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Great work Dr Stephen, i really like your conservative flaps..you think of patient comfort more than yours and i respect you even more for that..God bless you !
Thank you. I hope you have subscribed to DentistryMasterClasses.com. This is the best material with an organized library of all the Dental Minute videos as well as many other complete, comprehensive cases and important articles.
Terrific! Glad they are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Nice explanatory video. But few questions 1. Why not surgical metallic cannula not used rather than plastic suction? 2. Why air rotor is uesd instead of micromotor handpiece? Air rotor causes high risk of air embolism.
I use a plastic suction with a tube in the plastic straw to prevent suction of the tongue and soft tissue. A motor driven handpiece is a good idea. No problem with air embolism so long as you do not reflect the lingual tissue. Maintain keratinized, attached tissue to the alveolar bone.
It's so relaxing listening to your voice while watching your videos Dr. Cutbirth. I just had my Coronectomy last week and it was so painful. I think I felt the whole thing while they were doing it and it wont stop bleeding for 45 min 😭
What is your thoughts on lingual nerve damage doing an incision on the lingual past the mid occlusal line of the 2nd molar like you did to the DL of 2nd molar? because... all the respected surgeons I know advocate not crossing the mid occlusal line of the 2nd molar.. Here is what the research says: Furthermore, in between 4.6% and 21.0% of the cases, the LN may be situated at/or above the crest of bone [10,11,13-16]. Interestingly the less common site is at the retromolar pad region, which was noticed in 0.15 and 1.5% of the cases [11,13].
When extracting impacted mandibular wisdom teeth, I have made an incision from the DL of the second molar, extending distally to the midline, connecting with the incision from the DB, extending distally to the midline, forming a distal wedge, which is removed for proper flap closure, for 40 years with zero lingual nerve issues. That is the flap design I was taught in my 2 year oral surgery fellowship years ago.
I have been using regular water in my handpieces for over 40 years and have never had an infection post surgery. The water is clean and chlorinated. Think about the saliva, etc. in the patients mouth. It full of bacteria. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
So glad the videos are helpful. I might occasionally curette the socket very carefully to remove the follicular sac, but I normally remove the remnants of the follicular sac with rongiers. You do not want to take a chance of damaging the inferior alveolar nerve. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Thank you very for such an informative, precise video clip, Doc. For those upper wisdom teeth, did you perform the greater palatine infiltrations, as well?
Infiltration and intraligamental anesthesia. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Yes, there is a greater possibility of loosing all or part of the blood clot in the socket, resulting in a "dry socket." The packing serves as a matrix to retain the blood clot. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Glad you like the videos. More coming every week. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Not that I am aware of. I have been using this method for 40 years this coming summer. I irrigate the mandibular sockets 7 days post surgery and small amounts of blood clot is irrigated out, but I see no evidence of the resorbable gauze in the socket and at the patient's 6 month recall appointment the sockets appear radiographically and clinically to be healing well. I do not want my patients to experience a dry socket, period. With this technique, I have not had a dry socket in 40 years. All bets are off, however, if the patient smokes. Those patients will often have some post op discomfort no matter what you do.
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Always a pleasure watching your videos! Instead of using resorable material like plain gut, try using non- resorable material. In that way, the sutures won't resorb which results in no food debris within the socket and no need for irrigation ..
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You can. Watch the videos in DMC.com and continually get good training. Don't ever think you are a good dentist just because you are a nice person. You must train and learn the methods.
No, the soft tissue will granulate in to fill the void in a few weeks. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
thank you for this great video may i ask why not add more sutures and leave no holes communicating between the bone and the oral cavity? ...so no need for irrigation
You want a little space in the flap for drainage. The flap is normally going to open a bit over a week no matter how tight you suture the flap, so always check the healing after 7 days and instruct the patient in irrigation after the connective layer has formed in the socket.
Just do not use a burr past the apex of the pulp chamber if you must section the tooth. Make a cut to the apex of the pulp chamber, then use an elevator to fracture the tooth into mesial and distal pieces. I do not recommend a dentist perform surgical teeth extractions unless they have had hands on instruction. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Fantastic videos, Dr. Cutbirth. I have read a couple articles from 2012 (Anisha et al., Manoj et al.) that discussed closure by secondary intention when suturing for impacted third molars. Is there a particular reason why you favor primary closure--maybe to prevent food impaction or something--or is it just a personal preference? Thanks!
With secondary intention healing there is a large open wound, allowing more bleeding as well as a food and debris trap. Suturing the flaps closed helps stop bleeding with less debris accumulation in the extraction site. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
That conservative surgical approach is sublime Unfortunately, i didn't fully master it yet .. and still need to remove some bone to release the tooth But i have a question please.. do u always use the regular high speed handpiece for surgery ?
No, I sometimes use a regular slow speed straight handpiece with a long shank surgical burr or a motor driven handpiece. With a high speed handpiece you must be sure not to use a light touch with lots of water and to not reflect the attached gingiva on the lingual surface or you could get an air embolism.
Hi Dr. Steven. I would like to ask why is it important to remove the follicular sac? What will happen if you’re not able to remove it, after odontectomy? Thanks and more power!
There is danger of formation of a dentigerous cyst, which could then develop into an ameloblastoma, which can be a big problem. These pathologies are not common, but you do not want them to occur. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Both. The electric is definitely smoother and more powerful. The air driven have the smaller heads which are nice in tight spaces. I have had air driven so long, I have not replaced them simply because they continue to work well. I set 3 high speed handpieces and 1 slow speed hp for more involved procedures.
Watch my many videos on impacted wisdom teeth extractions in the library of DMC.com. I can show it in those videos better than I can explain it to you with words. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Thank you for sharing your knowledge with us! What kind of coolant do you use for your high speed handpiece while performing dental surgery? Is tap water acceptable or only sterile saline? Thank you in advance. I have deep respect for your work and I hope one day I can also become an expert in multiple specialties of dentistry like you are!
While suturing the wedge design flap, wouldn't it exert pressure on the wound or may cause limited mouth opening in future? I suggest vertical incision to mesial of wisdom to buccal & buccally placed crestal incision. Please do comment doc. love your work.
I have been suturing like this for 40 years and have never had a problem with limited mouth opening or any other problems I am aware of. Keep procedures as simple as possible. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
In what circumstances do you choose to use the motor driven straight handpiece instead of high speed air driven handpiece? I always found that those straight motor driven handpiece is difficult to angulate and position properly compared to the regular air driven hand piece.but im worried of air embolism if i use the regular air driven handpiece as i was taught not to use those for minor oral surgery at school. Thank you for your generous sharing !
The important thing in not getting an air embolism from a high speed, air driven handpiece is not reflecting the lingual flap into the unattached, non-keratinized gingiva. So long as the lingual flap, keratinized gingiva is firmly attached and in place you do not have to worry about an air embolism. I only use the straight slow speed handpiece when the angle is better with that handpiece than the high speed contra angle, such as making a straight hole into a maxillary third molar so I can place an instrument in the hole and elevate the tooth. You are correct, the angle is usually not right to use the straight handpiece in most surgeries.
@@centerforard That really clarifies alot. Appreciate your effort in posting up all these educational videos and replying each of our questions in detail!
Ideally, place either PRF or a resorbable collagen membrane over the perforation. Tell the patient not to blow their nose for 3 months. Place them on antihistamines, decongestants and nasal spray for at least 3 months. Oral astral communication is common following maxillary molar extraction because maxillary molar roots are often in the sinus. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hi DOC i had all my wisdom tooth pulled the question is. My right bottom molar last tooth on the right is a little loose it has a crown on it. the Dentisy says the tooth needs to pulled. Does loose teeth if not infected have to be pulled in your professional opinion if it's not infected?
High speed, but I am careful not to reflect the attached gingiva, especially on the lingual. I prefer a high speed to a slow speed because the slow speed is harder to control. A Striker handpiece is often used by oral surgeons. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hi Doctor, I saw a research paper done on a novel technique to extract impacted third molars called "implosion technique", which might be the same as "inward fragmentation technique". I'm wondering if you're familiar with it. It involves very minimal bone removal because you drill a hole into the tooth, collapse the walls and then pick them out through the small opening rather than having do a large guttering for the sectioned pieces to come out. What are your thoughts on it?
I am not familiar with that technique. I always try to minimize bone removal and cut the teeth into sections and remove the smaller sections so a larger hole is not needed. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
A bit of both. Be sure to use lots of water and a light touch and do not reflect the attached gingiva on the lingual alveolar process so you do not risk getting an air embolism. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Impacted mandibular and maxillary third molars can lead to bone loss between the impacted tooth and the adjacent second molar and a dentigerous cyst can form around the impacted tooth, potentially leading to an ameloblastoma. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Yes, most of the time I suture maxillary third molar extractions unless the tooth is extracted straight out of the socket with no tearing of the soft tissue. I do not want the patient to have a bleeding problem post op when they leave my office. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Hi Dr. Cutbirth, thank you for great video Someone or some textbooks prefer to section the tooth through the furcation into mesial and distal part, while others prefer to section the crown. I'd like to know which one is better or easier? During cutting the mandibular third molar, how to overcome the situation that the maxillary teeth block the approach of handpiece?
Depends on the angle of the impacted lower tooth. If the tooth is a complete horizontal impaction, section the crown off the roots. If the tooth is angled similar to the ones in this video, always section vertically to the furcation. I will have a video in DentistryMasterClasses.com library soon on removal of horizontally impacted mandibular third molars.
I use both high speed air driven and a motor driven handpiece for surgery. I am always concerned about and avoiding surgical complications. I am not concerned about air emphysema so long as the lingual attached gingiva remains unreflected and intact, firmly attached to the bone.
In what circumstances do you choose to use the motor driven straight handpiece instead of high speed air driven handpiece? I always found that those straight motor driven handpiece is difficult to angulate and position properly compared to the regular air driven hand piece.but im worried of air embolism if i use the regular air driven handpiece as i was taught not to use those for minor oral surgery at school. Thank you for your generous sharing !
I need help I have a long roots pretty front teeth a little overbit and an (overlapped) front canine But it’s only 1 on my left side of my (frontbuck teeth) lol but I believe I have a crossbite or tmj and to top it off I had my first primary permanent tooth pulled yes only 1 wisdom tooth pulled?? 350? No x-ray and during exam he pointed out that I had a really bad cavity or root canal tried to pull my mom up to look like she does this and came back in the room after extraction showed a graphic root canal picture on Google with the iPad flipped toward us? : ( I got the tooth extracted with Roseman for free and they extracted the first left anterior premolar and the other wisdom tooth since I was already missing one?? Now I am now missing 3 posterior molars teeth and still have my bottom wisdom teeth. And I just don’t feel right and I know no one can just help! I feel like the Jogger with to different length of legs. And my parents and medicaid decided that it’s only one tooth so I don’t matter she be fine. But that’s not to mention the PTSD and trauma I’ve been through the past for five years and that’s two babies one physically . Sincerely thank you for your calming it’s very easy to interpretation your lessons bc you simplify everything thank you for your amazing video.
Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I would suggest a resorbable collagen membrane to cover the bone graft. It lasts about 3 months, so the bone growing into the socket has a nice head start on the soft tissue.
I'm not sure why the intro song was not on this video. I agree, that and the "Subscribe" part of the videos are my favorite parts of the DM videos. My youngest daughter is a singer/songwriter and wrote and sang the DM song and does the "Subscribe" part at the end.
The packing material is listed on the video. It serves as a matrix for the blood clot to prevent blood clot loss from the socket during the first 7 days post op, which is the reason for a dry socket.
Sir, can we extract all four wisdom teeth in single visit.In india after extraction of right side we wait atleast a month ,as if we remove all four at once , patient can not chew food on any side.
Yes, I always extract all the teeth needing extraction at the same appointment. This prevents the patient from having to undergo a second procedure, sedation and 2 recoveries. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Thank you. I hope you subscribe to DentistryMasterClasses.com. There is an organized library of all the Dental Minute Videos plus many other complete comprehensive cases.
Just to be sure the teeth are completely anesthetized. I want predictability with all procedures, especially with local anesthesia. So many patients come into my practice reporting "my dentist could not get me numb." A PDL injection with Citanest 4% plain without vasoconstrictor with a 30 gauge needle, in addition to the normal maxillary infiltration and mandibular block, anesthetizes the tooth completely. No patient ever complained that "you got me too numb." Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I whish I could work with you together. After years of studying in Germany it is not allowed to me to work as a dentist. I passed 15 of 16 tests in the last exams. 8 years wasting time 😢
So sorry. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
I personally don't like to use air rotor to cut the bone/tooth instead you should use Contra angle motor-driven handpiece Air embolisum in tissue takes 25 days to heal completely and its very discomforting to the patient
You are correct. I am making these videos for the regular dentist, and most of them, especially in other countries, may not have a contra angle motor driven handpiece. If you cut the bone with a high speed hp, you must use a very light touch and copious water. Additionally, you must not reflect the attached gingiva, especially on the lingual. These surgical videos are not intended for use by dentists with no training in surgery. They are intended to enhance the skill of those dentists who have had hands on surgical training. I state that in the surgical videos. Thank you for your comments.
I don't know about that, but what a nice thing to say. Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Great. I was taught to remove a distal wedge of soft tissue so the flaps approximate after the third molar is removed. If you do not remove a distal wedge, there is too much tissue in the flap following impacted wisdom tooth removal and the flaps do not approximate ideally. They "bunch up." Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
I most often extract single rooted cuspids and premolars with the "Easy X tract" system if I am placing an implant to replace the tooth. This system removes the tooth vertically, straight out of the socket without damaging the facial bone. I have a Dental Minute video on the system.
Subcutaneous emphysema is the actual name of "air being forcefully pushed into the submucosal spaces, leading to tissue distention." Occasionally I get my "tongue tangled" and misname something. Sorry if this was one of those moments. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513
Something about the way you talk makes me feel calm. Like no case is going to be difficult anymore. May God bless you Sir.
Thank you.
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"Cut the tooth not the bone" best 😍🦷
Your voice 👌
Love from india.
Thanks. Glad you like the videos. I hope you have subscribed to DentistryMasterClasses.com. My best videos.
Already did .😍
Hey boss my jaw is is not huge enaugh for back theeth and while it growth it do. So much pain should i remove it ❓@@centerforard
Great work Dr Stephen, i really like your conservative flaps..you think of patient comfort more than yours and i respect you even more for that..God bless you !
Thank you.
We have a lot to learn from you! Thanks for sharing this “secrets“ with us! Happy holidays !
Thank you. I hope you have subscribed to DentistryMasterClasses.com. This is the best material with an organized library of all the Dental Minute videos as well as many other complete, comprehensive cases and important articles.
Thank you Dr. Cutbirth. This was one of the best video on wizzie ext.
Thank you. glad you liked the video.
Thank you Dr. Stephen , today I followed all your steps and I was able to Ext #17. Your dental minute videos are dental life savers.
Terrific! Glad they are helpful.
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Nice explanatory video. But few questions 1. Why not surgical metallic cannula not used rather than plastic suction?
2. Why air rotor is uesd instead of micromotor handpiece? Air rotor causes high risk of air embolism.
I use a plastic suction with a tube in the plastic straw to prevent suction of the tongue and soft tissue. A motor driven handpiece is a good idea. No problem with air embolism so long as you do not reflect the lingual tissue. Maintain keratinized, attached tissue to the alveolar bone.
It's so relaxing listening to your voice while watching your videos Dr. Cutbirth. I just had my Coronectomy last week and it was so painful. I think I felt the whole thing while they were doing it and it wont stop bleeding for 45 min 😭
So sorry. I suggest you contact your dentist and let the dentist tell you what to do about the bleeding.
Sir, you make the best videos. Thank you!
Glad the videos are helpful.
What is your thoughts on lingual nerve damage doing an incision on the lingual past the mid occlusal line of the 2nd molar like you did to the DL of 2nd molar? because... all the respected surgeons I know advocate not crossing the mid occlusal line of the 2nd molar..
Here is what the research says:
Furthermore, in between 4.6% and 21.0% of the cases, the LN may be situated at/or above the crest of bone [10,11,13-16]. Interestingly the less common site is at the retromolar pad region, which was noticed in 0.15 and 1.5% of the cases [11,13].
When extracting impacted mandibular wisdom teeth, I have made an incision from the DL of the second molar, extending distally to the midline, connecting with the incision from the DB, extending distally to the midline, forming a distal wedge, which is removed for proper flap closure, for 40 years with zero lingual nerve issues. That is the flap design I was taught in my 2 year oral surgery fellowship years ago.
Hey doc so the irrigant you use for your surgical handpiece isn't saline ? Wouldn't regular water pose as a contaminant for the surgical site?
I have been using regular water in my handpieces for over 40 years and have never had an infection post surgery. The water is clean and chlorinated. Think about the saliva, etc. in the patients mouth. It full of bacteria.
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I love your videos! They helped me a lot! Thank you!
On this cases you dont currete at all apicaly?
So glad the videos are helpful. I might occasionally curette the socket very carefully to remove the follicular sac, but I normally remove the remnants of the follicular sac with rongiers. You do not want to take a chance of damaging the inferior alveolar nerve.
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Thank you ,doctor. You are the best
Thank you. I hope you subscribe to DentistryMasterClasses.com.
Thank you very for such an informative, precise video clip, Doc. For those upper wisdom teeth, did you perform the greater palatine infiltrations, as well?
Infiltration and intraligamental anesthesia.
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So nice to wach your video.
But if we are suturing without placing a pack is there a possibility of dry socket to increase ?
Yes, there is a greater possibility of loosing all or part of the blood clot in the socket, resulting in a "dry socket." The packing serves as a matrix to retain the blood clot.
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Great video sir.And out standing explanation.Expect more videos.
Glad you like the videos. More coming every week. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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tnx doctor for your very informative videos.doesn't this packing technique delay healing?like gelfoams?
Not that I am aware of. I have been using this method for 40 years this coming summer. I irrigate the mandibular sockets 7 days post surgery and small amounts of blood clot is irrigated out, but I see no evidence of the resorbable gauze in the socket and at the patient's 6 month recall appointment the sockets appear radiographically and clinically to be healing well. I do not want my patients to experience a dry socket, period. With this technique, I have not had a dry socket in 40 years. All bets are off, however, if the patient smokes. Those patients will often have some post op discomfort no matter what you do.
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Do you have a video where you remove the follicular sac? This might be a silly question but how do you look for them without damaging the IAN?
With wrongers. Do not curette the socket of a mandibular third molar.
Always a pleasure watching your videos! Instead of using resorable material like plain gut, try using non- resorable material. In that way, the sutures won't resorb which results in no food debris within the socket and no need for irrigation ..
😊
Beautiful and professional
Thank you.
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Wow! Very helpful. I wish that i can be like you in my professional career
You can. Watch the videos in DMC.com and continually get good training. Don't ever think you are a good dentist just because you are a nice person. You must train and learn the methods.
Excellent surgery!!
Thank you.
when you cut that wedge tissue off. If suturing back. will it put the tension and displace the original soft tissue location?
No, the soft tissue will granulate in to fill the void in a few weeks.
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thank u so much sir for sharing such a great videos sir
Glad the video was helpful.
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When I had my wisdom teeth cut and pulled out in 1998, I was in so much pain. I had 2 teeth pulled today and no pain and I'm eating!!
Great.
Thank you for sharing your 40 years of experience with the community. Did you always practice in one place?
Yes, only in Waco, Texas.
thank you for this great video may i ask why not add more sutures and leave no holes communicating between the bone and the oral cavity? ...so no need for irrigation
You want a little space in the flap for drainage. The flap is normally going to open a bit over a week no matter how tight you suture the flap, so always check the healing after 7 days and instruct the patient in irrigation after the connective layer has formed in the socket.
What if the Inferior Alveolar looks like its passing through the roots of the impacted molar. Is it worth attempting The surgical extraction ?
Just do not use a burr past the apex of the pulp chamber if you must section the tooth. Make a cut to the apex of the pulp chamber, then use an elevator to fracture the tooth into mesial and distal pieces. I do not recommend a dentist perform surgical teeth extractions unless they have had hands on instruction.
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Simply love watching your educational video, learned a lot. Do you have hands on course for wisdom teeth?
Subscribe to DentistryMasterClasses.com. Sorry no more hands on courses since Covid.
Fantastic videos, Dr. Cutbirth.
I have read a couple articles from 2012 (Anisha et al., Manoj et al.) that discussed closure by secondary intention when suturing for impacted third molars. Is there a particular reason why you favor primary closure--maybe to prevent food impaction or something--or is it just a personal preference? Thanks!
With secondary intention healing there is a large open wound, allowing more bleeding as well as a food and debris trap. Suturing the flaps closed helps stop bleeding with less debris accumulation in the extraction site.
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That conservative surgical approach is sublime
Unfortunately, i didn't fully master it yet .. and still need to remove some bone to release the tooth
But i have a question please.. do u always use the regular high speed handpiece for surgery ?
No, I sometimes use a regular slow speed straight handpiece with a long shank surgical burr or a motor driven handpiece. With a high speed handpiece you must be sure not to use a light touch with lots of water and to not reflect the attached gingiva on the lingual surface or you could get an air embolism.
Hi Dr. Steven. I would like to ask why is it important to remove the follicular sac? What will happen if you’re not able to remove it, after odontectomy? Thanks and more power!
There is danger of formation of a dentigerous cyst, which could then develop into an ameloblastoma, which can be a big problem. These pathologies are not common, but you do not want them to occur. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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Are you using electric high speed handpiece or air-driven high speed handpiece, doc?
Both. The electric is definitely smoother and more powerful. The air driven have the smaller heads which are nice in tight spaces. I have had air driven so long, I have not replaced them simply because they continue to work well. I set 3 high speed handpieces and 1 slow speed hp for more involved procedures.
Excuse me doctor can I ask about the flap you performed because I can't quiet understand
Watch my many videos on impacted wisdom teeth extractions in the library of DMC.com. I can show it in those videos better than I can explain it to you with words.
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Thank you for sharing your knowledge with us! What kind of coolant do you use for your high speed handpiece while performing dental surgery? Is tap water acceptable or only sterile saline? Thank you in advance. I have deep respect for your work and I hope one day I can also become an expert in multiple specialties of dentistry like you are!
I'm sure you will. Filtered tap water in the handpiece.
While suturing the wedge design flap, wouldn't it exert pressure on the wound or may cause limited mouth opening in future? I suggest vertical incision to mesial of wisdom to buccal & buccally placed crestal incision. Please do comment doc. love your work.
I have been suturing like this for 40 years and have never had a problem with limited mouth opening or any other problems I am aware of. Keep procedures as simple as possible.
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Thankyou DR.
You are welcome.
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You really fantastic doctor. Explain for us practical fillings for caries teeth. Because l understand from you.
Lastly, Thank you for everything. 🌸
You are welcome. Beautiful baby in your photo!
In what circumstances do you choose to use the motor driven straight handpiece instead of high speed air driven handpiece? I always found that those straight motor driven handpiece is difficult to angulate and position properly compared to the regular air driven hand piece.but im worried of air embolism if i use the regular air driven handpiece as i was taught not to use those for minor oral surgery at school. Thank you for your generous sharing !
The important thing in not getting an air embolism from a high speed, air driven handpiece is not reflecting the lingual flap into the unattached, non-keratinized gingiva. So long as the lingual flap, keratinized gingiva is firmly attached and in place you do not have to worry about an air embolism. I only use the straight slow speed handpiece when the angle is better with that handpiece than the high speed contra angle, such as making a straight hole into a maxillary third molar so I can place an instrument in the hole and elevate the tooth. You are correct, the angle is usually not right to use the straight handpiece in most surgeries.
@@centerforard That really clarifies alot. Appreciate your effort in posting up all these educational videos and replying each of our questions in detail!
Sir what would you do if sinus perforated after extracting maxillar molar ?
Ideally, place either PRF or a resorbable collagen membrane over the perforation. Tell the patient not to blow their nose for 3 months. Place them on antihistamines, decongestants and nasal spray for at least 3 months. Oral astral communication is common following maxillary molar extraction because maxillary molar roots are often in the sinus.
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Hi DOC i had all my wisdom tooth pulled the question is. My right bottom molar last tooth on the right is a little loose it has a crown on it. the Dentisy says the tooth needs to pulled. Does loose teeth if not infected have to be pulled in your professional opinion if it's not infected?
Don't hesitate to get a second opinion if you question the first diagnosis.
Thank you Dr. Cutbirth!
You are welcome.
what type of hand piece you used?is it nsk slow speed redband band?
High speed, but I am careful not to reflect the attached gingiva, especially on the lingual. I prefer a high speed to a slow speed because the slow speed is harder to control. A Striker handpiece is often used by oral surgeons.
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Hi Doctor, I saw a research paper done on a novel technique to extract impacted third molars called "implosion technique", which might be the same as "inward fragmentation technique". I'm wondering if you're familiar with it. It involves very minimal bone removal because you drill a hole into the tooth, collapse the walls and then pick them out through the small opening rather than having do a large guttering for the sectioned pieces to come out. What are your thoughts on it?
I am not familiar with that technique. I always try to minimize bone removal and cut the teeth into sections and remove the smaller sections so a larger hole is not needed.
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Like previous videos ,perfect man
Thank you.
Thanks 🙏 dr, what is the best brand carbride bur for both bone removal and tooth section ,, i use 45 high speed handpiece ,, it??
Thak k u for honest
I use a long shank, #6 or #4 carbide round burr with a high speed handpiece, light touch and copious water. I try to cut minimum bone, mostly tooth.
That's interesting 👌thank you so much
Glad you liked it!
when you cut around the tooth, is it into the enamel mostly or also taking off alveolar bone on the mandible?
A bit of both. Be sure to use lots of water and a light touch and do not reflect the attached gingiva on the lingual alveolar process so you do not risk getting an air embolism. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.
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Why extract the maxillary wisdom teeth? No indication, right?
Impacted mandibular and maxillary third molars can lead to bone loss between the impacted tooth and the adjacent second molar and a dentigerous cyst can form around the impacted tooth, potentially leading to an ameloblastoma.
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Do you suture maxillary extraction sites?
Yes, most of the time I suture maxillary third molar extractions unless the tooth is extracted straight out of the socket with no tearing of the soft tissue. I do not want the patient to have a bleeding problem post op when they leave my office.
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Great content.
Thank you. I hope you have subscribed to DentistryMasterClasses.com. Those are the very best videos.
Hi Dr. Cutbirth, thank you for great video
Someone or some textbooks prefer to section the tooth through the furcation into mesial and distal part, while others prefer to section the crown.
I'd like to know which one is better or easier?
During cutting the mandibular third molar, how to overcome the situation that the maxillary teeth block the approach of handpiece?
Depends on the angle of the impacted lower tooth. If the tooth is a complete horizontal impaction, section the crown off the roots. If the tooth is angled similar to the ones in this video, always section vertically to the furcation. I will have a video in DentistryMasterClasses.com library soon on removal of horizontally impacted mandibular third molars.
Do you prescribe anything for post op pain?
Yes.
Is it regular restorative air driven high speed you're using? No concern about air emphysema? Thanks.
I use both high speed air driven and a motor driven handpiece for surgery. I am always concerned about and avoiding surgical complications. I am not concerned about air emphysema so long as the lingual attached gingiva remains unreflected and intact, firmly attached to the bone.
In what circumstances do you choose to use the motor driven straight handpiece instead of high speed air driven handpiece? I always found that those straight motor driven handpiece is difficult to angulate and position properly compared to the regular air driven hand piece.but im worried of air embolism if i use the regular air driven handpiece as i was taught not to use those for minor oral surgery at school. Thank you for your generous sharing !
That's so nice doc, wish u all the best ❤❤❤
Thank you.
Saludos desde México 🇲🇽
I need help I have a long roots pretty front teeth a little overbit and an (overlapped) front canine But it’s only 1 on my left side of my (frontbuck teeth) lol but I believe I have a crossbite or tmj and to top it off I had my first primary permanent tooth pulled yes only 1 wisdom tooth pulled?? 350? No x-ray and during exam he pointed out that I had a really bad cavity or root canal tried to pull my mom up to look like she does this and came back in the room after extraction showed a graphic root canal picture on Google with the iPad flipped toward us? : ( I got the tooth extracted with Roseman for free and they extracted the first left anterior premolar and the other wisdom tooth since I was already missing one?? Now I am now missing 3 posterior molars teeth and still have my bottom wisdom teeth. And I just don’t feel right and I know no one can just help! I feel like the Jogger with to different length of legs. And my parents and medicaid decided that it’s only one tooth so I don’t matter she be fine. But that’s not to mention the PTSD and trauma I’ve been through the past for five years and that’s two babies one physically . Sincerely thank you for your calming it’s very easy to interpretation your lessons bc you simplify everything thank you for your amazing video.
Amazing...
Glad the video was helpful.
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Can I use the resorbable gauze to cover bone grafting material after extraction prior to suture?
I would suggest a resorbable collagen membrane to cover the bone graft. It lasts about 3 months, so the bone growing into the socket has a nice head start on the soft tissue.
I miss the cute intro song! Nice video btw💖 so informative
I'm not sure why the intro song was not on this video. I agree, that and the "Subscribe" part of the videos are my favorite parts of the DM videos. My youngest daughter is a singer/songwriter and wrote and sang the DM song and does the "Subscribe" part at the end.
What is that material you used after extraction in mandible and how is it helpful?
The packing material is listed on the video. It serves as a matrix for the blood clot to prevent blood clot loss from the socket during the first 7 days post op, which is the reason for a dry socket.
Sir, can we extract all four wisdom teeth in single visit.In india after extraction of right side we wait atleast a month ,as if we remove all four at once , patient can not chew food on any side.
Yes, I always extract all the teeth needing extraction at the same appointment. This prevents the patient from having to undergo a second procedure, sedation and 2 recoveries.
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Thanks alot ❤️❤️🌺🌺
You are welcome.
Awesome 💗💗💗
Thank you.
Thank you 🙏
Superb Sir..
Thank you. I hope you subscribe to DentistryMasterClasses.com. There is an organized library of all the Dental Minute Videos plus many other complete comprehensive cases.
I'm curious as to if the wedge is a modified traditional ward incision ?
The distal wedge is done to allow better closure of the flap when sutured.
Why use a PDL injection? Just give a buccal infiltration and a palatal nerve block for maxillary teeth.
Just to be sure the teeth are completely anesthetized. I want predictability with all procedures, especially with local anesthesia. So many patients come into my practice reporting "my dentist could not get me numb." A PDL injection with Citanest 4% plain without vasoconstrictor with a 30 gauge needle, in addition to the normal maxillary infiltration and mandibular block, anesthetizes the tooth completely. No patient ever complained that "you got me too numb."
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Sir how many wisdoms you extracted in a single visit?
All 4 if all 4 need to be extracted. The patient is sedated. Why would I want to have the patient go through the recovery procedure more than once?
@@centerforard sir you did the procedure only under local anaesthetic or you used some kind of sedative?
I routinely use versed and demerol IV for surgery and significant restorative cases. Halcion can also be used.
I whish I could work with you together. After years of studying in Germany it is not allowed to me to work as a dentist. I passed 15 of 16 tests in the last exams. 8 years wasting time 😢
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Thanks eternally boss
You are welcome.
Can we do guttering with aeroter
Sorry, I do not understand your question. I do not know what guttering or aerotor are.
Dental Minute with Steven T. Cutbirth, DDS I mean cutting of bone with air driven high speed handpiece which we use in caries removal
Legend mate
Thank you. Glad you like the videos. Subscribe to DentistryMasterClasses.com if you want the best stuff.
Thanks
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I personally don't like to use air rotor to cut the bone/tooth instead you should use Contra angle motor-driven handpiece
Air embolisum in tissue takes 25 days to heal completely and its very discomforting to the patient
You are correct. I am making these videos for the regular dentist, and most of them, especially in other countries, may not have a contra angle motor driven handpiece. If you cut the bone with a high speed hp, you must use a very light touch and copious water. Additionally, you must not reflect the attached gingiva, especially on the lingual. These surgical videos are not intended for use by dentists with no training in surgery. They are intended to enhance the skill of those dentists who have had hands on surgical training. I state that in the surgical videos. Thank you for your comments.
The Clint Eastwood of Dentistry
I don't know about that, but what a nice thing to say. Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month.
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no need to remove a distal wedge of soft tissue.
Great. I was taught to remove a distal wedge of soft tissue so the flaps approximate after the third molar is removed. If you do not remove a distal wedge, there is too much tissue in the flap following impacted wisdom tooth removal and the flaps do not approximate ideally. They "bunch up."
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Hi doctor i want to know how to seperate first premolar please immediatly
I most often extract single rooted cuspids and premolars with the "Easy X tract" system if I am placing an implant to replace the tooth. This system removes the tooth vertically, straight out of the socket without damaging the facial bone. I have a Dental Minute video on the system.
Tissue emphysema is not the same thing as an air embolism
Subcutaneous emphysema is the actual name of "air being forcefully pushed into the submucosal spaces, leading to tissue distention." Occasionally I get my "tongue tangled" and misname something. Sorry if this was one of those moments.
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like fist
watch second
Sorry, I do not understand your comment.
He said ,
Firstly I liked the video ,then started to watch the video . 😅
He is your fan dr.
this is really not correct. suggesting the high speed is wrong. full stop.
Sorry, I do not understand your question.
🦷👌🙏
Glad you liked the video. Subscribe to DentistryMasterClasses.com.
😭
Glad the videos are helpful.
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Joe Biden doing extractions 😅
That might be scary!