Good evening, everybody, and welcome to tonight's exciting webinar. My name is Bruce Stevenson, and I have the honour and privilege of chairing this unique webinar tonight. Little bit of housekeeping quickly before we get going.
If you want to ask a question and you are on Zoom, please just move your mouse over the screen. You'll see the little, control bar pops up, usually a black bar at the bottom, Q&A box, click on it, type your questions in there. And, this is gonna be a bit of an interactive session.
So, with a high-tech help of some note passing, we will get those answered for you as we go along. We've also got a, a chat box. Let's keep that if we can, to questions rather than, general hello to friends and that.
And then for those of you watching on the website, if you have got a question, drop Dawn an email. And she'll put those through to us, and, we'll answer as many as we can. If we don't get through everything tonight, we will make a plan to get those through to you later.
Just as a reminder, we are, recording this webinar as well. So, if you want to watch it again and again and again, which I have a feeling that you're going to want to, it will be up on the website within the next 24 or 36 hours. So to start with tonight, a big, big thank you to our sponsors, Bonovate.
And we really do appreciate them bringing this to us. And also, to our speaker, Ivan Croters. Ivan has been a vet in general practise since 1999.
He has had a special interest in veterinary product design for 15 years, being responsible for R&D for a number of veterinary products. Ivan remembers being present with dental cases as a new grad with very little experience of dental extractions. Most technique was learned from other staff members, and as a lot of us know from experience, most of it was entirely wrong.
Ivan was sitting in a dental lecture in 2015, listening to the issues associated with blunt instrumentation. From this, the idea of dentinomic, a thin edged instrument with a replaceable blade like a scalpel, began to take form. Many years of engineering and testing later, dentinomic product was born.
Ivan and his team work across the UK, EU, USA, Canada, and the Middle East to demonstrate the techniques appropriate to thin-edged instruments. Ivan is also still a general practise veterinary surgeon, dealing with routine cases, rabbit cases, and day to day general dentistry. Ivan, welcome to the webinar vet and over to you.
OK, thank you very much. I think that's gonna be a key part for this evening. This is about normal routine dog and cat dentistry, the kind of cases that I used to struggle with and I suspect many of you struggle with.
So we're going to be going through in a very practical sense, day to day things that are straightforward and simple. But they're gonna make a huge difference to how you approach dentistry, how easy it is, how fast it is, and also how rewarding it is. You can do dental cases, routine extraction cases and enjoy them and feel good about it.
So hopefully that's where we're gonna get to by the end of this evening's talk. So we did a survey round about Christmas time to a lot of the webinar bet members and we were talking to you about the kind of problems that you're seeing. And what we're getting is absolute classic stuff, so people are struggling to gain purchase, getting the instrument down into the ligament space between the bone and the tooth.
People are having problems with the instrument slipping, and I know that's something I always used to struggle with. So you begin to put pressure on a dental instrument and it just goes sideways into the tongue, into the hard palate or into worse places. Root fractures is a biggie.
All of us know that feeling of the root fracturing. I'm not gonna say that you're never gonna fracture another route, but it should be a very, very, very rare recurrence if you use the techniques that we're going to go through. And then the last real thing is hand pain and wrist pain.
I have carpal tunnel problems, I know the feeling of pushing too hard and then having my hand hurt for a week afterwards. We should be able to resolve that one for you as well. So as we go through this evening, if you have questions that you'd like to bring up, if we haven't covered anything clearly enough, then pop a comment in and I can go back over that there and then.
Everything that we talk about is applicable to dentistry across the board. It's just as applicable in an equine dentistry as it is in small animal dentistry as it is in human dentistry. The periodontal ligament is very similar across different species.
We've been prepping for this lecture for the last few months. Building models, you can see models here to try and demonstrate things and actually this has changed the way that I think about dentistry and particularly about the ligament structures. So what we're going to go through tonight is quite different to what we'd originally planned because we've learned a lot of stuff along the way.
The big thing with dentistry, the reason we're struggling is because you have the periodontal ligament. Around the outside of the tooth root, locking that tooth in fighting against you. That's not really true.
The periodontal ligament is the avenue of soft tissue that allows you to extract the tooth. The tooth is hard, the bone is hard, the ligament is soft, but the ligament is extraordinarily thin. And you've got to see some of these models before you appreciate how thin it is.
Once you do appreciate that, the surgical technique becomes enormously easier and that's why we're going to spend about 5 minutes, promise to, no it won't be a lot more than that, and I want to take you through what the periodontal ligament looks like, how it works, and then we can use that information on the instrument technique, and that's what makes the surgery easier. So let's take a radiograph here, I'm just gonna hold that up. This is a pre-molar radiograph from a cat mandibular premolar.
Now to scale, we're talking about something that big. Very, very small tooth indeed. Probably about 5 millimetres tall crown, 4 millimetres tall crown.
So we inflate it up and we can see our black line on the radiograph. Is that clear enough there, Becky? You can all see that, that's good.
So black line on the radiograph, we all know that's the periodontal ligament space, fantastic. Let's zoom in a little bit, we'll zoomed in. That's this structure now as well, we'll leave that there for a moment.
So zoomed in, that's a pre-molar and cross section. It's actually directly from this radiographics to scale. And you can see there, we've got a ligament space around the outside, we've got our bone.
Let's zoom in a little bit more. We've been busy in the office over the last couple of weeks and we've got this guy here. So.
This is just to show you close up detail of periodontal ligaments, so anatomy wise we've got our tooth here, dentin here, cop cavity running up the centre. Cemento enamel junction is just here, so we've got the cementum, that's the anchor point for a lot of the ligaments running along here. Cemento enamel junction here, and then a thin skin of enamel around the outside.
And that enamel's remarkably thin when you look at it up close. We're talking that width on this entire section of tooth. Right, so the ligaments.
This is gingiva. Right there. And what we've got is a load of periodontal ligament extending from the tooth up into the gingiva.
So there's a huge great ray of periodontal ligament fibre going up here. There's intercepttal fibre going from the cemento enamel junction across to the next tooth. So there's a whacking great strap of ligament attaching the tooth to the gum.
And to the next tooth. And then there's a 3rd strap of ligament that goes down here that connects it to the crest of the alveolar bone, and that grabs the crown of the tooth and holds it downwards towards the bone. Now, remember those 3 lots of ligament, the gingival ligament, the interceptal ligament, and the crustal ligament here.
We'll come back to that during our extraction. They are super, super important and by thinking about those we can make the extraction much easier. What we've then got here is bars of ligament fibre stretching across the periodontal ligament space.
In between those bars of fibre, we've got a whole variety of things. So there's quite a lot of interstitial tissue there that that's extracellular matrix, very, very high fluid percentage, probably about 70% fluid, and that acts like a fluid shock absorber. And that allows this entire ligament structure here and here to absorb force quickly and effectively.
What you've also got, which I wasn't aware of until we started preparing for this talk, is a very fine meshwork of blood vessels, anastomosing blood vessels and particularly at the capillary level. So the entire root of the tooth is covered with this net meshwork of blood vessels. Now why is that?
Well, partly it's because the ligament is really active. This is not a half dead ligament with a couple of cells scattered around. You've got a lot of cell turnover in here, a lot of collagen turnover in here.
This stuff needs active blood supply and a lot of it. You've got blood vessels which cross from the bone into the ligament space, they're feeding the cementum. They're also coming through to anastomos with some of the pulp vessels.
So there's a lot of blood in there. But in fact, what it seems is that the blood is in there as a shock absorber. If you imagine at this scale where a blood vessel is about the width of my finger, so we're really zoomed in on this periodontal ligament.
If I move the tooth over here within the ligament space, it can't move until the fluid, the blood. Has been pushed out of these blood vessels here and been moved around the tooth, so it's another shock absorber, it's like landing on a squishy trampoline of blood vessels. We're gonna come back to this time and time again when you're using surgical instruments to extract teeth, you use them slowly, not quickly.
And what it seems is actually the hydraulic effect of the fluid having to move out of this meshwork of blood vessels to empty that space to allow you to move the tooth over. How long does it take to empty those blood vessels, we don't know for sure, but I'd be willing to bet it's in the order of a few seconds because that's what you find when you're doing extractions, when you're moving your hands slowly, you put a little bit of force on, you wait for a few seconds, then you put a little bit more force on, and I suspect that that's to allow the blood to move. That hydraulic thing has now been quite well established in human dentistry when they're doing some of the real high end stuff in the periodontal ligament, but it is a thing and it's worth knowing about.
So things to remember from this, even at this scale, this is a thin space, really, really thin space, but it's full of soft, well vascularized tissue. And #2, there's a racing great bunch of bars of fibrous connective tissue connecting your tooth to the gingiva. And to the adjacent tooth and to the crestal bone, and those bars of tissue run all the way around the circumference of the tooth.
So if we're not thinking about those, our extraction has just become 100 times harder. Does that make sense to everybody? Has anyone got any questions on that?
Yeah, if we're all good. Right, so. Little bit more On periodontal ligaments.
If you think about a large dog biting hard on your leg, on this point of the tooth, there's a huge force slamming into that enamel. Teeth are brittle, alveola bone is brittle. So why does that tooth not shatter against the alveola bone down here at the end?
The reason it doesn't shatter is because the periodontal ligament is capable of absorbing enormous forces very, very quickly indeed. So if you smack hard onto that tooth, the tooth is grabbed by the periodontal ligament and supported. And what that means is then the tooth is protected, the bone is protected, and the soft tissue takes the load.
That's what it's built for. Well, that's fantastic, but that's working against us when we're extracting teeth. So what you actually want to do is do it the other way round.
You want to move these teeth slowly, not quickly. Peridontal ligament is not good at resisting slow continuous force. Very good at resisting shock forces like that.
So if we put force on this tooth. Slowly and gently, we're stretching all the ligaments here and we're compressing all the ligaments here. So one of the secrets with successful tooth extraction is to move your hands slowly, not fast, and I know all of us probably do that with a dental instrument.
With a bit of luck, you'll never do that again after this evening, it slows you down. So, peridontal ligament, think of it like a seat belt in a car. If you jerk on it hard, it locks.
If you pull it slowly, it softens, it gives. So slow, not fast. Vicky, could you move the camera a little closer for me?
Make her work this evening. Let's just get this radiograph filling the screen. So lesson number 32, I've lost count already, we're only 15 minutes in.
Always radiograph before you extract. If you don't have dental radiography, that's not a disaster. The clinic that I do my part-time work at doesn't have dental radiography.
You can do decent dental radiographs with a normal X-ray head, providing you've got those little intraoral plates and a decent digital developer. So what are we looking for in the radiograph? Well, periodontal ligament space, the black line here starts at 0.3 millimetres at the top.
Look at that, see how much it narrows. About 2/3 down the down the road. It's almost disappeared, see that?
And again, on the other side of the root, almost disappeared. So it's wide at the top, narrow 2/3 of the way down, wide at the bottom. Do you see this guy here, this big blob, this curve on the end of the tooth throat?
That is one of the useful things to radiograph for because we're gonna have to extract that a little bit differently to this root. We know that there's a hook on the end of that tooth root, so we're going to compress the bone and give ourselves a little bit more space to pull that hook round the corner. But again you can see wide space at the top, narrow space 2/3 of the way down, wide space at the bottom.
That's cool, thank you. OK good. Veterinary nursing and camera work all at the same time, perfect.
OK, so. This wide narrow wide business, you know when you snap a tooth root, you know where they always snap, they always snap down the bottom where you can't get at the little things. The reason for that is because 2/3 of the way down is where the periodontal ligament grabs the tooth root most strongly.
So if we're wiggling the top of the tooth root around, the ligament will feel that, it'll react by tensing up, it's a seatbelt. Where does it tense up the most? Right there.
Where does it snap? Right there. Pretty much every time, I cannot remember a snapped tooth root that I've had that wasn't right down there where I couldn't get at it.
So again, What's the solution to that? Well, actually the solution to that is what we're doing here this evening. So we'll work through that stage by stage and get there.
So you can see, let's do the first part, let's move to this model, can you see that OK there, Vicky? OK. So the first part, this, remember, is this little feline pre-molar right there.
So I've magnified this up a lot when we built this model. This is what a standard elevator blade looks like in cross section at the same scale. And just to prove that we've actually done this, we took our, we, we make all of our own instruments.
So we took this to the machine shop and we cut these instruments in half so that we could accurately measure the cross section. So this elevator in my hand at the scale of this tooth looks like this guy. It is huge.
Now, we are aiming for a 0.3 millimetre space at the top of the periodontal ligament space. So if your instrument is wider than 0.3 millimetres, good luck.
Say goodbye to your lunch break is what I, is what I feel. And this was the interesting thing for me. I only realised just how important this was when we started making the models for this lecture.
So that's what a normal elevating instrument looks like. This one is a standard luxating instrument. Luxating instruments are much thinner.
But it's still way too big to go into that ligament space. What we make are very thin edged instruments, and that's what one of our elevators looks like. In cross section to the same scale, so we've got that thin pointy edge which is directing us into the ligament space.
And then this is what one of our luxats looks like to the same scale, even thinner, even pointier. Now those of you who've used our instruments, and I think there's quite a lot of you on the call this evening, there's pros and cons to finish instruments, and this is important and we'll come back to it. Please bear in mind I have some bias because I make the things, but I make them and I use them as a general practise vet, which is hopefully the position that you're in as well.
Thicker edged instruments like this are much stronger. You can abuse them, you can lean on them, you can bend them, you can take the bath and lock off and fix it with them, and they're fine because you've got a lot of metal in there, it's unlikely to bend. You can still bend them, but it takes a lot more effort.
It's much easier to bend and damage that. It's much thinner, there's much less metal in this. It's a sushi knife, that's what it's, that's how it's designed, very thin angle, but if you use it right, if you glide it down into that periodontal ligament space, then it will work for you because you're hooking that instrument into the ligament space.
So the answer to the question, we're struggling getting purchase. Into the periodontal ligament space, the answer is, if you're trying to get a big piece of metal into a thin space, ain't gonna work, you will struggle getting purchase, and if you look at the elevator, you're gonna struggle getting that past the gingula, let alone down into the ligament space. So that's why we always struggled going into the ligament space because we're using a piece of metal that's 1015 times bigger in its leading edge than the ligament space.
And bear in mind that when you're looking at this, you're looking at the top. 2 millimetres, 3 millimetres of blade at this level, it's that fine point right at the edge that guides you into that space and makes the difference. So that allows you to locate into the ligament space, that stops the instrument slipping out of the ligament space.
The downside, the downside is you need to use a precise technique to get the most out of a thin blade. But that's not a problem because that's what we're gonna do now. So we've got 2 different kinds of technique, we've got elevation technique and luxation technique.
And in some cases when I teach this, I say to people, hey, it's a new technique, it's not a new technique. This is textbook technique, it's very old, elevation technique like this goes back more than 100 years, but most of us. Either didn't get taught it in the first place, or more likely weren't listening when we did get taught it in the first place, night out before and all the rest of it.
So what we're gonna do, I'm going to switch the cameras over to a close up camera. I'm going to show you how to use a thin edged elevator and how to use a thin edged reluxating instrument. And the two, how to use the two techniques together, what we're then going to do is spend a little bit of time integrating that with a surgical extraction, and I'll talk through the differences between surgical and non-surgical extraction.
But this should all fit together for you. I Dentonomic instruments, like I say, shameless plug because we do make the things. I work partly as a small animal vet in a local practise, and partly doing some locum work.
I have a set of these in my car at all times because I never ever want to operate with old nasty dental instruments ever again. So yes, I'm biassed, but I'm biassed for good reasons, and I'm hoping by the end of this I'll make my point. Hand pain We want to be holding instruments like this, can you see that OK, Vicky?
See you in a bit. We'll just move in a little bit. Just so you can see the middle of my forearm.
That's fine. OK. Right, so always finger on the end of a dental instrument.
That's a finger stop, a safety stop, and what that does is it means that when we slip, not if we slip, but when we slip. We're not gonna do any bad things, we're not gonna be doing any damage. Never hold a dental instrument like that, always like that.
Notice that that fits into the palm muscle and it allows me to keep my arms straight in this dimension. And also in this dimension. What you don't want to be doing with a dental instrument is that and tensing those things.
Now, this is actually very old instrument from my first clinic that I've kept for sentimental reasons. And it's a longer handle, very commonly used in veterinary dentistry, actually designed for human dentistry to be held like that, which is lethal in a cat. So in veterinary dentistry, we teach you to hold it like this, which puts a huge amount of pressure on the palm muscles.
And on the ligaments and tendons down here, and that is a recipe for a knackered hand and wrist. So you see the difference with the way that this fits. We spent 2 years working with vets across Europe and the states actually to get this handled right, so the fingers can just drop over it.
When you're holding a dental instrument, it's no more force than you would take to move the instrument with two fingers. So it's a very gentle grip that you're after. You don't have to crank up hard on this because, surprise, surprise, it's a thin piece of metal.
You don't have to put as much energy into cutting with a thin knife as cutting with a thick knife. And apologies if this is basic, but this is what works for me and it's a good way to change. But can we switch to the other camera to the HD pro camera there, Vicky.
Got that? Just let me know if I'm not in the centre. Mhm The board's just slightly off.
Got you, is that OK? Yeah. Right.
So many of us, I'm sure, use an elevating instrument. I'm just, I'm gonna do what I said never do. I'm gonna move my hand back up so you can see the blade there.
Many of us do that with an elevator. And I'm sure anyone that's on the call tonight that says they've never done that, I'm sure I don't believe them. That is what causes us problems.
Why does that cause us problems? I take my little tooth model here. I'm gonna slide the elevating instrument down in there and I'm going to give it a turn.
As I give it a turn, the tooth has moved. If I turn it the other way. Then I move the tooth another direction.
So if I rotate the instrument this way, I move the tooth over here. If I rotate the instrument that way, I move the tooth over there. And it's as if you're shouldering the tooth one side of the socket to the other.
If I do this, what am I doing? I'm moving the tooth, left, right, left, right, left, right, left, right, left, right, left, right, left, right. What happens then, the periodontal ligament is a seat belt, you see this all comes together now.
Where does it lock up? It locks up there. You're wiggling the top, the bottom of the tooth is being held still, snap.
That is what causes root fractures. 99.99999% published information.
I don't know how, how common it is. Every single root snap I've ever had is because I got impatient and I wiggled. So wiggling is bad.
What you wanna do with an elevator is this. You go in. You turn You sing a little song in your head, you tell a bad joke to the nurses, you relax for another 1015 seconds, and then you give a little bit more turn.
And you feel as if you're doing nothing, which is what I like because I am lazy. So we are going to slide. The blade down alongside the surface of that tooth.
Remember what that cross section of that blade looked like. It's a very thin, pointy bit of metal, even though it's an elevator. We have designed our elevators completely different to everybody else, and because we make them ourselves, we can do that.
All of our instruments were made down in the south of the UK about 20 minutes away from where I'm standing. So we have meetings with the machinists and engineers and surgeons all in the same room and we design these things together ourselves. So slide the instrument in, single turn, wait.
Give it time. Now, broadly speaking, with a fresh tooth, I would give it about 20 seconds. Some people say 10, some 15, some 30, it doesn't matter.
Give it some time. When you've given it some time, a little bit more to oh there we go, we've moved it a bit more. Again, wait, wait, wait, wait, wait, wait, wait, wait.
And then what we're gonna do is slide in another part of the tooth and just repeat. And that's it, that's elevation, so elevation is in turn, weight. Repeat around the circumference of the tooth.
Notice the angle that that blade is going in. And again, apologies if this seems picky, but this is what will make the difference for you guys in general practise. So if you're going in at that angle, you ain't gonna get into that ligament space.
If you're not getting into the ligament space, you are just grinding bone and you're not getting a lunch break. So what we're gonna do is slide that blade round. Oh, there we go, straight into the ligament space.
So the blade has to be pointing down towards the apex of the tooth before it's gonna slide down into that space. What's the easiest way of doing that? Start on the crown.
So touch the blade on the crown, let the crown direct you in. Remember that big model? The the periodontal ligament attaches to the ligament coming out of the cementum.
The cementum's attached to the tooth. If you stick that blade on the enamel of the crown and slide it down, you are going to go straight into that ligament space. So that's the way I do it, and I would say that's the easiest way of pointing the blade correctly first time.
So that's it, that's elevation. How do we choose the right blade size? About half the width of the tooth that you're working on is a really good rule of thumb.
Slightly smaller will give you more precision, slightly larger will give you more power. Precision over power every day. Dentistry is not about strength or it shouldn't be about strength.
It's about strength you're doing it wrong. It's about putting a thin piece of metal into a thin space. It's, it's precision surgery.
Does that make sense? Any questions on elevation? OK.
And. All I want you to remember from this talk is thin edge blade being turned once and once only and weight. And then maybe a little bit more, or go around the tooth and repeat.
It seems silly, it's not, it works. All right. And again, to labour the point, it works because it's thin.
Elevation in this way doesn't work as well on thick edged bits of metal because you're relying on lodging that little thin edge into the ligament space in order to get the purchase on the tooth. If you're doing that with a thick piece of metal and we'll go back to the big the big model in a moment, it just won't work as well. Right, so a luxating instrument, is that in focus then?
OK, a luxating instrument, this is a luxating blade that I have in my hand here. And you see just how thin and pointy that piece of metal is, and that's, I think we might have used the next size up for that cross section, but that's what we're aiming at. So it's getting that thin edge into the ligament space.
How are we gonna do that? Hold the instrument as before. Those of you who don't use laxation, it is not a specialist technique, it is not difficult to do, it's simple to do.
So I would encourage you to have a go at it, it makes life immensely easier as a surgeon. Let's just move the camera out a little bit. So what we're gonna do is windscreen wiper that fine thin metal edge along the tooth root, so that's my tooth root.
We're gonna do that. Kind of snake it along like that. We're not gonna twist.
No forearm movement here at all. So with the elevating instrument. So in turn white.
Luxing instrument. The blade stays facing the tooth. And the movement comes from the wrist.
It's just. Movement comes from here. Like that, but I'm not.
Turning Very, very good idea for those of you who are surgeons on this call, teach your nursing team these two things and get them to watch your hand. It took me a good couple of weeks. So I was working with Matthew Oxford, who's one of the really good UK dental surgeons.
He helped us a lot with designing these things in the first place. And he looked at my elevation technique and basically said, What the hell are you doing? And showed me how to do it properly.
And even with Matthew helping me, it took me a week or two to get the hang of elevation and to stop myself doing this. Luxation may take you a week or two longer. It's a little bit more tricky because you've got to train your hand to work flat like that.
Why do we want to work flat? Let's just zoom in Can you guys see that? OK.
Why do you wanna work flat? We're gonna face it on the tooth. And use it like a almost like a wiggly chisel.
This this lecture will be full of technical terms like wiggly chisel. Because frankly the cough is kicking in, so we're just gonna keep cutting like that. And then we're gonna cut on the other side, and then we're going to go.
That way. So can you see it sideways to the tooth that you're working on? Never twist.
What happens if you twist? Well, it's not the end of the world. You're just gonna lose your lunch break.
So you're working that blade in like that. Great, it's going in deeper. As you twist, you bind the tooth between the, you bind the blade between the tooth and the bone, and you make your work much harder.
So you're just trying to slide it in between those two structures without twisting it very much. What's the difference between the two? Well, the elevating blade is for stretching periodontal ligaments, so you wedge that thin edge in there and give it a turn, and you wedge the tooth across and socket and you stretch this stuff.
Luxating instrument is for cutting and pushing periodontal ligament, so you're just driving it deeper. OK, we can switch back for a second, Vicky. Yes.
So the difference between the two. Is now going to be hopefully made very clear. It's not the case that if you're a specialist, you luxate and you're a general practitioner, you elevate that's garbage.
Luxation is sometimes taught as a specialist technique, particularly in the US, but it's wrong, they're just two different ways of approaching those ligament fibres. Think about how strong that space is. I would love to say that you can achieve these with your old knackered instrument set or the cheap silver instruments, you can't.
I used to say that maybe you could, if you got the technique down pat enough, I don't think you can, just because the piece of metal you're working with is so much bigger than the space that you're trying to get into, you're really gonna struggle. How do we take teeth out with conventional thick edged instruments? You take it out by crushing alveola bone, and alveola bone does crush, it's a little bit like .
The expanded foam stuff that you use for DIY it's got lots of little bubbles in it, and those bubbles can compress when you put enough force on them. But again, like I said before, I'm a lazy vet, I want my lunch break, I want out of that dental room. I want to be getting that 17 year old cat off the table.
I don't want it to be getting cold, I don't want it to be bleeding. So isn't it far, far, far easier just to use something thin and pointy and get right down in there, way faster. Most people that we do these sessions with, we can make them between 30 and 50% faster extracting teeth.
And partly that's because we're not drilling for oil down that tooth throat and snapping teeth. Every time you save yourself a snapped tooth root, you're knocking 10 minutes off that dental. And partly it's because it's far easier and faster to operate on soft tissue than hard tissue.
We don't want to be orthopaedic surgeons, orthopaedic surgeons don't go home for lunch. Dental surgeons hopefully do. So elevating instrument goes into the ligament space, single turn, we shift that tooth across sideways, we stretch this ligament, we shift it back the other way, we stretch the other ligament.
Luxating instrument cuts in down there. You can see this tooth is coming loose already, the Velcro's going. Luxating instrument cuts down there.
And cuts para down to ligaments. How do you know whether to elevate or whether to luxate? Well, actually in most cases you do both.
Elevation works by stretching and opening up periodontal ligament space. Luxation works by cutting fibres. Remember those fibre bundles?
In there, that's what your luxating instruments are working on. So your elevating instruments are stretching those things and ripping those fibres apart, your luxating instruments, it's going down in there and it's cutting and pushing those fibre bundles aside. So in most cases, you elevate, open up the space, and then luxate into that space.
Or you can do it the other way round, you can luxate into the space and cut some fibre, and then you put an elevating instrument in there and stretch the fibre. It's much easier to use an elevator when you've used a luxating instrument. It's also much easier to use a luxating instrument when you've used an elevating instrument.
So I use both together. What I would recommend is that when it gets difficult with one instrument, you switch to the other one. Pick a blade that's about half the size of the tooth that you're working on and be very careful about your, how your hand works.
So elevating instrument is a straight approach, utilise that thin edge, get down as deep into the ligament as you can before you turn. You then turn, apply some pressure weight. 1520 seconds or thereabouts, bit more pressure if you feel it's necessary or move to another point of the tooth and repeat.
Luxating instrument again, straight approach into the periodontal ligament space, and then that wiggly snaky movement without any twist to cut deeper into the periodontal ligament space. What's the exception? The exception is the weak teeth, the nasty ones, the I'm gonna be here till 4 o'clock in the afternoon teeth.
The feline osteoclastic resorptive lesions, the puppy deciduous canine, the 15 year old daxi with a really knackered mandibular synthesis that you don't dare touch. Something interesting that came up at a recent meeting was small toy breed dogs. As they breed them smaller, we all know that the teeth tend to stay big while the jaw gets smaller.
Well, don't forget that the alveolar bone underneath the tooth root in the mandible becomes very, very, very thin. And I saw some scary radiographs at that meeting, which made me really think hard about do I want to be taking on Pomeranian dentals. So if you've got a solid large tooth root in a Pomeranian mandible, for goodness sake, X-ray it before you go to extraction.
And if there isn't much bone underlying that tooth root, you might want to refer it to someone that's happy to do a jaw fracture repair rather than take it on yourself. And I certainly, I, I would do that now. Cheerful thought.
OK. So, in those situations, luxation is your friend. Luxation does not put as much torque.
You're not twisting. You're just gently and finely cutting around the tooth. This 2 millimetre luxating blade that I showed you up close, that is my friend for those difficult tooth roots.
It's very thin, it's very precise, it's very pointy. And that really is in my instrument set for pretty much every bit of dentistry I do. Big dog or small cat.
The other thing that's your friend is surgical extraction, which we're going to go on to now. So in surgical extraction, I don't know how many of you do or don't do this, but I'm gonna run through a generic surgical extraction with you. And the point of this is to show you it's quite easy.
It's straightforward, it's relatively fast. It does require more skill in a strict sense, but it does far less damage to the tooth. It does far less damage to the jaw, it does far less damage to adjacent structures.
You do have to be sensible about it, you are removing bone, there are nerves and blood vessels in there, you do need to know your anatomy. But get yourself Cecilia Gore's dental book. Get yourself the BSAVA manual of dentistry.
There are anatomical diagrams in there, just open it to that page and look at the picture as you're working it straightforward. So, let's take this model. Turn it round very carefully so it doesn't fall apart.
It's been very well engineered this model. And we're gonna go through how would I approach a normal surgical extraction. Well, step one, radiograph, radiograph, radiograph, radiograph, you want to know what you're getting into before you get into it.
It's not hard to do, you don't strictly speaking, need a special expensive dental radiograph unit. If you just have normal X-ray, you can make this thing work. What we're gonna do is take a scalpel blade and we're going to cut, remember in our big model down here, we had all of those fibres originating from CEJ and going out into the gingerur across to the next tooth down onto the alveola bone.
Well, the first thing you wanna do before you extract, for goodness sake, is take a scalpel. And cut vertically down around the circumference of the tooth root all the way down to there, and then across a little bit from there as well. So stabby, stabby, stabby, stabby, stabby, stabby, stabby, stabby, stabby.
And what that's gonna do, number one is open up access to the perontal ligament space, which is what I always thought it was about. But also you're removing all of those immensely strong ligament attachments to the adjacent gingiva, to the adjacent tooth down to the crest of the alveolar bone. And in fact, when you do this properly and you cut all the way around, it makes your extraction so much easier.
So even now, if I'm doing a non-surgical extraction, so that will be just conventional stuff where you split the tooth and extract. Without taking bone away and without making a gingival flap, even then I will still go around the gingula because that gets an awful lot of the periodontal ligaments strength out of the way before you even start. So we've cut all the way round.
We're going to then make two diverging cuts, one here. And one here. Down to around about 2/3 of the height of the tooth wood.
We're then gonna take our little friend here and you can't do surgical extractions without one of these. If you don't have one of these, get one, they're cheap. There will be a dentinomic one of these that fits on our handles later in the year, so look out for that.
In Germany, it'll be launched at the Munich show in October in the UK probably around about the same time, certainly before the London Fetch Show. So what a periosteal elevator is, is a spoon shaped thing with a curved back and we're gonna insert it between the bone and the gingivar and we're going to lift. Like that.
And then of course Being a model, We can unhook the string that holds the gingerbrew on, and we can just very quickly and easily peel it back. When I'm doing wet lab sessions with people. Elevating the gingivur is actually the trickiest part.
So it's a very precise pushing movement. I'll show you this up close in a moment. So you're going to hold the instrument in your hand with your finger on the end, always your finger on the end.
Push, lift, push, lift, push, lift, and you peel the ginger back. The 1st 3 or 4 millimetres are normally quite difficult and then it get gets progressively easier. The inside of this flap here is made of periosteum.
You've peeled the periosteum off the bone, and we'll come back to why that's important in a second. Then what we're going to do is remove some bone that's overlying the lateral aspect of the tooth root. We're going to create access to those tooth roots.
What I normally do, you can use a tapered crosscut burr, or you can use a round bird preference. Personally, I use a round burr held horizontally across the bone. And I just use it like a paintbrush and I paint over the bone with my round edge burr, just exposing the tooth root, and with good lighting you can quite easily tell the difference between tooth root and bone.
And of course it just comes off really easy. So now we've got about 2/3 of our tooth which exposed and we do the same here. Doing something like a full mouth extraction on a cat, you could start one end of your gingival flap at one end of the mandible and the other end of your gingival flap at the other end of the mandible, raise all of the gingival, and then you can just go down the tooth roots and jing jing jing jing jing jing jing like that and take the bone off.
It's very quick, it's very efficient. You do again need to know your anatomy, but you can cheat and just have the book there open on the countertop next to you, and that's as you can guess what I do. Splitting the tooth.
We want to split multi-rooted teeth into single rooted fragments, and when I first started my vet nurse showed me how to do dentistry, all wrong, and either he didn't split the teeth at all, or if he split them, he split them with a hacksaw blade, God knows how. But I always started splitting something like this pre-molar straight up the centre, quick and easy, totally useless. If I split this tooth up the centre, I can't get to this bit or this bit because the rest of the tooth is in the way.
So what you want to do when you're splitting teeth is use an angled V cut. So one cut here and one cut here with a side cutting, tapered fissure burr, something like that, side cutting burr. So you go From the bifurcation, cut and cut, always cutting from the ginger and the alveolar bone away so that you don't go down into the tissue and do more damage than you need to do.
Why do we do that? We do that because now I can get my. Lux instrument in there.
And in there and in there and in there Another handy little tip, and I ran out of patience doing this for these models and also Velcro. You can also take a round ended burr and take off that annoying little widget of bone of tooth there and that annoying little widget of tooth there. Really really useful, particularly for some of the larger and I'm thinking carnasseal tooth extractions.
So any little bulges of bone they're getting in your way, just buzz them off with your drill. Very, very important to use a new burr per procedure. Burs are cheap, drill heads and turbines are not.
If you're using a blunt burr and rotating it hard and cutting teeth with it, what you're doing is putting a lot of pressure on the sensitive components in your turbine, and that's what makes your turbine wear out and need expensive replacements. So what we're now gonna do, we've converted our teeth into two single roti fragments. We are then going to use our elevating instrument and we're gonna wedge it into that space.
And then we're gonna move this tooth over here, stretch the ligament, stretch it back the other way, or we could use our luxating instrument and we can luxate down in there. We'll use those two techniques in combination. Remember that we had that hook on the radiograph.
That one there. So if we've got the hook, we want to use elevating a little bit more as we go down to the base of that tooth. So on this Capri molar, I'd be using something like a 2 millimetre elevator because as you turn the elevator, the back of the blade compresses the alveola bone a little bit.
As you compress that alveola bone on the turn, you're creating more space and you can bring that hook up and round. So you can see. Very straightforward, simple extractions.
Word of advice, if you are using forceps of any description to grab a tooth root and wiggle it, forceps work like an elevator. So if you do this, your tooth will snap. How do we use forceps?
We grab the tooth, we give it a small turn until the tooth resists us. We count to 20 we look out the window, we tell bad jokes, we do whatever we need to do, give it a bit more turn. Or we take it back the other way.
So use of dental forceps is either a turn to the left or a turn to the right, but never ever both. Otherwise I will hunt you down with sharp instruments and I have a lot of sharp instruments. Right, so we've now got our big gaping wound with all the, all the bone taken away.
We're now going to use ideally a diamond burr on our dental drill, and we're just gonna smooth these sharp pointy bone edges because we don't want those causing gingival damage long term. If we try and flap that ginger back over like that, it's not gonna work very well. The ginger will just go back to where it was before and it's a struggle.
Do you get that thing where all your stitches start pulling through and you can't get the ginger over? The solution to that is twofold. One is remove a little bit of height from the bone, that's quite an easy thing to do.
Lifting the gingival flap properly will help as well, but the big thing is to sever the periosteum here and just check Vicky, make sure that they can see this and I don't know how to lift it up. So what we're gonna do is take a small pair of scissors. I have in my surgical kit, I have Supercut medicine bar and scissors.
Supercut scissors have a little micro serrated edge on one blade, and I have super cut curved iris scissors. I use either one depending on how big the flap is. And we're just going to cut.
A thin line through that fibrous tissue there. Don't use a scalpel blade because the odds are good that you'll cut all the way through your flap and just create a gaping wound. But when you sever that very thin fibrous tissue there, what you're doing is creating a stretch point.
So now that's severed, the entire tissue structure will stretch. And because it will stretch, you can then advance it back over the top of your socket. Suture it without tension to the other side and then it won't break down.
So it's the same as skin. If you can't pull your gingival flap back over your surgical wound, it's probably because you haven't severed the periosteum, get a decent pair of scissors, work your way along in good light, it's quite easy to tell the difference between gingiva and periosteum and just run those scissors along and cut a strip. Sometimes on a big flap, I cut two strips, so I might cut one here and one here.
Then you can suture without tension, then you're gonna get a nice gingivable closure. Right, can we just switch back to the other camera? So Dentomic instruments autoclave tray for the blades.
You have the blades lined up incise order, elevators on one side, luxating blades on the other side. Changing the blade is easy. There's a boat that runs through the middle like that.
And a blade that just drops in the other side. Spin the handle to do it up. Straightforward, takes a little bit of practise to get used to spinning a handle, it's not hard.
To pop them back in a tray like that, and that whole thing goes in the autoclave. I really do recommend autoclaving your dental instruments, they are touching alveola bone after all. We've then got Various handles here, we do make a longer handle for people with larger gloves, so glove size over 8, I'd use the larger one, glove size 7.5 and down, I'd use the smaller one.
And that's also for the autoclave. I use that to organise my instruments. What happens with what happens when you don't do what you're told this evening, right?
So, bear in mind the whole point of operating in this way is to make the surgery more precise. Precise surgery is fast surgery. So if I put an elevating blade.
The colours of the handles, by the way, mean nothing at all. The colours of the handles are because I've spent 7 years designing them and I do like pretty colours. Well.
If we do this, wiggle, wiggle, wiggle, wiggle, wiggle wiggle, wiggle. First of all, we're probably gonna snap the tooth and put another 20 minutes on this dental, and also we're taking that super thin, super slim metal edge and we start to bend it. So with any instrument, and particularly our instrument, if you're getting bent metal edges like that or chipped metal edges, can you see?
The chip Yeah. Let me zoom in. It's not focused.
OK, so there's a whacking great chip out of the corner of the blade, and that is a classic injury to any dental instrument. That's not because the nurses dropped it, that's our fault. What we've done is we've flicked the blade backwards and forwards so fast.
That the metal can't cope. Now with our instruments, what tends to happen, we'd be using quite a flexible metal, so the metal tends to bend rather than break, but when you see that, that's because you're drilling for oil. Please bear in mind, not all of the sales reps know this.
We offer a guarantee with our instruments, so as long as you've been on a training session and this one counts. If you've bought the instruments within the last month and you've done this to them, we will replace blades free of charge as long as you come on another training session. And we do run slightly less detailed sessions than we've done this evening.
To take people through elevation and luxation hand technique, so they're available to book on our website, that's Dentonomic.com, and we tend to run those twice a day on Thursdays, so you're always welcome to come on these sessions and ask questions of us. So look out for bent edges, look out for cracks.
The other thing that you may see is this. Can you see? OK, so this blade's been bent and what's happened is we've used this as a pry bar.
So you've gone into the tooth and you've pried out and away. So one thing is you're gonna bend your instrument, the second thing is, again, you're gonna slow yourself down. All of these instruments work better, just cutting straight down, so always point an instrument towards the apex of the tooth root and wiggle, wiggle, wiggle down.
That's how you get out of that room quickly. So those are the two things that you're watching for. Could we just switch back to the main cameras?
So Key points. In terms of solving the problems that we started with, how do we gain purchase in the periodontal ligament? You gain purchase by using a thin piece of metal to fit into a thin space.
And honestly, there is no other solution. If you're trying to approach that thin space with a thick piece of metal, it ain't gonna work. And as I said at the start, I am biassed, but we've spent 7 years working on this.
This works, it's practical, it's sensible for general practise and specialist surgery. How do you stop the instrument slipping? Again, it's the same answer.
If you wedge that thin, pointy edge into a thin space, it can't slip because you're going into a soft tissue space between two bits of hard tissue. Obviously you've got to get your hand technique right and that's super important, and that's really why we did this as a practical session, not a PowerPoint session. So elevation is a single turn left or right, but never both.
A luxation is the snaky windscreen wiper wiggly movement with no turn at all. Sneaky movement. How do we stop fracturing roots?
We stop fracturing roots by using a thinner blade in the ligament and not drilling for oil. Turn left, turn right, but never both. And how do we stop hand pain?
That's really two things. Using an instrument that fits your hand is very important. And the second thing is using an instrument with a thin edge, and I would suggest the word thin, robe and sharp is important here.
Thin edges work, thick edges don't. When you're getting our instruments, you've got those two, you've got the replacement thing over the first month. If you bend the blades, we'll replace one of each blade free of charge.
If you get to the end of the first month and you don't like them, as long as you've been on the training session and you know how to use them properly, we'll refund that money for you, send it back to the distributor, we'll give you a refund. We don't want unhappy people behind us. The other thing is that Iamma are offering a voucher that goes with this session.
So if you've been on this session, Webinar vet will issue you with a discount code that gives you a discount of £50 off a set of Dentonomic instruments. And you can go onto the Eichemaer website, you can look at the pricing. There's different sets of instruments.
I would always recommend you get a full set of blades, you will use them. And then generally either a set of 3 handles or a set of 5 handles, depending on how much you want to spend. I tend to use a set of 5 handles, it comes nicely in a tray and it's neat and it's easy, and I don't lose stuff by accident.
A set of 3 handles is fine, fewer than that, and you're gonna find yourself having to change blades annoyingly frequently during surgery. So I tend to set up 5 at the start of the surgery and I very rarely have to change blades during the procedure. So that's really been the point of the seed.
Now I want you to walk away from this and think, thin space, thin piece of metal. How often do we have to change those blades? I change mine between once a month and once every 3 months depending on what kind of surgery I'm doing.
Do I look after my blades? No, I do not. I'm working in general practise, there's a bunch of us using the instruments.
They get knocked around like everything else does. If I'm doing something super detailed, like a full mouth extraction in a cat, yep, I will definitely get a new set of blades for that. For routine dentistry, I get a good 3 months of life out of mine without having to hone them or sharpen them or do anything in particular to look after them.
I'm slapdash like that, they're working tools and that's the way that we treat them. You can hone instruments and you can come into one of our training sessions and we'll teach you how to do that. You don't want to sharpen them, sharpening takes metal off and turns a thin piece of metal into a thick piece of metal, but honing them is tricky, but you can do it and it'll make that edge last longer.
Perfect. Do we have any questions to go through? Ivan, that was absolutely fantastic.
Your techniques are brilliant, and having been a vet for over 35 years, myself and had many struggling dentals, I, I just wish I'd seen these earlier, but that's absolutely fantastic. And, even not using your instruments, your techniques work. They really work, but I think they will be so much easier.
And, and miss a lot less lunches. So, thank you for that. Really appreciate it.
Guys, if you've got any questions, you can either pop them in the Q&A box or you can put them in the webinar chat. Something that is coming through, that, maybe you want to, to give us a bit more information on Ivan is contacts where people can buy these instruments. Absolutely.
So, Eichemayer are are distributors in the EU and the UK. The reps and the country heads know a great deal about Dantonomic, so Eichemeyer would be the first port of call for buying them. For more information.
So we thought of this. Again, we are allergic to PowerPoint in this place, so everything gets printed out. So www.
Dentonomic.com, that's got more information about the surgical technique there and Facebook. If you go and look at Facebook slash Dentonomic, that's run by us, we are all vets and nurses.
So you've got someone clinical on the other end of our Facebook account, and if we don't know the answer, we can pass you on to some of the specialist dentists that we work with around the world for more expert opinion. Fantastic. Dawn has just popped that web address into the chat box as well.
There's a question that has come through, about the shape of the gingerable flap. Ea says, I was taught to cut an L-shaped gingerable flap and not two parallel cuts. Is there any difference?
Basically, no. So there are multiple kinds of flap that you can do and because we're doing quite a short talk this evening, I've kept it very simple. So that the most conventional flap is a diverging flap that gives you a wide base and good blood supply in there.
You can do an L shaped flap as well. The advantage of that is that you're doing one cut. So where's the model gone?
So just to show everybody. The flap that we're talking about there, you still take your scalpel blade and you cut the gingerb attachment. Super important, don't underestimate that.
And then what we're doing there is just making one cut. I would diverge it slightly, it just makes life easier for healing, and then you're peeling back from that corner. So if you were working on something like a canine tooth with a decent curve to it, that would actually work really well, .
That's, that's OK. So then the mother. We might cut there, peel our flat back that way, that's going to expose 2/3 of the tooth, remove the bone, it'll work fine.
And then you've only got one cut that you need to suture, so that's gonna be faster. There are also flaps where you can literally just peel the gingerbre back and hold it back with a spatula without cutting down the gingerbre at all. So for shorter roots and sometimes for feline roots, if you were doing a full flap from one side of the jaw to the other, there'd be very little cutting that will be required there.
So as long as you follow the general principles, any flap which exposes an appropriate amount of bone is going to work for you. What you don't want to do, the big mistake is to not remove or to not expose enough bone. So short, tiny little baby flaps mean that you, you're going to end up a not removing enough bone.
And that means that the extraction is harder when you put more force on the jaw, and B, almost certainly you're gonna drill through your gingival flap by accident or slip and cut your gingival flap, and then you've got a big hole that you can't close. So as long as whatever cut you make exposes the correct amount of bone, doesn't go through arteries or nerves, be careful, particularly with the mandibular artery that comes out the front of the jaw, just there. And as long as you can, and as long as you can push the flap back sufficiently far to clear the bone that you need to cut, then it's all fine, it'll work.
And ginger small gingival flaps tend to break down because you can't get that, that exposure by, by cutting through that periosteum. Yes, and that's exactly right. So the most of the time, the reason the flap breaks down is the flap wasn't prepared and it was under tension.
Why do skin wounds break down? Think about tumour removals when you've taken a huge amount of skin out and you're like trying to bring the skin back together, you know that's gonna break down. Well, again, actually this was the experience I had when I was working with Dentonomic, and this was Matthew Oxford again, sort of hit me around the back of her head and said, what the hell are you doing?
Showed me how to cut that slit along the periosteum and ever since he showed me that, they've all worked and they don't break down and they're easy and they're quick. Fantastic advice. David wants to know, how do you keep the blade parallel to the tooth, in a small mouth or those annoying back teeth?
Ah yes. A couple of different things. .
Where's my little mouse? OK, can we switch camera then? So there are various ways to do it.
What I normally do. So this would be the route that is my frustrating one, that tiny little root down there on the back of that molar. So you can actually come across that way.
You can come across that way and then bring it in, so you don't have to be absolutely vertical at 90 degrees. As long as the blade is pointing along the axis of the root, it doesn't matter whether you're pointing it from that direction or that direction, it'll still work. The other thing that you can do, and bear in mind I do a great deal of rabbit surgery, so this is not unusual for me.
Is on our instruments, you can take them without the handle. So for brachycephalic dogs particularly and luxation technique particularly, I will hold it like that, which gives me a very, very short instrument. I hold it in a pencil grip.
And then this is a 1.5 millimetre luxating blade, it's very small indeed, and that is your friend for the very difficult ones and you can see. That that can cut down in there, and because it's a thin edge, it is possible it's even quite easy to hold that in a pencil clip.
If you're doing this technique, I would stress you must have your finger on the end, as if you were doing it with a handle, because the luxating blades. And the elevating blades are thin and sharp, so you don't want to be doing this. You could spike right through the bottom of the mouth very, very easily indeed.
So providing, you don't even need particularly strong fingers to do it that way. If you're holding it between three fingers, that gives you a great deal of effectiveness in tight spaces, and they're shorter that way than any other instrument out there. Fantastic.
Jess wants to know, any tips for that annoying third root of 108-208? Yes, it's, Vicky, can you get me a piece of paper? May have to draw this one.
I know precisely what you mean. We had nightmare Bulldog dental on Tuesday and then yeah. Right.
See what my artwork is like this time in the evening. So we have got, yes. Got that there, we've got that there.
Got that bit there, got that one there, it's not too bad. There we go. So we're talking about the same teeth, it's been a long day.
So that's all done there. So first thing we're gonna do. Mm.
Oh. That way Hang on. My assistant will reposition the paper.
I think we're there now. High tech stuff. Is this, is this the this the technical presentation you've ever seen, yeah?
Right, so we're gonna make our diverging cuts. We're gonna get rid of a load of this crown, we don't need it, we don't want it, it's getting in the way. If we've got the blobby bit on the side here, again, you will excuse my use of technical dental terms, we're gonna remove that as well.
So then we're going to do a bone flap and remove bone. There, like that, we've done our gingival flap obviously as well, and we're gonna extract that too, it's wonderful. I normally get that one out of the way first.
Then what we're going to do is look at the top of these two roots, and we've got the lateral one which is slightly larger. And the medial one which is slightly smaller, and I'm going to cut vertically between those two roots to separate them. I've again done Bone flap, probably a little bit more than that, to about that level.
So then I'm going to extract that root there. Now that's a long thin root. What are we gonna use for long thin roots?
So long thin delicate roots, a little bit more luxation and elevation would be my recommendation. Because we've removed lateral bone here, if we get our, so we've we've removed bone. There, so if we get our luxating elevating instruments in behind, then we can move the tooth into the bone flap that we've we've created into the space that we've created.
So what we're now left with is that annoying little third root that always snaps and takes all day and you sit there getting frustrated. Well, actually, no, what we can then do is do a bone flap there. Now I'm just going to spin that round and show you that sideways.
So we've extracted this big root and that leaves us. With this view. And it So the root there and that little annoying bit of crown there sitting there with bone here, ready to ruin our day.
So what we're gonna do is then do a second bone flap. There, bear all that bone away, expose that root. And then it's easy because we're gonna get our luxating instruments and elevating instruments into that space and then actually we've got a nice little short stubby root with 2/3 of the bone gone and we can extract it really easily.
We're then going to smooth, there's a lot of knobbly bone left after you've done those 3 bone flaps. You're just gonna smooth those quickly over with a diamond burr and then just replace your gingival flap. Does that make sense?
And to the person that asks the question, particularly, does that make sense? Yep, that's very, very clear from my side. OK.
Just a question of every tooth you come to, if you're struggling with a tooth, use surgical extraction more than non-surgical extraction. Surgical extraction makes things easier. When you're struggling with that third route, you just do bone removal and surgical extraction.
Perfect. Perfect. Ivan, we have run out of time.
I know that the audience is absolutely fascinated with this and probably we could go on for hours and hours, but then you'd have to get Vicky to get you another cup of coffee. But I know that because there's no numbers dropping, even though we've run over. But this has been fantastic.
Your insights into dentistry, plus, the combination with your fantastic, dental equipment have really been, a, a breath of fresh air. So thank you for your time tonight and thank you for your ingenuity over the last couple of years in, trying to make our colleagues, myself included in private practise, that much happier with dentistry and, getting our lunch breaks. And I think one last thing, I did 2 nightmare dentals on Tuesday, which in fact were.
Nothing, little bit dull, nothing particularly happened, both animals off the table an hour, go home, eating within about an hour of coming round. So precision surgery actually makes dentistry, if not enjoyable, certainly tolerable. It can be a nice normal part of your day.
It doesn't have to be nasty. It's all about precision and just. Doing it carefully and doing it right.
Yeah, and it, it the, the patients benefit from it as well because there's less strain, there's less slipping, there's less damage, there's less brutalising the tissue, so that's fantastic. One last thing before we go. Ivan, just run through your discount code again for us, please.
Absolutely. So this, this is a discount through Ehemayer. You've got a discount code from the webinar vet that gives you 50 pounds discount off the Eichemayer pricing.
As a result of being on this, as long as you spend over 500 pounds, the smaller sets of Dentonomic instruments start at around about 500 pounds or euros depending on exactly which country you're in. So that's a discount that you can use on every purchase of a set of dentonomic instruments. Fantastic.
Folks, we have run out of time. It, it's, a pity because we could all sit here all night listening to this kind of fantastic wisdom on dentistry. Once again to our sponsors, Bonovate.
Thank you kindly to Ivan and Vicky in the background. Thank you so much for your time tonight. You have shed huge light onto the dental scene for vets, and, we really do appreciate that.
My pleasure. To Dawn, my controller in the background who's helped make things run smoothly as Vicky was doing, for Ivan. Thank you very much.
And last but not least, to all of you that have attended tonight. Thank you so much for your time. I know you could have been out on a beautiful spring or summer, early summer's evening, but, I'm sure you will agree with me that this was way more worthwhile than that.
So from myself, Bruce Stevenson, it's goodnight.
