in Preparation for
Howard Farran, DDS, MBA
Don’t plan on
retiring at 55.
Probably not at
60 or 65 either.
Answer to ‘how to do better’:
– Lower expenses – Pull teeth, even easier
– Increase marketing wisdom teeth
• Have a good website – Join insurance plans
and be “search engine – Use 3D CBCT
optimized” – Don’t do gold
• have a Facebook page (overhead too high)
– Add new products and – Place single root-form
– Do simple ortho,
– Freeze wages (after all, Invasalign
yours is going down)
– Treat sleep apnea and
– Do root canals, crowns, snoring
and dentures – Make mouthguards
Dr. Jay Reznick, Oral Surgeon
With fewer patients, many practices are trying to fill those
gaps by keeping procedures in-house that they would have
If you choose to refer fewer patients to your specialists and
treat them in your own practices, please make the
investment in yourself to become more proficient at those
Picture from the hotel.
Nice to have a choice.
A day of mountain climbing in Yung Ji.
The ultimate atraumatic extraction.
Dental school surgery
Bad for implant, bad for bridge.
45 y.o. female patient
Someone else’s extraction
My extraction. on the other side.
How it works…
– Stretch then snap the periodontal
– Stretch (expand) bone around the root(s)
– Section the tooth
– Wedge instrument into the PDL or thin
bur in the PDL
– Drill or break away the bone to get it out
Luxators into the PDL.
These are NOT elevators.
Texbook of Oral
Surgery, 5th ed.
Gustav O. Kruger.
3 mm luxator
0.1-0.3 mm wide.*
(*Dr. Myer Leonard in “Essential
Dental Handbook’. Edwab, R.
ed., PennWell, 2003.)
2 mm luxator with the MB
root of an upper 1st molar.
7 mm diameter
at base. Hu-Friedy.
Luxator: 3-4 mm into
PDL towards apex.
Spear-point and nylon-tipped mallet.
Dr. Dennis Tarnow:
A periotome is time
consuming and not
The Future of
SD 70Z SD 70
Hi Dr. Koerner,
My name is Dr. Eric Morrison and I have had the privilege
of taking your course several times when you have been
here in the mid-Atlantic area. I most recently heard you
several weeks ago when you were up in NJ.
After NJ, I purchased the DoWell Piezo. I must
admit, between the piezo and the luxator, you have
revolutionized the way I remove teeth. Quite frankly, it
allows me to remove teeth as your course advertises -
nearly atraumatically and certainly more
efficiently. Thank you.
to remove heat.
Osada Model EF-O15
Designed with extra
cutting power for oral
Uses of Osada’s ENAC tips:
• Surgical extractions
– Sever soft tissue attachments to tooth.
– Minimally invasive bone excision.
– Tooth sectioning.
– Cleaning and scaling of periodontal tissues.
– Can add medicaments to irrigation.
– cleansing and shaping of canals.
– Filing of canals.
– Removal of gutta percha, silver points, posts, separated files,
• Apicoectomy tips
– Apical resection.
– Ridge splitting - removing an implant
– Sinus graft procedures.
Brands of piezos…
Piezosurgery (Mectron) $18,000
Piezotome (Acteon/Satelec) 15,000
VarioSurg (Brasseler/NSK) 8,000
ENAC (Osada) 5,900
Piezoart (DoWell) 5,000
“Another technique is to take a long, thin
diamond [or carbide] and go around the tooth on
the mesial, distal, and the palatal (if the bone
To preserve bone, it is preferable when creating a
trough around the tooth, to cut slightly into the
tooth rather than the adjacent bone.”
FG Surg. Length: 30 mm
Cutting a root in half
Socket preservation case.
Main surgical suction tip: “ Special” surgical suction tip:
3.0 inside diameter. 2.0 inside diameter.
3.0 mm (15P3A)
2.0 mm (03EA)
Wire to clean it out.
(Also 1.0 mm diameter: 02BA w/wire too.)
Prior to bone graft.
What happens when you “slip”
with a Luxator or elevator? “Slip”
Small and large.
One in the set of “Apical” forceps.
Schumacher: 1174 “birdbeak” for
19 year old girl with
unerupted 2nd premolar.
Dr. Karl Koerner
removal caused root
Peet (mosquito) forcep
for root tips.
Before using an elevator or
Luxator on the broken root,
first engage the Hedstrom
file and attach floss. Then
try to remove the root.
while the file
was in the
Dentist: “I’m pulling as hard as I can.”
4-5 mm perforation (slit) into
sinus at apex of socket.
½ of a Colla-Plug as
between socket and
1 mo. post-op.
Painless removal of
PTFE membrane with
one month post-op.
Day of implant placement.
Full-arch extraction case. Surgical extraction
of # 3.
Very nice case, everything looks very clean and
planned. That is exactly what I would do, from the
semilunar incision, to the p.o. meds. It is nice that it is
a denture case, so you probably won't have problems
with the sinus opening. ( Provo oral surgeon.)
Alvogel placed at 3 days
for dry sockets.
This picture: 7 days.
64 y.o. male
Root tip pick
Air + Water =
Which is better? Both work.
“Surgical” 702 or 703
Can’t find a rear-exhaust
(surgical) without the
45 degree head.
No air in the
water is best.
Dr. Karl Koerner
Dr. Gordon Christensen
Practical Clinical Courses
Practical Clinical Courses (PCC)
Other group distracted while making repairs.
Erupted maxillary third molar.
If not loose after
Equivalent with a lower
erupted third molar:
Envelope flap, bone removal
to furcation, section the
tooth, remove in two
51 year old woman.
(Case submitted by an anonymous practitioner.)
Florid Cemento-Osseous Dysplasia
Cemento-osseous dysplasia is a fairly common lesion of
the jaws originating from the elements of the periodontal
Most of these cases occur in Asian or African American women
in fourth or fifth decade of life and most are asymptomatic.
Since diagnosis of these conditions is based mostly on
radiographic and clinical examinations, we must recognize these
conditions to avoid misdiagnosis and mismanagement of our
shang4 he2 dou4
Natural anatomy in
With a sinus membrane
sighting or perforation:
Don’t poke into it !
Use the “nose blowing” test:
– have patient pinch the nose
and blow “softly”
• Implement sinus precautions.
blowing the nose,
or coughing with
the mouth closed.
Also, don’t smoke or use
Five day post-op. Patient careful. No apparent
Medications (for 7-10 days):
–Example: Amoxicillin 875 mg, bid
• Oral decongestant:
–Examples: Sudafed 120 mg
sustained release, bid
Gauge treatment according to the size
of the opening:
• If 2 mm or less: no further treatment *
• If 2-5 mm:
– figure eight suture over socket *
• If over 5 mm: get primary closure
*place gauze over the socket for 1-2 hours
With a chronic sinus condition, get primary closure
regardless of size of opening.
Section cut too deep.
Required primary closure.
Avoid Losing Teeth/Roots
in the Esophagus or
In lung (right main-stem bronchus).
18 y.o. boy dead after
wisdom tooth removal.
Better (4 X 4s).
Is it malpractice to leave a root?
Pull or not ?
Not malpractice if..
1. The root is small (5 mm or less)
not loose, and not infected.
2. You feel that it is in the best
interest of the patient to leave it.
3. The patient is informed.
4. The occurrence is recorded in the
5. An x-ray is taken for
6. Follow-up is scheduled.
Physics forcep vs.
more traditional apical forcep.
“Creep” is a phenomenon whereby a material continues to
change shape over time under a constant load. In a tooth
extraction, creep may occur in bone and the periodontal
with your other hand.
My evaluation for CR:
– Generally, they do work. – Need to be careful in the
mental nerve area.
– They conserve bone by pushing
the tooth coronally enough to – Harder for 2nd molars because
snap the ligament. of the cheek.
– It is a faster extraction. – Steep learning curve,
especially not to squeeze.
– Patients are impressed by the
ease and quickness. – Need to section lower molars.
– Gauze in undercuts
– Fairly expensive.
Upper and Lower Molars
YouTube: Misch Power Elevators
Bumper on lingual or buccal.
Do not squeeze handles – just firm
Luxate predominantly to lingual if
buccal bone thin.
Allow time for bone to “bend”.
Section if molars widely divergent.
Upper and Lower Molars