Perfect. Thank you very much, Antony. Right, my story is quite similar to Anthony's.

I remember starting as a new graduate. Desperately worried about dentistry, wondering when the tooth was ever going to come out, not actually knowing particularly what I was doing, and I think most of us around the world have a lot less veterinary, dental, surgical training than we might like. Many universities have maybe a couple of hours or half a day, and it's very rare that you see anybody teaching for more than a day or two.

And yet this is surgery that we're doing day in, day out. About 70% of our patients have dental disease and a good proportion of those animals are going to benefit from having diseased teeth extracted. So that's the point of the talk today.

Now, what we're doing specifically, I'm not a specialist dentist, I specialise actually in product design and we've worked with some superb veterinary dentists around the world to design and manufacture specific tools for extraction. And because of that along the way, I've realised that one of the things that we don't get taught is precisely how to use the instruments, how to choose which instrument you should use in each situation and how to match the right instruments to the technique. So that's what today's talk is all about.

It's the basics of physically how do we use this stuff. Now. There is some other thing, other points that a normal dental lecture should cover, and these are vital points.

Specifically, think about anaesthesia, think about analgesia, dental surgery, we all know, we've all had dental surgery. It's not pleasant, it's not nice to wake up from a general anaesthetic with severe bone pain. So think about a balanced analgesia protocol, make sure that you've got safe airway management in place.

We're not getting leakage of all the fluids down in the airway. Think about the kind of surgery that we're doing. Now essentially we are taking a structure out of a bony site.

It's almost orthopaedic surgery. Now I know everything is covered in pus, but think about cleaning your surgical site beforehand. We would do that with any other kind of surgery that we're doing.

Very few people do that with dental surgery. If you clean, disinfect the mouth, remove the plaque, remove the tartar, use a an oral disinfectant flush, you're going to be doing much cleaner surgery. Examine the surgical site that you're about to operate in, which as a bare minimum should be probing the teeth, looking at the gingival pocket depth using one of these measured probes, writing this stuff down on a surgical dental chart.

Geography for those of you who can do dental radiographs is almost invaluable. There are things that you will see on a good dental radiograph that you're never going to see from the outside, and those things will change your approach to the surgery completely. In some cases, it might mean that you're operating on teeth that you'd never considered to be diseased.

And in some cases, particularly in resorptive lesions in cats, it'll help you avoid doing a damaging procedure when amputating a crown would have been sufficient. When you're operating to extract the teeth, the bits that I'm not gonna go through in this lecture. Raising a gingivo flap, removing bone to allow your extraction to be less traumatic, and particularly make sure that when you're extracting multi-rooted teeth, you separate them using a dental burr into single rooted fragments that will then come out much more easily.

So Those things are covered by the normal dentistry talks, by the normal books, by the normal videos, there's also stuff online as well. But what a lot of the books don't talk about is instrument technique, which is what we're going to go through now. So Why is it difficult to extract a tooth, and it is very difficult to extract a tooth.

Well, this is the reason. Peridontal ligaments, this stuff here. It's like a trampoline, it's a web of fibres that suspends the tooth in the socket, and it's a mixture of collagen and elastic fibres.

So that tooth has got a little bit of bounce to it, it, it can move slightly in the socket. The space, the periodontal ligament space is 0.1 to 0.3 millimetres wide in a healthy socket.

The more disease you have in there, the more infection, the more bone erosion you get and that that space will widen. But you are looking at a very, very slim structure full of ligaments. The reason for this, think about medium sized dog.

You've got a bite force of 300 PSI pounds per square inch, about 20 atmospheres. It's very, very, very strong. Some of the big dogs can go 6 or 700 PSI.

The periodontal ligament has got to stop that tooth fracturing. Tooth enamel is brittle. It's, it's, it's a tough material, but it's very brittle.

So if you suddenly put 300 PSI on the end of that tooth and it slams down into the socket, stuff is gonna break. So the ligament is stopping the tooth going into the socket. It's stopping the tooth coming out of the socket, and it's stopping rotation one way or the other way.

So it's, it's resisting force whichever way the tooth wants to move, and it's damping that force down. And of course in order to get that tooth out, we've got to operate on the ligament. So the message I want to put through now.

Is when you're operating to remove a tooth. You're actually doing ligament surgery. You're not doing bone surgery.

If you look at it this way, everything else starts to make more sense. So when we say dental instruments need to be sharp and they do need to be sharp. It's not because they are cutting as a sharp tool, it's that a sharp instrument has a slim edge, and a slim edge can get down into the periodontal space, and if you're getting down to the periodontal space, you're cutting ligament, you're not crushing bone.

That's the key point. So, Think about operating on the ligaments, not operating on the bone. Think about operating with precision.

And then everything becomes easier. If you're using a blunt instrument or a badly maintained instrument, the problem is that the edge is not thick enough to get into this periodontal space just here. So if you have something that's too wide, you have no choice.

The only way that tooth is coming out is if you break or crush enough bone. To loosen everything and eventually you're gonna lift that tooth out. Now that's hard work, and I don't know about you, but for me, I want my lunch break.

I want to finish that surgery. I don't want to cause trauma, certainly don't want to cause pain, and I want to get done. So it's quicker and easier and safer to operate on ligaments, not bone.

Now, when you hold dental instruments, I have to say I think we're going into this a little bit later. The images that I'm using here are images of the dental products that that we make, but every single thing that we're talking about here is applicable to a very wide range of dental instruments. So you need to hold dental instruments in a palm grip.

This is much easier to do with the shorter, stubbier dental instruments, and typically they are the ones that are beginning to be used more in veterinary practise. Human dental extractions, the angle that they operate at is different. So they're coming across the mouth diagonally, and for that reason they need a little bit more length to them.

Pretty much all surgical instruments, or most surgical instruments in the world are made in one location and then they're rebadged and repolished and relabeled to various manufacturers. And that's why you find that a lot of these instruments look much the same. But basically you want to be looking ideally for the shorter handled instruments that will fit in your palm.

Notice the index finger here is down on the tip of the blade. That's very, very important. That's giving you precision, so you're pointing your finger at where the blade is going to be going.

It means that you've got resistance to slipping. So what I often do is I'll have my left or right handed. I'll have my left hand on the gingiva, and then I'm resting the index finger of my right hand against the index finger of my left hand, and then operating.

And it means that I can direct that blade very, very easily. You are going to slip. You're operating in an environment that's full of blood, it's full of pus, it's slippery, it's messy, it's difficult.

Everyone, everyone slips occasionally when they're doing dentistry, however careful they are. So if you have this grip, when you slip, you're not going to do anything bad. Now that's important.

There are published cases, go and have a look on PubMed online. There are published cases of eye abscesses and brain abscesses that are being linked through to tracts that have happened during dental surgery. So you've got a sharp instrument, you're pushing, you slip.

And you go into bad places through the bottom of the the mandible into your own finger, that's a fairly common one as well. And the last thing you want to do with a dirty dental instrument is stab it into your own finger. Not pleasant So, We've got our palm grip, we've got our finger down on the end of the blade, we've got some control.

We've now got 2 techniques, 2 different ways of using a dental instrument in order to operate. And it's very, very important to separate those two techniques and be very specific about how you do them. This will make your life a lot easier.

The other thing to remember is that you need an instrument size, a blade size that conforms to the tooth you're operating on. So if you've got a greyhound up a canine, and you've got an instrument that's 1 millimeter.5m across, you're gonna be there all day.

You're not going to be able to slide that instrument down the tooth route properly, and equally, if you're doing. Caprimolar teeth using the same instrument you've just used to take a Stahai V terrier caracal out, you're gonna do some damage. So you need a range of instrument types, instrument sizes that fit different teeth.

So technique number one, elevation. This is probably the commonest technique that's out there and it's very rare that people are taught how to do it correctly. So what you're doing is you're inserting a blade at the top.

So just between the, the tooth and the alveolar bone at the top of the socket, and then you're levering the tooth side to side within the socket. Elevation tools are not cutting tools, they're leverage tools. They're they're mobilising tools.

Technique number 2 is luxation, which relies on a thin blade, so actually think about something like a number 11 scalpel blade or a very thin sculpting chisel. And you're putting that into the periodontal space and cutting down around the circumference of the tooth. What you're not doing with a luxation blade is you're not levering.

You're cutting, you, it's a precision thing. Now, as an explanation, these are the instruments that you're going to see, when I, what the, sorry, start again. These are the instruments that you're going to see me using for illustration.

I'm going to show you some pictures in a moment of the different shapes of blade. These instruments have a removable blade. So if you see a blade without a handle, that's what's going on.

So, luxation blades to start with. They have a thin side profile, this is a side profile here. And that is your scalpel blade.

They're used as a cutting tool for cutting periodontal ligaments. Elevation blades, these guys down here have a thick spade shaped blade. The key point with elevation is that you are using them to apply force over a period of time.

Peridontal ligament doesn't snap, it stretches. So elevation has to be a fairly gentle, prolonged procedure to allow that ligament to stretch. So, Specifics on the technique.

You're looking to put the instrument, apply it into the periodontal space, and rotate it over a period of time. For me, it's towards the, the latter end of that time. So 20 to 30 seconds is roughly how long I spend on each elevation movement.

Different specialists have slightly different techniques, but it's always about time. You're not twisting these blades backwards and forwards. That's, that's wrong, that does damage.

We'll go through that in a minute. Downside of elevation. It's actually quite forceful.

You're taking in a tooth that doesn't want to move. And you're physically levering it around. No.

What's the downside with that? The downside This is a technique that's great for thick, strong roots. It's not great for thin, slim, delicate roots.

Because you're putting all the pressure from the top of the root as you push that root sideways, it's gonna snap. If you're gonna use it on delicate routes, you have to use a very delicate technique, you have to be gentle, you have to do small instruments and give it plenty of time. The other downside with elevation technique is you can put a lot of force on these things.

I regularly see people bending or snapping steel blades, it's not unusual. So if you use this technique wrong, if you don't give the ligament enough time to stretch, bad things happen. So here's another picture, this is what the blades look like in real life, so thick spade shaped back.

Generally speaking, they have a curved surface which you apply to the tooth. And this is across the board. What you'll see with some designs, the winged elevator design has a larger side edge here and here.

It's taller in this plane. So it's got wings on it that extend the curve around. Now that is useful for conforming to the tooth.

The problem is that the more width that blade has got, the more leverage you can apply. And because elevation is a forceful technique, a wide blade can be more traumatic and more damaging. So you need to have a look at the instruments that you've got and check and see how wide those blades are.

The wider they are, the more gentle you need to be. The other thing to bear in mind, have a look at the edge of that blade. There's a very specific shape to it, there's a very specific angle to it.

We'll go through how to take care of instruments later on, but instruments that have damaged edges won't wedge into the correct place when you're trying to do this surgery. Here is my little 5 2nd how to elevate. You're putting the blade in at the top, you apply a single twist.

You're not wiggling this thing backwards and forwards. You put it in, you find a resistance point, you apply a gentle twist. You wait, you wait, you wait, you wait, you look at the clock, you speak to the nurses, you listen to the radio, you do whatever, but you give it some time.

The other tip that's quite useful is to, rather than putting all the force on, to start with, you crank the force up little by little by little and you'll actually start to feel the ligaments stretch as the ligament stretches, you can put a little bit more force on. So we've now in this picture, we've moved this tooth over to the left. And then what we could do is go across to a different side and move that tooth over to the right, then move it towards us, then move it away from us so that we are sequentially stretching that ligament and easing that tooth out.

So this is our video. Notice here, Matthew from the dental referral service, is. Doing everything we talked about, so he's found a resistance point here.

And now he's putting a single rotational movement on and he's waiting. Little bit more rotation there and that tooth is just beginning to move. This video was taken some time into the surgery.

So he elevated a few different times in order to get the tooth mobile you'd have to take out with forceps. Here again, he's putting on a small amount of force. Then he's moving around to a different location.

Now he's not wiggling his way down the tooth here, he's working the blade in until he finds a resistance point. Once he finds the resistance point, he'll then apply some rotation. And there we go.

And you can see that tooth beginning to move. Find another point of resistance. And you can see how much more the ligament is stretched there.

So that is elevation. Find an appropriate size blade, place it between the alveolar bone and the tooth at a point where you can feel the resistance. Apply a single twist around the axis of the instrument.

So it's just a straight twist around the axis of the instrument. Hold, wait, give the ligament time to stretch. It's very difficult to do that when you're used to wiggling that blade around and you physically have to stop yourself wiggling and actually stop and think and say, find that resistance point.

Now luxation Luxation is taught as a. More difficult technique and actually it's not, it just takes a little bit of practise. So we're working the blade towards the root apex but we're not twisting it.

Because it's a more delicate technique, you don't use as much force as you do with an elevation blade, and that makes it more appropriate for those long, thin, delicate roots that are quite prone to fracture. But, but, but, but. You are taking a very long, thin, spiky blade and you're pushing it down.

That means if you slip, worse things can happen. It's a more dangerous blade. Look at the cutting edge, look at the thinness of those things.

That's a thin, double edged, hardened surgical steel blade. So it's very, very important that you keep your finger down to the edge of the blade all the time when you're using a luxation technique. With elevation technique, what a lot of surgeons will do is once they've located the blade into the right position and found the resistance point, they will move their hand a little bit further up towards the handle so they can visualise what's going on.

But luxation, you must keep that palm grip. Now, here's my little 3 part picture. Movement number one, you insert the blade into the periodontal space, gently pushing towards the apex, but you're letting the blade work its way into that space.

Movement #2, you rock the blade sideways into the periodontal space. So in this picture, the blade isn't coming out and towards you, it's going side to side around that tooth. We're not using these blades as a lever device.

And then step 3 is we're contouring the blade around the root. If you want to have this, difficult to do this online, but basically, imagine you've put the blade on your finger, you're going to keep the blade facing your finger as the blade goes around the root. So you're contouring the blade around the circumference of the root, as opposed to elevation where you are twisting the blade around the axis of the instrument.

If that doesn't make sense, then we can go through this in the question and answer session after this. So when you're watching a surgeon do luxation, particularly on a small tooth, it really looks as if they're twisting the instrument, torsioning the instrument, but they're not. They're rotating the instrument around the circumference of the tooth.

So if you look carefully at this video, Matthew, again, you'll see him doing this. These are sectioned pre-molar boots. So he's got the blade wedged into the periodontal space, and you see it's wedged in quite hard, so when he moved his finger there, the blade stayed in position.

That's close up of Matthew. Personally, when I'm doing luxation, I find it quite difficult to combine both the step 2 and the step 3. So what I personally do is I will insert the blade into the periodontal space step one.

I will rock that blade, pushing it down towards the apex, step 2. And then I'll move around a little bit and rock my way down. Rather than trying to get movement 2 and movement 3 in the same hand movement.

So here he is again. He's rotating that blade. Around the circumference of the tooth.

He's moving it around here facing the tooth all the time with the blade. So, what do we avoid? Number one, my absolute bugbear is drilling for oil.

Do not do this. It screws everything up, it makes life extremely difficult. So what people try to do typically is they'll take an elevation blade, which is a big fat blade that's got some strength to it, designed as a lever, and they try and drill it down a space that's 0.1 to 0.3 millimetres wide.

And you say, oh, that's difficult. Dentals are hard, they take a long time. Yeah, they are hard because you're trying to get something that's 5 millimetres wide, down a 0.1 millimetre space.

It's very, very difficult. Specifically what it's doing, you're relying on the edge of the alveolar bone in order to get a leverage point to mobilise that tooth. And bone crushes very quickly when you wedge a hard piece of surgical steel down next to it.

So the main thing that this drilling for oil technique does is make it difficult to use the correct elevation technique. Other things it's gonna do, you're as you spin that blade down that root and you twist it all over the place, you're pushing the tooth backwards and forwards really quickly. But periodontal ligament doesn't like to stretch quickly, it likes to stretch slowly.

So something's got to give. The periodontal ligament doesn't want to give. What's gonna give is gonna be the brittle enamel of the tooth, and you're gonna get a tooth or a root fracture.

Very common. And of course, the other thing that can go is the bone. And particularly if we're thinking about cat tooth extractions or 15 year old Yorkshire terriers with an awful lot of periodontal disease and weakened bone, those are the times that we're gonna snap things.

So don't drill for oil. It's very, very difficult to stop yourself, and it's something that pretty much all of us have done because we've never been shown the other technique. And of course the other thing that can happen if you are torsioning instruments backwards and forwards really, really quickly, you start to get weakening of the metal of the edge, and it's one of the things that will destroy the edges of your instrument.

Second technique, these are slim pieces of metal, they're not crowbars. If you try and lift a tooth out, stuff's gonna go wrong. And typically, as you leave, you're either gonna get a root fracture.

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You're gonna get a root fracture halfway down the root or you're gonna get a bone fracture. Or you're gonna get crushing just where the, where the, where the instrument is meeting the alveolar bone. As you push down hard against it and leave it down against it, you're gonna get a lot of bone damage.

And you are absolutely gonna bend your dental instruments. And particularly if people are using small 2 or 3 millimetre dental instruments, those will bend very quickly if you try and use this technique. The most important thing, the mechanics of extraction don't work like that.

So levering a tooth out doesn't work. It takes a long time, causes a lot of damage, it's a lot slower than going back to elevation or luxation. If you use an elevation technique in this tooth, you are going to lift it.

Left and upwards simultaneously, that's how the mechanics of extraction work, levering, you're not gonna do very much at all. So, that's our two techniques. Elevation technique using a thicker, stronger blade, levering the tooth, left, right, forwards, backwards within the socket until the ligament has stretched.

Very important to give it time, very important to be gentle and be precise about where you're putting that blade, and it's good for those stronger, thicker roots. Luxation technique is your thin chisel or your #11 scalpel blade, and it's there to cut ligament, not stretch ligament. That's got that 3 part technique where you are pushing down towards the bottom of the root.

You are rocking sideways in order to work the blade in there and you're contouring around the root, but you're not twisting the blade, you're contouring around the circumference of the root all the time. So 2 different blades, 2 different techniques, 2 different kinds of route that you can use them for. You can operate with just an elevation technique and you can operate with just a luxation technique, and there are excellent dental surgeons out there that will only use one or the other technique.

And there are good technical reasons for that, however. In general practise, where most of us are, it's actually quite a reasonable thing to do to utilise both techniques. And certainly since I've worked with some of these guys doing the development work for the instruments, and I've seen excellent surgeons using extraction, elevation technique and excellent surgeons using luxation technique.

There are certain teeth where I get stuck and elevation's just not getting me anywhere. I'll then switch to a luxation blade, luxate my way down a little bit further. That will remove a little bit of ligament, and that means that my elevator will then work that little bit better.

And I find that where I get stuck with one technique, switching to the other technique can be quite helpful. Proviso always being, if you're using elevation technique on a long thin route, be careful, be gentle, use small instruments. Now all of this rather depends on having instruments that are the right shape.

And it'll be interesting to see if anyone wants to write in after we've finished and tell us when the last time, they changed their instruments or sharpened their instruments was. I know before I started this in practise, we had a sharpening stone, and it lived somewhere in the back of the drawer, and nobody really knew how to use it, and we all thought it was difficult, and nobody had the time and blah, blah, blah, blah, blah. And we had instruments that have been there for 20 years, never been changed, never been looked after.

They are not appropriate surgical instruments for doing bone surgery. So If we're going to use precise surgical techniques, let's have some precise instruments. Good news is it's actually not that hard.

And what we've been told about how to care for dental instruments is not the easiest way to do it. So, here we go. Just imagine we're starting with a nice instrument set.

How do we look after a nice instrument set to start with? So enzymatic cleaning solutions appropriate for your instruments. Make sure that your instruments are, your cleaning solution is rated for the metal that your instrument is made out of.

It seems like common sense, but a lot of people will use things like bleach. Bleach will damage surgical steel like you wouldn't believe, and it can shorten the lifespan of your instruments enormously. So enzymatic cleaning solution.

My instruments, the denomic instruments have got, aluminium, aluminium, for those of you in the States. The colour part is aluminium, the cutting part is surgical steel. A lot of the silver instruments that you have will be all surgical steel.

The Luxata brand from Sweden and a couple of the others have got different kinds of plastic attached to a steel handle. So make sure that the chemistry that you're using is appropriate for the materials that you're cleaning, and that should all be on the bottle of your cleaning solutions. Interesting thing, in certain areas in the US and certain areas in Europe, you have naturally soft water.

If you put naturally soft tap water into an ultrasonic cleaner, it will form an alkaline solution, and that alkaline solution damages surgical steel and surgical aluminium. And again, it's gonna shorten the working life of those instruments. So, water chemistry has some quite surprising effects on metals when you're cleaning with it.

So it's very important, particularly if you're using, ultrasonic cleaners to use distilled or deionized water when you're cleaning. Especially in the final rinse before things come out and go into the autoclo. So you'll prevent quite a lot of corrosion that way.

If you're not already doing that, I would actually do that across the board with all of your instruments. Once you've cleaned your instruments, then you want to be sterilising them. It is not appropriate to store any dental instrument, and whether they are the steel and aluminium ones or the plain steel ones or the steel ones with the plastic handles, you do not want to be storing those in wet disinfectant solutions.

It damages the metal, again, it's going to shorten the lifespan of your instruments. The single best way to sterilise and store a dental instrument is exactly the same way it's best to sterilise and store a normal surgical instrument. So In a steam water clave, vacuum steam water clave in an autoclave bag, dried off properly afterwards so that you're storing them dry.

So fully dried in an autoclave pouch or if you've got a nice sealed autoclave case. The mouth that you're operating in is not a sterile environment as such, but you are cleaning it hopefully before you start operating. It is worth using sterile instruments.

So treat your dental instruments like you treat anything else and again they're gonna last much longer. Sharpening dental instruments, so. Here's the deal.

You'd need that thin edge on the instrument, so it's important to have them sharp. But when you talk to me about sharpening, sharpening to me means grinding metal off the edge. And that's difficult.

Those luxation blades and the elevation blades, they've got complicated curves on them. Elevation blades have a thick angle like a meat cleaver. They are a strong blade.

The blade edge isn't particularly thin because it doesn't need to be. It's thin enough to engage the periodontal space but not go all the way down in there. Whereas a luxation blade has got a totally different shape edge to it.

Think about a high quality Japanese sushi knife. So if you don't know the exact angles that that blade started out as and you start grinding metal off them, trying to recreate that edge, you're probably going to end up with a blunter blade than you started with. OK, so don't think about sharpening, think about honing.

So think about a kitchen knife, you see a chef sharpening a kitchen knife on a steel. Just a steel rod or a leather strap for a razor. Leather on a razor does not remove metal from the edge.

What it's doing is realigning and straightening the edge. So when you chop down with any blade, the blade edge just bends over very, very slightly, and you can see that on the red arrow on the red arrow here. .

As that blade edge bends over, the edge gets thicker. As the edge gets thicker, it becomes harder to access the periodontal space and life becomes more and more and more difficult. If you leave that long enough, the blade edge will bend all the way over and then the metal starts to chip off.

So you want to catch it when that blade edge is just started to bend and flip it back the right way. And that's what you're doing with a leather strap or with a kitchen steel when you are sharpening, in inverted commas, a kitchen knife, you're not sharpening it at all. You're just straightening and realigning the edge.

So that's what I want you to think about. Now this relies on starting from a sharp blade. And in most cases, that's implies starting with a new blade.

So we start out, step one, we've got a sharp undamaged blade edge on the left. We've used it for surgery and we've just bent that blade edge over a tiny bit, not a huge amount, tiny bit. What we're then doing is using a sharpening stone or diamond card or ceramic or leather to hone that blade edge back to straighten it, to realign it, and we then.

We then back to Number 4, a rear lined straightened blade edge. The material that you use to do that needs to be minimally abrasive. Minimally abrasive for me would be ultrafine diamond.

That actually is my favourite. You can use ceramic, there are good ceramic honing tools out there, . You can use a fine sharpening stone.

The only problem with stones is they need lubrication. Generally that's oil, sometimes that's water, but normally the manufacturers recommend oil. The only problem with that is that you need to make sure that oil is cleaned thoroughly off the blade before that blade goes back in the autoclave and back into a patient.

You do not want to be leaving oil contamination down in the inner depths of some dog's mandible. You might get some nasty tissue reactions to that. So just for ease of use, ultrafine diamond or ceramic tends to be a good choice.

If you've got a very small burr, you can actually hone blades on a wooden tabletop, and that will work. It doesn't have to be anything particularly abrasive. Now the advantage of honing rather than sharpening is you're not trying to recreate a blade edge.

We're not trying to make you into an engineer. I'm just saying tickle up the blade that you've got and take it from being almost perfectly sharp to perfectly sharp. This kind of implies that you're doing it a lot.

So think about your top chef, they pick up the kitchen knife, they hone it on a steel, and then they use it. And that's really what I want you to think about. We do this as part of a cleaning procedure.

So you take your instruments, you clean them, you dry them, you check them, you hone them, you auto clothe them, we're good to go again. So how do we check them? Here you can see us using a cocktail stick to check the edge.

In the magnified picture you can see that edge is very slightly bent, and when you run the cocktail stick down the down the blade, if you, if you've got a fairly gentle grip on the cocktail stick, the cocktail stick will stop at the burr. You'll be able to feel that it doesn't slide off that blade nice and easily. So you want to check both sides of the blade, top and bottom and find those burrs.

You can also incidentally use your fingernail, depends on how accident prone you are. Remember that you are dealing with very sharp surgical instruments. Because of that, when you are actually honing, depending on the type of instrument that you're honing and what you're using to hone it with, you can get small metal fragments or small metal chips coming off.

Wear gloves, wear eye protection, be safe. So what you're seeing here, if we had a blade bend upwards there. If we've got that, the blade edge is bent upwards, we're using a cone shaped honer on the concave aspect of that blade, and I'm just putting a small amount of force onto the honer and I'm drawing the honer to the right.

As I draw the hole to the right, it should bend that little bend you can singing with the small curved red arrow that should straighten that out. And normally you're talking about doing this for something like 3 seconds, 4 seconds, a few strokes, not particularly hard, that should be plenty. And then you go back and you check with your cocktail stick again and you see what's happened to the birth.

If you're talking about flat surfaces, you can see that in the magnified picture here, we've got the . There we go. We've got a bend coming downwards.

We're drawing the blade backwards across the diamond card there, and that's bending and realigning that blade edge again. Personally, I actually do it the other way round. I find holding the instrument upwards like that with the card above the instrument, and then I just run the card in a few strokes around the circumference of the blade.

Notice in the magnified picture that we're matching the angle of the cutting edge of the blade to the honing device that we're using. Because we're not grinding and we're not using particularly abrasive surfaces, it doesn't have to be super precise. So try and match it up as best you can and then again, a few reasonably gentle, short, quick strokes should bend that blade edge back and realign it.

Now of course, once we've done that, we're gonna go and check the other side with our little stick, and we're just going to check that we haven't bent the edge all the way over to the other side, if we have, then you need to bend it back into the middle. Essentially when you're honing, if it's taking you more than 4 or 5 seconds, then you're doing it wrong. So it's not difficult.

It doesn't take a long time. It's not hard to get into the habit. If you're not doing it every day, don't bother because once that edge has turned all the way over, it's not gonna hone, you're gonna have to grind metal off and almost start again.

So that gives you two different options for maintaining those blades. Either hone them as part of the cleaning procedure, which is what I would recommend. It's gonna make your instruments last much longer, or say, OK, we don't have time to sharpen and hone the blades.

We've got other stuff on or we don't have the staff to do it. So when your instruments get damaged, when you get edge damaged, when you get burrs, dispose of them. And get new instruments.

If you are going to go and do precise surgery, you need instruments to do precise surgery with. Sending them off to be sharpened once every few weeks is not good enough, because those blades will blunt more quickly. Generally speaking, the high quality instruments will have hardened steel blades, hardened steel blades will bend less readily than softer steel blades.

And that is something to look out for. But bear in mind the downside is hardened steel blades can be more brittle. So if you use a hardened steel blade as a lever or as a crowbar, they will bend or snap more easily.

So they are more precise, but they're more delicate. The softer steel blades will take more abuse. But they won't keep an edge and you're gonna be finding that you're spending more time and more effort to keep a sharp edge on your instruments.

But the key point is either hone them frequently, ideally every single day, or check your instruments frequently, once a week or so as part of a maintenance thing. And anything that's got chips in the edge of the blade, anything that's damaged, anything that's bent, anything that's blunt, get rid of it and get a new instrument. There are The softer steel instruments are very, very cheap these days, the elevators and luxation designs that are out there.

So there are. Very economical ways to replace instruments, but as I say, you are better off honing them, your money will go further. So, in summary, Two different techniques, 2 different instruments, 2 different situations where we would want to use them.

If you match the right technique to the right situation, to the right instrument, everything becomes easier. It is not easy to change. You'll have to force yourself to change, you will have to remind yourself, in the notes for this lecture is a little print out of those two diagrams.

It's worth having those on your dental trolley so that as you struggle, you can look at the picture and correct your technique. Think about extraction tools being thin edged as much as being sharp and be precise about where you put them and how you use them. And that means that your life is better for your patients.

Sharp blades are safer. You don't have to push as hard, you're not crushing bone. Your patient is gonna wake up with less pain and less trauma.

And then on maintenance. As we say, one or the other. Either hone your blades as part of the cleaning procedure or dispose of instruments as they become damaged.

There's no excuse for what I used to have 20 year old instruments, and I've been in one practise that still had a mallet as part of their dental kit, small animal practise. So keep an eye on your dental instruments as they become damaged, replace them, move them on. That is me done, but I hope you will find that that's gonna make your lives a lot easier.

That's something that you should be able to go into practise with on Monday and almost instantaneously find a difference with your surgery. Thank you.