Now we're going to start making incisions in the mouth here.
Okay, so now we're going to start making incisions in the mouth here.
We're going to take a retractor and give some traction on the muscle here.
We are going to try to split that.
tissue. Evenly, so we don't have water with that gingiva, but we want some niche style.
And we're going to make a little release right there. So the reason why we do those releases
is we don't want to have tears, so that's the main thing, not to have tears. We want
I have a good release. Now I'm gonna do on this side. Again the goal is here to do
four or five implants in between the mental foramina.
4/4" All-on-4.
There's another release incision there.
So we're going to do a subperiosteal dissection with the subperiosteal elevator.
I like to do the lingual flap first.
all the way to that little hockey stick incision on the lingual wall you can see
a little bit right there so it doesn't tear and then pick up that one here and bring this one
This one anteriorly.
You can see this is anterior.
So we can identify the mental foramina.
I'm going to stretch the periosteum a couple of times.
Now we're going to come from here.
This is another mental nerve on the right side and now I'm going to pick up that periosteum
Okay, so good, so this other section here, I'm going to use a gauze to get rid of the
dissect clean, and we're ready to do the smoothing. So we're gonna use this burr to smooth the ridge a little bit.
Now we're going to do this, so ideally what you want to have is something from here, you
know?
Down.
You can easily have more than one camera doing that.
No, it's fine.
Huh?
No, no, it's fine.
I think that will be better, you know, if you do one, you know, maybe a little higher
if you can, you know, put some on the way, I don't know, like this, but, I don't know,
We're going to continue with the alveolar reduction here.
Come here.
That's why I'm going to use this, you know, one more view, for my own.
Okay, well done.
So let's do it.
Okay?
Mm-hmm.
Okay, what else? So let's do it. Okay.
Open your mouth wide.
Open wide and close the lid.
so
So with this first drill now, this first drill is going to give it a little bit of volume,
ability to guide so you can see this is the nerve and we're doing our first and
this is a second drill I'm sure it's for that mental parameter
I want to stay parallel to this bone right there
to this cortical bone and we're going to drill to 16 and intention is to place
implant number 13 on there
Here, same thing with the drill.
Here you see, we are repairing the sides of the filing point.
Open, open, open.
I'm going to go ahead and put this in.
You need three bites on this one. Okay. Mm-hmm.
So, let's go.
*sizzling*
Ok, so everything is prepped to about 16mm and I'm going to put a little antibiotic.
And now we're going to put 13mm implant.
Alright, I'm going to start from here.
So this is an implant.
4.3 by 13.
Mm-hmm.
Another implant, 4.3 by 13.
4.3 by 13.
As you see we did the mechanical installment on the hand piece and now we're doing torquing.
You can see how it's getting dense.
Now we're reversing to release the bone a little bit.
Now we're going to change retractors and change this side here to this and we're going to
Another implant, same. Implant 4.3 mm, about 13 mm, here, so it stops at 40 mm, right?
pork
Okay.
One more. We should have five.
No, we put four.
Yeah.
We bring these four.
I brought four, always?
Mm-hmm.
Thanks.
Look what I did for you.
I'll see you next time.
All right.
so
It is closed, so we are going to put a multi unit abutment so all implants are installed.
Add the chopped green chillies and fry for a minute. Then add the chopped green chillies and fry for another minute.
replacing the implants so making sure that rotation is in a good spot
so when we replace this abutment it goes into the central fossa which it does
Okay.
Thank you.
So, let's go.
*blows air*
I'll give you a good check.
Close, look right there, that's how, teeth are right there so we're gonna do, open, and
the bone is back so we're gonna do, okay, so all gonna be this, 3/5's.
Okay.
Ready for you?
Yep.
Okay, open wide, wide, wide.
so
So we're doing profiling now, and everything is going to be here, because this is 30 degrees
reverse, because we want to match it to the occlusion value, so we have to have a, yeah,
If we do 17 degree, it might be not as...
17 is pretty good as well.
Thank you.
*whistling*
Torquing those multi-unit abutments to 25, all of them.
We need to put the screw in itself. It's better.
All right.
Thank you.
Now we are going to tighten this one again, just to check.
centimeter. All of them.
Okay, so we'll do white caps.
Thank you.
You need to tell them. So, these are white caps, two comfort caps and also the scanning caps.
So, let's do the summary before we close. We're going to rinse and close, but this is the nerve.
We bypass the nerve, the implant like this, this implant like that, here, here, same thing there, away from those nerves.
And that will give us the ability to get about 10 teeth in here for him, so they're all going to hold about 10 teeth or more.
I'm going to put some antibiotic under the flap.
So those are Nobel Biocare white caps, and we like them because everything is new then except for those caps.
They're just very good for scanning. They're white, so the scan picks them up real nice, and we have a matching software for those components.
So now, since we did this incision here, which is a vertical releasing incision in the midline,
we're going to fold that first, do this, we're going to do a little horizontal mattress here,
So this is a very powerful suture, it aligns everything, and it's a natural suture so it
reverse the tissue a little bit
The patient is under sedation.
Mm-hmm.
I'll have this used right here.
Thank you.
So we're doing interrupted sutures. You can see five white caps and we're gonna
take a PIC scan. So we're gonna record the PIC scan and [STAFF] can do
annotation for the PIC scan.
I'm going to do the suture as you see it pulled through.
I think it will be amazing when the robot starts suturing like humans.
So even if you enjoy doing some surgery, but usually people are not enjoying suturing as
much so it might be done so it's a very repetitive task so so this can be
delegated to robotics
Did you call?
I like this chair, it's nice.
So the goal of this operation obviously is everything we did with the
IRB studies is to train AI the virtual model and then the robots to suture
and then do some manipulations in the mouth maybe even cut the suture so
and then when they become really good they can learn the surgeon skill
from hopefully only good surgeons and
can operate under supervision of the
humans especially things like this this is very repetitive task very boring it's suturing
i mean it's fun in the beginning but after a while it becomes very boring so
it'll be a good thing for the robot to do after big surgery like this go ahead and suture
So this whole operation, how long did it take us to do this forge?
recording time? 39 minutes. 39? So this is 39 minutes operation.
Incision to suturing.
It takes about 10-15 minutes to suture that big incision. So if they're
robot gonna suture it then your surgery time is 15 minutes in 30 minutes and
then robotics will take 10-15 minutes to suture maybe faster who knows that's an
interesting skill for the robot to learn suturing that requires a lot of haptic
function and a lot of vector data, spatial analysis. You don't want to suture the tongue
to the gum. Can you imagine if you suture it like this and the patient cannot move a
We have a doctor in New York who did that, sutured the tongue to the patient's wisdom
tooth incision. I'm going to say his name.
*snoring*
So we're using vicryl suture and so this, everything we talked about pretty much defies the operation.
So the only thing I can add is that our rotary speed was 1200 for the drilling of implants.
did the cooling irrigation of the saline and we use the antibiotic for the topical
antibiotic including this vancomycin irrigation. So we placed five implants and we can deliver
the up report from this recording.
Mm-hmm.
So, okay, now we're ready for PIC scan.
Yes, don't move, stay, just remove the white covers and put a special plaque, a special
So we'll scan the body for the scanning process.
Stay open and done.
Open, open, open.
*sad music*
Stampin', stampin'. That's number three.
1-9-6.
Stay open, stay open...
Open, open.
Open, open, removing flags and put white covers again, white caps.
I'm going to open up a little bit here.
It's just me, though.
Mm-hmm.
So, now I am going to make some impressions and vertical dimensions, bite registration
and everything for producing digital design and then printing the lower arch.
Dentures.
So, let's see the size, like that, should be good.
Relax your jaw and bite. Smaller sides, open. Relax your jaw. Open please. Open, open, open.
Open, open, open, open.
I'm going to take a picture of you.
Thank you.
I'm going to put it in the oven.
*phone ringing*
Just relax your jaw and close it, close it.
Wait, stop, that's it, don't open it.
Stay close.
Is it suction?
Yeah, that's it.
Okay, open, bite, open, bite again, bite, open, bite, bite, bite, bite, bite, bite, bite.
There we go, there we go, very good.
Okay, bait again, bait, bait, bait, bait, bait, sure, sure, bait, bait, bait, bait, see?
Thank you.
Okay, open.
Thank you.