Troughing Bone To Simplify Extractions | OnlineExodontia.com

[@arash_LA]

4th year dental student here! Great informative video. Thanks 🙏

[@ПетърВасилев-в4ы]

Super handy video ! Thanks doctor.

[@yuwenwang7205]

Thank you for your video. Those tips are very helpful. In the video, you demonstrated creating a Distal Buccal Gutter for a second molar extraction. Can I create the same Distal Buccal Gutter for extraction of an erupted 3rd molar?

[@petrosstyle2981]

if you trough the tooth like a crown prep, the tooth might fracture while elevating.. the same is true if you cut this root in two pieces... cutting the apical third of a root in half is not easy either, maybe in cartoons is easy.. but not in real practice. If one wants to take a root out, remove bone, expose root and then take it out, without weakening it with those ways you mentioned...

[@OnlineExodontia]

Petros - thanks for watching. With proper light, magnification, suction, and technique this works very well. It does take practice. If the tooth is snapping off on you, trough deeper prior to applying any force and consider doing both sides of the root so that when you apply your pressure the root has somewhere to go. All the best!

[@drjoshuadutton3972]

Can you do some bone grafting videos??? And membrane

[@gooddaytoridemtb4562]

Good video.

[@iGotMySniperSticky]

What are your critical structures on both maxillary and mandibular arches? I understand the sinus for maxillary teeth and the mental nerve/IAN for mandibular, but what are some other considerations with this technique? Great video by the way.

[@OnlineExodontia]

That's about your only concerns Tyler. Certainly the lingual nerve in the posterior mandible is something to consider if you're troughing there, (which shouldn't be often) you should consider an instrument subperiosteal to protect the nerve in case you perforate the lingual bone. Thanks for watching!

[@TK-gd9td]

also for maxillary even tho most dont need to go far into palate, be careful of the palatine nerve(s) foramen where they outlet to innervate palate soft tissue.

[@Qemarbaz101]

do you have the name of the luxator and the burr/or brand name/website where we can purchase it, thanks doc

[@OnlineExodontia]

3mm Luxator from Hu-Friedy. Truly, any 3mm luxator would do the trick. You can use a 700L FG bur. I believe you can get those from most dental suppliers. All the best to you!

[@Qemarbaz101]

Online Exodontia thank you doc!

[@OnlineExodontia]

@@Qemarbaz101 I guess more specifically, this elevator is the EL3SX Elevating Luxator from Hu-Friedy. All the best!

[@seannyx95]

I had a situation the other day where the maxillary first premolar broke halfway down the root. I tried to trough the bone, but the head of the hand piece was blocked by the adjacent teeth! What do you do in this circumstance?

[@OnlineExodontia]

Sean - you can often get away with extending the bur out of the chuck just a bit. This is terrible for your handpieces, but I admit I do it at times due to this reason. The other option is to look at a 700XXL bur which is even longer. Good for canine root tips or these situations. Or a straight surgical handpiece would do the job as well. All the best! Thanks for watching!

[@calvinchan2115]

Thanks for your video! May I ask that would you use the same bur 1703 for sectioning impacted third molar? will thinner bur easier to crack the tooth? thank you so much I love your channel!

[@OnlineExodontia]

Thanks Calvin! Most times with removing these teeth you're looking to cut them into bits to take them out easier. Part of removing them easier is creating space. Although a thinner bur will section things apart fine, it's a bit harder to maneuver the pieces out of the socket with more tooth structure present. Hope that makes sense? All the best!

[@calvinchan2115]

@@OnlineExodontia Agree, Thank you very much! look forwards to your new video!

[@suelamurataj4468]

Can you please suggest a good extraction practice book for GP?

[@OnlineExodontia]

dental-library.com/petersons-principles-of-oral-and-maxillofacial-surgery-3rd-edition/

[@jmatt2871]

take his course

[@imaanyousaf3073]

I had a surgery of second last lower roots they also cut the bone how much healing time it required??

[@OnlineExodontia]

Generally speaking you should be comfortable within 3-5 days and the site should be healing well by a couple of weeks. It can take months for it to completely heal over and fill in, however you’ll be comfortable during that time. All the best!

[@howard330]

Hey doc, for 1 root premolars, when do you decide to trough vs. sectioning mesial-distally and deliver 2 pieces? Doctors in my office have disagreements over it.

[@OnlineExodontia]

Thanks for watching! This answer is my personal approach to your question...I don't want to get in the middle of a heated debate haha! When faced with a single root on a premolar I will almost always trough with a thin bur. I will go circumferentially, then work the high side of the root to get it out with a root pick. When there are two roots I tend to trough between them and push the roots inward. Having said this however, I will still trough a bifurcated premolar and I will still section the root tip M/D on a single root, just I find it's rare that it's required. Again...just my approach. I can't really think of a reason why either approach would be inappropriate as long as it helps you achieve your desired outcome. All the best!

[@howard330]

@@OnlineExodontia Thanks for the detailed response!

[@noojoo5408]

Doctor today I met ankylosed molar ... so i search for your video

[@gowthamsendhil]

Awesome

[@drjoshuadutton3972]

What Rpms do you cut at?

[@OnlineExodontia]

I use an electric NSK handpiece for basic surgical extraction troughing and it runs at 40,000RPM. The 1:4.2 increaser however makes it spin much faster.

[@ricardogutierrez926]

Don’t you rather a low speed handpiece to avoid submucosal emphysema, instead hi speed, even if you don’t use a flap?

[@OnlineExodontia]

Thanks for watching Ricardo! I typically operate with one of two handpieces that are both electric as the torque is greater so you can cut a bit easier. The S-12 W&H handpiece (straight) and the Z-45 Ti-Max NSK. The Z45 is designed for surgery in that it doesn't exhaust air forwards. If you use a regular highspeed handpiece you will blow air into the surgical site and you are correct...even without a flap you do risk air emphysema depending on the situation. Other good choices for surgery would be the Impact Air, or Sabra-45 which are both rear-exhaust air driven handpieces.

[@OnlineExodontia]

@Joe Blow This is difficult to say Joe as to what happened there. What I can say is the mouth is very forgiving and almost no matter what the situation, new gum tissue should fill in over time. I wish you the best!

[@OnlineExodontia]

@Joe BlowNo worries! I'm afraid I can't comment on that as I have no prior experience with that product.

[@OnlineExodontia]

@Joe Blow haha I looked up aerogel and it's actually awesome looking stuff! Maybe you were thinking gel foam - this is an oxidized cellulose that helps with clotting. There are indications for this stuff, but it's not routinely employed. For most extractions, it's best just to leave the socket without any foreign material in it to reduce the likelihood of the material habouring bacteria leading to infection. All the best Joe! Hopefully that helps and thanks for bringing Aerogel to my attention!

[@aamin6933]

Great video. Trouble when troughing around the root and removing more of the tooth, sometimes the tooth fractures as it becomes weaker. Any tips?

[@noojoo5408]

Doctor today I met ankylosed molar ... so i search for your video