1
00:00:12,000 --> 00:00:25,000
Now we're going to start making incisions in the mouth here.

2
00:00:25,000 --> 00:00:29,940
Okay, so now we're going to start making incisions in the mouth here.

3
00:00:46,420 --> 00:00:50,820
We're going to take a retractor and give some traction on the muscle here.

4
00:00:55,000 --> 00:01:11,300
We are going to try to split that.

5
00:01:11,300 --> 00:01:22,260
tissue. Evenly, so we don't have water with that gingiva, but we want some niche style.

6
00:01:22,260 --> 00:01:30,820
And we're going to make a little release right there. So the reason why we do those releases

7
00:01:30,820 --> 00:01:36,740
is we don't want to have tears, so that's the main thing, not to have tears. We want

8
00:01:36,740 --> 00:01:46,980
I have a good release. Now I'm gonna do on this side. Again the goal is here to do

9
00:01:46,980 --> 00:01:53,260
four or five implants in between the mental foramina.

10
00:01:55,900 --> 00:02:00,100
4/4" All-on-4.

11
00:02:23,980 --> 00:02:26,980
There's another release incision there.

12
00:02:42,980 --> 00:02:46,980
So we're going to do a subperiosteal dissection with the subperiosteal elevator.

13
00:02:46,980 --> 00:02:49,980
I like to do the lingual flap first.

14
00:02:51,980 --> 00:02:57,500
all the way to that little hockey stick incision on the lingual wall you can see

15
00:02:57,500 --> 00:03:04,060
a little bit right there so it doesn't tear and then pick up that one here and bring this one

16
00:03:04,060 --> 00:03:11,060
This one anteriorly.

17
00:03:11,740 --> 00:03:18,740
You can see this is anterior.

18
00:03:24,660 --> 00:03:29,460
So we can identify the mental foramina.

19
00:03:29,460 --> 00:03:36,460
I'm going to stretch the periosteum a couple of times.

20
00:03:39,080 --> 00:03:46,080
Now we're going to come from here.

21
00:03:59,460 --> 00:04:29,300
This is another mental nerve on the right side and now I'm going to pick up that periosteum

22
00:04:29,300 --> 00:04:59,280
Okay, so good, so this other section here, I'm going to use a gauze to get rid of the

23
00:04:59,280 --> 00:05:18,800
dissect clean, and we're ready to do the smoothing. So we're gonna use this burr to smooth the ridge a little bit.

24
00:05:29,280 --> 00:05:46,580
Now we're going to do this, so ideally what you want to have is something from here, you

25
00:05:46,580 --> 00:05:47,580
know?

26
00:05:47,580 --> 00:05:48,580
Down.

27
00:05:48,580 --> 00:05:53,580
You can easily have more than one camera doing that.

28
00:05:53,580 --> 00:05:54,580
No, it's fine.

29
00:05:54,580 --> 00:05:55,580
Huh?

30
00:05:55,580 --> 00:05:57,580
No, no, it's fine.

31
00:05:57,580 --> 00:06:06,080
I think that will be better, you know, if you do one, you know, maybe a little higher

32
00:06:06,080 --> 00:06:14,020
if you can, you know, put some on the way, I don't know, like this, but, I don't know,

33
00:06:14,020 --> 00:06:29,920
We're going to continue with the alveolar reduction here.

34
00:06:44,020 --> 00:06:52,160
Come here.

35
00:07:14,020 --> 00:07:29,980
That's why I'm going to use this, you know, one more view, for my own.

36
00:07:29,980 --> 00:07:30,980
Okay, well done.

37
00:07:30,980 --> 00:07:31,980
So let's do it.

38
00:07:31,980 --> 00:07:32,980
Okay?

39
00:07:32,980 --> 00:07:33,980
Mm-hmm.

40
00:07:33,980 --> 00:07:38,980
Okay, what else? So let's do it. Okay.

41
00:08:03,980 --> 00:08:13,980
Open your mouth wide.

42
00:08:13,980 --> 00:08:17,980
Open wide and close the lid.

43
00:08:43,980 --> 00:08:53,980
so

44
00:09:13,980 --> 00:09:43,960
So with this first drill now, this first drill is going to give it a little bit of volume,

45
00:09:43,960 --> 00:09:50,560
ability to guide so you can see this is the nerve and we're doing our first and

46
00:09:50,560 --> 00:09:53,700
this is a second drill I'm sure it's for that mental parameter

47
00:09:53,700 --> 00:09:58,240
I want to stay parallel to this bone right there

48
00:09:58,240 --> 00:10:03,000
to this cortical bone and we're going to drill to 16 and intention is to place

49
00:10:03,000 --> 00:10:06,080
implant number 13 on there

50
00:10:08,120 --> 00:10:12,680
Here, same thing with the drill.

51
00:10:20,620 --> 00:10:27,660
Here you see, we are repairing the sides of the filing point.

52
00:10:38,120 --> 00:10:48,940
Open, open, open.

53
00:11:08,120 --> 00:11:15,120
I'm going to go ahead and put this in.

54
00:11:38,120 --> 00:11:45,120
You need three bites on this one. Okay. Mm-hmm.

55
00:12:08,120 --> 00:12:38,100
So, let's go.

56
00:12:38,120 --> 00:12:40,120
*sizzling*

57
00:13:08,120 --> 00:13:25,800
Ok, so everything is prepped to about 16mm and I'm going to put a little antibiotic.

58
00:13:25,800 --> 00:13:31,600
And now we're going to put 13mm implant.

59
00:13:31,600 --> 00:13:33,600
Alright, I'm going to start from here.

60
00:13:44,180 --> 00:13:46,180
So this is an implant.

61
00:13:47,080 --> 00:13:49,080
4.3 by 13.

62
00:14:01,600 --> 00:14:03,600
Mm-hmm.

63
00:14:31,600 --> 00:14:59,600
Another implant, 4.3 by 13.

64
00:14:59,600 --> 00:15:21,360
4.3 by 13.

65
00:15:29,600 --> 00:15:42,320
As you see we did the mechanical installment on the hand piece and now we're doing torquing.

66
00:15:42,320 --> 00:15:51,580
You can see how it's getting dense.

67
00:15:51,580 --> 00:15:58,400
Now we're reversing to release the bone a little bit.

68
00:15:58,400 --> 00:16:20,960
Now we're going to change retractors and change this side here to this and we're going to

69
00:16:20,960 --> 00:16:34,700
Another implant, same. Implant 4.3 mm, about 13 mm, here, so it stops at 40 mm, right?

70
00:16:34,700 --> 00:16:37,700
pork

71
00:17:04,700 --> 00:17:05,700
Okay.

72
00:17:34,700 --> 00:17:36,900
One more. We should have five.

73
00:17:37,000 --> 00:17:38,640
No, we put four.

74
00:17:38,880 --> 00:17:39,040
Yeah.

75
00:17:39,180 --> 00:17:40,020
We bring these four.

76
00:17:40,320 --> 00:17:41,300
I brought four, always?

77
00:17:41,380 --> 00:17:41,720
Mm-hmm.

78
00:17:42,540 --> 00:17:43,020
Thanks.

79
00:17:43,400 --> 00:17:43,640
Thanks.

80
00:17:46,840 --> 00:17:47,920
Look what I did for you.

81
00:18:04,700 --> 00:18:34,680
I'll see you next time.

82
00:18:34,700 --> 00:19:04,680
All right.

83
00:19:04,700 --> 00:19:14,700
so

84
00:19:34,700 --> 00:19:50,300
It is closed, so we are going to put a multi unit abutment so all implants are installed.

85
00:19:50,300 --> 00:19:57,300
Add the chopped green chillies and fry for a minute. Then add the chopped green chillies and fry for another minute.

86
00:20:20,300 --> 00:20:30,900
replacing the implants so making sure that rotation is in a good spot

87
00:20:30,900 --> 00:20:38,700
so when we replace this abutment it goes into the central fossa which it does

88
00:20:50,300 --> 00:20:52,300
Okay.

89
00:21:20,300 --> 00:21:50,280
Thank you.

90
00:21:50,300 --> 00:22:20,280
So, let's go.

91
00:22:20,300 --> 00:22:22,300
*blows air*

92
00:22:50,300 --> 00:23:01,260
I'll give you a good check.

93
00:23:20,300 --> 00:23:38,820
Close, look right there, that's how, teeth are right there so we're gonna do, open, and

94
00:23:38,820 --> 00:23:45,540
the bone is back so we're gonna do, okay, so all gonna be this, 3/5's.

95
00:23:45,540 --> 00:23:46,540
Okay.

96
00:23:47,540 --> 00:23:48,540
Ready for you?

97
00:23:48,540 --> 00:23:49,540
Yep.

98
00:23:55,540 --> 00:23:57,540
Okay, open wide, wide, wide.

99
00:24:15,540 --> 00:24:25,540
so

100
00:24:45,540 --> 00:24:56,580
So we're doing profiling now, and everything is going to be here, because this is 30 degrees

101
00:24:56,580 --> 00:25:03,580
reverse, because we want to match it to the occlusion value, so we have to have a, yeah,

102
00:25:03,580 --> 00:25:06,580
If we do 17 degree, it might be not as...

103
00:25:09,280 --> 00:25:10,880
17 is pretty good as well.

104
00:25:33,580 --> 00:26:03,560
Thank you.

105
00:26:03,580 --> 00:26:33,560
Thank you.

106
00:26:33,580 --> 00:26:35,580
*whistling*

107
00:27:03,580 --> 00:27:07,020
Torquing those multi-unit abutments to 25, all of them.

108
00:27:33,580 --> 00:27:40,580
We need to put the screw in itself. It's better.

109
00:28:03,580 --> 00:28:33,560
All right.

110
00:28:33,580 --> 00:29:03,560
Thank you.

111
00:29:03,580 --> 00:29:18,580
Now we are going to tighten this one again, just to check.

112
00:29:18,580 --> 00:29:27,480
centimeter. All of them.

113
00:29:48,060 --> 00:29:51,500
Okay, so we'll do white caps.

114
00:30:18,060 --> 00:30:48,040
Thank you.

115
00:30:48,060 --> 00:30:58,060
You need to tell them. So, these are white caps, two comfort caps and also the scanning caps.

116
00:30:59,060 --> 00:31:03,060
So, let's do the summary before we close. We're going to rinse and close, but this is the nerve.

117
00:31:03,060 --> 00:31:12,060
We bypass the nerve, the implant like this, this implant like that, here, here, same thing there, away from those nerves.

118
00:31:12,060 --> 00:31:21,060
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.

119
00:31:25,060 --> 00:31:27,060
I'm going to put some antibiotic under the flap.

120
00:31:28,060 --> 00:31:33,060
So those are Nobel Biocare white caps, and we like them because everything is new then except for those caps.

121
00:31:33,060 --> 00:31:41,060
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.

122
00:31:42,060 --> 00:31:49,300
So now, since we did this incision here, which is a vertical releasing incision in the midline,

123
00:31:49,300 --> 00:32:08,520
we're going to fold that first, do this, we're going to do a little horizontal mattress here,

124
00:32:08,520 --> 00:32:29,060
So this is a very powerful suture, it aligns everything, and it's a natural suture so it

125
00:32:29,060 --> 00:32:36,060
reverse the tissue a little bit

126
00:32:59,060 --> 00:33:25,960
The patient is under sedation.

127
00:33:25,960 --> 00:33:26,800
Mm-hmm.

128
00:33:55,960 --> 00:34:13,500
I'll have this used right here.

129
00:34:25,960 --> 00:34:55,940
Thank you.

130
00:34:55,960 --> 00:35:01,540
So we're doing interrupted sutures. You can see five white caps and we're gonna

131
00:35:01,540 --> 00:35:13,320
take a PIC scan. So we're gonna record the PIC scan and [STAFF] can do

132
00:35:13,320 --> 00:35:16,860
annotation for the PIC scan.

133
00:35:25,960 --> 00:35:47,560
I'm going to do the suture as you see it pulled through.

134
00:35:47,560 --> 00:36:07,420
I think it will be amazing when the robot starts suturing like humans.

135
00:36:07,420 --> 00:36:16,160
So even if you enjoy doing some surgery, but usually people are not enjoying suturing as

136
00:36:16,160 --> 00:36:27,500
much so it might be done so it's a very repetitive task so so this can be

137
00:36:27,500 --> 00:36:30,660
delegated to robotics

138
00:36:46,160 --> 00:37:11,200
Did you call?

139
00:37:11,200 --> 00:37:28,320
I like this chair, it's nice.

140
00:37:31,920 --> 00:37:37,520
So the goal of this operation obviously is everything we did with the

141
00:37:39,760 --> 00:37:49,040
IRB studies is to train AI the virtual model and then the robots to suture

142
00:37:49,040 --> 00:37:53,680
and then do some manipulations in the mouth maybe even cut the suture so

143
00:37:58,240 --> 00:38:02,080
and then when they become really good they can learn the surgeon skill

144
00:38:02,080 --> 00:38:06,000
from hopefully only good surgeons and

145
00:38:09,200 --> 00:38:12,720
can operate under supervision of the

146
00:38:15,200 --> 00:38:20,880
humans especially things like this this is very repetitive task very boring it's suturing

147
00:38:21,600 --> 00:38:24,880
i mean it's fun in the beginning but after a while it becomes very boring so

148
00:38:25,440 --> 00:38:36,000
it'll be a good thing for the robot to do after big surgery like this go ahead and suture

149
00:38:39,200 --> 00:39:04,080
So this whole operation, how long did it take us to do this forge?

150
00:39:04,080 --> 00:39:15,260
recording time? 39 minutes. 39? So this is 39 minutes operation.

151
00:39:17,680 --> 00:39:21,840
Incision to suturing.

152
00:39:23,840 --> 00:39:32,240
It takes about 10-15 minutes to suture that big incision. So if they're

153
00:39:32,240 --> 00:39:40,400
robot gonna suture it then your surgery time is 15 minutes in 30 minutes and

154
00:39:40,400 --> 00:39:51,260
then robotics will take 10-15 minutes to suture maybe faster who knows that's an

155
00:39:51,260 --> 00:39:57,380
interesting skill for the robot to learn suturing that requires a lot of haptic

156
00:39:57,380 --> 00:40:14,480
function and a lot of vector data, spatial analysis. You don't want to suture the tongue

157
00:40:14,480 --> 00:40:26,480
to the gum. Can you imagine if you suture it like this and the patient cannot move a

158
00:40:26,480 --> 00:40:49,340
We have a doctor in New York who did that, sutured the tongue to the patient's wisdom

159
00:40:49,340 --> 00:40:55,740
tooth incision. I'm going to say his name.

160
00:41:19,340 --> 00:41:49,320
*snoring*

161
00:41:49,340 --> 00:42:05,380
So we're using vicryl suture and so this, everything we talked about pretty much defies the operation.

162
00:42:05,380 --> 00:42:15,480
So the only thing I can add is that our rotary speed was 1200 for the drilling of implants.

163
00:42:15,480 --> 00:42:22,720
did the cooling irrigation of the saline and we use the antibiotic for the topical

164
00:42:22,720 --> 00:42:30,840
antibiotic including this vancomycin irrigation. So we placed five implants and we can deliver

165
00:42:30,840 --> 00:42:34,580
the up report from this recording.

166
00:42:39,991 --> 00:42:40,930
Mm-hmm.

167
00:42:40,930 --> 00:42:51,070
So, okay, now we're ready for PIC scan.

168
00:42:51,070 --> 00:43:10,070
Yes, don't move, stay, just remove the white covers and put a special plaque, a special

169
00:43:10,070 --> 00:43:13,570
So we'll scan the body for the scanning process.

170
00:43:23,570 --> 00:43:25,570
Stay open and done.

171
00:43:40,070 --> 00:43:59,170
Open, open, open.

172
00:44:10,070 --> 00:44:12,070
*sad music*

173
00:44:40,070 --> 00:44:47,070
Stampin', stampin'. That's number three.

174
00:45:10,070 --> 00:45:34,130
1-9-6.

175
00:45:40,070 --> 00:45:42,070
Stay open, stay open...

176
00:46:10,070 --> 00:46:13,070
Open, open.

177
00:46:16,007 --> 00:46:23,039
Open, open, removing flags and put white covers again, white caps.

178
00:46:44,579 --> 00:46:50,479
I'm going to open up a little bit here.

179
00:47:14,579 --> 00:47:27,579
It's just me, though.

180
00:47:27,779 --> 00:47:28,019
Mm-hmm.

181
00:47:44,579 --> 00:48:01,159
So, now I am going to make some impressions and vertical dimensions, bite registration

182
00:48:01,159 --> 00:48:13,819
and everything for producing digital design and then printing the lower arch.

183
00:48:13,819 --> 00:48:18,819
Dentures.

184
00:48:18,819 --> 00:48:19,029
Dentures.

185
00:48:24,816 --> 00:48:35,055
So, let's see the size, like that, should be good.

186
00:48:50,316 --> 00:49:19,316
Relax your jaw and bite. Smaller sides, open. Relax your jaw. Open please. Open, open, open.

187
00:49:19,316 --> 00:49:21,316
Open, open, open, open.

188
00:49:49,316 --> 00:49:50,020
I'm going to take a picture of you.

189
00:49:50,021 --> 00:50:12,009
Thank you.

190
00:50:12,009 --> 00:50:17,304
Thank you.

191
00:50:17,324 --> 00:50:47,304
I'm going to put it in the oven.

192
00:50:47,324 --> 00:51:11,324
*phone ringing*

193
00:51:11,324 --> 00:51:15,324
Just relax your jaw and close it, close it.

194
00:51:15,324 --> 00:51:18,324
Wait, stop, that's it, don't open it.

195
00:51:18,324 --> 00:51:20,324
Stay close.

196
00:51:30,324 --> 00:51:32,324
Is it suction?

197
00:51:32,324 --> 00:51:34,324
Yeah, that's it.

198
00:51:41,324 --> 00:52:11,304
Okay, open, bite, open, bite again, bite, open, bite, bite, bite, bite, bite, bite, bite.

199
00:52:11,324 --> 00:52:16,324
There we go, there we go, very good.

200
00:52:41,324 --> 00:53:08,324
Okay, bait again, bait, bait, bait, bait, bait, sure, sure, bait, bait, bait, bait, see?

201
00:53:08,324 --> 00:53:38,304
Thank you.

202
00:53:38,324 --> 00:53:45,324
Okay, open.

203
00:54:08,324 --> 00:54:38,304
Thank you.

204
00:54:38,324 --> 00:54:53,023
Thank you.