After watching this video I treated a patient for extraction of #6. Unfortunately I fractured the buccal plate, but thanks to your techniques, I was able to salvage the bone. It's been several months and still no defect. Thank you.
Thanks Doc for answering my question so promptly. Tommorow is actually the appointment for "permanent incert." Yes, I will most definitely be questioning options as well as your suggestion pertaining to a specialist & augmentation of the bone. Your wisdom is greatly appreciated. (wish I found you before this mess began). Again many Thanks Doc Blessings 🙏
Mt dentist broke my buccal plate over both canines. Nobody told me. I realized it because there's a huge open space where they were. The gums are squishy and tender. Now a huge piece of bone is coming out through the opening where the neighboring incisor was. It opened the gums back up about 10 days after my extractions. It hurts so bad. I go tomorrow to see him about that and the sinus perforation. I'm so frustrated
Nice video! This was in early 90s: While a dentist was pulling out my upper primary canine it broke (I believe the primary canine had a little cavity in it and maybe the structure of the tooth was weak). I don't remember what tool the dentist used to remove the broken part of my primary canine. It looked like some kind of miniature corkscrew, but I might be wrong. I didn't pay too much attention to the tool, I was glad that she could pull out the remaining broken part. This was in early 90s. I wonder what tools were used to remove broken teeth during extractions at that time. Also, do dentists use different tools to remove broken primary tooth vs. permanent tooth during extractions? The other thing that amazes me is that I had still this primary canine in my early 20s and nobody noticed it during preventive checks until I started to feel a "new" or "extra" tooth erupting in the palatal area. Panoramic x-ray revealed the truth: permanent maxillary impacted canine (that was the reason of extracting the primary canine).
Thanks for sharing. Extraction instruments have remained pretty much the same over many years. Similar tools would have been used in the 90's to retrieve roots as are used now. Root picks are often employed for this. Now there are other tools that are used as well called proximators / luxators which are thinner and designed to help remove roots a bit more easily. All the best!
Thanks Francisco - You as well. It is my goal to expand my content significantly this year and I will continue to drip some out to UA-cam as well. I appreciate your support my friend.
@@OnlineExodontia My field is oral surgery and your vids are very helpful! Keep it up like this! I always recommend to my fellow dentist your channel! .
Thanks for the video I love the quality and the content.. I will start my internship soon can you pls tell me what brand is ur teeth model and can it be used in fillings?
Thanks for your kind words! Good luck with your internship. The model I am using was from Ebay. You can find it here. www.ebay.ca/itm/Dental-Typodont-Teaching-Teeth-Model-Soft-Gum-Removable-Full-Hinge-Standard/123486396946?ssPageName=STRK%3AMEBIDX%3AIT&_trksid=p2060353.m2749.l2649
Apparently buccal plate broke during my extraction, didn't realize why so many stitches were being done. Apparently Tooth was too long for implant, even after a second round of grafting. Gum line barely dropped after much healing so a bridge was next plan. Temporary bridge looks awful!! The canine is indented in between other teeth. Now after molds taken for permanent I was told top part would be "pink" to blend better! It looks like someone punched me & their knuckle bashed my gum line in. I don't want a French manicure looking tooth especially in the front. I was told well, it's better then a "flipper, right?! Even that was subpar . Any suggestions are greatly appreciated Thanks for your video!😊
Hello Mel - I would ensure that you voice your opinion to your dentist. Although it's not always easy to do, there are generally ways to augment the bone in areas like you are describing. This may require a referral to an oral surgeon or someone comfortable doing these procedures. What you are describing is not uncommon, but I do know what you mean in terms of the esthetics. All the best!
I know no one is going to answer this but I had an extraction and graft on #3. It didn’t heal and fell out, I realized something was wrong. She did a third graft which also didnt stick. Realized the front of my jaw(buccal plate) had broken and she never told me. I brought up my concern with this after #2 graft and she brushed it off, acting like I was the first patient who’s had a failed graft. I now have a crater in the front of my jaw between my teeth and no graft. Is she at fault for this? Is she responsible for the breakage and failures? Please help me, I’m out of pocket with a caved in jaw.
a doctor took a nearly a 1 to 1.5cm of bone a week after my lower left wisdom tooth extracted because a bone was spearing out from my gum, he said he will file it but instead he just broke the bone and took it out. i'm not sure what to do now, is this normal? this feels very wrong , am scared my jaw bone will rot now. i think it is called lingual plate
Generally if bone is detached it will be removed and thankfully our baddies are very good at healing. I would assume you will make a full recovery and wish you the best!
Doc, let's say youre removing an erupted #16. I can typically remove these with just an elevator in a buccal and distal direction. However, since we should be applying forces both palatally and buccally as to minimize the chance of fracturing the buccal plate (not that the buccal plate is all that important in a region like this), should we really be using a pair of forceps to ultimately take these teeth out so that we can apply forces in both palatal and buccal directions? Sorry if this is confusing but your statement made me rethink how i do things.
In Canada this would be the upper right first molar, in the US system it would be the upper left third molar. My answer here would be about the upper third molar just to be clear. It's always super cool to watch teeth being elevated out without the need for a forcep and you're right, the plate is of reduced significance here, yet I would say whenever possible we should strive to cause the least trauma possible. Sometimes that would be with a forcep and other times that may be with an elevator. Certainly you'll break less bone if you move the teeth palatally as well buccal. Also when elevating, try not to lever to the distal / buccal and instead try rotating the elevator. Hard to explain, but this will also help to keep more bony plates intact back there. All the best!
So if buccal plate comes out with tooth while extracting upper wisdom tooth, what do I do. Are their any special instructions or precautions I need to take . Thank you doc
Generally nothing to do and this happens from time to time with upper wisdom teeth. Feel for sharp edges and use a rongeur to contour them if accessible if you really want, but typically this is of no consequence and will heal just fine. All the best!
If the bone is attached to the periosteum, attempt to separate it from the tooth and tease the tooth out. Once out reposition the bony fragment and stabilize it a bit with a suture (horizontal mattress is a good choice). The bone should remain vital if you follow the above. All the best!
Hi! I pulled the lower anterior teeth for a patient but noticed that for some reason bone was brittle and came out with Small chunks stuck to the teeth. I did a falp and ostectomy around tooth. As I was was using forceps tooth separated but with a chunk of buccal bone. Why is that and how manage? The bone piece that came out with the tooth was so difficult to separate even with handpiece
The bone was likely very thin as is typically the case in the lower anterior. If not, then consider applying different force vectors to the tooth to apply less strain to the buccal plate. Sometimes despite best efforts, this may still occur. Just remember to use a rongeur/bone file to smooth out the bone after to prevent frequent post-op follow-ups. All the best!
Thanks a ton Dr! I wanna ask , how about if I were extracting an upper 3rd molar and the tooth came out with a chunk of bone buccally? And i separated the bone extra-orally then returned it into its socket? Is it gonna cause lots of trouble? I had this situation but i wasnt able to follow up with my patient due to quarantine issues here
Hussain - you're welcome for the video. Thanks for watching! Once the bone is separated from the periosteum it should be removed. The method you used will result in a necrotic piece of bone / nidus of infection being added to the socket. Depending on the size it may need removal or it may come out on it's own. All the best to you!
why can't this bone be incorporated as a bone graft in the same socket and heal as a part of bone? we do bone grafts from the other place in jaw and it heals just fine.
Same principles apply here. Generally you may wish to compress the site gently to ensure the bone isn't pointing sharply toward the tongue. If connected to periosteum it should be fine and you would leave it in place. Occasionally when healing if the bone does not recover or is sharp, it will wear through the mucosa and you may have to remove a portion of it or smooth it with a football bur. All the best!
Did the periosteal flap instrument move the the ginigiva tissue away from the bone accurately. Or you sometimes you push Ali ally the the gingival tissue is not curing and moving away . In this case what should I do ? Best flap rise
If I'm following correctly, you are finding that sometimes the flap does not reflect completely away from the bone. To solve this problem, you need to be sure you have incised through the periosteum and ensure that your periosteal elevator is under the periosteum when reflecting. If done correctly, the tissue just falls away from the bone relatively effortlessly. So to answer your question, go back to your original incision and trace over it applying firm pressure to ensure you have cut through the periosteum and you should be good. Hope that helps. All the best!
After watching this video I treated a patient for extraction of #6. Unfortunately I fractured the buccal plate, but thanks to your techniques, I was able to salvage the bone. It's been several months and still no defect. Thank you.
That’s terrific to hear! Thanks for sharing!
@Keith Brannen
How were you managing the fracture buccal plates ?
Thanks Doc for answering my question so promptly. Tommorow is actually the appointment for "permanent incert." Yes, I will most definitely be questioning options as well as your suggestion pertaining to a specialist & augmentation of the bone. Your wisdom is greatly appreciated. (wish I found you before this mess began). Again many Thanks Doc
Blessings 🙏
Mt dentist broke my buccal plate over both canines. Nobody told me. I realized it because there's a huge open space where they were. The gums are squishy and tender. Now a huge piece of bone is coming out through the opening where the neighboring incisor was. It opened the gums back up about 10 days after my extractions. It hurts so bad. I go tomorrow to see him about that and the sinus perforation. I'm so frustrated
I just had my buccal plate broken on an extraction of #15. This was 2 evenings ago - I am still in pretty bad pain...
Nice video! This was in early 90s: While a dentist was pulling out my upper primary canine it broke (I believe the primary canine had a little cavity in it and maybe the structure of the tooth was weak). I don't remember what tool the dentist used to remove the broken part of my primary canine. It looked like some kind of miniature corkscrew, but I might be wrong. I didn't pay too much attention to the tool, I was glad that she could pull out the remaining broken part. This was in early 90s. I wonder what tools were used to remove broken teeth during extractions at that time. Also, do dentists use different tools to remove broken primary tooth vs. permanent tooth during extractions? The other thing that amazes me is that I had still this primary canine in my early 20s and nobody noticed it during preventive checks until I started to feel a "new" or "extra" tooth erupting in the palatal area. Panoramic x-ray revealed the truth: permanent maxillary impacted canine (that was the reason of extracting the primary canine).
Thanks for sharing. Extraction instruments have remained pretty much the same over many years. Similar tools would have been used in the 90's to retrieve roots as are used now. Root picks are often employed for this. Now there are other tools that are used as well called proximators / luxators which are thinner and designed to help remove roots a bit more easily. All the best!
Good vid! Happy New Year!!!
Thanks Francisco - You as well. It is my goal to expand my content significantly this year and I will continue to drip some out to UA-cam as well. I appreciate your support my friend.
@@OnlineExodontia My field is oral surgery and your vids are very helpful! Keep it up like this! I always recommend to my fellow dentist your channel! .
Thank you for the kind words! Where do you practice?
@@OnlineExodontia I'm from Peru my friend!! I guess you're from the USA right?
Excellent...You're close, but I'm actually from Canada! Maybe someday I'll make it to Peru. Looks like a beautiful country. All the best to you.
Thanks for the video I love the quality and the content.. I will start my internship soon can you pls tell me what brand is ur teeth model and can it be used in fillings?
Thanks for your kind words! Good luck with your internship. The model I am using was from Ebay. You can find it here.
www.ebay.ca/itm/Dental-Typodont-Teaching-Teeth-Model-Soft-Gum-Removable-Full-Hinge-Standard/123486396946?ssPageName=STRK%3AMEBIDX%3AIT&_trksid=p2060353.m2749.l2649
Apparently buccal plate broke during my extraction, didn't realize why so many stitches were being done. Apparently Tooth was too long for implant, even after a second round of grafting. Gum line barely dropped after much healing so a bridge was next plan. Temporary bridge looks awful!! The canine is indented in between other teeth. Now after molds taken for permanent I was told top part would be "pink" to blend better! It looks like someone punched me & their knuckle bashed my gum line in. I don't want a French manicure looking tooth especially in the front. I was told well, it's better then a "flipper, right?! Even that was subpar . Any suggestions are greatly appreciated
Thanks for your video!😊
Hello Mel - I would ensure that you voice your opinion to your dentist. Although it's not always easy to do, there are generally ways to augment the bone in areas like you are describing. This may require a referral to an oral surgeon or someone comfortable doing these procedures. What you are describing is not uncommon, but I do know what you mean in terms of the esthetics. All the best!
I know no one is going to answer this but I had an extraction and graft on #3. It didn’t heal and fell out, I realized something was wrong. She did a third graft which also didnt stick. Realized the front of my jaw(buccal plate) had broken and she never told me. I brought up my concern with this after #2 graft and she brushed it off, acting like I was the first patient who’s had a failed graft. I now have a crater in the front of my jaw between my teeth and no graft.
Is she at fault for this? Is she responsible for the breakage and failures?
Please help me, I’m out of pocket with a caved in jaw.
a doctor took a nearly a 1 to 1.5cm of bone a week after my lower left wisdom tooth extracted because a bone was spearing out from my gum, he said he will file it but instead he just broke the bone and took it out. i'm not sure what to do now, is this normal? this feels very wrong , am scared my jaw bone will rot now. i think it is called lingual plate
Generally if bone is detached it will be removed and thankfully our baddies are very good at healing. I would assume you will make a full recovery and wish you the best!
Doc, let's say youre removing an erupted #16. I can typically remove these with just an elevator in a buccal and distal direction. However, since we should be applying forces both palatally and buccally as to minimize the chance of fracturing the buccal plate (not that the buccal plate is all that important in a region like this), should we really be using a pair of forceps to ultimately take these teeth out so that we can apply forces in both palatal and buccal directions? Sorry if this is confusing but your statement made me rethink how i do things.
In Canada this would be the upper right first molar, in the US system it would be the upper left third molar. My answer here would be about the upper third molar just to be clear. It's always super cool to watch teeth being elevated out without the need for a forcep and you're right, the plate is of reduced significance here, yet I would say whenever possible we should strive to cause the least trauma possible. Sometimes that would be with a forcep and other times that may be with an elevator. Certainly you'll break less bone if you move the teeth palatally as well buccal. Also when elevating, try not to lever to the distal / buccal and instead try rotating the elevator. Hard to explain, but this will also help to keep more bony plates intact back there. All the best!
@@OnlineExodontia thank you!
So if buccal plate comes out with tooth while extracting upper wisdom tooth, what do I do. Are their any special instructions or precautions I need to take . Thank you doc
Generally nothing to do and this happens from time to time with upper wisdom teeth. Feel for sharp edges and use a rongeur to contour them if accessible if you really want, but typically this is of no consequence and will heal just fine. All the best!
@@OnlineExodontia thank you so much doc 🙏👍🏻
So basically, if the fractured plate is still attached to the periosteum it's left to heal? In this case the tooth is extracted from the lingual side?
If the bone is attached to the periosteum, attempt to separate it from the tooth and tease the tooth out. Once out reposition the bony fragment and stabilize it a bit with a suture (horizontal mattress is a good choice). The bone should remain vital if you follow the above. All the best!
If we do not place suture , will it be able to heal?
Yes - the key is that the bone remains attached to the periosteum so the blood supply can help it to recover. All the best!
Hi! I pulled the lower anterior teeth for a patient but noticed that for some reason bone was brittle and came out with Small chunks stuck to the teeth. I did a falp and ostectomy around tooth. As I was was using forceps tooth separated but with a chunk of buccal bone. Why is that and how manage? The bone piece that came out with the tooth was so difficult to separate even with handpiece
The bone was likely very thin as is typically the case in the lower anterior. If not, then consider applying different force vectors to the tooth to apply less strain to the buccal plate. Sometimes despite best efforts, this may still occur. Just remember to use a rongeur/bone file to smooth out the bone after to prevent frequent post-op follow-ups. All the best!
Thanks a ton Dr! I wanna ask , how about if I were extracting an upper 3rd molar and the tooth came out with a chunk of bone buccally? And i separated the bone extra-orally then returned it into its socket? Is it gonna cause lots of trouble? I had this situation but i wasnt able to follow up with my patient due to quarantine issues here
Hussain - you're welcome for the video. Thanks for watching! Once the bone is separated from the periosteum it should be removed. The method you used will result in a necrotic piece of bone / nidus of infection being added to the socket. Depending on the size it may need removal or it may come out on it's own. All the best to you!
why can't this bone be incorporated as a bone graft in the same socket and heal as a part of bone? we do bone grafts from the other place in jaw and it heals just fine.
What about broken lingual plate at lower molars?
Same principles apply here. Generally you may wish to compress the site gently to ensure the bone isn't pointing sharply toward the tongue. If connected to periosteum it should be fine and you would leave it in place. Occasionally when healing if the bone does not recover or is sharp, it will wear through the mucosa and you may have to remove a portion of it or smooth it with a football bur. All the best!
Did the periosteal flap instrument move the the ginigiva tissue away from the bone accurately. Or you sometimes you push Ali ally the the gingival tissue is not curing and moving away . In this case what should I do ? Best flap rise
Alially = apicaly
Curing = cutting
If I'm following correctly, you are finding that sometimes the flap does not reflect completely away from the bone. To solve this problem, you need to be sure you have incised through the periosteum and ensure that your periosteal elevator is under the periosteum when reflecting. If done correctly, the tissue just falls away from the bone relatively effortlessly. So to answer your question, go back to your original incision and trace over it applying firm pressure to ensure you have cut through the periosteum and you should be good. Hope that helps. All the best!