How is a tooth pulled
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
tooth
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
wrist
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
plate
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
facial
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
material
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
saliva
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
90-day money-back guarantee use them for
90 days if you're not a hundred percent
satisfied send them back and we would
happily refund your money for more
information and to watch several more
clinical videos please visit physics
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![Surgical Tooth Extraction [WARNING] Extreme Decay Beneath Crown](https://img.youtube.com/vi/6czvwyizvcY/mqdefault.jpg)
