Clinical Case Of The Month

GoldenDent is actively involved in continuing education (CE) and is extremely proud of our ongoing commitment to training other dentists who wish to excel in the use of unconventional dental techniques to obtain excellent clinical results in their practices. Based on requests of several of our customers and past CE attendees, we often post new and unique clinical cases focusing on various topics including extractions, grafting, implants and much more. Each clinical case will be quickly explained with step-by-step photography to explain and demonstrate the techniques. Please see below the Clinical Case for August 2018 as mentioned in our August Newsletter.

Dentistry by Dr. Tim Kosinski
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Figure 1: Pre-operative digital radiograph of a non-restorable mandibular molar.
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Figure 2 & 3: The crowned tooth is to be extracted and the site prepared for future dental implant placement. Crowns are often not an issue with the Physics Forceps (GoldenDent) as the beak is engaged on solid tooth structure, versus engaging the crown. However, on a lower molar it can sometimes be helpful to section the tooth, where the crown would have to be removed first.
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Figure 4: The WAMkey crown remover (GoldenDent) is used to remove the crown before the tooth can be sectioned.
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Figure 5 & 6: A small opening or "window" is made on the buccal side of the tooth, where the goal of such window is to identify where the cement layer is between the crown and the tooth. Once the position is located by feel or using loops, the channel should extend into the center of the cement layer as it is best to leverage from the center of the preparation or on the long axis of the tooth.
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Figure 7: The WAMkey #1, the smallest size instrument in term of head size, is inserted into the opening. The head of the instrument lays flat when inserted into the crown. Once the instrument has been inserted the instrument is simply turned 1/4 turn with your finger tips allowing the instrument head to stand upwards and to gently break or release the cement layer allowing the crown to be removed in an efficient manner.
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Figure 8: As you can see in this image, the crown is completely preserved and it makes for a great temporary, or can even be re-used on a permanent basis.
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Figure 9 - 12:Using a surgical bur, the lower molar us sectioned into two roots, where now the tooth can be extracted as two individual roots using the Physics Forceps (GoldenDent).
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Figure 13: The Lower Universal Physics Forceps in placed on the tooth. In doing this, the bean engages the lingual aspect of the root and the bumper is placed as low or deep in the vestibule as possible to ensure the instrument can achieve the proper leverage it is designed to utilize.
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Figure 14: The instrument handles are never squeezed and held lightly in your hands, where the instrument is really a lingual elevator rather than a forcep. Squeezing the handles is not the technique that should be utilized here, where the handles should be held very lightly and just held allowing the instrument to do the work. No strength or arm pressure is required.
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Figure 15 - 17: The narrow beak of the Physics Forceps engages each root separately to elevate the tooth 1-3mm from the socket. Once the tooth has released from the socket and moves 1-3mm the instrument has performed its designed function and another instrument should be used to deliver the tooth.
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Figure 18 & 19: The distal root is delivered from the socket after the Physics Forceps.
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Figure 20:Extracted socket site showing distal root extracted and mesial root to be extracted.
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Figure 21 - 23: The Distal root is elevated with the Physics Forceps and then delivered with a delivery instrument..
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Figure 24: Extraction site. The socket site is aggressively curetted, removing any granulation tissue resulting from the fracture. This is an important step for any grafting procedure..
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Figure 25: Radiograph of extraction site.
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Figure 26 - 29: An Osteogen Plug (GoldenDent) is cut in half, approximating the contour of the socket site and placed into each root. The product is available in a large and a slim size. This is not just a collagen plug and it does predictability grow bone. The plug is lightly condensed into the socket site and inserted dry.
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Figure 30: Suturing is completed. Note that no membrane is necessary with this Osteogen Plug, which is a great benefit in terms of time savings and from a financial perspective.
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Figure 31: Immediate post operative radiographs illustrate that the material is initially radiolucent.
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