Airway Protection During Dental Implant Procedures

By Back Lexi Marino May 14, 2021

Mistakes happen and we understand the stress that comes along with them. In this piece, will share two minor mistakes made in a dental implant procedure case and how Dr. Tom Hirsch, DDS fixed them.

Watch this video to learn how the Isolite System helps you:

  • Protect the patient’s airway – even when you choose the wrong size Mouthpiece
  • Achieve full access within the mouth
  • Maintain a dry, well-lit working field


Rolando Mia: Welcome everybody to Dr. Tom’s Tips Case of the Week. Today we’re going to hear from Dr. Tom Hirsch and how he uses the Isolite® System in implant restorations.

Dr. Tom Hirsch, DDS: Good morning Rolando, hi everybody. What I want to talk about is learning from your mistakes.

Tooth number 30 was an implant that I placed some months back and now we’re getting ready to put the implant crown in. You can see the implant at tooth number 30, and we’ve already taken off the healing abutment. The patient had limited opening, so we put the mouthpiece in his mouth.

Mistake #1: Selecting the Wrong Size Isolite® Mouthpiece

The one that I thought would work the best, was a small mouthpiece. So, this is a small mouthpiece. So, let’s just kind of roll from there and we try the crown in. Then, I dropped it. Mistake number one, I dropped the crown, it went down into the lingual vestibule, right where his tongue was. I retrieved it and that was no problem, but because I chose a smaller mouthpiece, I should do something about that gap. Initially, I probably would have been better with a larger-sized mouthpiece.

Mistake #2: Not Fixing Mistake #1 Fast Enough 

Here’s mistake number two. And that’s a big one right there, it will surprise your life. Pause that for a second Rolando. First, when you recognize a mistake that you’ve made, correct it right away. Don’t wait for things to compound it. I was blowing air to dry off the inside of the, of the implant restorations. There’s a gap on the lingual aspect. You’re blowing here. Don’t do that. Look where that thing flies from. Got the shock of my life and boy, that’s about ready to go South, but we stopped it at the equator. I told the patient don’t move. Luckily my assistant’s right there and gave me cotton players right away.

What should I have done initially? Either A) put a larger sized mouthpiece in or B) protect the airway. Let’s roll you’ll see what happens from here.

Rolando Mia: Yeah. Although, the mouthpiece still stopped the piece from dropping?

Dr. Tom Hirsch, DDS: Yeah. That’s a great point Rolando. Even though I had the wrong size mouthpiece, I chose the wrong one. It still stopped the screw from going down the hatch.

Let’s see where that screw shoots out. I think it would’ve gone right down the guy’s throat. Watch it,

Rolando Mia: Yeah.

Dr. Tom Hirsch, DDS: Boom! You see what? It bounces right back there. It would have gone right down his throat with the Isolite. So anyway, I had the mouthpiece in there and it protected the patient and me.

How to Fix Mistake #1 

Learn from your mistakes. That’s kind of what this is all about. So, I go back in there then I retrieve that thing. I’m not going to make the same mistake twice. First of all I’m not going to blow any air into the canal, and, number two, let’s take a cotton roll and place it back there. Actually, I should have even put a glass-square way in the back because there’s still a little tiny gap of the back on the bottom behind the second molar. But now, I’m going to put that in there. I’m not blowing in the air a second time reason I don’t think I dared.

Rolando Mia: What’s cool is, it shows you can still use cotton rolls. You can still use the other tools.

Dr. Tom Hirsch, DDS: So, if we have a takeaway, today the first lesson is learning from your mistakes. The second lesson is, protect the throat. The third lesson is, don’t be afraid to use a cotton roll or a triangle or a glass-square in there.

Now the rest of this, you may know already or maybe new for some of you, but I have removed so many implant crowns and pulled out cotton balls out of the inside of the crowns. They were wet. They stuck; they were bacterially loaded. I just want you to see, a lot of you probably already do this how we, we fill up the inside of the screw retained crowns. Now, I just take some regular Teflon tape and I want to dry this out.

Rolando Mia: There you go.

The Benefits of a Dry Working Field

Dr. Tom Hirsch, DDS: Yeah. Now the screw is not going anywhere because I’ve torqued the thing down. No problem. Get it dry. And then use my Hartzell and pack that Teflon tape. We’ll pack that in with that instrument seems to, really take it down and compress it and a ball burnisher works nicely there also, but that’s a long strip of tape and we pack it way down in there. I want to have about two or three millimeters or composite.

Switching next to a little ball burnisher and plugging that in down there. I think that’s it’s nice that it obliterates the canal. It doesn’t absorb any moisture, so you don’t have any saliva getting in there its nice and its dry. There’s not any bacterial buildup in there ever.

Then after we do that, we’ll put some composite in there. The thing that’s nice and we just got this nice dry working field once again and I left the cotton roll there and I could have taken it out but why? You know. It’s just another little added area of protection.

Rolando Mia: Yeah.

Dr. Tom Hirsch, DDS: I wish we had an audio track on here. I would have loved to have you hear me and my assistant going back and forth about what we’re doing. There was probably a little bit of urgency in my voice right the other day, “Danny, cotton plyers quick!”

You’ve got to have an assistant who’s on top of it right away and make sure you have everything ready, in case of emergency. This was a minor emergency, but an emergency is just the same.

Then we took a little lateral condenser and made the shape a little bit better. Yeah. I love that instrument because it gives you a nice contrast of the restoration. Gets right down and gives you some good anatomy. We’ll cure it and we’re done in five minutes. It can go that fast.

Rolando Mia: You know what’s cool? Your patient, if I understood correctly, had difficulty opening their mouth. So, you used a smaller mouthpiece.

It’s not that you made a mistake per say, even with the smaller mouthpiece, you were still protecting the throat.

Plus, you didn’t have to throw it away. You could have just added a cotton roll.

Use Everything in Your Arsenal

Dr. Tom Hirsch, DDS: Sure.

That’s a great point. I didn’t have to throw it away. Had I been thinking ahead, what I would have done is used a Medium DV Mouthpiece. But even so, it would’ve gone in easier but then I still would have had to use cotton or glass-square to block things off. So don’t be afraid to use everything in your arsenal to help you out here. If you see a gap, something’s could fall under the gap.

Rolando Mia: You shared with me once that, there’s so much variability in the anatomy and morphology of the mouth. Although you designed the mouthpieces, to fit the broadest cross section of patients, they’re always going to be variables.

Dr. Tom Hirsch, DDS: We all make little minor mistakes. We want to make sure that the minor mistakes, don’t add up and become major mistakes. This could have been a major mistake.

Okay, There’s a gap right there. Do something about it. Now you’re not thinking about doing something about it until the second mistake happens. Like I said, the second mistake happens. I blew that screw out. Yeah, you could saw that was much worse of a scenario, than just the crown falling there. If I had not corrected that, the third mistake could have been the nail on the coffin, so to speak.

Rolando Mia: Well, I love the fact that, as our inventor, you’re willing to share that. Thank you so much for doing that.