014: Sinus Perfs, Expose & Bonds, and Immediate Bone Grafts

Here are the podcast show notes for this episode, where I answer some common questions from referring dentists and online dental communities. As always, I'm sharing my personal approach and opinions.


Hey everyone, Russell here. This week I'm switching things up and answering a few questions that have come my way recently. Remember, these are just my thoughts - if you do things differently and get good results, that's great too! Let's dive in.

Sinus Perforation Repair:
- 5mm perforation during #3 extraction
- My approach:
- PRF membrane over exposure
- Collagen plug on top for added soft tissue support
- Primary closure with 4-0 chromic gut, creating 4-corner flap and scoring periosteum
- If repair fails, next step:
- Titanium-reinforced non-resorbable membrane over PRF and collagen plug
- Wait months if needed before removing membrane to avoid re-exposure

Expose & Bond for Impacted Canines:
- Surgical side: Expose tooth, remove bone, etch & bond button/chain (I use Smart Bond), secure to ortho wire with nylon sutures
- Ortho side: My colleague uses elastics and a spring (not twisted wire) to apply traction and prevent debonding
- Key tips: Luxate tooth for mobility, suture chain to a spring on arch wire, get patient to ortho within 7 days

Bone Grafting Extracted Sites:
- I'm comfortable with immediate grafts if no frank pus present
- Clean out site well, use PRF sticky bone and membranes
- Controversial: Are grafts even needed for mandibular molars? Some evidence shows minimal difference vs. non-grafted sites
- Case-by-case basis with many variables to consider

As always, feel free to send me your questions at [email protected] and let me know if you enjoy this Q&A format. Talk to you next week!