ty_1_02-17-2026_163430 0:46

That sweet.

damon_1_02-17-2026_183430 0:47

So, you know, this is the only picture on this case, but this was probably the most, you know, if somebody was to ask me what, what's kind of been, you know, one of your more surprising cases. it would have to be this one for sure. Uh, so this, this was like a 85, I don't know, maybe she was 78. I don't know. Somewhere between that 78, 85 range. I did this case about three years ago. Uh, postmenopausal female, she

ty_1_02-17-2026_163430 1:17

Yeah,

damon_1_02-17-2026_183430 1:17

right? She didn't have a denture. And so, you know, generally when our patients have teeth, their, their bone is actually, fairly well. Like I, I, I think we have a 95% chance of, uh, you know, utilizing standard implants on patients like that.

ty_1_02-17-2026_163430 1:36

sure.

damon_1_02-17-2026_183430 1:37

But, you know, so took out her failing teeth, prepped the alveo, then just, you know, you hear that just, you know that butter bone all the

ty_1_02-17-2026_163430 1:47

Yeah. It's just evaporating. Yeah.

damon_1_02-17-2026_183430 1:49

Totally evaporates. And you know, again, I do surgery the same way on every patient every time. And you know, the key concepts that I teach at my course, and one of the key concepts is bi bicortical stabilization.

ty_1_02-17-2026_163430 2:03

Hmm.

damon_1_02-17-2026_183430 2:03

you know, once, once we do our alveolectomy, we kind of remove one of the cortices.

ty_1_02-17-2026_163430 2:08

You bet, man.

damon_1_02-17-2026_183430 2:09

then our only cortex here is that, you know, kind of lateral nasal wall

ty_1_02-17-2026_163430 2:14

Mm-hmm.

damon_1_02-17-2026_183430 2:15

want to engage our posterior implants with. you know, did like a four, oh, you know, 18, you know, I think we got, you know, five newtons and, and, and her, her nasal cortex was so thin,

ty_1_02-17-2026_163430 2:31

Yeah.

damon_1_02-17-2026_183430 2:31

I thought, okay, all right, well let's go from a four to 18. Let's throw in a 5 0 18, you know, still absolutely nothing.

ty_1_02-17-2026_163430 2:39

Yeah.

damon_1_02-17-2026_183430 2:39

I was like, I was like, all right, okay, well let's go ahead and mo you know, move on. So we then we went to the anterior, uh, and, and really kind of s same thing. I went to the nasal crest, uh, you know, went, you know, medi medially there. Okay, no big deal. We'll go lateral, nasal, absolutely nothing. So, you know, so then I'm, then I'm like, okay, all right, well, know that that side's a quad and so let's, let's, let's go ahead and, you know, let's go to the left side and see what we get. you know, po left like 70 Newtons. You know, like, I was like, man, okay, thank goodness I got

ty_1_02-17-2026_163430 3:24

Yeah. Something.

damon_1_02-17-2026_183430 3:25

tilted on the left,

ty_1_02-17-2026_163430 3:27

Yeah.

damon_1_02-17-2026_183430 3:27

and so, you know, uh, then proceed to do the anterior, uh, max left side maxilla nothing, right? So I'm just like, oh, man, okay. All right. So then I'm like, okay, well can we, can we at least get the OIDs So then, you know, boom, nail, nail OIDs bilaterally. So I was like,

ty_1_02-17-2026_163430 3:49

yeah,

damon_1_02-17-2026_183430 3:49

high, fives there, you know. So then, but you know, this, this patient just out of, out of the blue required a, a maxillary quad almost, you know? So,

ty_1_02-17-2026_163430 3:59

yeah. Okay.

damon_1_02-17-2026_183430 4:01

Definitely, definitely took a lot of time and, you know, but again, you know, my goal here is not to hope. I do not want to then just bury some implants, leave the patient in a denture,

ty_1_02-17-2026_163430 4:18

Mm-hmm.

damon_1_02-17-2026_183430 4:18

you know, uh, for five or six months and then come back and uncover and, and hope that, you know, you have, you know, stability with your implants. you know, generally my protocol is, is, you know, I don't hope, I want to know, I want, and that's what I teach and that's, that's why I get these people to, you know, take these advanced courses so that when a, when a, when a standard case comes up and it's just absolutely butter bone on a postmenopausal female, well,

ty_1_02-17-2026_163430 4:48

Yeah.

damon_1_02-17-2026_183430 4:49

able to provide her permanent fixed teeth in a day and two weeks later she's eating a hamburger. You know, uh, you

ty_1_02-17-2026_163430 4:57

and I,

damon_1_02-17-2026_183430 4:58

and you can tell even on her lower, her

ty_1_02-17-2026_163430 5:00

I,

damon_1_02-17-2026_183430 5:01

so soft.

ty_1_02-17-2026_163430 5:02

I was just about to say, you, you get done with this upper and you're like, oh, well, surely the, lower will be better.

damon_1_02-17-2026_183430 5:07

yeah. Yeah. And yeah, and, and definitely it wasn't, I mean, we had to use, I think

ty_1_02-17-2026_163430 5:12

Yeah,

damon_1_02-17-2026_183430 5:13

fives and

ty_1_02-17-2026_163430 5:13

Yeah. definitely. Yeah. You're, you're in the inferior cortical border on all four of those front four implants and, and you actually, uh, crisscross your anterior ones. I don't see that very often.

damon_1_02-17-2026_183430 5:24

Yeah.

ty_1_02-17-2026_163430 5:24

is that what I'm saying? Yeah. Yeah. That's, that's.

damon_1_02-17-2026_183430 5:27

um, you know, this, this brings up a really good point. You know, the, the, the question sometimes on a mandible is like, okay, well what, what width of an implant are you gonna use? Like, if you're gonna use neo dent, is what I like to use, that you have, you have several options. You have a four oh, and you have a four three, right?

ty_1_02-17-2026_163430 5:47

Yeah.

damon_1_02-17-2026_183430 5:48

So on a, on a case where, know, you have to pay attention to your drill, right? If, if you already know that with your two oh drill or your spade, it is super soft

ty_1_02-17-2026_163430 6:01

Mm-hmm.

damon_1_02-17-2026_183430 6:02

and you know you're to 18 and you really haven't reached that inferior border, that's, that's okay. But don't place a four three implant because the challenge that you have, if you place a four three, and then now you need to switch back and you need to place the GM long.

ty_1_02-17-2026_163430 6:21

Yeah. Four. Oh.

damon_1_02-17-2026_183430 6:22

you have, you have 16 millimeters of your osteotomy that's actually 0.3 millimeters wider than your implant. So, so, so on, on a, on a case where you may not wanna just throw in a GM long, but you may wanna try, me try a 4 0 18.

ty_1_02-17-2026_163430 6:43

Mm-hmm.

damon_1_02-17-2026_183430 6:44

a 4 3 18.

ty_1_02-17-2026_163430 6:46

I like this. Yeah.

damon_1_02-17-2026_183430 6:47

So you, you try a 4 0 18, and then if you need to use your 25, well then boom, just bust out your GM long drill, you know, drill to drill to 2225, and then now you can put your four oh by 25 in there.

ty_1_02-17-2026_163430 7:01

Yeah. Yeah. No, that's brilliant. We, we were actually, we did a, we just did an episode with, uh, cliff Gratz, who's the product development specialist at, at den. And, you know, he was talking about how a lot of where den derives is stability, at least with the GM helix, is the, the threads in the Crest portion are compressive. And so if you're not able to engage that with your now GM long implant that is undersized for your osteotomy, you're not getting any of that compression, and now you're just relying on stability from that cortical engagement, which, you know, it'll work, you'll get some torque, but not as much stability of the implant as you would had you not oversized that osteotomy.

damon_1_02-17-2026_183430 7:38

correct. Yeah. So then, then if you roll with your four, three, and then downsize to a GM long four oh, you're right. You're just, you're just

ty_1_02-17-2026_163430 7:46

Yeah,

damon_1_02-17-2026_183430 7:47

AP apical stability,

ty_1_02-17-2026_163430 7:49

right.

damon_1_02-17-2026_183430 7:50

which, works. I mean, I've, I've never, I have never had a GM long implant fail. And I've, I've used, I've used quite a few,

ty_1_02-17-2026_163430 7:58

Yeah.

damon_1_02-17-2026_183430 7:59

you know, just because we get really good stability down here, it winds up being the same principles as, uh, as zygomatic. Right.

ty_1_02-17-2026_163430 8:08

Yeah.

damon_1_02-17-2026_183430 8:08

just because you have just that such a, such a long implant.

ty_1_02-17-2026_163430 8:12

You,

damon_1_02-17-2026_183430 8:13

but, you know, I also. case I do, we, we do, we provided that they can do it. We do six implants in the mandible.

ty_1_02-17-2026_163430 8:23

mm-hmm.

damon_1_02-17-2026_183430 8:24

And so, uh, you know, I, I pre, I prefer to load I have not seen Crystals, bone loss with, you know, loading the, the, the posterior implants.

ty_1_02-17-2026_163430 8:39

Mm-hmm. Yeah.

damon_1_02-17-2026_183430 8:41

so, you know, that, that, that really helps with, with just getting everything very, very fixed.

ty_1_02-17-2026_163430 8:48

Yeah. And you're,

damon_1_02-17-2026_183430 8:49

it,

ty_1_02-17-2026_163430 8:49

are you usually using those GM shorts or do you use a lot of the eight millimeters? The, the regular gm?

damon_1_02-17-2026_183430 8:54

yeah, I mean, I think my, my, my preference, it, always just depends, you know, I, I go, I go back and forth. I, I like the

ty_1_02-17-2026_163430 9:03

Yeah.

damon_1_02-17-2026_183430 9:03

0 7, which is a ti

ty_1_02-17-2026_163430 9:05

Mm-hmm. Yeah.

damon_1_02-17-2026_183430 9:07

You know, and, and I like that because you don't buy a different abutment. You know, the GM abutments or the GM short abutments are different. and it's a more parallel, right? A more parallel implant actually gives you more compression

ty_1_02-17-2026_163430 9:22

Mm-hmm.

damon_1_02-17-2026_183430 9:23

implant.

ty_1_02-17-2026_163430 9:24

Mm-hmm.

damon_1_02-17-2026_183430 9:24

so, you know, that's so, so Paulo Malo, what he created was the Nobel Speedy Groovy, and he was like, we get more compression with the Nobel speedy groovy than you do with the noble active, because the noble active was tapered. And so, you know, that's, that's where the GM Helix really is a great implant because it's apically tapered. But then in, in, in the mid body and the, the coronal portion, is, uh,

ty_1_02-17-2026_163430 9:52

It.

damon_1_02-17-2026_183430 9:53

So it's, it's su super compressive, which is, which is really great.

ty_1_02-17-2026_163430 9:59

Awesome. Awesome. Yeah. I use a lot of, um, four, three by eights and, and five oh by eights in the GMs, but it's

damon_1_02-17-2026_183430 10:06

Typical, typically in the po,

ty_1_02-17-2026_163430 10:08

good.

damon_1_02-17-2026_183430 10:09

typically in the posterior it's, it's all five ohs. Um, and you know, I, I've used a lot of the GM shorts, you know, five oh by five five, and then really that 5 0 7 is, is really fantastic.

ty_1_02-17-2026_163430 10:23

Yeah. That's nice. I might need to try that. That's gonna gimme a little bit more flexibility. That's really nice.

damon_1_02-17-2026_183430 10:27

But, you know, I would, if I'm leaning to a five oh GM short seven. I would rather just use a 5 0 7 tiam max and be able to keep the same

ty_1_02-17-2026_163430 10:39

The same about, yeah. Yeah. That's, Yeah. That, that's kind of what's kept me away from using the shorts is I don't want to use different puppets.

damon_1_02-17-2026_183430 10:46

No, but

ty_1_02-17-2026_163430 10:47

yeah.

damon_1_02-17-2026_183430 10:47

I've, had so many patients where, you know, literally the, the, the nerve is at six mil, six millimeters, seven millimeters, you know, from the crest.

ty_1_02-17-2026_163430 10:57

Mm-hmm.

damon_1_02-17-2026_183430 10:58

so that, uh, five oh by five five works really well.

ty_1_02-17-2026_163430 11:03

And if you're not gonna do any alveo, you can still grab that bi cortical, well. not bi cortical, but you still have the cortex to give you stability, which, which, you know, you get a little more success that way. So, Yeah. Here we.

damon_1_02-17-2026_183430 11:17

Yep. So, you know, here we have one of, one of my cases, uh, for sure. And, you know, patient came back and he was like, oh, you know, I'm, I'm, I'm speaking kind of nasally. And I'm like, okay. And he's like, you know, I'm getting some fluid in, but he is like, not all the time, it's, you know, kinda rare. So I was like, Hey buddy, we're just, let's just take your prosthesis off and let's look under the hood.

ty_1_02-17-2026_163430 11:39

Yeah,

damon_1_02-17-2026_183430 11:40

know, lo and behold, boom, there's this nice little, you know, hole staring back at me. And I'm like, all right, well we're gonna, we're gonna have to fix that. So.

ty_1_02-17-2026_163430 11:49

yeah,

damon_1_02-17-2026_183430 11:50

Uh, you know, again, you know, fixing an OAC, you know, my preference is can I close it a penalized CT graft?

ty_1_02-17-2026_163430 12:00

yeah.

damon_1_02-17-2026_183430 12:01

let's hit the next slide. I think, I think this particular patient, we were not able to, uh, clo close the hole. Yeah. So, uh, know, off oftentimes, you know, I, I run a busy clinic. I'd love to, you know, just be able to take photos all day long. I can't,

ty_1_02-17-2026_163430 12:20

I get it.

damon_1_02-17-2026_183430 12:21

I didn't take a picture of the hole. I think in the chat, I've sent several holes that have been like the size of your thumb, you know,

ty_1_02-17-2026_163430 12:27

Yeah. Yeah,

damon_1_02-17-2026_183430 12:28

uh, it's like, uh, there's, there's not enough connective tissue in the world that

ty_1_02-17-2026_163430 12:32

right.

damon_1_02-17-2026_183430 12:33

that.

ty_1_02-17-2026_163430 12:33

Of course.

damon_1_02-17-2026_183430 12:34

But so, so, so my protocol is, okay, we're, we're going to, get, get the, rotate the pal, rotate the connective tissue graft over. Let me see if that will close it. If it won't, then that's when we have, okay, now we're gonna need to advance the buccal flat fat pad,

ty_1_02-17-2026_163430 12:55

Yeah.

damon_1_02-17-2026_183430 12:56

to close it. And here, you know, we're able to advance the buccal fat and look how nice that

ty_1_02-17-2026_163430 13:01

Beautiful. Yeah. Yeah.

damon_1_02-17-2026_183430 13:03

it's not stringy. It's not pooled. That's, that's what you want your buckle fat pads to look like. If, if your buckle fat pads are stringy, they're, they're just gonna die.

ty_1_02-17-2026_163430 13:12

Yeah.

damon_1_02-17-2026_183430 13:14

but so we pull this forward Know, my preference here is that we wind up with a multi-layer closure. Okay. So we'll have buckle fat, and then this picture to the right is actually the penalized CT graft. And so that is gonna go over, uh, we're then gonna create a trans osseous suture so that we can then suture all of that down and make it very stable. Sometimes I'll secure, so sometimes I, I will secure the buccal into the vestibule as well. Um, but I, I, you know, if, if you can, I, I prefer to get it down to the, uh, maxillary alveolis, so, uh, so buccal fat, connective tissue, and then we'll close it with our mucosa so we get a really nice triple layer, uh, closure there.

ty_1_02-17-2026_163430 14:17

Very nice. So the buccal fat, the ct, and just mucosa closing over the top of it. That's our Tator. Very nice.

damon_1_02-17-2026_183430 14:24

Yep.

ty_1_02-17-2026_163430 14:25

Beautiful. Awesome. Yeah, you can, I mean, you can see how vascular this tissue is, you know? Beautiful. And, that's our closure. Yeah.

damon_1_02-17-2026_183430 14:34

and there's your closure.

ty_1_02-17-2026_163430 14:36

Yeah. Or Damon.

damon_1_02-17-2026_183430 14:37

some, sometimes you have to pay attention to your prosthesis because now you've kind of shortened the vestibule.

ty_1_02-17-2026_163430 14:45

Yeah,

damon_1_02-17-2026_183430 14:46

so you need to relieve your prosthesis a little bit so that you don't wind up cutting into your mucosa

ty_1_02-17-2026_163430 14:53

yeah.

damon_1_02-17-2026_183430 14:53

or, or compressing onto the buccal fat. And also, we need to pay attention posteriorly. there are several times where I will then do a minor sinus crush posterior to this area that I, I move, I move the, the, you know, maxilla a little more, superiorly so that we still have a lot of restorative space

ty_1_02-17-2026_163430 15:25

Oh, okay.

damon_1_02-17-2026_183430 15:25

you gotta

ty_1_02-17-2026_163430 15:26

Yeah.

damon_1_02-17-2026_183430 15:26

think we're gonna have, we're gonna have, uh, connective tissue, we're gonna have buccal fat, all that can wind up taking up

ty_1_02-17-2026_163430 15:33

Getting pinched. Yeah, for sure. And, and when do you recall,

damon_1_02-17-2026_183430 15:38

we'll tap that down.

ty_1_02-17-2026_163430 15:40

do you recall, um. How, uh, how long postoperative this was?

damon_1_02-17-2026_183430 15:46

Well, this picture here is immediately postoperative surgery.

ty_1_02-17-2026_163430 15:49

No, no, no. I, I, yeah, I mean, like, when did he have his initial surgery. and when did the OAC present? Is that, is that usually an early complication? Late?

damon_1_02-17-2026_183430 15:56

It's, it's definitely an early complication. It's, it's within, it's, it's within, uh, three months.

ty_1_02-17-2026_163430 16:02

Okay,

damon_1_02-17-2026_183430 16:04

Yeah. So,

ty_1_02-17-2026_163430 16:07

So, this is another one I stole, um, from Tribe. So this is from, uh, Dr. Bruce Smer. He shared it in the group, so I assume that he'd be all right with us talking about it. Um, and he had, uh, Dr. Juan Gonzalez, uh, come in to help with the closure. And this can be very much like what you already reviewed. Um, you can see this is a really, uh, sizable, you know, OAC we have here on the left. And I think, I don't recall the entire history that Bruce, um, shared. Um, but I, I think that that was a, a zy igo that had to be, um, extracted and they closed over it, and then it opened back up and now they have a, they're dealing with an oac. Yeah. So we kinda just kind of, yeah, go ahead, please.

damon_1_02-17-2026_183430 16:43

know, uh, taking, taking out the sinus, uh, tract and taking out the fistula.

ty_1_02-17-2026_163430 16:48

Mm-hmm.

damon_1_02-17-2026_183430 16:54

Just, uh, here, you know, Juan's getting a really nice, uh, uh, distal incision

ty_1_02-17-2026_163430 17:02

Yeah. And so he's, he, is he reflecting tissue? This is the point of this is to go in from back to front and reflect all the tissue instead of doing it directly over the the defect. Is that what's happening here?

damon_1_02-17-2026_183430 17:15

decision. Uh, go to the next slide.

ty_1_02-17-2026_163430 17:17

Yeah. It shows the whole incision design a little bit. Yeah.

damon_1_02-17-2026_183430 17:21

Yeah. So, um, you know, they did not. They, they wanted to be able to rotate that tissue so he went distal to it so he can actually rotate that tissue more anterior.

ty_1_02-17-2026_163430 17:35

Okay. Oh, okay. Okay. I understand that. Okay.

damon_1_02-17-2026_183430 17:41

And then really nice, uh, description here. You know, this is great. I mean, this is a, you know, across the midline, you

ty_1_02-17-2026_163430 17:49

Mm-hmm.

damon_1_02-17-2026_183430 17:49

incision,

ty_1_02-17-2026_163430 17:50

Mm-hmm. Yeah, that makes sense.

damon_1_02-17-2026_183430 18:03

so just ref, ref reflecting there.

ty_1_02-17-2026_163430 18:06

Mm-hmm. And there's our wedge.

damon_1_02-17-2026_183430 18:11

Yeah. So then that's obviously that, that was rotated from an anterior

ty_1_02-17-2026_163430 18:16

Yeah.

damon_1_02-17-2026_183430 18:16

now rotating that posteriorly and laterally.

ty_1_02-17-2026_163430 18:21

Is there, is there a reason why, I mean, do they typically go that way? Like you're in sizing anterior to posterior, and then you're swinging it back versus going the other direction, like back to forward and then you loop it around?

damon_1_02-17-2026_183430 18:33

so that's, that's a really good question. where does the blood flow come from?

ty_1_02-17-2026_163430 18:38

Uh, well we come coming from? the, the GP ultimately, right?

damon_1_02-17-2026_183430 18:42

Which is in the posterior,

ty_1_02-17-2026_163430 18:43

Yeah,

damon_1_02-17-2026_183430 18:43

So if you, if if, if you, you cut it off at the posterior and then rotate it anteriorly,

ty_1_02-17-2026_163430 18:51

yeah,

damon_1_02-17-2026_183430 18:51

now it's just gonna necros and die because

ty_1_02-17-2026_163430 18:54

yeah.

damon_1_02-17-2026_183430 18:54

it off of its blood supply.

ty_1_02-17-2026_163430 18:56

That makes sense. Makes a lot of sense.

damon_1_02-17-2026_183430 18:58

Very good question. Yeah. Always. These are always rotated from an anterior to a posterior.

ty_1_02-17-2026_163430 19:03

Great.

damon_1_02-17-2026_183430 19:07

And then this is just, you know, one doing that lasso kind of that we talked about, where you're gonna, you're gonna go through your buccal fat several times to really get a good web. I would call it more of a web than a lasso, but

ty_1_02-17-2026_163430 19:21

Yeah, well, yeah, he is. He is in Texas. Well, I guess you are too, so

damon_1_02-17-2026_183430 19:27

we got, we got a lot of spiderwebs here, so I

ty_1_02-17-2026_163430 19:29

Sure thing. Yeah, that makes sense. Dale, there we go. Position,

damon_1_02-17-2026_183430 19:33

just, you know, again, just kind of securing that down with a trans osseous suture

ty_1_02-17-2026_163430 19:39

and I assume that in trying to cover this defect, ultimately we want to have quite a bit of BFP, you know, circumferential to the defect. Is there any guidance on like how much more we need to overlap it?

damon_1_02-17-2026_183430 19:51

so, know, the, the, the buccal fat will contract.

ty_1_02-17-2026_163430 19:56

Yeah.

damon_1_02-17-2026_183430 19:56

that's kind of one of the disadvantages of it.

ty_1_02-17-2026_163430 19:59

Okay.

damon_1_02-17-2026_183430 20:00

I, I would definitely go double the distance that you need. I mean, the, to, to me this is a little risky where, know, if, if the tissues really, so, so, so they, they're, they're beginning to do a split tissue thickness to then advance, advance kind of that lateral and, and kind of, kind of move it medially. You know, the, the, the challenge that you can get there is if, if, if you over score it, you can, you can really kind, uh, impede your, your, your blood supply kind of

ty_1_02-17-2026_163430 20:47

Yeah.

damon_1_02-17-2026_183430 20:48

lateral aspect of it.

ty_1_02-17-2026_163430 20:51

Yeah, that makes sense.

damon_1_02-17-2026_183430 20:53

But you need to mobilize the flap. so, you know, it's, it's really easy to do this when you're doing arch surgery. It, it's oftentimes a lot more complicated whenever you're, uh, fixing a complication from arch surgery because oftentimes, you know, your, your flap hasn't been elevated for as long, it's

ty_1_02-17-2026_163430 21:15

Yeah.

damon_1_02-17-2026_183430 21:17

So, you know, there's, you, you. I always think you do more harm to the patient, uh, with a smaller flap. And, uh, bigger flaps sounds scary to people. They think that, oh my gosh, you know, Mrs. Jones is really gonna be pissed if I give her a big flap. Well, she's really gonna be pissed if you tear the tissue, you know?

ty_1_02-17-2026_163430 21:45

Yeah.

damon_1_02-17-2026_183430 21:46

and then you're gonna have other, other sutures here or there that are gonna contract. So, you know, that's, that's kind of one of the reasons, you know, if you look at, uh, Dan Holtzclaw's remote Anchorage book, I don't like doing of that first molar, kind of lateral incision that he kind of makes.

ty_1_02-17-2026_163430 22:05

Yeah,

damon_1_02-17-2026_183430 22:05

cause o because oftentimes that's gonna be right over,

ty_1_02-17-2026_163430 22:09

I know.

damon_1_02-17-2026_183430 22:10

my, my zygomatic and, and

ty_1_02-17-2026_163430 22:12

Yeah.

damon_1_02-17-2026_183430 22:12

are with a, with an incision running up that hole, uh, you know, ru ru running superior and lateral right over, right over our, our zygomatic. So, you know, my preference is, is I just go straight back all the way over, all the way to the plates and, and, and, and then a nice big lateral, uh, pool.

ty_1_02-17-2026_163430 22:35

Mm. So there, do you do like a releasing incision at all back there, or is it just going so far distal that you're not gonna have as much tension on your flap?

damon_1_02-17-2026_183430 22:43

Yeah, I mean the, the, yeah, it's, it's so far just, I mean, you, I guess you could say, you know, there, there would be a, a, a, a slight vertical releasing incision in that, uh, ular notch.

ty_1_02-17-2026_163430 22:55

Okay. Yeah. Kind of like a hockey stick sort of.

damon_1_02-17-2026_183430 22:59

some people don't even have a, a a, a real notch there. So really it's just going straight back.

ty_1_02-17-2026_163430 23:05

Yeah. Okay. Yeah. no, I, I, I've definitely been adherent to the, uh, releasing incision up that, up that process there, but so often I've found myself having split tissue right where a fixture is, And you know, it, it's just not a, it's not an ideal situation.

damon_1_02-17-2026_183430 23:19

Yeah. And you're compromising blood flow, you know?

ty_1_02-17-2026_163430 23:23

You bet. Yeah, of course.

damon_1_02-17-2026_183430 23:25

So, you know, you know, I know, I know Bruce gave us this. He, he, he says, you know, obviously they were going for three layers of closure, but then somehow he says they got four. I don't know where they got the fourth layer from.

ty_1_02-17-2026_163430 23:40

That was a question that I,

damon_1_02-17-2026_183430 23:46

yeah. So, you know, again, just it's kind of the same principles. Uh, buckle fat, you know, maybe they're calling that fourth layer, you know, maybe some of the tissue that they advanced over that. But

ty_1_02-17-2026_163430 24:00

oh, from the split buckle flap? Maybe. Maybe. Yeah. Okay. That makes sense. Um, I'm curious, would there be any use or utility at all in, in using a, a membrane at all?

damon_1_02-17-2026_183430 24:13

Good question. People ask that kind of stuff all the time. You know, should I graph, should we, should we do generally in these, the least amount of intervention is best.

ty_1_02-17-2026_163430 24:24

Okay. Yeah.

damon_1_02-17-2026_183430 24:27

know, you, you put something there and then, you know, the last thing you want is, you know, now all of a sudden you have something in the sinus and then they get a sinus infection, and then, then, then, then you're back to OAC again after you've already, you know, had all this major, you know, type of work. So generally less is more.

ty_1_02-17-2026_163430 24:45

Okay, cool. And, and I'm curious too. So what if, um, you know, what, if you're in this situation and you use the buckle fat pad during the surgery, what do you kind of have to work with?

damon_1_02-17-2026_183430 24:59

Well that's, that's, that's why I don't,

ty_1_02-17-2026_163430 25:02

Yeah, don't get, don't get in that. Just don't do that. There we go. Fair enough. Okay. So eCOA is the fourth layer, but I, still count three.

damon_1_02-17-2026_183430 25:13

I, I I count three. I I think

ty_1_02-17-2026_163430 25:15

Yeah.

damon_1_02-17-2026_183430 25:15

they're being special here, but that's off. That's all.

ty_1_02-17-2026_163430 25:19

Um, and I wanted to throw this one in'cause we, we kind of alluded to this, um, earlier, um, when it comes to, you know, thinning the tissue and people talk about, you know, bleeders and such, we have a really nice video here and you can see quite a, quite a gusher there.

damon_1_02-17-2026_183430 25:33

Yeah, I mean, you know, you could imagine just left untreated, know, even though that's, that's actually a small arterial.

ty_1_02-17-2026_163430 25:40

Yeah.

damon_1_02-17-2026_183430 25:43

you know, probably, I mean, if you were to leave that for about a minute,

ty_1_02-17-2026_163430 25:51

Yeah.

damon_1_02-17-2026_183430 25:52

I mean, maybe less the entire mouth would be full, full of blood

ty_1_02-17-2026_163430 25:55

There it's overflow.

damon_1_02-17-2026_183430 25:56

20 seconds.

ty_1_02-17-2026_163430 25:58

Yeah. Right there. Yeah.

damon_1_02-17-2026_183430 26:00

so, you know, obviously this patient's under general anesthesia, so I know their blood pre, their blood pressure is low.

ty_1_02-17-2026_163430 26:06

Hmm.

damon_1_02-17-2026_183430 26:07

their blood pressure, there's probably, I bet they're a hundred over 60,

ty_1_02-17-2026_163430 26:11

Yeah,

damon_1_02-17-2026_183430 26:11

be, they could be 95 over, over 60, you know, or

ty_1_02-17-2026_163430 26:16

yeah,

damon_1_02-17-2026_183430 26:16

over over 55. But, uh, and, and you know, I mean, imagine encountering that on a wake patient, you know,

ty_1_02-17-2026_163430 26:25

yeah, yeah. So,

damon_1_02-17-2026_183430 26:27

they're gonna be freaking out.

ty_1_02-17-2026_163430 26:29

no, no question about it. Um, so is your, is your first go there is just electrocautery It's gonna be the quickest thing.

damon_1_02-17-2026_183430 26:35

Totally electrocautery, quickest thing. And you know, you so, you turn the power up on the unit, so you just zap it and it's done.

ty_1_02-17-2026_163430 26:46

Yeah.

damon_1_02-17-2026_183430 26:46

you, you need to act fairly quickly on these, you know, if, if you're dealing with a older patient and if they've already lost, you know, a fair amount of blood, which obviously they do in these surgeries,

ty_1_02-17-2026_163430 26:58

Mm-hmm.

damon_1_02-17-2026_183430 26:59

they, they can have, you know, trouble, uh, getting, you can have trouble getting them from the chair into the wheelchair they could pass

ty_1_02-17-2026_163430 27:06

Yeah. Oh, you bet. Yeah.

damon_1_02-17-2026_183430 27:08

So, you know, it's always, it's always a good idea, postoperatively to at least give your patient a good 500 cc bag of just, um,

ty_1_02-17-2026_163430 27:22

Fluid.

damon_1_02-17-2026_183430 27:22

so, so sodium chloride, just some fluid, right. Just to kind of help, you know, with their homeostasis.

ty_1_02-17-2026_163430 27:29

That's a great idea. Yeah, I love that. Very nice.

damon_1_02-17-2026_183430 27:34

are. We just do a nice little zap.

ty_1_02-17-2026_163430 27:37

Mm-hmm.

damon_1_02-17-2026_183430 27:38

Did we, did we do the zap?

ty_1_02-17-2026_163430 27:40

Uh, I think, I think, well it seems like you, I think you had a tip in there that was gonna work on it. I don't, I don't think this video had this app, but it looked like you'd actually already done it a few times. So do you, um, what is your recommendation on an electrocautery unit?

damon_1_02-17-2026_183430 27:56

Uh. I don't know, just, you know, park Hill makes one,

ty_1_02-17-2026_163430 28:02

Yeah,

damon_1_02-17-2026_183430 28:03

I don't even know the brand that we use, but they're, I think that starts with a, a,

ty_1_02-17-2026_163430 28:08

I got an RE one.

damon_1_02-17-2026_183430 28:09

I

ty_1_02-17-2026_163430 28:09

Is that

damon_1_02-17-2026_183430 28:10

what we have. I think

ty_1_02-17-2026_163430 28:11

okay?

damon_1_02-17-2026_183430 28:11

have. Yep. There

ty_1_02-17-2026_163430 28:12

Yeah, it was like 800 bucks. Like eBay? Yeah,

damon_1_02-17-2026_183430 28:14

those work great.

ty_1_02-17-2026_163430 28:16

yeah,

damon_1_02-17-2026_183430 28:16

Um, you know, the, the, the, the Bantam pros, the, the, the Bovie, that's, that's, that's a really good unit. And, and what's nice is you can, you can really customize all of your tips that you can just order from McKesson.

ty_1_02-17-2026_163430 28:32

yeah.

damon_1_02-17-2026_183430 28:32

Uh, so that's, that's also a really good unit.

ty_1_02-17-2026_163430 28:36

Nice. Uh, and then on this one, so this, this is one that I found that, um, someone had this is had been a student of your course and they sent this over. Um, so patient is looking at an upper all nx. Um, and, and I see this a lot. You've got this really flared. Maxilla here, and I think he will see him kind of rotating our skull here. So we can see, I mean, very intact, you know, lower arch, lots of root canals and implants and things, but, so, got some mileage, but up top whole lot of, you know, traumatic inclusion, your teeth have flared out a whole lot, some skeletal class three going on as Well, in addition to that. So, you know, the question is, you know, can I treat this person with a single arch? Right. Um, because am I gonna end up with a huge interior cantilever? Is there some other way to set them up on the occlusion? I mean, this kind of goes back to that, uh, case two or three we were talking about where we had, you know, some collapse bite. We opened it up, we got some more class two characteristic in there. How, how would you approach a case like this? I know, I know there's more that goes into evaluation, but this is what we have,

damon_1_02-17-2026_183430 29:40

you know, so this, this is, this is a perfect case example. So this is all the information that was given.

ty_1_02-17-2026_163430 29:47

right? This is all I got.

damon_1_02-17-2026_183430 29:48

you know, I just, I just said, I can't help you. Like, I need to see a cef,

ty_1_02-17-2026_163430 29:55

Mm-hmm.

damon_1_02-17-2026_183430 29:55

need to see like facial profile. Like, like, like we, we need to see a smiling, a smiling photo. Like we have, we have absolutely nothing to go off of, you know, other than all they're doing is looking at tooth position and bone,

ty_1_02-17-2026_163430 30:11

Yeah.

damon_1_02-17-2026_183430 30:12

So it's, it's missing really what the whole full arch patient is,

ty_1_02-17-2026_163430 30:17

Great.

damon_1_02-17-2026_183430 30:17

profile, you know, are they overlo? You know, do we need to open'em up? You know?

ty_1_02-17-2026_163430 30:24

I.

damon_1_02-17-2026_183430 30:25

also it goes into planning. I mean, who, who allowed this patient to spend all of this money on the lower teeth

ty_1_02-17-2026_163430 30:32

Yeah.

damon_1_02-17-2026_183430 30:33

with nothing? against it, you know?

ty_1_02-17-2026_163430 30:36

Right, right.

damon_1_02-17-2026_183430 30:38

I mean, I, I would, I would be shocked. I would be shocked if you told me, oh, this patient got this work 15 years ago. They're a, there's no way, those are like zirconia crowns. know, b if you've lost all those upper teeth, you're gonna lose all those lower teeth in a a, a short period of time. Um, so, you know, not really having all of the info, it's really hard to see. I think, I think what I think the pearl here is if this is all the info that you give, like I need to see a SEF full face. I wanna see axial images, um, where, you know, you know, anytime you wanna send something to an advanced doctor, send us the axial, coronal and sagittal images and take the video where you scroll all the way back. All the way forward and then come back like, I want to, I wanna, I wanna see you go forward back, and maybe even forward and back again. And then let's go to the other one. Let's, let's, let's look in the, you know, axial position.

ty_1_02-17-2026_163430 31:47

Yeah.

damon_1_02-17-2026_183430 31:48

you know, all the way down, all the way up. Let's, let's look in the coronal position. that then really gives us such a better example. I mean, I will see people who've been like, oh, I've planned this case and all they're doing is showing like the 3D recon of where their implants are. well, I, I have no idea. You know, how much, how much buccal bone do you have to your implant? You know, where are you in relation to the, the, the crest? Where are you in relation to the lateral nasal wall?

ty_1_02-17-2026_163430 32:18

Yeah.

damon_1_02-17-2026_183430 32:19

so there's, there's really so much, you know, that really kind of goes into, uh, advising on a, on a case like this, you know, the, the possibilities here are endless. I, I, I,

ty_1_02-17-2026_163430 32:31

Yeah.

damon_1_02-17-2026_183430 32:33

I ultimately can't say anything. but I mean, I think that your point is really well taken about like, Hey, this may be a case. Let's open'em up. see how much restorative space we actually have then, then kind of go from there.

ty_1_02-17-2026_163430 32:49

Mm-hmm.

damon_1_02-17-2026_183430 32:51

you know, don't, don't just look in a tunnel and say, okay, I can do crowns and we can do crowns on your lower teeth, and we'll talk about the upper, upper next. I mean, I. Whenever, whenever I talk to a patient and we have a consultation, it is only at the very end of the conversation do I even really kinda look in the patient's mouth. I'm wanting to find out what are your goals, what are your treatment goals? How does all this kind of come in? Like we're, we're gonna go macro and we may not even go micro, you know? Um, so,

ty_1_02-17-2026_163430 33:28

Yeah.

damon_1_02-17-2026_183430 33:30

you know, when, when you're extracting patients' money outta their wallet, you know, think of the end result, right?

ty_1_02-17-2026_163430 33:37

Mm-hmm.

damon_1_02-17-2026_183430 33:38

one little pearl in talking to patients is if you want to go to the beach, that's great, but you better be specific in what beach you want to go to, because I can take you to a beach in Alaska or I can take you to a beach in Cabo.

ty_1_02-17-2026_163430 33:54

Uh,

damon_1_02-17-2026_183430 33:55

we went, we went to the beach, we did what you asked for, but your expectations were a hundred percent or 180 degrees different from reality.

ty_1_02-17-2026_163430 34:04

yeah. I like that.

damon_1_02-17-2026_183430 34:06

always, always something to consider and think about.

ty_1_02-17-2026_163430 34:10

very good. Very good. Let's see if I got any more. I don't think I do. Yeah, I think that's my last one. That's slide 49.

damon_1_02-17-2026_183430 34:18

Sweet.

ty_1_02-17-2026_163430 34:19

Yeah.

damon_1_02-17-2026_183430 34:20

Well, I think, I think just these are all just examples of learning that, you know, you can be a part of. In implant groups that are out there, you know, you know me, I'm not trying to push my stuff. There's, there's so many things that, that are out there. But also we talk about the stuff in Texas Implant Institute in, you know, our all OnX cadaver course in the Zy, zygoma and OID course, and just in our WhatsApp group. So, uh, you know, I would love to help you guys along your journey. You know, visit Texas implant institute.com. I have some videos on there now, and we also have quite a few videos on, uh, our, our YouTube page. So, so, so check those out. And, uh, you know, you know, we're, I'm, I'm, you know, me and Tyler and Soren, we're all, you know, very approachable and,

ty_1_02-17-2026_163430 35:14

Yeah.

damon_1_02-17-2026_183430 35:14

know, we, when when you care about the patient, you know, there's always enough to go around, right? so, you know, it's ultimately caring, caring about the patient, but it's also caring about the doctor and their journey and not having, you know, just a, a, a waiting room full of complications and a waiting room full of problems.

ty_1_02-17-2026_163430 35:38

Yeah, you bet. I mean, I, I, I, you, you've said it perfectly well, and you know, I think that being a part of this community, going to your courses, it, it just needs to be a foundational, um, part of anyone's full arts journey, in my opinion. Um, because you just put together such a good group of, um, people, and there's a whole lot of very honest discussion about, um, how to approach cases, what to do about a case when it's gone south, and it, and it's, it's nothing personal. There's not any judgment attached to that. But I, I have, I learned something from that. Uh, that group every single day. And it's, it's encouraged me to go back, um, Texas implants to do more courses there. And, um, you know, we certainly don't really have any incentive to be singing your praises. It, it really just has been such a foundational part of our development and, uh, you know, I just appreciate you coming back on here to keep sharing what you share. I mean, you were an incredibly busy doctor. You know, you're having third arch months and things like that. You're teaching courses, you're doing all these other things, um, being expert witness and all that, and you still take time to go in and, you know, help me make a little PowerPoint with all these different case examples to, to teach people. And, and I think that's just a really admirable thing that you do. And, uh, I really appreciate you, you know, giving us your time and expertise.

damon_1_02-17-2026_183430 36:39

Sweet.

ty_1_02-17-2026_163430 36:40

Awesome. Well, this certainly won't be the last anyone sees of, of Clark Damon on the Fixed podcast. He's, he is been a repeated guest and certainly a highly valued one. Hope you guys really appreciated. You know, the series that we put together, um, you know, with all these, you know, visual aids with all these cases, I think, you know, this is what we really wanted to do with this podcast. Uh, up to this point, it's kind of been a little bit of a challenge getting some of the media, um, aspect into, um, these podcasts. So we've mostly just been talking about stuff, but I hope you guys appreciate the video content. Um, it's certainly, uh, a labor of love to put it all together, but, uh, I think this is really, um, really helpful. I, I think it's productive. I certainly learned from it and, uh, you know, Dr. Damon has, has been very gracious in giving us this time. So, um, hopefully we'll be back, um, with some more video content for you guys. And, uh, you know, let us know how you like it. Let us know how we can change it, make it a little bit more interactive, um, and, and make it more educational for you so you don't have waiting rooms, uh, full of complications. Just like Dr. Damon said.

damon_1_02-17-2026_183430 37:30

Sweet. All right. Well,

ty_1_02-17-2026_163430 37:31

Awesome.

damon_1_02-17-2026_183430 37:32

on everybody's journey. Sweet.

ty_1_02-17-2026_163430 37:33

You got it. Thank you.