Physics Forceps Upper Molar Tooth Extraction, Cytoplast Barrier & Grafting

hi I'm dr. Tim Kaczynski from Michigan

and today we're going to demonstrate a

grafting procedure using direct Jen from

implant direct our patient today has a

non restorable maxillary right first

molar that has root canal therapy and

the anodyne esteem that the tooth was no

longer functional or restorable we will

extract the tooth a traumatically using

the golden physics forceps

now the maxillary first molar is a very

interesting tooth because it has three

roots on it and when we extract it we're

going to create three sockets so

immediately placing an implant is nearly

impossible or it's very difficult to put

that implant in the correct position so

following extraction will correct the

area and we will graph the site with

direct Jen cancellous cortical ella

graft from implant direct this material

will be allowed to heal for about four

months prior to placing a dental implant

in the future now we're taking out a

fairly large tooth so we're going to

have to put some type of barrier to

protect the grafting material and to do

that we are going to use a non

resorbable material called cytoplasm

again from implant direct will suture

that in place and hopefully we'll be

able to demonstrate a really nice

technique for you

to remove this tooth this maxillary

first molar tooth that's kind of badly

broken down as we'll demonstrate in a

few moments I'm gonna use the golden

physics forceps this tool has been just

outstanding in my hands and it's allowed

me to a traumatically remove a tooth

without damaging the buccal plate now

when we're extracting a tooth we want to

do it very a traumatically if we have

socket sites we can easily graph the

area or the sockets and allow for

outstanding healing so let's demonstrate

the use of the golden physics forceps

and you can see the force that has two

components if we little closer to the

tip we have a beak which is a flattened

edge and what is known as a bumper and

it's just a silicone protection we're

going to engage the beak onto the

palatal surface of the root deep down

into onto the root surface now sometimes

I have to take a burr in flatten that

root surface to compensate for the for

the blunt edge of the beak of the golden

physics force' so we'll do that we'll

demonstrate that in a few seconds and

then I'm simply going to use rotational

motion to elevate the tooth out of the

socket so if we can get a close-up view

of the tooth itself and you can see that

we have a very badly broken down

maxillary first molar tooth that was

deemed to be non restorable so the first

thing I'm going to do is I'm going to

take the handpiece and I'm simply going

to flatten the palatal surface of the


about two or three millimeters sub

gingival I will then engage the peak of

the force up now I'm right-handed

dentists but I'm gonna use my left hand

here for video demonstration I'm going

to engage the beat of the force up onto

the powell surface of the root the

bumper is engaged as high up the

vestibule as possible and I'm simply

going to rotate my wrist and if we can

back off into my hands you can see I'm

barely barely holding the force that I

really have it in the pump of my thumb

and really one finger and I'm rotating

my wrist no forearm no bicep pressure

I'm rotating my wrist really towards the

corner of his right eye so I'm using

rotational motion and it may take a

minute or two which is a long time for a

dentist sometimes you need a little

purchase point and the root of the tooth

and again I'm using my left hand I am a

right-handed dentist and I'm rotating my


and you saw that tooth just pop now the

instrument is not intended to remove the

root completely and we'll simply take a

force up

and we're rotating and using my tooth

removal instruments to remove the tooth

in total without any complication buckle

plate is intact we have a great buckle


and we have three sockets that we simply

have to wrap the next step is to really

correct the sockets very very very

efficiently you're at you're at you're

at you're at stop correct correct

and as I mentioned earlier we're going

to use the the direct Jen material which

comes in 1/2 CC vials I like to use the

250 to 1000 microns in size it allows

for nice pantry and what I've done

is wet the material so it almost becomes

a putty it allow me to place it into the

socket very effectively now one of the

things that we have to do is when we

have any type of grafting material we

have to use a barrier to protect it

tissue grows much faster than bone so

what I'm doing here is just taking a

simple elevator and I'm loosening the

tissue so that the barrier will end up

about two millimeters on to the bone

surface on both the palatal and the


the cytoplasm aterial is this is a non

resorbable material because we're not

going to be able to get very close

contact in a mole or two comes in sheets

and what I'm going to do now is cut this

sheet to the proper size I've done is I

cut the barrier that we described

earlier the smooth side will go towards

the socket erupt inside towards the

tissue and what we're going to do now is

we're going to place the barrier first

in the proper position and then place of

our allograft

material now it's very very important

when we're using a barrier we have to

use a barrier that we properly position

it so that it fits very passively we

will be suturing it in place but the

biggest mistake that doctors make is

they fold it or the material is not

engaged two millimeters on to good bone

facially and Palelei

so we're going to try this in first to

make sure we get a passive seating of

failure you can see I was able to place

our barrier onto solid bone on the

facial eventually we will hold it over

onto the palatal surface and then suture

it in place but before we do that we can

go ahead and use our our barrier

material so we're taking our allograft


simply placing it into the socket sight

now some of it falls into the mouth you

don't want to use that and I'm just

taking a packer and I'm lightly packing

the material into the sockets and not

crushing the material and filling the

socket site with our material gently

packing into position now we're not

going to get excessive height past the

CDJ of the adjacent teeth and again you

don't want to use anything that's

falling into the model that's touch the


final thing we're going to do is take

our barrier and whether to passively

insert it onto the PAL little bone and

then we're going to suture this into

position so you can see we have a

passive fit we don't want any any

bending just doing a little X here in

our suturing to hold the material down

or all the barrier down we get that

first one it's usually pretty stable

okay so I have to cross stitches and I'm

going to put some vertical sutures to

really hold that material in place

so you can see my nan resorbable barrier

covers the extraction site we would

never get complete closure we have cross

stitched and two vertical sutures to

hold the nan resorbable barrier in place

I will bring this patient back in one

week to remove the sutures I will leave

that reserved nan resorbable barrier in

for about four weeks after which I will

just pick it out and let the graft site

heal for a minimum of four months prior

to placing my ideal dental implant in

the future again we did not place an

implant immediately because we have

three sockets that are almost like the

fingers of a bowling ball or the holes

of a bowling ball and I would not be

able to place the implant in an ideal

position if I put it in the palatal root

then the final crown would be to Palelei

positioned if I put it in the mesial or

distal root then the implant would be

too facial or we would have a cantilever

either towards the mesial or distal we

want ideal position and we were able to

do this graft in very efficiently very

effectively with very little trauma to

the patient

very much for your interest and learning

about the physics forceps not only are

they fantastic and they work

hey traumatically we are offering you a

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