Very Dental Student: Kevin and Zach Extract!

[00:00:01] This is a production of the Very Dental Podcast Network.

[00:00:09] It's time for a Very Dental Podcast just for students and new dentists.

[00:00:14] Welcome to the Very Dental Student Podcast.

[00:00:17] And now here's your host, Mohamed Aboubasha.

[00:00:20] Very Dental Student listeners and Very Clinical listeners, I have a very cool announcement for you.

[00:00:27] So, if you listen to the whole feed where you listen to all the different shows that we put out here at the Very Dental Podcast Network,

[00:00:33] you know that the Very Clinical Show is our Tuesday show.

[00:00:37] And it features Dr. Kevin Fryer and Dr. Zach Miners as the hosts.

[00:00:42] This has been going on for years, years and years.

[00:00:45] And then more recently in the last couple of years, we also have a show called The Very Dental Student Podcast,

[00:00:50] which features our host, Mohamed Aboubasha.

[00:00:54] He's currently a third year student at Oklahoma in dental school.

[00:00:58] So, each of these shows kind of has their own sort of way of doing things.

[00:01:04] I've had the honor of being on both shows multiple times in a lot of different capacities.

[00:01:09] But what's interesting is Zach and Kevin and Mo, I don't think have ever podcasted before now.

[00:01:16] So, what we have is this epic crossover between Very Clinical and The Very Dental Student Podcast.

[00:01:23] And today and tomorrow, actually, you're going to hear kind of like two sessions worth of that interaction.

[00:01:31] And they talk a little bit about dental school.

[00:01:33] And it's very cool.

[00:01:34] It's really exciting to hear all three of these guys.

[00:01:37] So, maybe at some point, the four of us can get on an episode and, I don't know, do like Dental Jeopardy or something like that.

[00:01:45] That would be epic.

[00:01:46] In any case, you have a lot.

[00:01:48] Actually, they have multiple episodes that they've recorded.

[00:01:51] Then, like I said, the next two days, you'll be hearing from them.

[00:01:55] So, I'm just going to put it in one day is going to be very dental student episode.

[00:01:59] The next day will be very clinical.

[00:02:00] But they'll be kind of consistent.

[00:02:02] There's sort of one after the other.

[00:02:03] So, don't be too surprised by that.

[00:02:05] And so, with that, I give you The Very Dental Student and The Very Clinical Podcast.

[00:02:10] Hello, everybody.

[00:02:11] Welcome to another episode of The Very Dental Student Podcast.

[00:02:14] I'm your host, Muhammad Abu Basha.

[00:02:16] Coming at you live again with now my most frequent guests on the show, Kevin and Zach.

[00:02:25] Do we get a jacket?

[00:02:27] I'll make one and send it out.

[00:02:29] Nice.

[00:02:30] All right.

[00:02:30] That's like one of those t-shirts.

[00:02:33] I came on this podcast and all I got was this t-shirt.

[00:02:35] Yeah.

[00:02:36] That's the part.

[00:02:37] I'm with stupid.

[00:02:41] So, Kevin and Zach, for this week's bit, I was thinking we would talk about finals week.

[00:02:49] That's right.

[00:02:50] Because, as it is currently the week that this is coming out, I believe I'm actually taking my finals right now.

[00:02:56] Are you nervous?

[00:02:57] Are you okay?

[00:02:57] I think I'm actually very nervous.

[00:03:00] All right.

[00:03:01] Do you remember, Zach, that being just a week of stress?

[00:03:05] Oh, yeah.

[00:03:06] For sure.

[00:03:06] It was terrible.

[00:03:07] It was terrible.

[00:03:08] And now do you think, like, what was the big deal?

[00:03:11] No, I still remember it sucking.

[00:03:13] So, no.

[00:03:14] I can actually, my palms might be getting a little sweaty just thinking about finals week, to be honest with you.

[00:03:19] I don't know if I like talking about it.

[00:03:20] Can we move, we just move on?

[00:03:22] No, we gotta have some stories.

[00:03:23] All right.

[00:03:24] That's fine.

[00:03:24] So, actually, my strategy so far in dental school has been, I like to build up as much of a cushion in my classes.

[00:03:32] And then just basically take finals week as just like, I need to get 50s on all the finals to just pass the classes.

[00:03:40] So, maybe not.

[00:03:42] Wait, your classes are pass-fail?

[00:03:44] No, they're not pass-fail, but I have no plans on going to a residency.

[00:03:48] Oh, okay.

[00:03:48] I got you.

[00:03:49] Hey, C's get degrees, right?

[00:03:51] Yep.

[00:03:52] Yep.

[00:03:52] Okay.

[00:03:54] Excellent.

[00:03:55] I like the strategy.

[00:03:58] Yeah.

[00:03:58] I dig it.

[00:03:59] So, which one of y'all wants to go first on memories from finals week in dental school?

[00:04:04] I have an anecdote.

[00:04:05] Okay.

[00:04:06] So, first year of dental school, I stayed in the grad dorms, but we, I had like a meal plan, like a, you know, like you're an undergrad.

[00:04:15] So, I would go get food at the food hall or whatever they called it.

[00:04:20] So, there was all sorts of people there, you know, like undergrads, everybody, right?

[00:04:25] So, I'm waiting in line to get my hot dog or whatever gross food they were slopping on my plate that day.

[00:04:34] And there were two obvious freshman girls in front of me in line.

[00:04:41] And, um, they were talking about finals week.

[00:04:46] And one of them said, Oh my gosh, I have four finals this week.

[00:04:51] And I just snapped.

[00:04:52] And I said, I have 14, which is what I was like.

[00:04:55] True.

[00:04:56] Right.

[00:04:56] You had like 14 finals.

[00:04:58] How are you going to cram all those into four days or whatever it was?

[00:05:01] It was, it was remarkable.

[00:05:04] Crazy.

[00:05:05] The amount of, you know, cause a lot of these classes where you had a lab and didactic, you'd have two finals.

[00:05:11] It was just insane.

[00:05:12] So, um, I snapped.

[00:05:14] I apologize to whoever those young ladies are now.

[00:05:18] I'm sure they're listening.

[00:05:20] I was under a tiny bit of stress for my anatomy, biochem, whatever, dental anatomy.

[00:05:30] I don't know, whatever those silly classes were.

[00:05:35] Yeah.

[00:05:35] It was a lot.

[00:05:38] So play it on.

[00:05:39] So one, because I also wasn't shooting for residency, your strategy, Mohamed's like speaks to me.

[00:05:46] I always had in my head, like, okay, I've got this grade in this class.

[00:05:49] So I need to get X on the final.

[00:05:52] And it was almost like the lower score I had to get on the final.

[00:05:55] Then that got moved down on my like cramming and studying list.

[00:05:58] So I had a, I almost spent more time.

[00:06:00] I feel like figuring out what I had to get on the final and actually working on the final.

[00:06:04] You're like the Las Vegas odds maker.

[00:06:08] I mean it, that I, I get that guy.

[00:06:11] So I understand that.

[00:06:13] So anyway, I had one of those 14 finals weeks like Kevin to the point where like, I think

[00:06:19] one of them got like double scheduled.

[00:06:21] And so then they had to reschedule it.

[00:06:23] So I had the, I had the classic thing happened to me that like you almost only see in movies where I woke up and, and someone had someone to my phone ringing.

[00:06:38] Someone called me from the school saying, Zach, what the hell?

[00:06:41] Get your ass here.

[00:06:42] It's on.

[00:06:43] It's happening.

[00:06:44] What are you doing?

[00:06:44] My, my, that's my roommate.

[00:06:46] He left.

[00:06:46] He thought I'd already gone.

[00:06:47] Yeah.

[00:06:48] Um, and so, I mean, fortunately, you know, I had people that, that, that cared about me and I was only, uh, I lived very close to the school.

[00:06:57] So I think, you know, whirlwind getting up.

[00:07:00] I think I was at most 10 to 15 minutes late for the final.

[00:07:03] It was everything turned out fine, but I, that, that is a, that's one of those memories that like, you, you don't forget when you're like, that's like a bad dream.

[00:07:13] Yeah.

[00:07:13] Yeah.

[00:07:13] I was about to say, I've had that nightmare.

[00:07:15] Exactly.

[00:07:16] Well, okay.

[00:07:17] Yeah.

[00:07:17] So I have you, I don't know about you guys.

[00:07:19] Well, I guess Muhammad doesn't know yet.

[00:07:21] Kevin, do you have like bad recurring?

[00:07:24] Yes.

[00:07:24] Like almost dental school dreams for, for years after you had to wake up and be like, well, I've already got a license.

[00:07:29] I'm good.

[00:07:30] You know, here's how my, those dreams have come, have come for me.

[00:07:33] They, I've progressed from having, um, as an adult elementary school dreams like that.

[00:07:41] Yeah.

[00:07:41] And then I'm in my middle school.

[00:07:43] Like, like this is over decades of time.

[00:07:45] Yes.

[00:07:46] Now I'm in middle school.

[00:07:47] Now I'm in high school and I miss the exam.

[00:07:49] Now I'm an undergrad at Purdue and I miss the exam.

[00:07:52] Now I'm in dental school.

[00:07:54] And I, I miss the exam.

[00:07:57] And what you just said, like when I woke up from the dental school one, I'm like, I have a license.

[00:08:02] Why am I still having these stupid dreams?

[00:08:04] Why would I have a elementary school?

[00:08:07] Like I missed the spelling test or whatever.

[00:08:09] Right.

[00:08:10] But it was somehow my brain was cattle cataloging or categorizing chronologically all these times where you could possibly miss an exam till you got to the end.

[00:08:20] Yeah.

[00:08:21] So I think I had some kind of a recurring dream along those lines of like not getting my license or not passing.

[00:08:28] Yeah.

[00:08:28] I think it took, I think it was about 12 to 15 years after school.

[00:08:32] And then I can't remember the last time I've had a, woke up with a bad dream.

[00:08:36] Like, Oh dude, you have a license and you've had one for 20 years, you know?

[00:08:40] Yeah.

[00:08:40] Anyway, they go away.

[00:08:41] The bad dreams go away.

[00:08:43] So I had one a couple months ago.

[00:08:45] Did you really?

[00:08:46] Yeah.

[00:08:46] It was really weird one too.

[00:08:47] It was like interconnected with different.

[00:08:49] I don't know.

[00:08:51] My brain.

[00:08:52] Sorry, man.

[00:08:53] Yeah.

[00:08:54] I've definitely had a history of those dreams as well.

[00:08:57] And I always think that they're real life when I'm dreaming.

[00:09:00] Yeah.

[00:09:00] Oh yeah.

[00:09:01] Very realistic.

[00:09:02] They're hyper realistic.

[00:09:03] Recently I've been, I've been having dreams that I, I like miss an appointment with a patient

[00:09:08] and they give away my endo or something.

[00:09:10] So that's the new, that's the new adaptation.

[00:09:13] That's too real because you're currently going through it.

[00:09:15] Yeah.

[00:09:16] Don't love that.

[00:09:18] But I'm glad you guys gave me something to look forward to, which is apparently the continuation

[00:09:22] of these dreams.

[00:09:23] Yeah.

[00:09:24] 10 plus, or I guess in Kevin's case, 25 year plus of recurring nightmares.

[00:09:30] Another nightmare I've been having recently, which will transition us nicely into our topic

[00:09:37] is I've been dreaming that I've just been extracting a tooth and like ripping off a maxillary tuberosity

[00:09:43] or maybe tearing off a buckle plate or something.

[00:09:46] It'll happen to you.

[00:09:46] That'll happen to you.

[00:09:48] But so anyway, that might be real.

[00:09:50] It may be a foreshadowing.

[00:09:51] Yes.

[00:09:52] Foreshadowing.

[00:09:53] That's a, that's a premonition from the future.

[00:09:56] That's future Muhammad talking to younger Muhammad.

[00:09:59] That's right.

[00:09:59] You're going to do this one day.

[00:10:00] Yeah.

[00:10:01] So, which transitions us perfectly into our topic for today, but we wanted to talk about

[00:10:07] extractions for students.

[00:10:09] And I mean, I, it's all up to you guys for this cause I've only extracted like, um, you

[00:10:15] know, maybe 15 teeth total and probably more than half of those are very perio involved.

[00:10:20] So really could go anywhere.

[00:10:23] I really don't know anything about extracting teeth.

[00:10:25] So where, where should we begin?

[00:10:29] Um, I'll begin.

[00:10:33] So I've thought a lot about this since we, um, kind of talked about this behind the scenes

[00:10:39] and, you know, help teach a extraction graph course in North Carolina.

[00:10:44] And I think that, um, very directly to you, Muhammad, uh, you're paying $5 billion to go

[00:10:52] to school.

[00:10:53] Is that true?

[00:10:54] 6 billion.

[00:10:55] 6 billion.

[00:10:55] Um, for those $6 billion, they should be teaching you, especially you, as you progress

[00:11:05] in your career, they should be teaching you atraumatic extractions and grafting.

[00:11:11] It should be, that should be the course, not some grip and rip, whatever they're teaching

[00:11:18] you that is, is not going to help you lay a good foundation for the future.

[00:11:23] Um, my, what I've noticed is that we have to either the people that go through the tooth

[00:11:34] replacement therapy class in North Carolina at 3D dentists are either, we either have to

[00:11:40] re teach them, un teach them bad habits or teach them from scratch.

[00:11:50] Um, and these are all, you know, people who've graduated from dental school and practicing for X number of years.

[00:11:56] And, um, you know, I think it's sort of getting a little bit of a disservice because as your career progresses,

[00:12:07] for, for sure, uh, implant dentistry is going to be, you know, very, even more common than it is now.

[00:12:16] So that's my soapbox two cents.

[00:12:19] If you're paying $6 billion, they, they should teach you the best of everything.

[00:12:24] Mm hmm.

[00:12:26] Yeah.

[00:12:27] I think we get some of the foundations, um, in lecture, but it's really, we don't get, I don't think we get the reps at all.

[00:12:34] Have you ever sectioned a tooth?

[00:12:36] We have in preclinic.

[00:12:38] Yeah.

[00:12:38] In preclinic.

[00:12:39] Okay.

[00:12:39] Yeah.

[00:12:39] On a live human.

[00:12:40] Yeah.

[00:12:41] No.

[00:12:41] Do they encourage you to do that at all?

[00:12:43] Um, no.

[00:12:45] And I don't think as a third, they don't even have the hand pieces set up in surgery for that.

[00:12:49] Do they, I, there's, there's one hand piece unit.

[00:12:53] Yeah.

[00:12:53] And then I think if a third year grabs the resident or the attending and says, I think this needs to go surgical.

[00:13:02] Um, I'm pretty sure they just come do it for you.

[00:13:04] They just take over.

[00:13:05] Yeah.

[00:13:06] That's exactly, that's exactly my experience.

[00:13:08] So what I'm thinking right now is the good news is you don't have to pay $6 billion to watch this on YouTube.

[00:13:15] And there's probably plenty of people, I guess I would imagine.

[00:13:21] Yeah.

[00:13:21] I can tell you how to section a tooth on YouTube, but, um, Zach, what are your thoughts on this?

[00:13:30] Um, I would say that aside from learning better anesthesia, that learning how to,

[00:13:40] use a hand piece and section more teeth unlocked my confidence as a clinician who, who started off at a very, very low, low confidence level on all, almost all types of extractions into, I'll take out most, you know, most teeth.

[00:14:02] And, and, and the ones that are like endodontically treated that you're going to have to, you know, cut all up.

[00:14:07] Don't, don't scare me as much as they, as they used to.

[00:14:10] I wouldn't have even attempted them.

[00:14:11] And so learning how to use the hand piece, the hand piece should be hooked up on almost, almost every extraction you do, except for maybe the perio involved one or an anterior tooth of some sort.

[00:14:24] Um, I think that somewhere along the line, I think you said, you know, like either group chat in the past or something that you felt like that was a failure.

[00:14:34] If you had to pick up the hand piece.

[00:14:36] Yeah.

[00:14:36] I did.

[00:14:37] Yeah.

[00:14:37] That was the way it was taught to me is that like, if you got the hand piece out, you had not, you'd done something wrong.

[00:14:43] And I'm picking up the hand piece first.

[00:14:46] I'm picking up the hand piece to, to do it right.

[00:14:48] Correct.

[00:14:48] Or to do it easier or to do it better.

[00:14:51] All the, actually all of those things, three of those things faster, better, easier.

[00:14:55] Um, uh, you know, I was taught that like, Oh, you're going to waste all this time cutting this tooth apart.

[00:15:01] Just, just, just, you know, start, start loosening it up.

[00:15:04] Uh, I think Kevin is quicker to go to the hand piece than I will.

[00:15:09] I will at least give like a couple elevators a try before I, you know, just to see if it might be an easier one.

[00:15:16] But, um, I'm much, like I said, the key is you have your assistant, have it hooked up.

[00:15:22] If it's there, then you're more likely to use it and then you'll get after it and then you'll get the job done.

[00:15:27] And, uh, anecdotally, I think since using that, I'm getting less of those callbacks.

[00:15:34] Like, ah, I need more pain medicine or, ah, you know, less stress.

[00:15:38] Less it's, I don't know.

[00:15:40] It's better all the way around.

[00:15:41] It's, it's been a major, a major change for me.

[00:15:44] Huge, huge change.

[00:15:45] So what are your thoughts about hearing that Muhammad?

[00:15:49] I mean, I've heard, I've heard you guys talk about this before on your podcast.

[00:15:53] And I've also heard other podcasts where they talk about sectioning.

[00:15:57] There's one in particular, um, the Protrusive Dental Podcast.

[00:16:01] I don't know if y'all have heard it, but he, he actually has a whole YouTube series on sectioning.

[00:16:06] So I've watched that and I know it's the better thing to do.

[00:16:10] I just wish I could have some reps to do it.

[00:16:13] Um, so what kind of hand piece are you guys using?

[00:16:16] That is, are you using just a regular, regular hand piece to section?

[00:16:20] No.

[00:16:22] Um, I will actually, Kevin should answer that question.

[00:16:24] No, I mean, I'm using a surgical hand piece that's at an angle that blows the air out.

[00:16:29] So, so we don't get a air emphysema.

[00:16:32] Okay.

[00:16:32] Um, but I think, you know, the, the whole approach, like in a nutshell, uh, I'm going to visualize the area.

[00:16:41] That means reflecting a flap on the buckle and lingual so I can see where the furcations are.

[00:16:48] Um, if it's an intact tooth, like with a crown on it, I'm going to section it horizontally and pop the top of off the tooth so I can get better access to the roots.

[00:16:59] If it's a lower molar and then I'm just going to cut through the furcation deep, like bury it.

[00:17:07] Um, you want, you want to see bleeding from the, from the bone?

[00:17:11] I want to see, I want to see bleeding and I want to see that the pieces are moving independently, which generally means most general dentists are timid about that.

[00:17:21] You need to really go for it.

[00:17:24] But what you need to be cautious about on the lower is not blowing through the lingual plate and, you know, hitting someone's lingual artery.

[00:17:31] So don't do that.

[00:17:32] There's a, there's a trick to not having that happen.

[00:17:37] But, um, that weak, if you, if you're weak about your sectioning, you can, I think you can actually make it worse.

[00:17:42] Correct.

[00:17:43] Yeah.

[00:17:44] You know, if you don't get it sectioned and then you start moving things right, you're, you're going to break it at a point you don't want it to break in.

[00:17:50] And, and you're probably going to have made your life worse.

[00:17:53] But my whole strategy, I'm just setting these up for the graph for a future implant.

[00:17:59] So my approach is way different than it was 10 years ago or 15 years ago where I would just, let's just get this thing out.

[00:18:05] And I, I don't know how that when I wasn't placing implants, how these patients would end up in my role surgeon.

[00:18:13] And he could put anything there because I was not, um, respecting the buckle bone at all.

[00:18:19] But even if you had no intention of grafting or implanting it, it's just a whole lot easier to take out three little individual roots or two individual roots than it is something that's connected, you know, um, or something that's spread wide.

[00:18:35] Do you get any CTs on these teeth before you take them out or strictly like 2d stuff?

[00:18:39] Muhammad.

[00:18:40] I know, I know you do.

[00:18:42] Yeah.

[00:18:42] I mean, I was going to comment on that.

[00:18:43] So I'm glad you mentioned that.

[00:18:44] We don't, we don't, we don't have, uh, CTs.

[00:18:49] Like we have a CT at the school, but I don't know even when it gets used cause we don't use it for endo and we don't use it.

[00:18:57] I think maybe the perio and oral surgery residents get to use it for implant cases, but yeah.

[00:19:05] Yeah.

[00:19:05] So once you start getting those, then the sectioning will even make more sense to you cause you're going to see how it's, how, how the tooth's going to come out.

[00:19:16] You know, you'll know what's like, oh, okay, this all fuses together into one root.

[00:19:20] So maybe this is not a good section candidate versus the ones that are like, if I don't section this, how is this going to possibly come out?

[00:19:26] Mm-hmm.

[00:19:27] I think that's, yeah.

[00:19:28] So I think.

[00:19:29] A neat thing.

[00:19:30] Zach and I are using our cone beams as a roadmap to how to take the tooth out.

[00:19:37] So taking a step back from what I said five minutes ago, I'm looking at that, um, cone beam and coming up with a plan in my head, um, in terms of how I'm going to section this, why I have to section it, what these roots are shaped like.

[00:19:54] And, you know, having all that information in 3D that I never could have prior to 2018, you know, it makes everything that much easier.

[00:20:05] I don't, I, I.

[00:20:07] You've mentally taken the tooth out before you ever, before you ever put a handpiece to it, right?

[00:20:11] You've kind of mentally taken the tooth out?

[00:20:13] Yeah.

[00:20:13] Yeah.

[00:20:14] I'm, I'm going through the motions in my head and now, you know, that's very quick.

[00:20:20] Like, okay, I got to do this, this, this, this, and this.

[00:20:23] Um, but not the, the 2D image is useless to me.

[00:20:29] Yeah.

[00:20:30] Relatively useless.

[00:20:32] Okay.

[00:20:33] So.

[00:20:33] But I mean, you know, you can't do anything about that right now.

[00:20:36] I w I would say since you don't have a handpiece and you don't have a 3D, I, the, the, do they

[00:20:44] give you approximators or a little like little, those little thin little, like almost knife

[00:20:48] style instruments to take teeth out with, or do you just have a series of elevators and

[00:20:52] forceps?

[00:20:53] We have.

[00:20:54] So, I mean, we have, I don't, I don't exactly know what you're referring to.

[00:20:59] So I assume we don't have them.

[00:21:01] Okay.

[00:21:01] Yeah.

[00:21:01] So we don't, we go number nine elevator periosteal elevator, and then we go to, you

[00:21:07] know, just a luxation with the regular elevators.

[00:21:10] Yeah.

[00:21:11] Got a small and a big one.

[00:21:13] Yep.

[00:21:13] Um, I think we have a spade, like one single spade that you have to get out of the cabinet

[00:21:18] if you want to use it.

[00:21:19] And then, and how much are you paying again for school?

[00:21:22] $6 billion.

[00:21:23] Yeah.

[00:21:24] It went up to seven, $7 billion.

[00:21:25] So I think it just, they just announced an increase for the fourth year from experience

[00:21:29] teaching other people.

[00:21:32] The, we use an elevatome, which is, you know, kind of like approximator, kind of like a spade,

[00:21:39] but almost everyone uses it wrong.

[00:21:43] And.

[00:21:44] Oh, I wonder if I'm using it wrong.

[00:21:46] So.

[00:21:46] Probably am.

[00:21:47] The, the, the, the elevatomes that I use have a, have a spade on the working end and then

[00:21:55] a long shank with a ball on the end that fits.

[00:21:58] It's, I'm pointing to my palm.

[00:21:59] It fits in the palm of your hand.

[00:22:01] Okay.

[00:22:02] And the motion is to drive, not wiggle, but drive that thing at my head.

[00:22:08] I'm trying to drive that to the apex.

[00:22:11] It's not going to get.

[00:22:11] Cause you're cutting the PDL.

[00:22:13] I'm cutting it.

[00:22:13] I'm separating the tooth from the PDL and widening the space between the root and the bone.

[00:22:20] Okay.

[00:22:21] And.

[00:22:22] Um, almost everyone uses it wrong.

[00:22:25] Almost everyone holds it wrong.

[00:22:27] They're designed to be held and used in a certain way.

[00:22:31] And the only way I can describe it on, on air is a deliberate driving motion to make the head of that spade disappear.

[00:22:41] Yeah.

[00:22:42] Once it's, once it's gone, like way down in there, you've done your job.

[00:22:46] Now you do it from the other side.

[00:22:47] If you've done that on the distal, you do it on the mesial, whatever you need to do.

[00:22:51] Um, and the tooth will magically pop out after that.

[00:22:55] But, um, yeah, that's, that's, um, a common thing that I have to teach.

[00:23:05] So Kevin, I see that I'm listening, listen to him describe his, what he has available to him.

[00:23:12] That brings back all of my like bad memory.

[00:23:15] Right.

[00:23:15] Like of, of when I was very unsuccessful at oral surgery, which was in my entire dental school career and a good solid, like, you know, five, my first five to seven years outside of school.

[00:23:27] We're, we're full of very negative oral surgery experiences.

[00:23:32] I, if you gave me those tools now took away my handpiece and took away my spades, I wouldn't be back in the same spot.

[00:23:39] I would have a hard time taking teeth.

[00:23:41] Like sometimes when I'm using that elevator tone in the, in the proper way and things are starting to get loose.

[00:23:47] I wonder like what in the world was I doing all that, you know, previous.

[00:23:52] Yeah.

[00:23:52] It'd be like going back to a single carpalitocaine, right?

[00:23:55] Yes.

[00:23:56] Yeah.

[00:23:57] There's a common, like, I just don't think, I just don't think I could get, get the job done.

[00:24:02] Well, same.

[00:24:04] Yeah.

[00:24:05] Same.

[00:24:06] Well, I guess I'll be taking some sort of extraction graft course.

[00:24:11] But here's the problem with that.

[00:24:13] You're paying $6 billion and your license should, as a general dentist, you should be able to do fillings and crowns and some root canals and definitely extractions.

[00:24:28] And, you know, if you could, I never did this, but other of my classmates did, and they were smarter than I, hang out with oral surgeons.

[00:24:40] Like, just see if you can hang out with them.

[00:24:43] And.

[00:24:44] Sure.

[00:24:45] Watch them do what they do.

[00:24:47] Even, even the hand pieces though that they're going to use.

[00:24:49] Yeah, that's true.

[00:24:50] Very drastically from what, if you're a GP, what, what you're going to buy for yourself or what we hope that an office that you were to join would have or be able to order for you.

[00:25:01] And these, these, these are not expensive hand pieces.

[00:25:04] I mean, I think you can get an eBay version of these.

[00:25:06] I have eBay versions up on them.

[00:25:08] Yeah.

[00:25:08] So, I mean, this is not, it's not a money problem.

[00:25:10] It's just a, having the stuff and having the, the, the birds and the birds are cheap too.

[00:25:15] Well, yeah, I mean, I'm, I'm a little bit radical on that.

[00:25:18] I'll, I'll use a disposable crown and bridge diamond for sectioning a lower molar.

[00:25:23] I have it right there.

[00:25:25] Sure.

[00:25:25] I don't want to order something special.

[00:25:26] It'll cut through very quickly.

[00:25:28] And it makes a wide enough, um, path where I can start getting, getting some movement.

[00:25:34] Is that part of why you cut off the, you chop off the crown so that you actually have.

[00:25:39] So, I can get deeper.

[00:25:40] Yeah.

[00:25:40] Okay.

[00:25:41] That makes sense.

[00:25:42] Mm-hmm.

[00:25:43] So, I call that popping the top off.

[00:25:46] Yeah.

[00:25:46] So, like you section horizontally, sometimes from both sides and then, um, stick an elevator

[00:25:52] in from the horizontal cut and then pop the top of, off the tooth.

[00:25:57] You gotta be careful.

[00:25:57] You don't pop that down the patient's throat.

[00:25:59] I gotta throw that out there.

[00:26:01] If you're a dental student listening to that, you gotta be really careful with that, but it

[00:26:04] just comes right off.

[00:26:05] And now you're into, so I think one of the things that in the patient's mind and in the

[00:26:12] inexperienced dentist's mind is that you need something to grab onto, which I don't need

[00:26:17] that anymore.

[00:26:17] I need something to elevate away or, or, um, luxate away.

[00:26:23] Yeah.

[00:26:24] So, if I can get down to the roots quicker, I can get into that space quicker.

[00:26:28] What you said spoke to me, Kevin, because it was always the experience.

[00:26:34] Extractions I referred for the, like I said, the first decade or, or I would say, all right,

[00:26:38] dad, you gotta, you gotta do that.

[00:26:39] I practiced with my dad.

[00:26:40] Mm-hmm .

[00:26:40] You gotta do this one.

[00:26:41] I don't know how to do this because if there wasn't something to grab.

[00:26:44] Yeah.

[00:26:45] I didn't know how to make up, make up something to grab or make up, you know, how to, how to

[00:26:52] get the space.

[00:26:53] I would prefer that there's nothing to grab.

[00:26:55] I love when they're broken off of the gum line.

[00:26:58] It just saved me a step.

[00:27:00] Yeah.

[00:27:00] That's fair point.

[00:27:02] So, I mean, we, I mean, we are taught that we shouldn't be grabbing the crown of a tooth

[00:27:07] anyway.

[00:27:08] So, I guess that makes sense to you.

[00:27:09] Oh, because they're telling you to get a little bit deeper down in there.

[00:27:12] Yeah.

[00:27:13] I get that.

[00:27:14] But...

[00:27:14] I get that.

[00:27:15] It's still, I think the, I think you'd be surprised if you spent a day at a private

[00:27:25] practice oral surgeon's office, what they do.

[00:27:27] Um, I think that, I think as a general dentist, if you're doing like crown and bridge and veneers,

[00:27:34] that's like a finesse game, right?

[00:27:37] So, you have to have that finesse skill.

[00:27:39] And then oral surgery is like, this is a rougher game, like a more aggressive game.

[00:27:44] And so, to get into that mindset and, you know, I can do that very easily now, but way

[00:27:51] back in the day, I couldn't, I was, you know, timid or whatever.

[00:27:54] Um, you're, you're playing too, you know, I've said before, uh, teaching like these are

[00:28:01] not crown preps.

[00:28:02] You're just, you're blowing through this.

[00:28:04] Just get, get it done quick.

[00:28:06] Yeah.

[00:28:06] There's, you know, you're not like refining a margin and trying to make it perfect at all.

[00:28:11] You're destroying things.

[00:28:13] Yeah.

[00:28:14] Yeah.

[00:28:15] My first, my, one of my part-time jobs in undergrad was assisting an oral surgeon.

[00:28:20] Yeah.

[00:28:20] So, I know that's good.

[00:28:22] Yeah.

[00:28:22] My, the very first surgery I, uh, I assisted actually first day was a double full mouthed

[00:28:30] dentulation and all on four.

[00:28:31] And I was like, I did not think that dentistry looked anything like this.

[00:28:36] So, I know exactly what you mean.

[00:28:38] Yeah.

[00:28:38] That's a different level of dentistry though too.

[00:28:41] Yeah.

[00:28:41] That's a different, different level for sure.

[00:28:44] So, just for the sake of learning, um, and visualization for the listeners, could we go

[00:28:50] through, let's say we're going to extract a lower, uh, molar, just the actual step-by-step

[00:28:56] of what you're going to do.

[00:28:59] Me or Zach?

[00:29:00] Either one of y'all.

[00:29:02] Kevin, you go ahead.

[00:29:02] All right.

[00:29:03] So, I'm, I'm going to give you the full thing here.

[00:29:08] I am telling the patient that we're replacing this tooth.

[00:29:13] So, I know that I'm going to graft it.

[00:29:15] So, we're going to go all the way back.

[00:29:17] I've, I've taken a cone beam.

[00:29:18] I've, I've reviewed it.

[00:29:20] I've looked at, uh, if it's number 19, the shape of the roots, if they're curved or straight

[00:29:26] or whatever.

[00:29:27] I'm looking at, at that.

[00:29:29] Um, we're doing a blood draw.

[00:29:31] So, we can, uh, make, uh, PRF and sticky bone.

[00:29:36] So, that's being done in the background.

[00:29:38] Patient's numb with one carpial lidocaine only.

[00:29:41] That's all I can use.

[00:29:44] Do you use the whole carp, Kevin?

[00:29:46] Uh, I sometimes save a little bit.

[00:29:48] That's good.

[00:29:49] I don't want to, you might need it for the next person.

[00:29:51] I don't want the patient to die from lidocaine overdose.

[00:29:53] That's right.

[00:29:54] That's good.

[00:29:54] Yeah.

[00:29:56] So, we're assuming the patient's numb.

[00:29:58] Now, I'm going to make a sulcular incision from, let's say, the distal of 18 to the mesial

[00:30:06] of 20 on the buccal and lingual.

[00:30:10] And then I'm going to take a sharp periosteal elevator and reflect that pretty far down, like

[00:30:17] meet halfway down on both sides.

[00:30:21] That is giving me multiple, um, uh, there's multiple benefits for that.

[00:30:28] I can see where the furcation is.

[00:30:30] I can see if there's a dehiscence that's going to affect my graft.

[00:30:34] And it's going to also allow me to tuck my membrane in at the end.

[00:30:38] We're assuming this is number 19.

[00:30:40] Let's say that the crown is intact.

[00:30:42] I'm going to section the crown horizontally, pop the top off, get that off very rapidly.

[00:30:48] Then, um, because I have the flap reflected, I can see exactly where the furcation is of

[00:30:54] the roots.

[00:30:55] I'm going to go down vertically and bury the head of the handpiece through the two roots.

[00:31:01] Um, and then I'm going to take my elevatome.

[00:31:06] Or no, I'm going to bury the head of the handpiece through the two roots.

[00:31:12] And I'm going to stop, uh, a couple millimeters short of the lingual aspect of that.

[00:31:18] And then I'm going to make a small cut down vertically.

[00:31:20] So I don't perforate the lingual plate.

[00:31:23] Then I'm going to take an elevator or an elevatome and see that those two roots are moving independently.

[00:31:30] That's important because if not, I got a section more.

[00:31:34] And I'm either going to elevate the meso root out first or the distal root out or whatever

[00:31:39] is, you know, path of leaf resistance, whatever starts moving first.

[00:31:43] I'm, uh, in order to do that, I'm likely going to take that elevator, elevatome and use that

[00:31:49] driving motion to bury the head of the handpiece or the head of the, um, spade in there.

[00:31:56] And then I'm going to get both of those roots out.

[00:32:00] Then I'm going to carefully clean the socket, debride it with a degranulation burr.

[00:32:08] Um, then I'm going to tuck my membrane on the buckle or lingual, depending on what tooth it

[00:32:14] is.

[00:32:14] If it's 19 and I'm on the right side, I'm going to tuck it in the buckle and I'm going to load

[00:32:20] that socket with sticky bone, um, wrap my membrane over the occlusal portion of that, tuck it in the lingual.

[00:32:28] And then I'm going to put in three sutures, let's say, and, and hold that down.

[00:32:33] Oh, before I do that, I'm going to put a, um, PRF slug over the top of the sticky bone.

[00:32:41] And that's how we do that.

[00:32:43] Okay. So you have a, you have a, you have a membrane, you have sticky bone membrane and PRF slug.

[00:32:50] I have sticky bone, sticky bone into packed into the socket.

[00:32:56] I have a PRF slug over the top of that.

[00:33:00] And then a cytoplast membrane over the top of that.

[00:33:03] Okay.

[00:33:04] Cytoplast membrane is nonresorable.

[00:33:06] It's going to need to be removed in a month.

[00:33:08] Okay.

[00:33:09] That makes sense.

[00:33:09] But we build back amazing bone doing it that way.

[00:33:14] Like fantastic.

[00:33:16] And that's the name of the game if you want to do some implants.

[00:33:20] But even if you don't, I was thinking about this also today.

[00:33:24] Um, you know, I had that implant surgery today.

[00:33:29] This guy I've been seeing for 30 years.

[00:33:32] Some of those teeth I took out years ago, um, they came into some money.

[00:33:38] Someone died.

[00:33:39] They got an inheritance.

[00:33:40] They want to spend it on their teeth.

[00:33:42] I'm all for that.

[00:33:43] So, thank God I grafted those, you know, years ago.

[00:33:48] I had some good bone to place my implants in.

[00:33:53] And that's why that's important.

[00:33:55] Yeah.

[00:33:56] And so, um, my understanding is if you do like a simple, like collagen plug or something

[00:34:04] like that, you're not really going to retain the bone.

[00:34:06] You're going to have epithelial only?

[00:34:10] Yeah.

[00:34:11] Yeah.

[00:34:12] That's, you're going to have epithelial downgrowth.

[00:34:15] That's going to take nine months or more for that to turn into bone.

[00:34:20] Okay.

[00:34:21] And it goes away faster too.

[00:34:23] Like it doesn't.

[00:34:24] It'll be gone in a week.

[00:34:26] Okay.

[00:34:26] Hmm.

[00:34:30] Zach, anything to add, subtract, disagree with?

[00:34:34] Uh, no, I think that I, I mean, what I would do.

[00:34:40] You on the same 19, I, I would have a method of telling you how to do it.

[00:34:45] If you, if there was no chance, you're going to do an implant on it.

[00:34:48] And it, a lot of it would look the same minus the flapping and all the grafting stuff, but

[00:34:54] I'm still going to section those teeth.

[00:34:56] Most of the time these days, I will probably at least put a cow horn on it and see if it'll wiggle.

[00:35:02] Um, you know, before I go to the effort of sectioning it because, you know, a third of the time, it's just going to, it's going to pop out and you save yourself a little bit of time.

[00:35:12] Um, but, uh, if it, if I don't get some immediate movement on it, boom, I'm going to section it the same way Kevin did one root, two root.

[00:35:19] And then, you know, that's, that's that.

[00:35:21] But what Kevin's doing is, is, uh, certainly a better service to the patient, especially if they're considering a replacement at all.

[00:35:29] But if you were doing something like a, a denture thing or something like that, where they're not going to be replacing it, that's, you know, that's what I do.

[00:35:36] But I guess the number one thing I would tell the student who might've been overwhelmed by what Kevin said is that when you get out, just learn how to use your handpiece and learn how to use some kind of, uh, uh, the tome that, uh, Kevin was talking about or a, or a Schumacher approximator, something along those lines.

[00:35:57] Those two tools alone have like, you know, quadrupled my competency and efficiency and competence when it comes to just taking out teeth and feeling good about it.

[00:36:10] Also, uh, in addition to sectioning, making buckle to lingual cuts, uh, let's say, let's say I have section 19.

[00:36:21] I put my elevator tome on it and nothing's moving at all.

[00:36:24] No movement.

[00:36:25] I'll take a number two round.

[00:36:28] So this is a good tip.

[00:36:30] Handpiece or burr and go from, uh, let's the mesial root.

[00:36:36] I'll go from the buckle to lingual.

[00:36:39] So if we're talking about number 19, this is really the distal of 20.

[00:36:43] I'll go buckle to lingual and make a slot deep and I'll do the same thing essentially on the mesial of 18 for the distal root, a buckle to lingual slot.

[00:36:54] And now I have a purchase point to put my elevatome or elevator in when you have dense bone and nothing's moving.

[00:37:04] You're, I can tell you have a quizzical look on your face, Muhammad.

[00:37:08] Yeah.

[00:37:08] I don't, I didn't really understand what you're saying.

[00:37:11] So are you cutting a, cutting a groove so that he can actually get, get down into the tooth.

[00:37:16] He's just cutting, he's taking, he's taking a burr.

[00:37:19] He's cutting it.

[00:37:19] He's cutting away some bone so that he has, he has a purchase point to be able to get his elevator.

[00:37:23] In the proximal surface.

[00:37:25] You're cutting.

[00:37:25] Yes.

[00:37:26] Yes.

[00:37:27] So as deep as you can get it kind of, as deep as you need.

[00:37:32] Yeah.

[00:37:33] As deep as you need is the right answer because you still have to be cognizant of the adjacent

[00:37:39] roots of those teeth.

[00:37:40] And I don't want to inadvertently nick those, but if I've made a sectioning between the two

[00:37:48] roots of the tooth, I'm, I'm just making some slots, uh, on the mesial and distal of those

[00:37:55] roots, um, in order to get a purchase point to start some movement happening.

[00:38:00] Okay.

[00:38:00] Yeah.

[00:38:01] That makes sense.

[00:38:02] Here's, here's another thing I'm going to throw in before.

[00:38:04] I know we, I know we're up against it on time, but, uh, I wish you had almost would have

[00:38:09] said three instead of 19 because the most mileage that you're going to get from, from the sectioning

[00:38:16] is going to be on these first molars, especially if you start to be able to view them in 3d,

[00:38:22] you're going to realize that like, there's not a traditional extraction method that was going to

[00:38:28] get this tooth out just because they was, the roots were splayed out. Like it wasn't,

[00:38:33] it wasn't going to happen without significant trauma to, you know, all the surrounding structures,

[00:38:38] if it would come out at all, just the physics on it weren't going to work.

[00:38:42] Yeah. We're joking about removing it to veracity.

[00:38:45] That's how that doesn't happen.

[00:38:47] Yeah. Yes.

[00:38:48] Zach was saying that I'm thinking the combination of the cone beam and the handpiece makes those

[00:38:54] upper molars way easier.

[00:38:56] Upper, upper molar used to be a, almost like it was a, it was a sure referral for me because

[00:39:03] I didn't, I didn't know what I was getting into. And I, I, for sure it was going to be a negative

[00:39:08] experience for me. And, uh, you know, cone beam plus handpiece has made, I, at a, at a minimum,

[00:39:17] if I, I know what I'm getting into. So if I, if it looks really gnarly, I know it was like,

[00:39:22] I don't want to mess with this guy. It's not going to be profitable for me. Um, and then at worst,

[00:39:27] or I mean, at best it's like, okay, well here's, here's how you're, you're mentally doing the procedure

[00:39:32] before you're doing it. Uh, and really that, that phrase sums up a lot of Kevin's entire philosophy on,

[00:39:41] you know, implant dentistry, crown and bridge dentistry, everything, the whole, or, and even,

[00:39:45] and endo too, you know, if we get into the, if we do an endo lecture, it's, it's the same thing.

[00:39:50] You're meant, you've mentally, you know, root canal of the tooth before you start.

[00:39:54] Correct.

[00:39:54] So very good. Well, one, one last question before we wrapped up, I know it's, we're up on time and

[00:40:00] like Zach said, but, um, I'm really curious. I could feasibly potentially convince the faculty

[00:40:08] to let me section teeth, but I'm definitely not getting a cone beam. So if I'm, if I was going

[00:40:14] to section a tooth, um, is flapping and being able to visualize the furcation enough for me to kind of

[00:40:22] be able to decide where my section is going to be.

[00:40:25] It, it depends. If it's an upper molar, you don't know if the buckle roots are fused or not.

[00:40:33] So your, your cut's going to be different. So if they're not fused, you're going to make that

[00:40:39] inverted Y cut. If they are fused, you're just going to make a horizontal cut or I say that right?

[00:40:45] Musial distal cut. Um, I don't know if you have the experience to, to, I, I, I don't know.

[00:40:53] I don't know. Tread, tread cautiously with that because without tread cautiously with hang out

[00:41:00] with their oral surgeons. Yeah. Hang out. You need to watch several teeth get sectioned before you

[00:41:06] pick up a hand piece, especially with no, with no cone beam involved for sure. But ask them maybe

[00:41:11] what their decision tree is on what they're doing while they do it. And the other thing that I,

[00:41:16] that I tell attendees is that, um, you know, let's say you're, we're back to our number 19 and

[00:41:25] something breaks. It's, it's not, that's not a bad thing. It's an opportunity to do the next thing.

[00:41:33] But Muhammad, you don't know what the next thing is. I've already filed that through my brain

[00:41:40] a million times. So I'm moving on to the next thing, which would probably be making,

[00:41:46] removing some more bone or whatever. It's there. They're not mistakes. They're not bad

[00:41:51] things that are happening. They are just things, opportunities for you to just move on to the

[00:41:56] next step, whatever. But they're bad when you don't have a plan and you don't know what the

[00:42:00] next step is though. That's when it is bad. They're bad when you're inexperienced. Correct.

[00:42:05] Yeah. Yeah. It's not the end of the world though. Okay. Well, I think, uh, this will definitely be

[00:42:12] one that I listened back to, um, before my next oral surgery rotation. Um, I appreciate YouTube's

[00:42:18] your friend on this. Yes. I agree with that. There's so much, there's so much good stuff on that.

[00:42:24] Yeah, for sure. That that's what a blessing to be in that kind of an era for sure. For sure.

[00:42:29] Well, I think, um, we go ahead and, uh, wrap this up. Um, thank you guys both for the advice

[00:42:35] and we're the listeners. We will see you next time. See ya. See ya.

[00:42:41] Next Tuesday.