so I've pre-mixed the simulated allograft bone and I've drawn back in
the syringe and I have about two-tenths of a CC of bone and then incrementally
I'm in the premolar place it and you never exceed beyond the crustal bone so
when you're this step suction is off because you don't want the assistant to
inadvertently so we'll have two by twos four by fours draping and also readily
handy is cotton tip applicators to get saliva and and and ooze and then you can
use the would end of the cotton tip applicator surely check first to make
sure there's no splinters and then you condense it to the level of the bone and
I actually use the butt end of my dental mirror which I don't have in in this
setup as my condenser people ask how much pressure to condense the bone and
even though I'm a surgeon I remember how much pressure to gently condense dental
amalgam I would say that's the pressure every dentist understands that that
amount of pressure that feel and then collagen plugs come this is cut in half
so you'll cut it maybe in a third pardon me fumbling here and then you'll place
it over the socket and here's where your assistant comes in handy
because once it gets wet with tissue fluid and the Sailing then it can slime
so now you're just I place 2 interrupted sutures in an X pattern and I'm going to
do that and I will honestly tell you that it's easier to sew oral mucosa than
this simulation gingiva and take your pull so that you only have about one or
two inches protruding so that you don't have a tail
being contaminated and here's where your system comes in handy as you are
bringing your your nots there holding that collagen plug in place and it's
almost like wrapping a Christmas present when you're putting the ball on you need
that third hand to hold that in place and then just a simple square knot with
a third throw to secure it and we're usually in the esthetic zone for this
exercise whether it's premolar or incisor and we are taught in dentistry
to have the knots on the labial but more often than not the patient's going no
pun intended they're more often than not the patient is going to be leaving with
a transitional removable appliance aka a flipper or an SA and the last thing you
want is they're not sticking out on the labial so I either tie them on the
palatal or rotate them after I tie and cut and that way that's not showing
through so I'm just throwing one interrupted in there just to give you an
idea and I usually just do it X on occasions you may need a third one in
the middle the next thing I want to show you is how to use the socket repair
membrane which is geniusly designed for the clinical scenario where we have a
labial dehiscence from a chronic broken down incisor and if there's a facial
pair ulis and underlying that it's a lot of granulation tissue the inflammatory
tissue that has caused erosion of the bone so you hold it from the top down
kind of looks like an ice-cream cone and you deliberately make a crease so it's
almost like a 45-degree angle and again this is where you and your assistant are
ready to go the syringe is full the two by twos are ready and the cotton tip
applicators are ready so once you placed this membrane you have to act
fast to get the material in there because once it gets wet it will slump
so you have it ready you place it in the socket and now sorry about that
you place it in the socket and now you have a ramp it's within the alveolus you
have a ramp with which to pack your bone against top up the excess gently place
it condense add more and more and then you get to the point where you have it
to the level of the crest and you fold this over gently tuck it underneath the
lingual gingiva and then you place your sutures now there is a technique that's
been published you'll see it in a lot of YouTube videos or product demonstrations
where you flip that over and tie the margins of the soccer repair membrane to
the gingiva that is really good in the very very best of hands however you run
the risk when you're manipulating the tissue and tying the knot pulling that
out from inferior crystally and once you've displaced it you've lost the
purpose of why you're protecting that and rebuilding that with that barrier so
I am NOT an advocate of that so instead of have a lot of suture and flying
around you just need a short tail
you tie
square knot and you're just passively tying the knot you this is not under
tension and you do not need primary closure this is just to facilitate the
collagen plug holding the the sutures holding in place so that those surface
crystals can be saturated in the first 24 hours then it granulates in there are
techniques where you people will use membranes and all that and that's very
fine that's that's up to your preference but that adds cost to you and that you
pass on to the patient for something that as I mentioned this is the very
basic basic socket graft preservation grafting technique and I'm asked a lot
on is this bilberry of course it's billable and there's actually a code
ADA accepted codes D seven nine five three it is standing the test of time so
that's the exercise that we're we're going to do or for those of you who are
comfortable and you just want to incorporate this in your practice and
you say oh so that's how it's done this is it's great stuff