[Music] a graduate of Harvard University and he was a very close friend of mine from Harvard University and foresight so he's a diplomat of the International dental implants and dental practice limited in conserving fertilize you may know of cents extensive work especially in Ukraine for the past couple days because they've enacted treating day and night army personnel and a lot of soldiers and so we're grateful for not only for his son scientific background but also for a lot of did the public health services that is giving so Sam is going to give us a talk but with several critical points about how to learn about regeneration they had lunch it's my honor to be here Ukraine for a third time I come from San Diego California and I practice in New York Boston and San Diego we have educational facility called International Academy of dental implants in San Diego and we train many dentists around the world our mission is to help underserved communities we need to China Republic Mexico many countries to help them gain weekend in their smile and that is our main mission at the same time to advance education and research by 13 Ukraine again with Myron we came here last year to treat many soldiers I consider them to be fuels this gentleman as you can see he lost his leg for his own country and he's a volunteer and for me as a doctor to treat such a hero was a blessing and I would like to [Music] to the soldiers and the anesthesiologist nurses and the surgeons in Ukraine who volunteered to make this happen and we are happy to be here back after one year with over 14 doctors from United States France UK now we're doctors we treat patients and we had a huge responsibility because if we make mistake our patient this patient unfortunately has failed science and patients suffer when patient was referred to me she couldn't drink every time she tried drink he would come up from the nose and our quality of life diminished because so how can we rescue such disaster as a clinician I always want to try minimally invasive approach that way I won't do any damage to our dish so I let this wound heal and best way to fix oriental communication is not that it's not what a petrographic is actually to use to prevent communication between entropy and so after the soft tissue healed it took about two years for the soft tissue to do we attempted to retry sinus but because she had a tantrum she said I'm very scared do you think this one can you utilize minimally invasive approach well I will be a scientist so I believe in minimally invasive approach minimal incision is the best for our patients in fact if I want to undergo oral surgery I want to choose invasive so I'm a split take this father because I deal there was no bomb on 30 in precise after making split thickness 5 we elevated the front and we folded the split thickness tissue into the silence to be able to sinus so after we push the split thickness flap into the silence with very minimal family we're not doing lateral approach everything is done through crust approach wine because when we make a decision within keratinized tissue there is virtually no pain but when you extend your Fabiana good introduction then patient will have lots of pain and swelling so as a clinician I child minimized incision within mucosa to the junction and I will utilize the voluntary to augment the site and I like to use metal either in this case just to make sure that we don't get reinfected into the science area and gently we will push the bone into remember dissipation and global picture had zero milliner can we place it back at the same time well the patients refer to only one surgery because of previous dental trauma so we will try to place implant at the same time but how can this be possible when there's no bomb at the site we know the osteon in science by author sizing the austerity of one kilometer by choosing the right diameter and by choosing the right shape of the fixture were able to place the implant and get enough exposition so that we can have guarantee that we don't push our implant into the sinus between the so as you can see we're placing a four point five by eleven point five millimeter fixture and even though we had a millimeter of initial height we weren't able to achieve 50 Newton's percent why is this possibly in fact this is much easier compared to when you have ten millimeter bomber when you have ten in a bit of bonding that someone you only have one cortical bone and rest is measurable however when you have very thin bone now we have to quarry COBOL and it's easier to - you better initial instability so as you can see after the surgery we were able to a traumatically live the silence without making huge incision without making huge level window annotation was very happy but what's more interesting is not only to be to eat in a size asleep or we also did lateral augmentation as dr. cocky mention best membrane is actually very hostile tissue I do not use membrane in my practice unless I have to in this case I didn't use any membrane to do is photograph and six months later you can see that we were able to maintain this because we are very much in addition you can see that this integration of old sinus form and we get a new scientist transformation new quad common for information that's an indication that our graft has completely turned over to the native on another case this patient also received in fun however the implant went into the science this is why we have huge responsibility we have to know what limits if we go outside the limits our patient was poor lady she had she developed sinusitis as for the employment to the silence and she was referred to my clinic to remove not only one or two implants from the Sun as a clinician once again we have to take what is the best approach to rescue this case I want to make as minimization as possible and I want to make minimal trauma to the existing body as you can see this is probably the previous defect when you're making a season rudabeh one and you have to remember is not to make incision where there's no bone always you must be decision where otherwise when you suture that tissue or the cross so in this case instead of making traditional crest transition we will make palak incision so that our incision line is so we made have a precision and for me making non 42 incision is very traumatic for the patient in fact mucosal tissue will extend there's no reason to make long vertical incision with only two or three millimeter of fertilization beyond Millcote introduction we can minimize swelling and pain for our patients yet mucosal tissue will stretch and you will have great access to in this case I chose to deliver window because implant was too large it was very I thought it'd be very difficult for me to be moving in from transport but I want to minimize the surgical time for our patients so we will utilize the latest technology in sinus lift this sinus very will be able to try the sinus yeah to memory why because there's a hydraulic pressure from the bird protecting the membrane as soon as we crying the science using this innovative tool only three seconds we can get access to the scientist membrane and at this point I do not know where the implant is above the membrane or yellow diamond but I'd like to do sinusoidal for this patient and perhaps implantation to minimize comment our vision so I just pretended that implant is below the shredder membrane I begin to lift and try to find the implant below the standard unfortunately I was not able to find it was not under the study room I looked everywhere and I could not find so where could it be where's Dean when I took on the x-ray it was moving around which means it was outside so I have no I have no choice or to perforate memory I actually cut it with scissors so that I can have access inside then by using the Crimea I had the patience it up and gravity help me to push the implant downwards as soon as she set up as you can see I was able to see a plan and now we have huge perforation and I still grasp on grab for this patient how can i patch this membrane we can use College membrane the problem is if the College of memory goes into the sinus and it gets dislodged it procs dasya then we'll have a huge problem with sinusitis I do not want to take the risk so what is the best way to seal on that there may be the best way to fix soft nor hard tissue is marrow aspiration we can take bone marrow from many places but these traumatic place to take is to porosity as we all know is very soft well it's like Spanish so we're able to penetrate the tuberosity with 20 gauge needle and by penetrating the tuberosity with 20 gauge needle I am able to aspirate Omen which has cells which has the stem cells growth factors it has all the ingredients that I want to fix this point so as you can see very a traumatic you can draw omen from RT so we draw oh man and this is very different from pure and for PRT or PDGF or other different types of osteo in documentary why because this is very very sticky and my previous type shows at cd34 and 45 cells are present in created in this rotation so we've been playing surgeries with osteoconductive for many years then we we try to advance our science with also inducted for in 2019 I think it's time to go into osteogenic and have the best material which is the stencil for artists remember this is a huge 10 instead just by a prime by Omega expiration after 20 minutes huge perforation is now I am able to and bone for this mission we added additional VRS and now because the terror of standard memory is gone I am able to add fun for this mission all their aspirations of tourism is very special because you can't so fast it has so many osteoprogenitor cells you will see my presentation to all that I gain by mixing with this material is phenomenal and the handling is really nice because all grab a stick some people call it is stickable or stapled whatever it is he hosts the bone graft together and you have great so once again we went to the other side as well we removed the other implant from the other side we apply the same technique and after the CT scan even though there was large perforation you can appreciate that the bonebridge are held together and this is a huge huge secret in bone grafting technique so I want to show it five hot tips in own augmentation and number five is all marrow aspiration are you guys ready for number four let's look at number four this young man came to my practice and she had a very limited income she said I need to extract for mr. T and I need to have 325 of course here we have some portico bonus some horizontal effect does tend to implant last by time I don't think so if he lasts 30 years I think you'll be also instead to implant as good as our natural tea unfortunately as developing dice emergence profile is the most difficult part most common problem I have in my practices patients complain that food has done under the article because of improper emergency so whether young patient comes to my practice I don't want to damage to my patients so I think again what is the best treatment for parties for young lady like this instead of placing three implants and wisdom teeth extraction I like to the dough infants and utilize orthodontics to close together this is the best way to have the best emergence profile and economically this is the best way for the patient so please remember that orthodontics is very very important if you want to practice best implant dentistry you cannot do it with order when you're missing a tooth according to the point and you need to utilize to intrude we can do CPR technique we can do open our technique we can do we just be effective there are predictable however every time we do a bump the problem is that we lose keratinized tissue and we have to do additional procedure to in addition what is the best way to beautiful recently answer is orthodontist do not extract hopelessly build and utilize simple orthodontics to beautiful at the same time you can build changeable you can be built callus tissue this is the least invasive way to build oh yeah inspiration so always think about beautiful this is 54 years old and she lost so much power in the end yet if you look at her smile recession is nothing but we know as soon as we extract what we have the poor movements because no number help the common class because and she's 54 years old still not very if you mess up we have to marry the [ __ ] so the best way to grow both is to do supported optics you have to have very high degree to know how to patreon you just need to know how to extrude if you do too fast is called extraction there's three ways there's three things you have to remember when you are doing it true now what throw an extra faster than number two you must surface because intention has traumatic inclusions or what happened you are loosed about what is number three number three is most important number three is to collect monthly payment now after extrusion once again this is the only technique that can be bombed and the gun and to see and now I had so much fun when I'm placing implants it was very very easy to place and we have fun and now so number four secret in grafting is three we briefly talked about sinus lift and talked about that we did a great job talking about sinus lift complication especially when it comes to the artery this is why I like to do crest approach because the arteries are about sixty point four millimeters from the crest on average and you can have some shooting blood during the surgery so in order to avoid this type of complication I recommend doing crest approach but when we do approach what my teachers taught me that when I have more than five millimeter bone we do crest approach when I have less than five little bit of bone we do this has been the standard for many many years however McHenry which is a two dimensional x-ray was the standard carry now in 2019 ladies and gentlemen we have three dimensional convenient cities so we have to utilize three dimensional kite lines when we are doing science I love to ensure women's private use short and wide time I might short and narrow that me because I think those can give you problem especially when the patient is pretty special lack of Canaan guidance when you get large battle to support it could be defeated so I would advise wide and short I am ready but when patients have wider than the literally when pictures have very low but yet usually positive face break official romantic same roster they have white bone when God is telling you you have why you have to you with so when patients have wide implant there's no reason to do never window we can make window through the crest because the bone is warming why not make window to the crest now when patients have very ticklish then you can use osteotome or the type of scientific technique or level technique that I have shown before so in 2007 I developed this technique called crest oh we do technique especially the extraction site you can do eyes the instruments to make window through the crest and place in man this is Cresta approach but it's not uprightly you can still see the memory but there is coordinated to the patient because there's no bleeding from the army to enroll in the cookies time-consuming however by utilizing instrument like such as this anybody can open another window within three seconds how many people how to open a can very easy it takes you less than a second I applied the same concept we can use a trash fire to weaken the bomb then we can utilize the power opener to talk to Silas it takes three seconds so protectively remove the sinus but this was developed in 2008 now in 2019 11 years later I am proud to announce the iPhone 10 Silas what's the difference with the iPhone 10 now we need to be predictably going to the sinus on into a tear the membrane we actually use the hydraulic pressure to lift the membrane at the same time so the whole scientists procedure becomes very easy because we're now visiting the membrane at the same time but it's very important that the water doesn't shoot directly above he has to shoot sideways why because Silas is never fun if it looks flat he has a slope according as you can see as soon as we penetrate designers for immediately the hydraulic pressure will live this is the easiest way to live once again flat sinus disease because it's perpendicular to the burden you can utilize him at the admin tool if designers or most difficult part is when you have inclined plane more slope you have is more difficult so here we are simulating inclined plane at 45 or more and as you can see even though we are directly touching the snare membrane doesn't care why because the waters coming from the side once again flat sinus is easy but inclined plane is very so here we decided to push the limit and even lift or that two millimeters into the membrane and as you can see at one thousand ten the membrane is giving time because then how do we inject bone easiest way to inject bone is to use putty home from the syringe called avocado this is the best material that I like to use inside the sizes by utilizing mobile phone were able to live beside us and further protect Silas is very contained effect even if you don't put any bone it will become just by having blood it will become so let me show you a clinical case once again most difficult case is when you have slope here is almost 90 degree this is the most difficult case because is that 90 degree flat sinus is easy or an inclined plane is a short video flap has to be done on palatal side down on the Kratz because in case you get perforation we don't want to have original communication very important to make palak incision then we will use our bird and we would lift the silence make the patient's breathe in and out to confirm that we don't have any perforation and I will utilize SDB a 2-pack and condense into the science slow insertion is very very important because if you insert implant too fast he will burst amendment it's very important to slow I'd like to utilize implants with bounds because in the middle I can verify the angulation is needed I am able to change the emulation of the fixture and I utilize the mount to the inside designers and even though this was a dangle I am able to predictably leave to sign us without permission so once again it's safe to go into the sinus as much as familiar with this trail and teacher is happy because he has no pain this is my daughter and she said I want to be able to do in France fine so so there are many ways we have to we can have dice for at the same time I do not want to have a lot of swimming so I want to take a journey I always thought that a cartilage bone is the gold standard really quickly I haven't utilized on block anymore because is not necessary this type of older technique is not necessary is traumatic to the patient and the result is as actually is not as good as the newer technique without a thought citing Oprah technique is car I don't utilizing my practice anymore when patients come in with very very thin rich we have trouble with popular because we have limited source we have limited quantity so titanium reinforced membrane mr. go-to technique for me because it's easy to use I don't like to use tags at my disposal I would like to use titanium enforcement because he's stiff he was stabilized by ground and I don't have to use screws or tablets you just need to over graph the site and utilize the titanium reinforced membrane once again no screws no tanks you just need to stabilize it with suture with internal metrics after eight months you will see that we have dice generation without any type of screws or tentacles vortex in the mandibular procedure is very similar all the differences that we have to do the collocation because mandibular bone is very dense nature so we also need the mandibular case for her we have to relax petition película and the collocation has been done and we have to achieve primary so here we have to be careful not to place any pressure all depend on earth but again I will utilize titanium enforcement brain because I have stiffness to be created from a cloture is very important and when we go ahead and open divers Vader you can see that by using osteoconductive method we can augment the side without limit I will have to depend on a target this was truly a breakthrough in my career because now I can truly trust however I must tell you this is you I don't use this technique often anymore and we place the implant at the same time many of questions here that show that is possible in 2018 instead of place a plan at the board level we have to place a plan where the CDJ of that implants go and beautiful at the same time and by utilizing the same technique that I've shown without any tax or skeptics group just by using sutures we can grow all vertically as one still this is when this is a veritable can we place impact at the same time you have to do it with precautious because when patients have ferreted bone like this especially maxilla as you are placing implant the boat can fracture and you get a lot of damage to our patient so instead of under drilling is very important to drill accurately with very little stability on the implants so that we don't induce fracture of this is your bone and I like to place implant as power to as possible making decisions on the power side and fenestration on the then I will utilize membrane remember we have to have stable you cannot be moving during the healing phase so either we have used progress or we have to utilize titanium enforcement in this case I chose to use collagen membrane and by stimulating the collagen membrane we decided to use rock this is a special platform that doesn't require tacky doesn't require any and we can stabilize we chose sutures so the second surgery becomes very very easy because they remove all the membrane in this case it's not necessary but if I have to remove any brain once again this is a great material to use and as you can see we can at the same time still present but this patient came in with severe very advantageous are we able to recoup on our own 'filling implants as long as you remove all the soft tissue and infection and as long as you can get primary closure and stabilize the bone this is possible as you can see this is Supra body defect there is no bone power but by utilizing the same concept by utilizing bone graft over crafting it with titanium in force membrane and primary closure we can see we keep it around remember if you put any pressure and if we boot the first three weeks you will have so very important that patients have six prosthesis and after three months we decide to open you we can appreciate that we all the way to the top of my Tony here is as a clinician I do not want to induce a lot pain and swimming so what is the iPhone 10 technique for boner this is not something new in fact is been around since nineteen eighties but it has been under humans so we talk we don't make any incision and the Crescent to preserve the classified but we need to have to write material to prevent movement during days so my good friend of mine suggested that we start to internally and I want to give credit to my good friend dr. Simonton for continuing research in this happened and now we can make incision just after you couldn't before and we just thought this procedure is wonderful for you and the patient because we'll love it because there's no pain and you love it because you only take five minutes to be done and it's very simple and easy procedure for your patient however you'd have to be careful patient would not want to pay you a lot of money if you only spent five minutes so take a long time to do this so faster we panicked it's very important that you overtime and it's very important that you use omens aspiration why because bone-marrow aspiration allows you to make very stable is bed without titanium beam force so we will give very simple sutures the procedure is very clean and very easy two weeks later patient won't report me to pain sometimes pictures movie / report exceed ear pain as well because it's close technique if you have a little bit of survival into a tunnel it's not very forgiving and if the patient says this was very painful procedure for a patient comes back to you to explain I said this was wonderful I don't feel any pain then you will have so much six months later you can feel them and as you can see this poll was done only by doing simple tunneling in five minutes look at the power that we can have through a very small incision he almost looks like too much I can academic orgasm when I see is and this little group or bomb that supports the baklava is the key for long-term success for your dental implants this is truly the iPhone 10 grafting so number three is to use me deeply missive approach number two is to preserve what we have is very important to preserve characterize tissue so whenever you're making incision make liquidize incision to to preserve calculus teacher as much as possible we need to have minimum of two millimeters of tissue and also so we used to utilize a traumatic extraction in 2019 i I knew partial extraction therapy instead of removing the whole tooth we preserve the barcode half of the tooth and by leaving the root we are able to preserve the emergence profile and the bank account or for the rest of patient's life without thinking about trinket and I do the same for party area and as you can see we can please even the Pontic area forever as long as the patient is alive this patient or have nice third we have to learn how to preserve Abdullah as long as the patient doesn't have a paradigm of omission I always you might have experienced Asian in the posterior region instead of making very sick position we have to make Mickey Mouse incision in order to redevelop in the proximal tissue this is modified how much technique to utilize a bomb pop the interproximal tissue and more to preserve calculus tissue to our patients a fourth we have to preserve the standard membrane because we want to alphabet to sign us in posterior and seven and by preserving the Snyderman printers don't limit as to how much we can lift without doing any lateral window precision lastly the most important is to preserve classified by preserving classify we can have great outcome so always try to do we develop invasive funding technique so that / - secret was too serve what we have we get some permission to finish number one can I have some extra minute so planning is very very important if you do poor planning your implant will be misplaced and when you misplace your in fact it will be very difficult to prospectively finish the restoration however doing kind surgery on second molar is almost impossible because not many people can open why so we have to have different method to do to position our dental implant therefore I utilize the stopper as my guide in this case in diameter so that I always my implant on if you are doing multiple plans I utilize the same concept I just made stopper that is exactly same as seven point five point five but at the same time it helps you to save time instead of using multiple trailer in 2019 consider using would be one drill what do you want - why is it possible how come nobody thought about using one drill for any different size because of heat I have in hollow space our research shows that when you have a hollow space it doesn't create as much heat so 47 is based upon rabbit model probably human we have much more higher temperature but in Revit model you know 47 degrees Celsius is the threshold and our study shows that when you have a hardwood tree oh it was important about there's a difference of 10 degrees Celsius when it is hollow drill and also by using hollow drill were able to collect both at the same time so this completely changed the way I practice my implant dentistry and is really help you your practice as well lastly the kaya surgery has really changed my life even my 4 years old son can do implants now because of this special patient came to my practice he turned 100 years old so we were talking about whether we can place implants on geriatric patient and this patient said I am sick and tired of wearing tension yet nobody wants to do because so because of his age we want to use beautiful evasive I want fast surgery this patient doesn't have 6 months for the bone to him we need to give the final prosthesis in just one day but in 2018 that is possible with guy a surgery with computer-aided surgery we can plan the procedure in the computer and protectively place team plan for this patient without any so Qaeda circa has been done and I developed once again hot water because I won't waste time on these patients using multiple trio today sky surgery has a bad problem because too many steps is confusing but what if you do one burn and one implant [Music] so one true we don't want any fat in 2018 if we are practicing kinda surgery we're not practicing at the level of because even specialists even myself I do kind of certain because I know we were able to face the apartment and the temporary on the same day and patient was so happy from start to finish we finish in 46 minutes and we have the Guinness Book of record or with this patient to receive for art and she was so happy he was able to be artitude for the first time in my practice almost always you see the patients have money and no mom or and I'm sure we have same problem here as well but if patient has consider doing MIT on graston technique which only takes five minutes of MIT technique has really changed the way I do on graft for patients if you want to learn little bit more about MIT technique when you go to my website you'll find of all the hands-on courses on MIT so my last secret in bone grafting procedure is to utilize the blade technique and tools that we have in our practice [Applause] [Music] we have the number of the five techniques so any questions [Music] this is controversial but I'm telling you from my experience when I realized dftba to resolve that idea is not asking a lot of shrinkage and I have to wait so I switch the FDA which is the winner and then we have an option for Dakota solids can service a coracle own in my hands best material is infused cortical cassavas it may work in may not work what I'm talking about is complicated when you do totally technique you need stability of the ground but when you use can solid from the FDA is too much it doesn't move at all and I think that is the secret stabilizing the grasp with the right choice but is we would we would a deli she has always important especially scary episodes that I'd appreciate ago I tried much for saying that atchoo very good question I am a specialist and almost every month I have at least referred to my clinic to remove in fact it was referred to me and I think comfortable doing it with minimum I choose to remove myself but I agree we may have awesome to to Yeti but I believe my technique is less invasive because it could be done under local anesthesia every day who knows what here to give an idea when you didn't see until they caught you can su casa Tonny vecher dr. Farhat said it was very good question you can you guys both scraping or with the bird if you have coming for next three days we'll be treating your soldiers if you come to - clinic you'll be able to see the tunneling technique that we do for your heroes we can make a tunnel and we can detach all the fire we can even place implants and then type O so making the corrugation through a tunnel it's not a party I invite anyone to come to my relief if you want to see our action the truth she'll be designed extraversion but they are overdoing solution together first MK period really met you very question you have to make decortication to the bone marrow for two reasons to increase blood flow and also is a mechanical retention for your protein body a question while you're returning salmon how much bone marrow aspiration in terms of oil we use safely very good question it depends on the size of tuberosity some people have large to proxy I can extract as much as 10 CC but some people have gone to rusty and I have minimum I need it depends on the phone volume for one cc I win at least once into hydration questioning superelevation Catawba Cristo is a Canadian server she Reza Madani aversion to substances that's a very good question actually I skip a lot remember one thing we have to preserve is the character last issue so I made incision with number 11 blade so that when I am drilling the gingiva opens so we're getting the last question right now is you're really running out of time this is the last question the rest of the questions will be asked afterwards very good question whatever bacteria we have in the sinus in help designers there is no snow better it's a sterile environment so as far as the sanitary membrane is thin and as long as the our technical pendant you can assume there's no [Music] [Applause] [Music] [Applause] [Music] [Applause] [Music] [Applause] Oh [Music] [Music] yes speech [Music] also he answered all our questions and we will get more information convenience of Santa [Music] you