Precision + Clarity

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THE ANATOMY OF A STITCH Before you understand at all, you are in awe -- what is this amazing wonder?! Then, when you understand a little bit, you scoff -- eh...I knew that already and you're not teaching me anything!! Then when you fully understand, you look back and laugh at yourself for having scoffed, but the best way of once again gaining awe is to have students in the early awe phase. An example of this in the layman's life is when you're all grown up and your kids are excited about bugs and then you learn there are 20,000 species of bees and over 400,000 species of beetles. All of a sudden, you can be in awe again. But let's get back to suturing... SLIDE 1 Extraction is done, grafting is done and collagen membrane has been placed. No release has been made and no release is necessary, but how do we suture for best results. What are the best results? 1 - Primary closure 2 - Proper approximation of gingival margins to adjacent teeth 3 - No tears in soft tissue due to super high tension sutures You'll see that I flapped to the first premolar in order to gain proper access during surgery. SLIDE 2 For greatest flap security, you can first place a horizontal mattress. Here you can see I placed a figure-8 horizontal mattress. Thanks to Dr Effie Kenneth Gluck for sharing his favorite suture with me. My go-to suture material is Vicryl 4-0. SLIDE 3 That's how relaxed the F flap can be with the mattress suture tied as such. It can be made tighter, but no need. This holds the flaps so you can continue suturing. Observe the gingival margins on the adjacent teeth and how they approximate throughout this procedure. SLIDE 4 Simple interrupted in each end (just D of M, just M of D). You'll notice that the M is fully closed but not the D. The D could have been made tighter, but the gingival margins are fully approximated against the molar. SLIDE 5 Final suture to close: a figure-8. The D suture is loose now because the figure-8 is tighter. But it'll all heal well enough. ------ Check out RIPEGLOBAL.com for over 20 hours of my presentations on atraumatic exodontia, immediate implant dentistry, as well as amazing lectures on all aspects of dentistry!

Here's my favorite blade, the 12b, on top, and the 15c, on the bottom. I recommend the 15c over a 15, the latter of which is great when you're cutting into the abdomen, but the 15c (c for cute) is a much better fit in the mouth.

As for the 12b, it's labeled "b" for "both" -- it has a cutting edge on both the concavity and the convexity of the sickle, whereas a standard 12 blade only cuts with the concavity. With the 12b, you can cut the tissue both when you pull and push in the sulcus, making it quite an agile tool in tight and hard to reach spaces.

Here's my guide pin to depth.

I liked the coronal angulation but decided to move it a bit M at the apex to grab more subantral bone.