Helping your patients shouldn’t stress you out. Ever dropped an extraction? The patient’s tongue crossed paths with your high-speed handpiece? You shouldn’t have to worry about this happening.
Watch this video to learn how the Isolite System helps you:
- Keep the tongue permanently retracted
- Continuously suction blood and saliva
- Achieve maximum working room in the oral cavity
Rolando Mia: Welcome to Dr. Tom’s Tips Case of the Week. Today, we have a really cool extraction procedure with Dr. Tom.
The Case: Extracting Tooth #19
Dr. Tom Hirsch, DDS: Today, we’re going to talk an extraction, a graft, and instant anesthesia. We’ll also discuss how Isolite helps you in all these procedures. So, let’s rock and roll.
Here we go. We’re extracting and grafting tooth number 19. Big defect on the distal aspect, referred to the endodontist. They said it was not possible to save, probably a fracture. So, we decided to take it out. I’ve talked about how to get instant anesthesia.
Right there, you see me just poking right through the alveolus, through the attached tissue. After that, I’m pumping that up and down just to make it easier to find my needle access point. Right now, I’m putting the anesthesia in. Literally within just moments of injecting the anesthetic in there, the patient is numb.
So, he had a crown on the tooth, and we had to cut the crown off. It was pretty quick. I know people spend hours and hours taking out crowns but just get right to it. The Regatta Zirconia crown, you’re going to be there all day, unfortunately, but this is just a PFM.
This, right here, is a great little tool, give it a little twist, and man. Look, it just comes right off. Some people would have gone in here with cow horns. I decided since we’re going to extract and graft on this particular one with big fat roots. It might be easier to separate those two.
Keeping the Tongue Out of the Way
So, I just kind of separated it right on down from the top. What’s cool about this is as you see the Isolite® keeps that tongue out of the way. I don’t worry about the tongue. Also, I don’t have to have my assistant retracting the tongue and I don’t have to use my hand to retract the tongue. Lastly, if I’m making a surgical incision, the tongue is out of the way and I just concentrate.
I have this nice, open, well-lit operating field that I can work in without the tongue getting in the way. You don’t see any my assistants that are in there suctioning either. So, this part is just really easy just to go scalpel. We have our Luxators. So we did a little, once we got root separation, we took a Luxator in there, separated the roots, grabbed a forcep, and just took them out one at a time. Divide and conquer is always a lot easier. You know, that way you don’t have to break root tips. There’s nothing that I hate worse than digging for root tips. These weren’t even separating. These were tough to get out.
Continuous Evacuation of Blood and Saliva
I was trying to conserve as much bone as I possibly could. I didn’t want to remove any extra bone. Distal root first, mesial root second, but you can see sometimes these things are just tough to remove. I think if you notice throughout this whole procedure my assistant was not in there once evacuating anything. It was just my Isolite and it is doing such a great job sucking everything up. You can see the blood being sucked up in there.
Make sure that you flush your Isolite out immediately afterwards so that you don’t get any coagulant built up inside the tubes there.
Rolando Mia: Yeah. You’re really working that one.
Dr. Tom Hirsch, DDS: Yeah, that was hard to get out. More elevation, more elevation. Finally, it works its way loose, but it had some big bulbous root tips.
We eventually get the mesial root out.
Finally, we curette out the socket, go back in there, then I just wanted to debride the socket down the side there. I cleaned out all the granulation tissue that was in there. Then, I decided I wanted to graph that we’re preparing this for an implant. And so we’re going to do a little graft, and I wanted to put a membrane over this thing.
I had to go back in and make an incision so that I could reflect the tissue a little bit more. It’s just one way to do it. Might’ve been easier to reflect the tissue initially speaking, but at the end of the day it was all the same.
Rolando Mia: And your patient doesn’t seem uncomfortable?
Sometimes You Need a Cotton Roll to Soak Up Excess Blood
– No, not at all. I want to mention, he was on blood thinners and so he was really bleeding. Therefore, we had a little bit more blood than we usually have in this procedure. So, we had to soak that up with like a little cotton roll there. They were acting as little pluggers.
Most of the time there’s no additional suctioning going in except for my assistant right there. You know, it’s just six handed dentistry with just the two of us. In a moment here, we’re going to throw a little membrane in there. Tuck it in. Buccal and lingual, tuck it in. Throw a couple of sutures in, and that’s pretty much it.
It’s just real easy everyday dentistry. Nothing fancy about this at all. Just get in there and get the job done. The points of this case that I think are kind of nice is A: the instant anesthesia, where we’re able to just to start right away, and B: the fact I don’t fight the tongue or saliva, and I have a lot of room to work.
The point here is, even with oral surgery cases that are complex such as this, you can utilize the Isolite.
Rolando Mia: Awesome. That is fantastic. Thank you so much.
It’s amazing to see that during the course of the procedure, there is no muss, no fuss. It’s pretty straightforward.
We’ve had viewers asking, especially with regard to the extractions, they’ve had difficulty extracting second molars, third molars, any tips or tricks with regard to that?
Does Isolite Work for All Extraction Procedures?
Dr. Tom Hirsch, DDS: Yeah, I do. So, Isolite doesn’t work in every single situation, every single time. If it’s in your way, take it out and set it off to the side. Don’t don’t try and fight the mouth, the patient, and the Isolite at the same time. It’s too much work.
I do have a tip for anybody that’s doing third molar extractions. The way the Isolite is shaped for third molar extractions. This rests on the retromolar pad right down here. This goes up in the Hamular notch. Those are areas that you have to access to get to your surgical site. So even though Zyris doesn’t make the recommendation to do this, I as the clinician make the decision of when I can trim this and when I can’t trim it.
So, it was entirely up to me. If I’m doing a third molar extraction and the whale’s tail part is in my way, it’s really easy for me to make an adjustment. I just pick up a pair of scissors like this and cut it off. This portion right here, the tongue retractor still keeps the tongue out of the way.
It still protects the airway, but now it gives you access to the whole surgical side. So if you’re doing mandibular third molar extractions or even maxillary third molar extractions, you don’t have this part coming around and wrapping out on the cheek.
This is not recommended by Zyris, but clinically I do what I need to keep my patients safe.
Rolando Mia: That is awesome. Thank you so much.
With regard to blood you mentioned the context around blood and water. What was that?
Prevent Coagulation in Your Dental Lines
Dr. Tom Hirsch, DDS: Oh yeah. So, you know, your patient’s bleeding. All the blood and saliva are being aspirated with the Isolite.
To clean your lines, your assistant can put water down on the floor of the mouth and Isolite will suck it all up. The other thing that’s important is when immediately after you take this out of the mouth, and you’re throwing everything away, go ahead and flush your Isolite head and system with lots and lots of water. Get a bucket of water put it in the sink. Just flush it with lots of water, so the blood doesn’t accumulate on the inside of the tubing.
Rolando Mia: That is fantastic. If you have questions for us, if there are things that you’d like to see please send them over to us.