Tooth Extraction, Bone Grafting, PRF and Suturing - Dental Minute with Steven T. Cutbirth, DDS

[@benedictlui6273]

the number and direction of the knots near the end of the video is a true nugget of info!!!!!

[@centerforard]

Glad the video is 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.

[@donaldxavier2056]

I have learned so much from watching your videos and they have definitely helped my confidence with oral surgery. Thank you!

[@centerforard]

Terrific. 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

[@michaloszwaldowski6523]

Thank you for a wonderfully prepared and explained clinical case. The practical knowledge that yoy share with the whole world is extraordinary. I use a similar augmentation technique with a slight difference. I leave the flap without vertical cuts, the flap is lengthened just by cutting the periosteum.

[@centerforard]

I want to visualize the alveolar crest, and if there is facial bone loss, as in this case, I will reflect a flap past the bottom of the facial bone defect so I can graft the defect properly and cover the graft with a slab of PRF and/or resorbable collagen membrane.. 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.

[@ToanNguyen-kk1rs]

Great presentation. Have a great weekend Dr.

[@centerforard]

Thank you. 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.

[@rtyankeedoodle]

Beautiful work, Dr. Steven. Your videos are always practical and never fail to illustrate the difference between reality and our perception. During a procedure, not everything goes as we've planned and it's required of a surgeon to be ready to face the challenges, be calm, and make the best clinical decision. We don't have to be perfect but be brave, trust our skills, have faith in god, and do what we believe is good.

[@centerforard]

Great comment. I agree. 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

[@Perseverence]

I like how he stresses the intraligamental injection in almost all of his videos :)

[@centerforard]

It is critically important for profound anesthesia in most cases.

[@zoewoods677]

@@centerforard it Yyuuuh

[@richvrdameyaw]

getting this procedure done on my central incisor and this vid made me 10x more amped! lovely vid! their’s a pt2 for this?

[@centerforard]

Glad the video was helpful.

[@haoyang9719]

Here is something I learned: you can soak the resorbable collagen membrane in PRP (from spinning the white tube). This will soak up the membrane and make it sturdier to retain more buccal bone.

[@centerforard]

Great idea! I always soak the collagen membrane is sterile water, but I will start soaking it in PRF serum. 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

[@drdidar7541]

i love you sir, for your clear explantion

[@peppio]

I love Your videos... I love how you explain.. I love how you work.. Congratulations

[@centerforard]

Thank you. Glad you like the videos. 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.

[@nashagyan412]

omg 🤦‍♂️really your amazing you did great job

[@centerforard]

Thank you. A very tough case. I just placed the implant last week after the site healed. The grafted defect healed well. The entire case will be in the library of DentistryMasterClasses.com in a few months.

[@marinelbaz5539]

what will happen if graft covered with prf membrane without collagen membrane? .. thank u for great presentation

[@centerforard]

The resorbable collagen membrane is not essential. I like it because I feel it gives the healed bone a flatter, smoother surface and I find it easier to evenly pack the graft. by compressing the membrane onto the graft.

[@centerforard]

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.

[@estelaolalde6882]

Me gustanmucho sus videos dr. Steven!!! Vivo en Argentina y me gustaria que esten subtitulados en español.Gracias .

[@SimonPhoenix2022]

This guy is a bad asss. I'm not even a dentist

[@raveyravedays6592]

Hey so I had my 2 wisdoms removed on the left side . I got prf done. 7 days later my top left side area hurts. Can u get a dry socket after? I feel like i wasted money.

[@centerforard]

Normally, a dry socket occurs within the first 7 days post extraction, so it is probably not a dry socket. If you feel you have a problem, go back to your dentist and have the dentist examine you.

[@zainasalman258]

Amazing work

[@centerforard]

Thank you. 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

[@megax5000]

hi Dr. Quick question, is it possible to put in bone grafts for teeth with 50% bone loss (particularly in the front teeth)? and if so, do those procedures have a good prognosis? thanks!

[@centerforard]

Yes, you can graft those areas but it is very difficult to increase the vertical bone height with a graft. Maintaining horizontal bone and preserving the existing vertical bone height is the primary objective with a bone graft, and is more effective if you can preserve the facial and lingual/palatal bone by vertical extraction of teeth vs. horizontal extraction. In the library of DMC.com I have a very good video on replacement of 4 mandibular incisors with an 8 unit fixed bridge because there was so much bone loss from periodontal disease a 4 unit implant supported bridge was not a good option. I also have some videos on mandibular anterior implant supported 4 unit fixed bridges, including grafting. 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

[@bookmark5162]

Dear colleagues Dentis have close impression screw with the plastic cap ,i am using that in Romania abour tow years ago till now .🙏

[@centerforard]

I do not want to have to place a preformed abutment prior to impressing the implant. I want the abutment and crown to come from the lab tech. I use screw retained implant abutments and crowns 99% of the time. 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

[@traceyj.dibenedetto186]

Can nerve damage occur from the bone graft?

[@centerforard]

Not that I am aware of, and I have been bone grafting for many years. You must always be careful in the mandibular posterior region, from first bicuspid to second molar when "drilling" the implant osteotomy. You must be concerned with damaging the inferior alveolar nerve in that region with the drills, not the bone graft. 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 .

[@jeffmcknight4818]

Is the grafting with L-PRF essential for proper healing, or does it just speed up the process? Could min/demin CC allograft only be packed with a resorbable membrane?

[@centerforard]

My understanding is the PRF just makes the site heal faster. I have grafted sites that healed as well with just min/demin. bone and a resorbable collagen membrane. Other types of artificial bone graft work also.

[@jeffmcknight4818]

@@centerforard Thanks for the response. I haven't found a lot of sound literature on PRF but I know it's a common procedure. I'll keep looking into it

[@admin8446]

Now the flap is coronally repositioned. Leading to reduction in keratinized tissue. Also, horizontal mattress sutures are better to fix the membrane.

[@centerforard]

There are many different ways to perform procedures. This is just one method I was taught many years ago in my oral surgery fellowship and have used successfully for many years. 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

[@tashinarosewalkingeagle8884]

Hello, is there a possibility that a bone graft like this could be rejected? Two of my top back left teeth are missing and have been for years so the bone has gone away and I wanted to build it back up before getting implants to replace the missing teeth. I'm looking for the best way to do that. Any info would be appreciated, thank you.

[@centerforard]

It is difficult to build bone up vertically once it is lost. Much easier to build it horizontally. An oral surgeon would be the person to speak with.

[@MyMagnumOpus]

What if #14 pulled, and instant load abutment done? What happens? Frankly, i have had problems now afterwards. got it in 2013 and it still hurts all the time. looks black all around the abutment like the screw is floating in there. He said he did PRF, but thinking back, he didn't draw blood from my arm. and no machine spinning. should surgical notes give certain detail giving a clue? So you wait for healing, and what have u experienced by instant loading?

[@centerforard]

I would discuss any issues you have with your dentist. Sorry, I cannot diagnose without examining you.

[@junaidmalick]

Excellent Video. I amazed how easy you make it seem. Could I ask how long the whole procedure took? Also you mentioned the 2 vertical releasing incision but did you also make a horizontal releasing incision at the top of the sulcus? The last suture in the video seemed to indicate this. If so how deep was the incision and also how wide relative to the flap.

[@centerforard]

Think about the objective. My objective for reflecting the flap was to visualize the alveolar crest and, in this case, the facial bone. If the facial bone had been in tact, I would only have reflected the facial flap just enough to visualize the alveolar crest so I could gauge the placement depth of the implant. I like to leave the flap attached to the alveolar process when I can to preserve the blood supply from the soft tissue. Obviously, once I reflected the flap in this case, I found that the facial bone was gone almost to the apex of the tooth, so I reflected the facial flap to the apical extent of the defect, and actually past the apical extent of the defect, so I could be sure to graft the entire defect and extend the resorbable collagen membrane past the apical part of the defect. I extended the flap into the non-keratined, non-attached gingiva so I could pull the facial flap over the defect and, if possible, achieve primary closure of the flap. Primary closure is sometimes not possible, so you do the best you can and it works if you cover the defect with PRF and a resorbable collagen membrane. I just placed the implant following 3 months healing and the defect was well healed. The implant placement, then the forthcoming restoration will be in the library of DentistryMasterClasses.com shortly. I schedule about 4 hours for a difficult extraction, grafting and possible implant procedure like this. If a procedure has parts that are unknown, I always like to have more time than I anticipate so I will not be rushed and can do my best work. I just reflected the flap from the alveolar crest, making the flap wider at the base.

[@salival7246]

Dr, great video! Your material is so well documented and informative. Is it unnecessary to do a periosteal releasing incision if you extend the vertical releasing incisions into the apical mucosal tissue? Or did you still do one to help mobilize your flap for closure?

[@michalbeznazwiska4772]

I am not sure if I understood you well but If you are looking for a closed tray impression coping for Dentis system you can use a standard abutment (make some incisions on it) then pour bite registration material over it, wait till it sets and take an impression. You can then remove the abutment, screw the analog and insert the abutment into the impression.

[@centerforard]

I like simple systems. That sounds like a pain.

[@michalbeznazwiska4772]

@@centerforard In fact there is no differnece between dedicated closed tray impression copings and abutments. But well you see it different way. Anyway You can mill whatever you need for any implant system by yourself. I use Exocad for this purpose and mill by myself but you can email your .stl file to any milling center and have fun with any implant system that falls in your hand.

[@centerforard]

Thanks for the information.

[@perrymatasa1581]

Please how long does it take to put implant after bone grafting

[@centerforard]

I wait at least 3 months after extraction and grafting the socket before implant placement. If a molar tooth is the tooth extracted, I wait 6 months after extraction and grafting before placing the implant. Many times, if a single rooted tooth can be extracted vertically, preserving the facial and lingual/palatal bone plates, I place the implant immediately following tooth extraction, placing some bone graft around the implant if there is any space between the implant and the alveolar crest. In those cases, I try to get 35ncm of torque on the implant. 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

[@د.قتيبةالخليفة]

Very nice doctor

[@centerforard]

Thank you. 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.

[@ippaziopalama335]

dot thank you for the video fantastic please i want ask how much just the bone grafting i need to do myself as i lose 3 teeth and i suffer aesthetically so much and i don support the denture please reply thanks

[@centerforard]

Sorry, I do not understand your question. It sounds like you are saying you are going to place your own bone graft, but that cannot be correct. Please clarify the question.

[@ginagiangreco7920]

@@centerforard I think he meant to say he lost 3 teeth himself and needs to undergo this procedure and was wondering how much it costs. Thank you for the great content as usual.

[@ippaziopalama335]

@@ginagiangreco7920 thank you for your reply yes that my mean i need know the cost for the procedure

[@centerforard]

The cost may vary depending on many factors.

[@ippaziopalama335]

@@centerforard please Doctor can you give a range from minimum to maximum please 🙏

[@Perseverence]

Doctor, do you always have to remove non-resorbable membranes even if the surgical is completely healed and the membrane is not showing at all such as doing apicoectomy on an upper anterior tooth?

[@centerforard]

I have never placed a non-resorbable membrane. If it does not resorb, I am pretty certain you must remove it at some point.

[@Perseverence]

@@centerforard okay thank you very much.

[@pavann11]

hi dr i hve question if i’m trying to get pregnant it’s okay to do teeth bone graft surgery ??

[@centerforard]

Any type of non emergency dental treatment involving pregnant women is always questionable. The bone graft should not be a problem, it's just non emergency dental treatment in general. You do not want to do anything, dental or other things, that could endanger your pregnancy. If you are having an emergency tooth extraction, the bone graft should not cause a problem with the preganncy..

[@ozzyozzy6728]

Legend doc

[@centerforard]

Thank you. 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

[@poemsoflove_]

had this procedure done two weeks ago

[@centerforard]

I hope it went well.

[@multizoozable]

Dr try Hiossen, they have the same kit as dentis with the shoulder and they have close tray impression coping, the system Is Awsome

[@centerforard]

Thanks. 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

[@PapaDave85]

It is important to cut periost horizontaly for primary closure after grafting, for realising soft tissue, just vertical incision in non keratinised gingiva is not enough, sorry for my grammar :)

[@centerforard]

You would like to achieve primary closure of the flap if possible, but by the time you "bulk out" the facial part of the defect with PRF and artificial bone, it is sometimes not a reasonable expectation because there is too much surface area to cover. If you cover the grafted defect with a slab of PRF, it is shown you do not have to have primary closure for excellent healing. I normally cover the grafted defect with a slab of PRF and cover the PRF with a resorbable collagen membrane simply because I find it easier to create a smooth surface by placing the collagen membrane. It's always a trade off, reflecting a big flap trying to achieve primary flap closure but compromising the blood supply to the bone from the soft tissue or not reflecting a big flap to preserve the blood supply from the soft tissue to the bone but not getting primary closure. So long as you cover the grafted defect with PRF and, for a smooth, regular surface, a resorbable collagen membrane, the defect should heal well. 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.

[@PapaDave85]

@@centerforard tnanx for such a detailed answer

[@faribashafaei6420]

Thank you so much 🙏♥️

[@centerforard]

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

[@idioticstuff2685]

Holy hell, nice save

[@centerforard]

Thank you.

[@despoinakalimeratzi7603]

Why did you drill if you didn't place the implant?

[@centerforard]

I initially thought I could place the implant and graft the facial, but once I got into the procedure decided it would be a better and more predictable outcome if I grated the socket, waited 3-4 months for healing, then placed the implant.In my videos, I am trying to show what happens in a real practice, not just ideal cases. Sometimes the treatment plan is changed based on the circumstances.

[@despoinakalimeratzi7603]

@@centerforard thank you!

[@Realtormosha]

Could this client wear a flipper while the bone graph is healing? Being that it’s a front tooth???

[@centerforard]

Yes, that is the provisional restoration he was given. That part will be in forthcoming video segments on this case. I just placed the implant last week. The entire case will be in the library of DentistryMasterClassess.com when I complete the case in about 4 months. 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.

[@mafamafa1281]

I’m going to have the same surgery after two das😢

[@centerforard]

I hope things go well.

[@theroyalprincess8400]

Sir it's out of context but can I ask if you have used articaine 4% for nerve blocks ? Is it safe to administer in every case ??

[@centerforard]

See above reply..

[@DEEZENUTZ69]

I'd love to hear the conversation about this with the patient, So what brings you in today get kicked by another cow?

[@centerforard]

I find the pre-exam interview with the patient in my private office to always be most interesting. Everyone has a story. 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

[@DEEZENUTZ69]

@@centerforard Nothing wrong with poking some fun if you know the character well enough were all just people at the end

[@mmwosu]

Why gut sutures? They resorb too quickly and jeopardize primary closure and the integrity of the site as a result. 4-0 PTFE seems a far safer choice. Also, why not papilla-sparing vertical releasing incisions?

[@centerforard]

This case was a train wreck. Almost all of the facial bone was gone. It was not a "fine tune, split thickness flap, pristine surgery." I needed access to the facial alveolar process so I could graft it and plump it up. The body will heal itself. Having the suture In place for 7 days is fine. The tissue adapts by then. Having stiff chromic gut suture in place for 2 weeks is uncomfortable for the patient's lip and tongue.

[@mmwosu]

@@centerforard I understand the issue with the dehiscence and the decision to graft and do a 2 stage surgery rather than place immediately. I also agree that the body will heal itself, however my concern is that having the fibroblasts living under and around that flap ready to stand on their own in 4-7 days is a really tall order even with the enhanced healing from the PRF. Have you ever had to resuture one of these cases where you used gut? I tend to use PTFE (just how I was taught, everyone is different) which is not stiff and you can take it out in 2-3 weeks, which is a good excuse to make the patient come in for a follow up. I am also curious if this patient had any papilla left by the time to restore. This is always a tough problem. Thank you for the responses.

[@centerforard]

I have had to resuture a few lower anterior flaps due to the facial muscle pull from the lower lip pulling the suture through the tissue, not because the suture dissolved. I am not against chromic gut, silk or proline. I use them all.

[@berjhadidian9790]

🙏🙏🙏

[@centerforard]

Glad you like the video. 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.

[@michalbeznazwiska4772]

So you are telling you can't place an implant in bicuspid or molar area right after extraction in the spot where you need it and graft. Man just face the truth it is time to retire for you.

[@centerforard]

I'm not saying you cannot place an implant immediately following a multi-rooted tooth extraction, I am saying the final height of the alveolar crest cannot be accurately predicted if you extract a multi-rooted tooth, graft the socket and place the implant at the same time. If you are concerned with the cosmetics of the implant restoration, wait 6 months for the bone to heal so you know where the alveolar crest is and can place the coronal part of the implant at the alveolar crest or slightly sub-alveolar crest so the metal is not displayed.

[@YOu-jl2bn]

You are very rude person just face the truth

[@YOu-jl2bn]

@@centerforard He doesn't deserve a reply from you dear doctor

[@michalbeznazwiska4772]

@@YOu-jl2bn yes I am rude and you are telling me I don't deserve the answer. Doesn't it mean you are not tolerant ? You don't tolerate rude people, do you ?. Lack of tolerance leads to racism, shame on you.

[@michalbeznazwiska4772]

@@centerforard I don't remeber when I had the problems you described. Of course I have cases with compromised aesthetics and visible abutment and even visible implant body but it happens regarldess if I do immediate placement or not.