reduce. There is a...

Strengthen the material. It looks good, et cetera. Anyway, those are the two things that I normally see from a beginning surgeon. And the one being the multiple implants. And that's true for myself as well. What... The real reasons why I did that, one, I was inexperienced and didn't really know any better. And it made me feel good having extra screws. Two, to be quite candid, I didn't have to pay for any implants when I started. And I didn't have to pay for any implants when I started.

I started this back in the day when I worked for somebody. And I didn't... I hadn't placed that many implants. So that's an extra four implants per patient. Quite candidly, that's really a big reason. It felt good getting my numbers and keeping them up. But what I learned over time, and the reason why I went six to five to four, was that we were really kind of doing the patient an injustice. And actually, let me back up two seconds.

So those are the two initial reasons why I did six. The third reason why I did six, and the mostly what I talk to patients about when we discuss it with them in the consults and such, is that in the traditional methods with an old protocol, temporary, that's glued together, all of the steps to get the good information to build the zirconia, requires a lot of time and effort from myself and the prosthetic or the restorative dentist.

It also requires a lot of actual cash money to make that and or remake that again. So if you have a patient who loses an implant in a year, you and the other dentist involved in this case are now scratching a head or pointing fingers at each other. And it ends up being like this big whole disaster and hassle. And you can't go back to the patient and ask them for any more money because they've already mortgaged their house at the price that it used to be.

And so you end up overbuilding the case because in the event that you lost an implant, there was a chance that you could put those teeth back in. So when you see, when I see a person pushing for six or seven or five or, you know, pushing for an absolute minimum number that's more than four, what I'm seeing is either inexperienced because they're just getting started. They want to build their numbers up or they're just not confident in the four.

Haven't done enough cases to be confident or they're protecting themselves and buying themselves an insurance plan. And for me, I felt, I still felt good about the way I was treating patients because it was the best way to flow through everything. But now that the whole scenery has changed, the whole world has changed in the advent of digital dentistry and owning a lab, et cetera, that it doesn't cost me enough for it to be a problem to put less implants in. And so I think that's one of the things that we have to do. And I think that's one of the things that we have to do. And I think that's one of the things that we have to do. And I think we then can be more altruistic, if you will, about the number of implants we place. And so for us, when we go into a surgery, anyone that does surgery with Dun & One and myself, what we're looking at is what is the appropriate amount of implants versus maxing out or minimizing out something. Yeah. I never really thought about it in that view, I guess, especially the fight side of things, because obviously as Dun & One, we kind of have a global set fee that, you know, if you always tell everybody in our consultations as well, if you need an additional implant thrown in there during surgery, you would do it. It's not no additional fee. It's just whatever you see is the best call or Dr. Hauer sees is the best call. But obviously that puts patient at risk for if you have six versus four, you have that percent, whatever that percent is of if you have an implant fill, you're, you have two more to worry about at risk. And then if you have to replace them, whatever the fees are that. And then on my end, it's trying to design around six holes versus four holes. Yeah. And I actually ran into that, um, last week, um, designing a case that had six implants and it was like, okay, well I can make it everywhere. There's a lot of holes. Yeah. It's, it's a lot, it's additional holes. It's additional fees and stuff like that.

▶And our warranty actually covers implant replacements. So it's thankfully not something that patients have to worry about, but I can definitely see that being like a, an easy upcharge for another office. Yeah. Rather than the way I tried to look at the way we approach the world is very Lego based. So build a model of say a millennium Falcon, that model can have parts and pieces removed and it's very replaceable and very fixable. If it breaks, you can fix it very easily with a standard set of components that makes it so that it's still that model, but fixed.

And quickly and easily versus say it was, um, I can't think of a brand right now, but like a, you know, 10 year olds model that you have to glue and paint and all of that. That's what it used to be. And when that falls on the ground, that's a much bigger problem

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than we find today. Is it always six on the top and six on the bottom, or can it be six on the top and four on the bottom? Um, different people have different routes. Then you're getting into the materials that you restore on the bottom. Um, with a number of implants, there's a lot of forces at play that people don't think about. So you've got torquing forces, um, twisting forces rather that are on your bone, your jaw from opening, closing, chewing, et cetera, right? With the muscles and those torquing forces can put pressure on zirconia and flex them in a way that they don't want to flex. And if you put say six implants, that means you're more or less, are we going to go be going further back? And by going further back, you're going into the areas of the bone that are much more susceptible to those torquing forces.

So there's a lot of positions and things that we're thinking about when we're talking about putting implants in, you know, um, Nadia was probably part of this. Let's, let's go through this real quick. So when you and I would put six implants in a case back in 2016, um, we were using more or less as standards, 10 millimeter and 11 millimeter implants, right? So a little bit shorter. We, we now put pretty much as a standard of 13 or 11 and a half.

And anyone that's a dental professional right now is saying, well, 10 is all you need. I understand that, but it is nice to have a little bit of a longer implant. So you compromise by putting more implants in, um, you're putting in sort of shorter implants than you could cause there's more, there's less space to go around. And then the other thing I was going to bring out is how many sinus lifts have you and I done to accommodate for getting that fifth and that sixth implant a little bit further back?

Yeah. Back in those days, it was a lot more. It's at least, it's well over a thousand, I would say. Yeah. ▶It was almost as part of a routine thing was, was having enough bone to put an implant in, into the, in through the sinus, but we would, um, lift it in such a way that we could use an implant for the. back because there wasn't enough space for the six. We did that daily. Um, and that was, that felt good. You know, a lot of these things are the people doing the surgery need like to feel good about themselves. We all have egos, unfortunately. And so doing more implants and doing more sinus lifts is an ego feels good thing for the surgeon. Right. Um, so I have a question actually, cause sometimes we get this at our office too. Some patients are like, Oh, I need to throw an extra implant in there because for that last molar or yeah, for that last tooth, if you had an additional implant in there, would that have anything to do with the amount of teeth that are on our prosthesis? Not really. So, um, the first thing is, uh, the reason why I got away from the sinus lift situation wasn't because things weren't working well with sinus lifts.

Those are very pretty straightforward. They're pretty smooth and easy. They didn't add a lot of stress to them. They didn't add a lot of stress to them. They didn't add a lot of stress to surgical time. Um, but over time I realized that if you have an implant failure or a problem going back into that sinus would become a problem if you had already messed with it. So we like to leave that intact as a future, Hey, I got you. No, Hey, we could do this to fix it. Um, but going into your question, if, if you get further spread on those implants, be a sinus lift, or let's say the person comes in with, with plenty of bone, you're still dealing with a lot of that, um, torquing force that the implant is further back. Therefore you're still going to have that torquing force issue. So for the functionality you gain in the extra teeth, you don't really gain, you don't really gain a lot of extra functionality in the extra teeth, but you put a lot more at risk because of the restoration being able to not be able to withstand that pressure. Sure. Okay. Um, and so when we go, when we, when I'm looking at the number of implants, so you may ask, okay,

so for so great, I ended up with five with Dr. Noorthoek in 2024, um, or six, you know, I must,

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I must've been a really bad scenario. Um, and the answer is not really that right. Okay. Um, we go in with us pretty much open eye, uh, CT scans give us sort of the, a lot, like if you're taking a road trip, CT scans give us the map quest for those that are old enough, the map quest to where they were going. Wow. You just showed your age. I know. Don't drag me. Um, you're right in there too, girly. Um, I was doing something the other day and I, your, your, um, birthday came up and I was like, Oh, she's right around me. Um, but, uh, the year of your birth, actually, not just your birthday. Um, at any rate, it's, that's the roadmap, right? So we all have a plan. Let's just say I'm from Michigan. Let's say I want to drive home to Michigan. I can follow that map, but guess what?

In 1200 miles, the odds that there's going to be a traffic jam in Atlanta or a detour from unknown construction, et cetera. You can only have so much of a plan till you get punched in the face. Uh, and that plan sort of needs to stay open and ready to be able to, uh, accommodate for different changes, which is why we fit best in a global fee. And I'm not going to tell you, I a hundred percent guarantee we're going to do four or a hundred percent guarantee we're going to do six or maybe charge you for the extra two and then find some reasoning because of that extra two charge that I'm going to put it in there.

So we try to go in there with a clean slate. We're not just trying to be cheap. Cheap. So the kickover to Nadia is, um, when we would go, when we would do these cases, you know, from surgery, I mean, there's sometimes when you go to put an implant in and it ain't going to happen there. Nothing. Yeah. Infections probably. What would you say is the number one reason why we have to work around a space and add, say an extra implant or add extra support?

Bone quality. Like if they have like what you call soft bone or not enough bone from maybe like an infection that was present. It was eating away the bone. So you wouldn't place it in that area. Yeah. I would say that's definitely number one. Number one is definitely, um, infection. You could, you can maybe see on the CT. Oh, that looks like it's not so great, but I'm going to have to figure it out. Those are the things. And sometimes let's just say it was the tooth that we like to put it in, which is the lateral incisor.

▶We still have good bone on either side and we can still build up that bone, that's the reason why I say if I end up putting five or six in, you're not any worse off. It just means that that place that day today is not the right spot. And so working around that and then restoring that infected site is important because we want to be able to use that in the future for if we need to replace something. We get this comment a lot during like our consultations too, because some patients say, oh, I consulted with X, Y, and Z. They told me they were going to do six implants.

Why are you telling me you're going to do four? So it gets a little confusing and for, you know, the average person to kind of figure out what is the benefit of this. Great. And exactly sort of on the point of just like, what is the intention of us talking today? Right. It's not to demonize six and it's not to demonize anyone that pitches on six. The correct, what, what I genuinely deeply feel is the correct number is what was appropriate in your case. So it's not to demonize six and it's not to demonize anyone that pitches on six.

So to be able to just say blanket statement, you're going to get six. That doesn't mean that that's right now. Right. And what, by comparison, we're a hundred percent, we're six. What would you say you see now as a five or a six? Not very many. Half of a percent. Yeah. Half of a percent. Yeah. So there, you know, half of a percent of the time I'm going to add more. Um, but, but the, again, you don't know what that person that they went and spoke to is speaking to. So it's, dentists have a really bad habit of jumping on and saying, well, he said six for you. I would never do that. Well, you don't know what that person is coming from, where that person is coming from, or if it's appropriate or not. That's the difficult part of being a consumer in dentistry is that I could say you need seven and some other guy says you need three. Well, well, he may be right. And I may be right as well, but knowing where those people came from is, is very difficult to ascertain and pull out. So I think the only way that we can kind of make a statement is that blanket statements as a all on six center, I would be leery of that because I've, I've done, I've been an all on six blanket statement center. And you see over time,

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you see that those implants, get jammed up next to each other and implants do not like to be next to each other that close. ▶They can affect each other. I always tell people on the consult implants are like country folk. They like, they don't even like to know they have neighbors. They don't like to be able to see the next door neighbor. Whereas, uh, when you're putting six, you know, the implants are not like residents of lower Manhattan. They don't like to live on top of each other. Um, do you remember the lady, poor old lady, maybe, right? When I first started at Joel. So 2014 individual, individual implants, individual implants, implants were so close together. She was, and maybe she wasn't water picking too, but it, it just, she was not able to clean properly. It was too close. And then she had just, just a tooth on top of the implant. So it was like crown and bridge, but implant, implant, like right next thing. It wasn't her fault. No, no. And by the time we ended up seeing her, she had already worked through the system for so long that there was almost no changing anything.

[redacted]

[redacted] It wasn't all any, anything of her fault, but I, I think of

it as an example of what, what we're trying to avoid. Right. That's the scary part about the person, the same people that live in a, you know, let's say I was a, just a regular practicing periodontist. The danger is in, they want to keep that money in the clinic, not predatorily, but they want to keep that money in the clinic. And so if you need three implants, they start with three implants and then you start filling in the holes and those holes start to be an implant next to an implant next to an implant. Right. So you end up kind of going down this hill where it can't be caught and you end up in the situation that this lady did. Right. It wasn't that she was doing anything wrong.

It wasn't that, that the practitioner was doing anything wrong. She just kind of snowball rolled all the way down the hill. Yeah. And that's the fear is that if a person that's getting into the four and the five implants is that far down the road, my, my concern, we see it every day is that by the time they get to us, one, they have to find it on their own because it's very hard for that system to refer out or say, listen, you're a, you're a 10 implant gold mine and we're going to switch you to four and I'll never have to touch you again. Or they have to come out and they have to find it by themselves. And then they have to reason with it mentally. I just bought a $40,000 car and they're telling me I need to get rid of it to then replace it with another $40,000 car. That's the exact same. It's screws, right?

To them. Very confusing for the consumer. ▶So that's the, that's the other side of like the too many implants, the falling down, the rolling down. The hills, I call it. So that's, that's a big concern for me in the, in the industry is just how do we navigate and get it so that we don't just have one off full arch only centers. How do we get those patients into the full arch centers, but then the people that are going to be able to maintain and keep four implants and not get down this snowball, how do we keep those in that world as well, where they don't just seek out full arch care just because they're over it. So there's a dynamic there. That's, that's tough.

I know there's a very wordy answer to when you are looking at a center, the blanket statements concern me. I don't like blanket statements other than I'm going to start with four cause that's the minimum you want. I'll put the appropriate amount in. That includes taking in the information from my map quest, my highlighted Rand McDally Atlas and my navigation and my real world

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situation, right? You have to take all of those into account to decide where you're going to actually go with the case. Um, but our goal is always to avoid it. And the reason why, and the take home from that is number one. And most importantly, implants don't like next to be next to each other. We like to always have a backup plan for what we're going to do. If there's an issue, we don't want to plan for issues, but if there is an issue, what are we going to do?

And then something we've really kind of glossed over, we mentioned it, but I want to hammer in a little bit more is when you have more than four implants, those screw holes are two millimeters around circle, which doesn't seem like much, but by the time you had a fifth and a six, you're talking about, let's just do some quick math. Each tooth is approximately 10 millimeters wide, right? So we're going to put in 12 teeth. That's 120 millimeters. If you put in four implants, 18, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20, 20.

▶Eight of those millimeters, essentially, this is very rough math. Eight millimeters will be taken up by screw channels. You do five, 10 millimeters. You're talking about getting to 10% if you do six and seven implants. So it's a big concern. And they'll need bigger teeth. Yeah. It kind of falls into, it's funny because we just did an episode not that long ago about refresh cases and kind of explaining what our refresh cases are and just, you know, in general. And that's something that we see often too. They're usually more than four implants. Yeah. And then it comes to kind of a tricky part of the restoring process.

Yeah. Right. Depending on what implant system it is. And yeah. Do you ever find if in a case, let's just say it's an old case that I did with six implants, that you just wonder like, how am I going to fill and get the screws to engage into these channels? Because they're so close together and there's so many of them here. Like, do you ever, I guess, feel bad? They're not always like that close to each other.

Yeah. There are cases from the bone in the situation though. I've never ran into that. It's more so like the teeth in relation to the hole and ensuring that the patient has a strong enough prosthetic. So making sure that their prosthetic is not, their teeth are not too thin to where it causes a weak spot. And then they're, you know, running into issues. Which is a very important part. I know, we were kind of wrapping up, but that's a very important part. So reiterate kind of what you were saying there.

As far as... More screw holes leads to more variants and where they're going to come out. ▶Yeah. And to weaker spots, potential weaker spots in the teeth. We want a strong, big set of teeth, maybe not big, not massive, but a decent size set of teeth that patients can function with and don't feel like they have to talk around their teeth or function. Around their teeth. And so having six holes versus four holes just makes it a little more challenging to achieve a more comfortable prosthetic.

Yeah. And puts your long-term, the biggest thing from there, I think, is not just your difficulties with filling all of those access holes and the risk, the additional risk of them falling out and all of those things that come along with the restorative side, but it's the more holes equals one, more chances that it's going to fracture because it's... Yeah. In a place that it just makes the tooth thin, to what Nadia was saying. And then the bigger thing too is these materials are not infallible yet. And so the more holes you put in something, the weaker it's going to be, which goes into the console example that I always... The other console example that I always say is that you can't just say, oh, I'm going to mount this 20-inch TV on the wall, which would be ludicrous these days. Can you even buy a 20-inch TV? I'm full of...

I'm full of old school stuff today. I didn't want to use the example of an 80-inch TV, but as a comparison, if you're hanging a 20-inch TV, you're not just going to blanket put six screws in to hold that retaining piece. Likewise, on an 80-inch TV, you might need more. And it does go into how many holes are you putting into the wall? Are you creating more damage with more holes? Are you making it better and stronger? And those are the considerations that need to go in.

▶And the more screw holes you put in a set of teeth, even if it's... Let's just say it's even better for the bone. The other thing you have to consider is what's the longevity of the teeth? Because now you are not just putting a full solid block with only four holes, let's say it's six, becoming more like Swiss cheese. It's got more fail points. It's got more

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things that it can't flex and deal with. It's very much an exercise in engineering and physics. And probably the two biggest deficiencies that we have in dentistry and in dental schools is probably engineering and physics. We go through biomaterials and stuff, but this is all engineering. This is all physics. You can't just build a bridge as a blanket statement and say, I'm going to put 18 pier abutments to create a bridge. this 10 foot crick because guess what you're going to stop the flow and you're going to ruin everything underneath there's a lot of dynamics that go into it there's environmental impact that goes into it versus 18 is probably not enough if you're talking about the verizono bridge in new york it has to be engineered and made appropriate to the situation appropriate to the patient and do so in a way that doesn't encumber them and create a choice that they have to make yeah i love being able to look at them in the face and say i couldn't care less how many implants i'm going to put in because i'm going to put the right number of implants in you right yeah adding an extra implant doesn't add a lot of cost to me replacing teeth on and unnecessarily your implants going bad in the future you having big issues with the implant you're going to have to make sure that you're doing the right thing with nadia and the breaking and the and the stuff like that those are going to cause me bigger problems than anything so it's very important to choose the right number of implants rather than make a blanket statement so you know i don't typically use the comment or the term all on four all on six i do when i am trying to make these like hook type statements because they kind of are all encompassing but i i think that i really align with the mentality of all on all on all on all on all on all on all on all on all on all on all on all on all on all on x right yeah all on x is the appropriate term it just makes more sense because it's whatever you need it's whatever however your bone comes in however you come in with your bone like available bone yeah it's however much your body will be able to tolerate yeah at the time of surgery so i think that's perfect because when they ask me all on four all on x what's the difference i'm like i'm just here to put your teeth in let me make them look pretty first it's all sort of marketing all on x is used i'll say this um in the industry all on x was sort of created as a we'll say social media to social media or conference to conference scenario they didn't want me as a let's say at the time i was doing six they didn't want to alienate me from going to this all on four conference right because i'm a six guy right so they created sort of all on x to be this all in conference and they didn't want me to be this all in conference term that allows me to say i'm an all-on six or an all-on seven or an all-on five guy right well so i will i will i will say this as the caveat after we just said that it was the most appropriate term that allows me to still stay in entrenched in the blanket statements it's more of a dental term than it is anything so i'm going to make one more modification i align with all on appropriate i like that all on x is is really just an inside the dental term to allow me to feel okay sitting at the same table as somebody that's a different number than me as a blanket thing that's generally how they get us to sit at the same table or allow us to have the um description kind of where it includes both of us but i will say that i'm more of an all-on appropriate guy yeah makes sense that just makes sense it's kind of the same as all on x yeah i just wanted to make the distinction that all on x was created to allow people to stay entrenched in their beliefs of these blanket statements which i just think that the blanket statement is inappropriate yeah when i start to talk talking to somebody and they they start discussing how they make judgment calls on what is appropriate for the right number of implants i know that you've been through the ringer you know what you're doing and you're looking to do the right thing yeah are there any misconceptions that patients have about implant count oh that's all that's i mean it used to be it comes in waves sometimes it's more and sometimes it's less um but it sounds like nadia gets more of it i had headed off and have this discussion with every single patient in the consult and i believe everybody else's consults do as well where it's hey don't worry about the number we got you yeah and it's not a blanket statement it's whatever is appropriate yeah it sounds like you have more of the maybe they just not use their head not choose the right number but it's not a blanket statement it's whatever is appropriate and then they start to ask you the question so i guess you're more of the person to ask that question too yeah like it's what was the question are there any misconceptions that patients have about implant count yeah they they sometimes they think that they'll get more teeth on their prosthetics if they have more implants and that's not the case whether it was six eight four implants five implants the prosthetics still come back with the same amount of teeth maybe the upper jaw design would be a little different but it would not have an additional tooth it would just have like tissue behind that last tooth i'll show you a picture so there is nothing that we cannot do as an all-on-four office all-on-x office versus an all-on-six we are not limited in any sort of way due to the number of implants that we place no if anything it's freeing if if anything anything putting six in puts more teeth on their prosthetics so it's not a blanket statement more holes in your teeth makes it less strong makes it less capable of holding more teeth you know it's a little counterintuitive but it does not it's not one implant equals x amount of teeth it's how many implants support your full set of teeth yeah and four is just that's the sweet spot that's all you four is the sweet spot four four gives you the ability to place implants in really good bone generally long implants that are strong for the initial phase of healing and the final phase of healing and also allows spaces for you to work around problems if they do happen since we all live in a human body yeah it does not granted there are outliers but it does not affect your design of teeth at all

Part 836:04

from what i've seen it it has not at all no okay well you guys hear it here so i'm glad we were able to get some clarification kind of clear things up a little bit i know this is something that is a pretty common topic honestly in the consultations huge it's definitely interesting always kind of like explaining the difference to patients and obviously if they're told six and now we're telling them four it can be it can be a lot to handle it can be overwhelming because you don't know what would be the best um or what the difference of it honestly even is or what effects it has on your body so that was a really fun topic i'm glad we got to chat about it i hope this helps any like patients anybody who's going through consultations right now kind of understanding it a little bit better and getting to know it a little bit better and getting to know it and getting a better grasp on it yeah i mean i think it's it's taken a long time for us to even get to this episode but it is very important it's very common topic i try to avoid it as much as possible because i don't want to get in the in the scrum of fighting of somebody says oh well i did five and i have a hundred percent success okay fine i want to get in that scrum but as an example of how complex and convoluted it is i'm sure that you're sitting here and we had some some parts of this discussion where you're like well i didn't really know that and you've been in this for five years right it's more so just clearing the air we're not fighting anybody we're not saying anything this is just this is why we do what we do yeah it's our position awesome any last minute thoughts guys nope thank you very nice all right well thank you everybody for listening and join in again next week