Preventing Patient Aspiration in Dental Procedures

By Lexi Marino February 3, 2021

Patient safety and comfort are not only important for the patient, but in turn, they give you peace of mind so you can focus on your craft. In this piece, we’ll show a broken implant procedure featuring the Isolite® dental isolation system.

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

  • Have less stress in your workday
  • Assure the patient in knowing your keeping them safe from aspiration
  • Maintain a good legacy


Rolando Mia: Good day, everybody. Welcome to Dr. Tom’s Tips Case of the Week.

So, everybody look at the screen. This is a little teaser to show you what we’re going to be covering today – removing a broken implant crown. Good day Dr. Hirsch, how are you sir?

Case Review: Fractured Implant Crown

Dr. Tom Hirsch: Good day, Rolando. We’re going to talk about how I could have really had a crappy day, but I didn’t and why that’s the case.

So, I want to share with you what happened. I had a patient that came into my office with a fractured implant crown. I had done an Emax crown in there with a Tie based restoration and he walked in. He said, “Hey doc, I think something’s wrong.” All in all, he split this crown right in two. Let’s show you what happens in this video.

So, here’s the pre-op picture. I did both those implants and those implant crowns, a number of years back, the one on tooth number 19 fractured. That’s the one that we’re dealing with right now.

Anyways, I’ve got the Isolite® in this patient’s mouth. Pause for a second, Rolando.

Rolando Mia: Sure.

Dr. Tom Hirsch: Thanks. The implant crown had split right in two there. You can see it going buccal to lingual, buccal to lingual distill. Also, the little composite plug that I had in there had come out already. Now, I’m going to go in there I’m just going to remove the screw. Go ahead and run it.

I have my handpiece driver rolling right now so that’s on reverse. You can see the handpiece getting longer and longer, the crown is loosening up a bit and we’re unscrewing – there we go. Now I can grab it but I have a potential right there of dropping that crown down the patient’s mouth.

Isolite® Prevents Aspiration

Dr. Tom Hirsch: However, I’ve got the Isolite in for protection and look what happened all of a sudden there’s the Tie base. The crown came off so now I’m just going to dry everything off right now and add a little three-way syringe. We start drying the area and boom there’s a surprise of the day for me. Holy moly I’ll say that…that’s not what I said in the office. Pause that right there.

So right there, that was a massive surprise. These are the things that you just don’t even expect are going to happen. I had no idea that screw was going to come flying out of there. You know, a lot of you are smarter than I am and you probably would have put your finger on top of that. It was kind of wet and I wanted to clean it all up. So, I just blew the air there. The air goes right down inside that abutment or the Tie base and blows the whole thing out.

I mean, it was just crazy lucky that I had the Isolite in there because that screw could have been swallowed or even worse aspirated. So, just happened to get lucky on that one. I have to tell ya, I don’t use the Isolite every day but I’m glad I had it in.

The patient could have swallowed or even worse aspirated that screw or swallowed and aspirated the Tie base. From here, what I have to do is just take a new impression to make a new crown. There’s a little astringent to stop the bleeding. If that goes down the patient’s throat he’s not going to like that but all this gets vacuumed up quite nicely with Isolite.

You can see as we’re going along here, I’m the only one in the mouth. My assistant’s not there she’s not retracting the cheek. She was there blowing air, but I didn’t have any cotton rolls, no throat pack in there. If I didn’t have the Isolite, I would’ve had a throat pack in there. The Isolite saved my bacon that day cause, boy I’ll tell ya when you have something that goes to the back of the throat I mean, everybody just goes, “Oh my gosh”, and your whole body just tightens up.

Importance of Creating a Predictable Oral Environment

Rolando Mia: So during the course of your procedure I noticed, is it often that they’re loose like that or is that you just don’t know what’s happening when you enter into a case?

Dr. Tom Hirsch: When you go in there, you don’t know if the Tie base or the abutment has been wedged in there. Sometimes, they’re easy to get out and sometimes they’re hard to get out and sometimes you have use a lot of force and sometimes you need a hemostat. You never know what you’re going to get.

Rolando Mia: With the mouthpiece inside there your patient looked really comfortable. It looked like their mouth was kept wide open. You didn’t have to retract, deal with the tongue, or the cheek.

Dr. Tom Hirsch: No tongue, no cheek, no saliva, no saliva ejector. I had a good enough seal right there that I didn’t even have to put any gauze around there to block any holes. Everything was just sealed up very nicely, so I felt safe but once again, never expected in a million years that screw was going to come flying out of there. It was startling.

The fact that we caught it on video, I mean that was something, you know. Sure you know, I could make anything happen like last week, where I dropped something on purpose just to show you what can happen, but you never know what’s actually going to happen.

Rolando Mia: Awesome. Well, first of all, thank you so much. During the course of this season, each week Dr. Hirsch is going to be sharing with us different situations, different cases that he’s working on with Isolite.

Have a wonderful rest of your week. Please be safe. Look forward to Dr. Tom’s Case of the Week next week on Tuesday.