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.

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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!