Very Clinical: Extractions, Sticky Bone, and Guided Implants

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[00:01:00] [SPEAKER_01] This is a production of the verydental podcast network. Welcome to the very clinical podcast. In about the time it takes to do an MO on three, we will entertain and amaze you with tips and tricks on regular daily dentistry. Here's Kevin and Zach.

[00:01:31] [SPEAKER_04] What is up, Very Clinical listeners? Welcome back to yet another episode of the podcast. I'm Zach Miners coming to you from Kansas City, Missouri, and with me as always, my trusty co-host, Dr. Kevin Harefriar. Kevin, what's cracking in Cleveland?

[00:01:46] [SPEAKER_03] Um, is this Labor Day? No, it's the week after Labor Day.

[00:01:50] [SPEAKER_04] It's the week after Labor Day.

[00:01:52] [SPEAKER_03] Yeah. How was Labor Day?

[00:01:54] [SPEAKER_04] Mine was awesome.

[00:01:56] [SPEAKER_03] Yeah.

[00:01:56] [SPEAKER_04] How about, yeah. Mine was too. World class.

[00:01:58] [SPEAKER_03] Yeah. Very good. I went to go visit my sister in Baltimore. Okay.

[00:02:03] [SPEAKER_04] It was great. That's good. We brought back our high-budget guests from last week. Why don't you reintroduce them? And if you missed last week, it's probably better to listen to that one and then this one. So, go back.

[00:02:15] [SPEAKER_03] Yeah. Go back. Listen to how cults work and then we can get some actual clinical dentistry. Very good. Talked about. So, we have my good friends, Shane Lingler from Lexington, North Carolina. Say hi, Shane. Hello. And Emily Wedowitz from Elroy, Wisconsin. Say hi, Emily.

[00:02:39] [SPEAKER_00] Hello.

[00:02:40] [SPEAKER_03] All right.

[00:02:42] [SPEAKER_04] So, Kevin, if everyone listened to, if you listened to last week, then you know what Emily and I did last summer. Or this summer. I don't know why I keep saying that. Except that damn movie, you know?

[00:02:53] Yeah.

[00:02:55] [SPEAKER_04] So, anyway, it's Shane and Kevin's turn. Kevin, I'm going to let you go first. I think Shane should go first. Shane should go first. Yeah. He's the guest. Oh. What did you do with your summer? That was my intention. It was a slight. So, anyway. Go ahead, Shane. You want to say, what did your summer consist of?

[00:03:13] [SPEAKER_05] The summer's been a little bit of a blur. But I started it off with a trip to Rhode Island. We were there for about four days. With Emily? Wait, wait. It was the same. Were you guys on the same trip? Not with Emily. Oh, okay. All right. My brother-in-law got married and currently lives in Rhode Island. So, her wife's whole family is from Rhode Island. Lives up there. So, we went up there and stayed. It was a lot of fun. So, we kicked off the summer kind of with that.

[00:03:41] [SPEAKER_05] And then the rest of the summer has been pretty chill because my wife and I had a baby on July 10th. Congrats. Thank you. So, we've just been kind of chilling this summer and doing that whole thing.

[00:03:54] [SPEAKER_03] We know, but tell the audience what kind of baby you had. What kind of baby.

[00:04:02] [SPEAKER_04] It's a human. A human baby. It's a human baby. It's two legs.

[00:04:06] [SPEAKER_05] I'm an alien. Two arms. Yeah. A head. We had a little girl.

[00:04:11] [SPEAKER_03] Oh, what's her name?

[00:04:13] [SPEAKER_05] Yeah, we're super blessed. Her name's Tilly Joyce. She's named after her great-grandmothers. Oh, that's cute. So, super blessed. Everybody's healthy. She's a chunk. So, we had a baby. And then we also have a... He's getting ready to be three years soon. And then after about four weeks of that, we decided... We were glutton for punishment and we loaded up and went to the beach with 15 other of our family members in the same house and spent a week at the beach with a four-week-old.

[00:04:40] [SPEAKER_04] Oh, my goodness.

[00:04:41] [SPEAKER_05] It was great. Honestly, it was a great trip. It was really good. Kids did well. It was much needed. And I was pleasantly surprised. But that was pretty much my summer in a nutshell right there.

[00:04:53] [SPEAKER_04] Well, that's a lot going on in the summer for sure.

[00:04:57] [SPEAKER_03] I love it.

[00:04:57] [SPEAKER_04] All right, Kevin. Now, you can talk about what you did this summer.

[00:05:01] [SPEAKER_03] Well, this whole summer revolved around the 4th of July when my son got married in Utah.

[00:05:08] [SPEAKER_04] Awesome. Look at you guys coming in with big life events this week.

[00:05:13] [SPEAKER_03] So, we realized the day after the wedding that pretty much our lives had been on hold for the whole year leading up to this event. And I got to say, it was a great wedding. Um, I still think about it every day. It warms my heart how much fun we had, how great they are together, how our family was there. And it was just a blast. So, that was the-

[00:05:40] [SPEAKER_04] Plus the views from your place, the pictures. Outstanding. Good stuff.

[00:05:44] [SPEAKER_03] Yeah. Yeah. Funny story. So, the rehearsal dinner was on the top of Snowbird Mountain at the summit. And, you know, the sun starts going down and there's all these colors, you know, purples, oranges, all this stuff. And all of the people that aren't from Utah are just staring out the window or going out on the sort of the deck area there. And we're like oohing and aahing. And then we ride the tram down.

[00:06:09] [SPEAKER_03] And, um, my son's wife, I've only said that like five or six times ever. One of her friends came up to me and she said, you guys are all like oohing and aahing over the, over the views and everything. But I've lived here my whole life and it just seems like another day to me. Is there something wrong with me? No, I don't think there's something wrong with you, but this is cool. Like we don't get to see this every day. So, it was kind of funny.

[00:06:38] [SPEAKER_03] Um, and then, you know, that pretty much dominated the whole year and the summer. We went to one Indians game and they lost. That'll probably be it. Um, what else did we do? I went to, uh, Virginia to pickleball camp a couple of weeks ago. That was fun. And, um, are you rated?

[00:07:02] [SPEAKER_04] Are you rated now? Do you have a rating?

[00:07:04] [SPEAKER_03] I have a rating.

[00:07:05] [SPEAKER_04] What's your duper rating?

[00:07:06] [SPEAKER_03] My duper rating, uh, I'm probably like a three seven. Nice. Um, so moving up. That's really good. Yeah. It was, it was, uh, it was a lot of fun. Played a lot of pickleball this summer. Also a lot.

[00:07:19] [SPEAKER_04] Great use of a summary. A lot. All right. Um, so Kevin, we, we promised clinical content after people, you know, after we, if we did rock and roll for like three or four weeks in a row.

[00:07:32] [SPEAKER_03] I wonder if anyone listened to that at all.

[00:07:34] [SPEAKER_04] I don't know. I've never heard a comment from it. So I, you know what? I had, I had enough fun making it that I don't care if you don't listen to it or not.

[00:07:40] [SPEAKER_03] We're just making this for us.

[00:07:42] [SPEAKER_04] Yeah. Yeah. I made, I made it cause I wanted to have the conversation. Um, spoiler alert. We have real clinical content.

[00:07:49] [SPEAKER_03] Well, spoiler alert. Oh, okay. In the near future, we're going to have a completely non-clinical, but dentist related podcast series. Um, but we'll, you know.

[00:08:00] [SPEAKER_04] I'm really excited about this more than you can possibly imagine too. So anyway.

[00:08:05] [SPEAKER_03] Yeah. I might have to do it.

[00:08:07] [SPEAKER_04] That's another thing no one will listen to, but it's going to be great. Let me tell you. Yeah.

[00:08:09] [SPEAKER_03] It'll be fun for us.

[00:08:11] [SPEAKER_04] That's right.

[00:08:11] [SPEAKER_03] Emily and Shane are like, what the heck are they talking about? We'll tell you later. Uh, but anyway, we are, it now, well, maybe a plant that eats people, but that's about it.

[00:08:28] [SPEAKER_04] All right. So we got real content, Kevin. Yes. Real content is coming.

[00:08:34] [SPEAKER_03] All right. So, uh, Shane and Emily, we're going to be teaching the TRT class in a week and a half. We decided, and I thought, uh, we would let our listeners have some tips and tricks. I think one of the strengths of this team of the three of us is that, you know, we all have some strengths that compliment each other. So, um, we're going to talk about extraction graft and guided implants, and let's talk

[00:09:04] [SPEAKER_03] about extraction graft first. Uh, Emily, give me the tip, just the tip. Give me one tip that you would give an attendee at our class.

[00:09:17] [SPEAKER_00] I think what really changed things for me, um, when I was an attendee four years ago, um, four and a half years ago is making sure your flap is extended and big and that you can see. I mean, that makes your life so much easier when it comes to placing your membrane at the end. Um, your membrane is less likely to fall out. Uh, the graph is contained better, um, because you made a big flap.

[00:09:47] [SPEAKER_03] Yeah. So for the listener, so that, that step, we call that visualization where we're reflecting a flap back. And I think you're exactly right. I think that's something that we need to overemphasize next week or whenever it is, or it actually is this week. If you think about it, uh, when this podcast is coming out. Um, really extend those flaps because it makes everything else following that so much easier.

[00:10:16] [SPEAKER_03] Everything that you, you outline there. It really, uh, flows from one step to the next, particularly, um, allowing you to visualize the tooth to section it if, if you need to, and also placing the membrane in just makes it a piece of cake. You shouldn't be fumbling around with that. It should be like stuffing a letter in an envelope. Uh, Shane thoughts.

[00:10:44] [SPEAKER_05] That's a great tip. That, that tip is like, that is like the key. That's, that's the foundation that sets you up for the whole success. Almost of the whole thing. It's like, if you didn't flap enough to see what you're doing, you're either going to have to go back and flap more, pick up your blade again. Your assistant's going to be mad at you passing stuff back and forth. You might tear your flap if you don't have it big enough. So then you got to deal with the tear and placing the membrane and all those things.

[00:11:11] [SPEAKER_05] Um, so that's a very, I think it's a very, very, very key one. I think I have another tip, um, that I would share. I think it's specifically for molars, upper lowers, and maybe even double rooted pre molars. Um, go to the handpiece, go to the handpiece quicker than you, than you think you need to. Because I felt like when I graduated dental school, they made us like scared, like to section teeth, right? Like it was a scary thing. It's a section of tooth.

[00:11:40] [SPEAKER_05] You were supposed to, uh, beat on the tooth with a hammer and a chisel and break it off and break root tip, break the crown, do all this stuff. An hour and a half later, you might then remove a little bone and try again. So it was just, they, they kind of scared you. And now it's like, one of the reasons that we can do it so quickly now with molars is because we don't mess around, you know, we either take the crown off if it's there, get it out of our way so we can see where to section clearly.

[00:12:10] [SPEAKER_05] We know the anatomy looking at our CBCT ahead of time, where the roots are at, where the forcations are at, plan everything pre-plan and just go straight to the handpiece and section the tooth. Um, that's, that would be kind of my tip is get comfortable with the handpiece from the get go after the flap.

[00:12:30] [SPEAKER_03] So I have to say something to you, Shane. Uh, someone else that's on this podcast today sent me a message via Facebook messenger, Zach. Um, tell me what you said to me today or to us.

[00:12:46] [SPEAKER_04] Today I was talking about endo. Oh, the handpiece.

[00:12:50] [SPEAKER_03] Yeah.

[00:12:50] [SPEAKER_04] Oh, the handpiece. Uh, I mean, I don't remember the exact thing that I said, but I said that, that, that one thing, the handpiece has, has changed my ability to, to take out teeth completely, completely and the comb beam to know where to cut, know where to cut, know where your roots are and then the handpiece. But yes, even when I was in school, I also was not taught to use the handpiece and my dad wasn't taught to use it. It was what I practiced with until very recently. And so none of us used it and we all just fought through these teeth and I hated extractions.

[00:13:20] [SPEAKER_04] I hated them. Still can't say it's my favorite procedure, even not even close, but I'm way more confident and most of that's due to the handpiece and my little Kevin Fryer set on my shoulders saying, take the number two round and chugging around the tooth and you'll get it out, bro. And lo and behold, it happens. So yes, handpiece for the win.

[00:13:41] [SPEAKER_03] Yeah.

[00:13:42] [SPEAKER_04] So it doesn't even have to be an expensive one. The eBay ones are fine for my purposes, at least.

[00:13:48] [SPEAKER_03] So whatever works. But I do think whatever, you know, the analogy always is make the tooth smaller or the bone bigger or whatever that is. And it I mean, it's just it's just becomes a logic problem at some point. Like I always think like you're deconstructing the tooth to get it out or deconstructing a puzzle to get it out. And there are really two moves and you've just got to figure out which one it is.

[00:14:18] [SPEAKER_04] I got to figure and you guys you guys can answer this, of course. Almost every student who probably maybe comes with pretty limited extraction experience. They've never even picked up a handpiece for an extraction probably or or don't even know what they're doing with it. If they do have it. Is that accurate for the for the pretty limited? Yeah.

[00:14:37] [SPEAKER_05] I mean, we when we were in oral surgery, we didn't even like we weren't even allowed to take teeth out unless we were like on the oral surgery floor.

[00:14:44] [SPEAKER_04] Yep.

[00:14:44] [SPEAKER_05] Correct.

[00:14:45] [SPEAKER_04] Same.

[00:14:46] [SPEAKER_05] And then then it was the what's the drill like the hall drill, the NASCAR pit stop, you know. Oh, yeah. Oh, yeah. That's pretty insane. Yeah.

[00:14:53] [SPEAKER_02] Yeah. Yeah.

[00:14:54] [SPEAKER_05] Yeah. It's the yeah. So it was like, yeah, I mean, it's kind of brutal. So I don't even know if I was in dental school and got to use like a normal was it one to four two or whatever the surgical handpieces to cut a tooth with. I don't think I did.

[00:15:12] [SPEAKER_04] No, I didn't for sure. Didn't know. I haven't close. Didn't even know about that. Those existed for the first several years of practice either. So, Kevin, what'd you do like early on in your career? What did you when you were taking out teeth? You didn't have a handpiece, did you?

[00:15:28] [SPEAKER_03] I rarely used it and I broke a lot of buckle bone and I didn't care because I wasn't placing implants. I just gripped and ripped and moved on to the next patient. I mean, that's, you know, like I this was 1990. No, I understand. 91. Like implants didn't exist. They rarely existed.

[00:15:49] [SPEAKER_04] I know what you're saying. And it's, you know, like I said, though, just even even even just taking out teeth.

[00:15:56] [SPEAKER_03] Sometimes I cringe at like because I section every single molar now. And even then, sometimes like an upper molar, a three rooted upper molar with some really splayed roots. It takes a little bit of work to get it out, no matter who you are. And I think you just grab onto this and just rip it to the buckle and it came out and I'm like, I'm done. Where's lunch? Yeah. Yeah. But life has changed.

[00:16:19] [SPEAKER_03] I would like to add one tip to this that I added to the lecture and Zach alluded to it to analyze the cone beam. I think that's that's not something that's something that we always do in the clinic. But I don't think we've ever really expressed it that much in the first part of the lecture on that day three when we go through cases we do. And that's important.

[00:16:41] [SPEAKER_03] But, you know, knowing that there's two roots on an upper molar or whatever anatomical anomaly there is, knowing that ahead of time is a great help before you start sectioning a tooth in particular. And also knowing how much infections there, because as we know, sometimes it takes longer to get all that stuff out than the tooth. And that can be a lot of fun. All right.

[00:17:09] [SPEAKER_03] Another extraction tip if you have one. Anyone anything else?

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[00:17:43] [SPEAKER_01] Use VERYSHIP, all one word, today.

[00:17:48] [SPEAKER_03] Because I have one if you don't. Because it happened to Matt today.

[00:17:53] [SPEAKER_02] See it. Yeah. Go for it. Shoot.

[00:17:55] [SPEAKER_03] So Matt was taking out number, this might have been yesterday, but anyway, it was an upper molar. And it was pretty badly infected. And so, basically, the infection was underneath the furcation on the buckle. Like, where the furcal bone is in the buckle.

[00:18:23] [SPEAKER_03] And, you know, you could feel it in there. He called me in to look at it. I'm like, just get rid of that bone. So, get rid of it now. Like, don't dick around with it. Just get rid of it so you can get down to where the granulation tissue is quickly. So, the tip is, you're not going to get that out without, and that bone doesn't matter. You're going to graft that area anyway.

[00:18:52] [SPEAKER_03] So, just get it out of there and get visualization of that area and scoop it out. So, and I think my exact words to him was, I used to, you know, waste time basically trying to scoop that out somehow. And it's never going to happen. Just get rid of the bone and put your bone graft material back in there. So, that can happen on a lower molar or upper molar, any multi-rooted tooth.

[00:19:22] [SPEAKER_04] So, Kevin, speaking of bone grafts, I think that's a good segue. What is your guys' bone grafting or membraning or whatever it is that you guys are teaching these days for that? What's your tip of the day on that? Let's go to Shane first. What's your bone graft tip of the day?

[00:19:41] [SPEAKER_05] Tip of the day is, I guess, sticky bone. I mean, sticky bone, sticky bone, sticky bone. That's all I got to say about that.

[00:19:49] [SPEAKER_04] What is sticky bone for the uninformed? What does that mean? Is that a brand? Should it be a brand?

[00:19:56] [SPEAKER_05] That would be a really good brand. Man, that'd be a great marketing brand. We should come up with that. I'm the sticky bone. That's what I'm here for. No, so sticky bone is... Oh, there you go. No, you draw some blood for sticky bone. So, we draw blood that gets spinned in a centrifuge, pulls out some growth factors out of liquid. So, you're using normal bone graft material, like an allograft, the bone dust out of a vial.

[00:20:24] [SPEAKER_05] And instead of hydrating it, maybe with saline, you are using the PRF or the liquid PRF that you get out of the blood draw and the centrifuge. And basically, it causes the bone to hydrate and congeal almost like a little pancake. You can pick the whole vial up in one little splat if you wanted to. It just makes handling so much easier. So much easier.

[00:20:49] [SPEAKER_05] Packing your bone graft material, your assistant handing it over to you, a lot easier to work with. It heals unbelievably well. So, that is my tip, is if you're not in the sticky bone yet, get into sticky bone. I bought a cheap centrifuge to get started on Amazon. And started there and started on my practice and on my assistants and did it myself. Then we trained everybody.

[00:21:17] [SPEAKER_05] And now my whole team does it for us. It's just part of what we do. We just, one day I walked in and said, guess what guys? We before we're always doing sticky bone. And that was about, I don't know, two and a half years ago. We haven't looked back since.

[00:21:32] [SPEAKER_04] But you, Emily, but your grafting tip of the day.

[00:21:36] [SPEAKER_00] Yeah, that was mine too.

[00:21:39] [SPEAKER_04] Dang.

[00:21:40] [SPEAKER_03] Sorry, I stole your thunder.

[00:21:42] [SPEAKER_00] I had life before sticky bone and life after sticky bone.

[00:21:46] [SPEAKER_03] I think we all have.

[00:21:48] [SPEAKER_00] Yeah, and kind of same. I did it at first. I owned it. I really didn't enjoy drawing blood. It's just sort of, I don't know, I don't like it. And so I brought in a phlebotomist, trained my whole team. And now every single one of my assistants can draw blood like way better than I can. And not only does it make the bone handle better, things heal faster with PRF. It increases the speed of healing.

[00:22:13] [SPEAKER_00] And even if something came out that proved that wrong, I would probably still draw blood just because it makes handling the bone so much easier. But, yeah, other than that, I guess for grafting, you know, suturing is super important because you don't want to lose your bone graft after just spending all this time placing it.

[00:22:35] [SPEAKER_00] And so really taking your time to place good sutures and making sure they're snug but not too snug and overengineering it, as Kevin says.

[00:22:49] [SPEAKER_03] We're laughing because of something that happened yesterday. But go on.

[00:22:55] [SPEAKER_00] Yeah, it's been hard to say this with a straight face. But no, really, I mean, like when I first started getting more into surgery, I bought a suture pad off Amazon and would just sit at my desk and practice suturing until it was like really muscle memory. Because nothing can be more frustrating. And then you finally get the dang tooth out, you get your membrane tucked, and then you struggle suturing up the case.

[00:23:21] [SPEAKER_00] You know, you have to really, even when you're tired, suture well. So that would be my tip. Okay.

[00:23:30] [SPEAKER_04] What about you, Kevin? You don't usually have any tips on this kind of stuff.

[00:23:33] [SPEAKER_03] What's your tip? So my tip would be that you completely clean out the socket. And that... What does that mean? Removing every last bit of granulomatous tissue or PDL or endodontic material or whatever else junk is in there.

[00:23:53] [SPEAKER_04] How do you clean that out? Tell me what you do. What do you do?

[00:23:55] [SPEAKER_03] So we have a bear claw curette. That's my go-to first thing. And, you know, every once in a while you get lucky and the whole thing comes out in one big goober. And life is great. But that doesn't happen that often. And then the next go-to is the degranulation burr that you run in the handpiece to...

[00:24:22] [SPEAKER_03] You know, I usually glide that gently up and down the walls to remove the extra tissue that's there.

[00:24:31] [SPEAKER_04] What does this burr look like? Now you've got me curious.

[00:24:35] [SPEAKER_03] I can send you a picture of one, but it's basically like a slow speed with spikes on it. Is that fair to say, Kevin?

[00:24:42] [SPEAKER_04] Wow. Kind of want one even though I'm not going to use it. I kind of just want one. That kind of sounds badass.

[00:24:48] [SPEAKER_03] You do want one.

[00:24:50] [SPEAKER_04] I do. Absolutely.

[00:24:51] [SPEAKER_03] But I think, you know, the back of my mind on all of these is if I don't get all this out, my implant is going to fail. That's just what my thought process is. So I'm super meticulous at that. Good. I don't think... You can't skimp on that.

[00:25:10] [SPEAKER_04] All right. Well, we're to the titanium now. We're done. We're grafted. It worked. Your sticky bone was successful. You're suturing exquisite, you know? So what's the titanium tip of the day, Shane?

[00:25:26] [SPEAKER_05] My titanium tip of the day, especially even with guided surgery. That's what we teach.

[00:25:31] [SPEAKER_02] Yep.

[00:25:32] [SPEAKER_05] Is guided surgery. Sometimes with guided surgery, you can't tactile feel kind of the density of the bone. Sometimes you can. You can tell how hard you're having to push to get a drill into your guide. But sometimes you can't. My tip is look at the flutes of your drill when you're done with that drill sequence. Like each drill you use, take it out and look at it. Is it covered in bone or is it completely bare?

[00:26:00] [SPEAKER_05] If it's completely bare, that usually tells you you've got not great bone. Like not very dense bone, kind of like styrofoam, a lot of air in there. If it's covered in bone, it means you've got really, really dense bone. And the reason that that's important is because sometimes if you're trying to get good stability on an implant so that, you know, it heals well, if you want to do a healing abutment or anything like that on top of it, sometimes you have to undersize your drill sequence.

[00:26:29] [SPEAKER_05] So we always teach, you know, a lot of times to follow the drill protocol from the manufacturer, whatever system you're using and place your implant. But that's not always the case in real world because if you follow that sometimes and you've got really mushy bone and you go to place your implant and it spins and it doesn't torque out, you're like, what happened? I followed everything. What's because your bone kind of sucked and we weren't paying attention to kind of the density.

[00:26:55] [SPEAKER_05] So stop and look after each drill and just see, you know, was that like air or mush? Am I one drill short of where I'm supposed to go? Maybe I can go ahead and place my implant. If I went one drill short and it's absolutely covered in bone, then I know I need to use that final last drill. So that's my tip is just pay attention to your drills after you're done using them. Super.

[00:27:21] [SPEAKER_04] All right, Emily, go.

[00:27:23] [SPEAKER_00] It's a great tip, Shane. Mine would be, again, we teach guided surgery. So you have a plan going into it. We place neodent implants. It's a bone level implant. So you want it a couple millimeters subcrestal for the best immersions of your restoration and to see less crustal bone loss. So you have a plan going into it, but it doesn't mean you shouldn't think critically.

[00:27:50] [SPEAKER_00] So my tip would be after you're done with your drill sequence, say you're placing a 10 millimeter implant, take your guide off and measure the depth of your osteotomy so that you know if you're placing a 10 millimeter implant, your plan should have that osteotomy be 12 millimeters deep. Um, but some things are sometimes not perfect, you know, and if your osteotomy is only 11 millimeters deep, you know, you may want to consider placing,

[00:28:19] [SPEAKER_00] going deeper with your drill if you have the bone. Um, you know, if you're in an upper premolar site and you've got a lot of depth, you can go one more drill length to go a little deeper so that you can get your implant to two millimeters subcrestal. Um, if you're on the lower and you're worried about nerves, um, it might be worth considering placing a shorter implant, like an eight. Um, but if you don't know the depth of your implant, you don't know when you're finally torquing it down,

[00:28:48] [SPEAKER_00] um, how, where you should end up at the end. And so you run the risk of spinning your implant out, wallowing, um, yeah.

[00:29:01] Okay.

[00:29:02] [SPEAKER_00] Super. Great tip.

[00:29:04] [SPEAKER_04] Yeah. Uh, and what about you, Kevin? You've done a few implants.

[00:29:09] [SPEAKER_03] Yeah. So my tip is, um, so one of the issues with guided surgery is making sure that the irrigant gets to the bone. And one of the things I like to teach is hovering above the guide a little bit. I don't know where that noise is coming from.

[00:29:28] [SPEAKER_00] We'll have to figure that out. What is that?

[00:29:29] [SPEAKER_04] I think it's, I think it's, Shane, is your headphones come unplugged?

[00:29:34] [SPEAKER_05] I don't think so. I'm not moved.

[00:29:37] [SPEAKER_04] Okay.

[00:29:38] [SPEAKER_03] Yeah. Um, but anyway, I, I think the best way to avoid heating up the bone is to hover above your guide a little bit and press the rheostat and let the, um, irrigant kind of flood the field and then proceed with your osteotomy. And I've taken to, when I remove the, uh, osteotomy drill, just touching it with my other hand to see if it's warm or not.

[00:30:08] [SPEAKER_03] It should be cold. It should be, the metal of it should be cold from the, from the irrigant. And, um, you know, that gives me a little bit of peace of mind. Um, by the way, there is a place where you can see a bunch of tips of the week, by the way, uh, on my Instagram page. Um,

[00:30:27] [SPEAKER_04] those are very good quality, by the way, Kevin, I, I've meant to compliment you on those. They're, they're good stuff.

[00:30:32] [SPEAKER_03] It's AI. But anyway, um, but they're, my cases, but there have been augmented.

[00:30:40] [SPEAKER_04] But, but AI did them? That you have a, you have an AI robot placing your implants? No,

[00:30:46] [SPEAKER_03] I'd say the AI is making the photo, not the photos, the slides look pretty.

[00:30:53] [SPEAKER_04] Okay. All right. And yeah, that's good. I'll, I'll accept that. I'll accept that. Um, okay. So obviously, by the time the show comes out, you guys will probably be giving this next September course. What's coming up after that? What's when's the, if, if someone's listening to this and like, yeah, I'm, I'm in, when's the next one after, after the September one? Or do you know yet?

[00:31:13] [SPEAKER_03] March, 2027, I believe. I don't know the exact dates, but I believe it's in March. March 8th. Okay.

[00:31:20] [SPEAKER_05] March, March 8th, I believe. Yeah. Okay.

[00:31:22] [SPEAKER_04] And Shane and Emily, are you going to be at that? Are you guys going to, are you guys at that one? No,

[00:31:27] [SPEAKER_00] I will be.

[00:31:31] [SPEAKER_04] You'll be there.

[00:31:32] [SPEAKER_03] I will be there.

[00:31:33] [SPEAKER_04] Excellent. All right. I probably, thank you guys for taking,

[00:31:36] [SPEAKER_03] been skiing the week before that.

[00:31:39] [SPEAKER_00] Same, Kevin. Well,

[00:31:42] [SPEAKER_03] I always go to Utah for my son's birthday to ski. So, March 1st.

[00:31:47] [SPEAKER_00] March 1st. Okay. I think that's when we're going to.

[00:31:50] [SPEAKER_04] Oh, where are you going? Great. This is,

[00:31:51] [SPEAKER_00] I think we're going to Colorado.

[00:31:54] [SPEAKER_04] Wow. Well, yes, but where?

[00:31:55] [SPEAKER_00] Yeah. So my brother lives in Breckenridge. Okay. So we might go there. Easy. Or hit up a couple of, maybe go to Keystone for a day. I would love to go to Crested Butte. That's way away from that. I know that, but. Yeah. Do a little, like Colorado skiing road trip, I think would be super fun. So that's sort of on our bucket list. Oh man,

[00:32:20] [SPEAKER_04] we'll bring you back for ski season. I could do a whole episode on that for sure. Yeah,

[00:32:24] [SPEAKER_03] maybe we should do skiing and dentistry.

[00:32:27] [SPEAKER_04] There we go.

[00:32:27] [SPEAKER_03] We should do that.

[00:32:28] [SPEAKER_04] There we go. There we go. Hey, all right. Thank you guys for listening. If you need more information, Kevin, what's the website for 3D? Is it just 3DDentist.com? Okay. Just Google it. It's one of those things. You'll find them. All right. And again, thank you guys for taking some time to talk to us about implant stuff. Kevin, always a pleasure. And thank you guys for listening. We will see you next Tuesday.

[00:32:54] [SPEAKER_03] See ya.