TRANSCRIPT:

So here we are. We got an edentulous jaw, which is nice. Obviously, if you had extractions to do your extractions, but we're going to make the incision. We're going to do this at the right side of the jaw first. As I mentioned, we're going to take the incision from the tuberosity all the way back here, all the way to the midline. We're going to make a midline incision as well. So I'm going to go ahead and make the midline incision here, just so we have some good access. We're going to make it nice. This patient has a lot of tuberosity here. We're going to make the unbone, make it a nice crestal incision. I like it a little bit more palatal, so I'm going to angle it towards the palate here. These atrophic jaws are a little bit harder sometimes to, and also we are dealing with a cadaver, so.

So we make an incision here, attach the front, and I'm going to make my... There's no blood, so it's hard to see that. That's funny. I'm going to make a lateral kind of hockey stick almost up here. And you want it right. Okay, so the incision is made, midline, crest, and all the way to the tuberosity. Let's see if we can get a periosteal elevator here, and I should be able to easily lift the palatal tissue at least here. Nice. Excellent. So get our flap going here. Hopefully you guys can see okay. This tuberosity is always a little bit harder. I always find that edentulous patients are harder to reflect anyways, than dentated patients. Dentated patients are much more easier to reflect the tissue.

Try to make this as clean as possible here. It's pretty clean. There's no blood. No blood at all, which is great. But sometimes this tissue is hard to elevate. Okay, so I'm just going to use the blade to finish retraction. In a real patient, it just kind of flaps open. Sometimes again, edentulous patients are a little bit easier. Lift this off the bone here. Perfect. Okay. So we're going to just, you know, you want to take care to raise the flap obviously, because this is something that you're going to be closing later on. So we want to take our time. So I can get this tuberosity extended. This patient has a big tuberosity. Push the 15 later. So look at this. Tuberosity is exposed here. Palate is exposed. This is the bone here. I'm going to start dissecting. I like to just get my orientation right. So I'm going to retract to the nasal floor. There's a nasal floor here. I don't know if you can see it. There's a nasal floor right there. You can see it. I can dissect in it right there. There's one in there right there. There's a nasal floor there. This is the vomer bone here. Right there. And then this is coming up here. Obviously in a real patient, I wouldn't go all the way this high. There's tuberosity, and you can see this hue right here is the buccal fat pad. You guys see it kind of looks like fat right here. This is going to be the buccal fat pad. I don't want to tear into this right now, because this is going to come out in real surgery, okay?

Now what I like to do, there's a lateral wall of the sinus right here, the anterior wall of the sinus, and what I like to do sometimes is, as I've got my hand in here, I put my finger here. There's the orbital rim. There's the maxillary zygoma here. So I'm dissecting here. You see the fat coming out a little bit here? That's not the buccal fat pad. That's more over the zygoma here. So this orbits this way. There's that infratemporal fossa back here that you don't want to necessarily get to. I'm going to dissect back here. You're coming over the zygomatic arch over here. I'm going to dissect down here. See, I'm just lifting like that. That's where you said all the muscles are attached, right? Yeah, this is all the muscles attached right here. This is the muscle attachment right here. You see it? This is the tendons of the muscle here. So you want to be above that. You want to follow that up? Yeah, you want to follow that up. You're going to feel over the curvature. So see, I'll make a tunnel for myself. That's the tunnel I need because that's where I want it to poke through. So you want to get to that curvature? Exactly. I want to get to that curvature because that's where the implant is going to come through. So implant's going to go through here.

You said this is more of a straight wall. This is a Zaga type 2 here. I don't know how much crestal bone here is because we don't have a sinus graft here. I mean, not a sinus graft, a CT scan. But we're not going to do an intrasinus. Since we're doing intrasinus through the model, we'll do like a slot technique. So it's going to start here. It's going to follow this. This is more of the midline, number 8, number 7, number 6, 5, and 4. This is the first premolar area. We're going to follow that. That's the wall that I was telling you about, the anterior wall, the sinus here. We're going to parallel that wall right there. Okay? So the implant's probably going to exit right in that area. You said I made a tunnel. That's all I need. I don't have to dissect further up. I just need to see a tunnel. I actually like this periosteal and I'm stretching the patient. You see that? So I can see it come through here. So this is kind of going to be the angulation that we're dealing with here, right here. You see that? Perfect. So that's the dissection. So we have good dissection here. Perfect. See how we can see everything here? Very nice, good view. Beautiful. Okay. So if you can hold that for me, doctor. So we can set up our handpiece here. So now we need to get into the sinus, basically.

Lesson Summary

Here is a summary of the video: - The video shows a demonstration of a surgical procedure on an edentulous jaw. - The surgeon begins by making an incision on the right side of the jaw, extending from the tuberosity to the midline. - A midline incision is also made to provide better access. - The surgeon then lifts the palatal tissue and reflects the flap, which can be more challenging in edentulous patients compared to dentated patients. - The tuberosity and palate are exposed, and the surgeon starts dissecting to identify landmarks such as the nasal floor and vomer bone. - The anterior wall of the sinus and the buccal fat pad are also identified. - Care is taken to stay above the muscle attachments and follow the curvature towards the implant placement area. - The surgeon creates a tunnel for the implant and notes that a CT scan is not available to assess the crestal bone. - The implant is expected to exit in the desired area, and the tunnel created is sufficient. - The surgeon mentions the need for good dissection and a clear view before proceeding. In summary, the video demonstrates the incision, flap reflection, and dissection process involved in preparing an edentulous jaw for implant placement.