Atraumatic Extractions – WHY and HOW? – PDP127

Jaz’s Introduction:
Be very proud of it. And from what I understood, it takes a bit more time, like you need to be a bit be more gentle, need to preserve that precious bone. But from speaking to our guest, Diyari Abdah today, using specialized tools such as the Piezo, like this was all pretty new to me in terms of its applications for atraumatic extractions. But using that, your atraumatic extractions don’t have to be very slow. They can actually be very efficient. So that was a real takeaway for me. Hello, Protruserati. I’m Jaz Gulati, and welcome back to another episode of your favorite Dental Podcast. Today I’ve got Dr. Diyari Abdah, who’s such a fascinating man, like to me he was this like educator and implant dentist in Cambridge. From our conversations, I figured out that he’s been nominated for an Emmy before. He’s got an MBA. He’s a bestselling author. He is got books on business, completely not related to dentistry. He’s a really smart cookie and I’m sure you’ll finding very fascinating, but in terms of what we’re covering today, it’s all about atraumatic extractions. What do you need to use? Can you just use luxators and do everything you need to do with that to call in atraumatic extraction? What is different about a traumatic extraction compared to a regular extraction, and what are the benefits of doing it in this way?

Protrusive Dental Pearl:
Before we get to that though, the Protrusive Dental Pearl. So, today’s pearl is philosophical in a way. It’s gonna give you just generic life advice, and it’s something I just came across in a book. And I just wanna share with you guys, never take advice from anyone who you wouldn’t aspire to be like. So, there might be an amazing dentist, let’s call it a male, for example, male dentist, who’s really cool. But I wouldn’t take advice from this dentist, even if they’re an awesome dentist. If they were abusive to their wife and their children hated his guts and he was failing at every other aspect of his life and he wasn’t looking out for his health, for example. So that’s someone who I wouldn’t wanna switch places with. Cuz for me, I value family very much. And I value relationship with children, et cetera. So just because their dentistry is good, I wouldn’t take advice and especially life advice from someone who’s failing in that regard. And it’s because I wouldn’t wanna switch positions with that person. So, I’d only take advice from someone because advice is quite freely available nowadays. You have to kind of be selective about who we take life and clinical advice from. So always think as a rule of thumb, never take advice from someone who you wouldn’t swap with. If you wouldn’t trade places with that person, you’re probably not best taking advice from that. This episode is brought to you by Enlighten Smiles. The premium brand of teeth whitening. If you do their online training, which I’ve talked about so many times for the link is in the show notes, is well worth it. Even just for the one hour of learning you can do with Payman Langroudi, their training is awesome, but I posted a case recently on my Instagram and my Facebook, so it’s @protrusivedental for Instagram and the Facebook page just lets you type in Protrusive a full protocol. So, 10 images on Instagram, cuz that’s the cap’s kind of annoying and about 25, 26 images on Facebook, how I replaced this lower incisor that was aesthetically failing and a crown, the upper right four. But also, as part of that case, we did some teeth whitening with Enlighten. We got a great result with that. So, you can see the kind of results I’m getting with my whitening plus the vertical preparation that I did on a lower incisor and how I replaced a aesthetically unacceptable lower incisor crown. So that’s all available on social media if you check out the full case. And thanks again to Enlighten for supporting the podcast. Now let’s get to the main episode where Dr. Diyari Abdah.

Main Episode:
Dr. Diyari Abdah, welcome to the Protrusive Dental Podcast. How are you?

[Diyari]
I am very well my friend. Thank you very much for having me. I’m a big fan, by the way, for what you do, and it’s just amazing, you know, the way you described things.

[Jaz]
I really appreciate it, and I’m excited to tap into your brain and share the knowledge with everyone. And just so you know, I always like to give a little bit about how I know someone. So, I know you through Dylan, your son, went to dental school together. And when he always spoke very fondly of you over the years, and I actually didn’t know how involved you were with education implants. And I thought, okay, we have to do an episode. So, we were kind of brainstorming, okay, what should we talk about? And one thing that’s always talked about is atraumatic extractions and perio-implantitis, there’s two separate things, but that’s the main theme for today. But before we delve into that Dr. Abdah, just tell us a little bit about yourself. You’re obviously very much into personal development cuz you were talking about Tony Robbins via WhatsApp the other day or by email. So, just tell us a bit about you. Who you are, where do you work and where you developed this interest in implants over the years.

[Diyari]
Sure. Thank you very much again for having me. I really appreciate it. Yes. I mean, Tony Robbins had a big, major influence in my life many years ago, over 20 years ago. In fact, Dylan was with me. went there on his 15th birthday party, you know, father’s from-

[Jaz]
You are the coolest dad ever!

[Diyari]
To turn to walk on fire. Thank you. So, we have the hat and we have the set of kids. So, we, yeah, we’ve done it. Been there. So, no, it’s always good to revisit these things. I mean, one of my mentors, my special mentor said, in a motivation or it’s a bit like taking a shower. You can’t be motivated once every 10 years and say, ‘That’s it.’ And it’s like a shower you have to take every day. So, there are all these routines you have to get yourself into now, saying all that. I mean, that led me to a different path altogether. I was talking to college students in the States telling me about my story, how I all started. sometimes you need to hear from somebody else, your story. And it was quite a humbling experience because that led to something, something else led to something else. And doors opened and I met great people, you know, like yourselves and when you have an open mind, you know, like a parachute, you do land well, you know, so we ended up doing some charity work in Mexico for orphans. And at the time they invited a some filmographer from Hollywood and they did the documentary. And then one day I get this phone call to my clinic in Cambridge. I’m just this little humble dentist in Cambridge. I get this phone call from the Emmy Award nominee committee, and they said, ‘Well, Dr. Abdah you are invited to the Emmy Awards because you are one of the producers of this documentary, which has-‘ Anyway. Long story short, the documentary-

[Jaz]
That’s so random, and so brilliant!

[Diyari]
So I can brag and say I’m a n Emmy award producer, but that was all for humanitarian efforts and also, I always wanted to develop, I always want to go further. So going back to my dental background. I have two dental degrees from two different countries, and believe me, that’s not my choice, my friend, because I studied in Romania for six years and then, I could not go back to my country at the time, which was Iraq, and I had to move somewhere else. So I went to Sweden, and at the time Sweden was very welcoming, but also very difficult in the face of foreign certificates. So, I mean, the study in Romania was unbelievably helpful in terms of practicality, maybe not so much technological. Now I go to a place where it’s all about technology. But the practicality was quite funny, talking about the extraction later. When we had extractions three, four students had to train on the same patent because you know, one will wiggle it and the other one will do something else, and then we all pretend the tooth is out. We put it back in only because the oral health in Sweden apart from the chewing tobacco that they use sometimes. It’s actually quite high. You don’t see many people with dentures. You don’t see many people. And of course, I was at the clinic where-

[Jaz]
Wow!

[Diyari]
Bruno Merk was only 20 meters away in his office, you know, and some of the biggest names now we hear in the world of perio or implants, they were all either with us or something. So, you can imagine being in that environment now, finished Sweden, then moved down here to UK. My master’s degree in implants. Very early stage, but for about three years. This is interesting bit for about three, four years. I was actually a very, I don’t mean any disrespect. I think there’s greatness about being just a general dentist as doing your thing. Listen, as long as we all do what we do perfectly, I think that’s great. The trouble is to be trying to be master of everything because you’re gonna be master of none in the end. So general dentistry, I loved it, but I wanted to move on from there. And this comes from a guy who, and I just say this to your audience cuz I respect you and I respect them. This is coming from a guy who probably didn’t like to hold a scalpel in his hand, okay. For a few years I thought. I don’t wanna do it, but then I fell in love with Implantology. It was still quite a normal thing to do. I mean, when I finished my master’s degree, I think there was only probably in the tune of 20 people in the UK who had master’s degrees.

[Jaz]
Okay, so Diyari, what I wanna just pick on further is how did you know it was your calling? Because if you hadn’t placed an implant before, I imagined before doing your master’s, and you correct me if I’m wrong, and there weren’t many people doing implants. How did you know to commit to something that you were, was almost like a novel field? I guess it’s a bit like someone nowadays committing to laser dentistry, having limited experience in lasers and committing into a master’s and laser dentistry and whatnot, and going all in. How did you get that sort of premonition?

[Diyari]
Sure. Well, the thing is, as I said before, we were actually only few meters away from Professor Bruno Merk’s office. And this is a guy we used to see you know, around the cafeteria. He used to hang around sometimes talk to us always in that bow tie. And so, everybody wanted to be him. You know, everyone wanted to be, I can’t imagine anybody in my class who actually didn’t wanna place implants. I think, I haven’t followed everybody, but I think most of us actually became Implantologists in the end because there was just such an aura. Such, it was in the air, you know? In Sweden, other department, they did train everybody on implants, so when we came out, we were actually ready to place implants. We already were certified to place implants.

[Jaz]
Wow.

[Diyari]
Yes. As a result, I was already placing implants and then I thought, well, I wanna go a bit deeper in this and do a master degree. Little did I know that a master degree was more academic than practical, so I still then had to go and pursue other forms of knowledge and basically in anything you do, if you wanna do it well, you need to look who’s the top guy and you go for that. So, I had my eyes on somebody for years in the States. So, I just pursued him, and I went to him and I said, look, I wanna learn everything from you. Was there to learn? And then I spent a good time.

[Jaz]
Who was it? Share the name.

[Diyari]
This was Professor Dennis Tarnow. So, Professor Dennis Tarnow. He’s very widely referenced everywhere. I mean, you cannot do your master degree if you don’t have gone through two studies of him. So anyway-

[Jaz]
Yeah, I mean, I don’t do implants, but I still appreciate Tarnow’s, lore of, you know, five millimeters from the crestal bone, the papilla that kind of stuff. That’s all from Tarnow, right? If I’m not mistaken.

[Diyari]
And he’s just an amazing guy. So, and then again, there was a late Carl Misch as well, and I also approached him. So, with Professor Tarnow, there were a few courses happening that I attended. It was only for like 20 people and you got to spend a week with him and that was great. And also with the late professor Carl Misch, I spent some time with him as well. And these are by far the two biggest names out there. And of course, there are other people who have my respect. I’ve been running courses and lectures and things, but I’m still a student, you know, because the learning never stops.

[Jaz]
Absolutely. Well, we’re gonna extract some more fundamental, basic concepts from you today.

[Diyari]
Sure.

[Jaz]
To help those Protruserati listening in and want to gain some nuggets, maybe on their commute to work or chopping their onions as they usually do. Let’s start with atraumatic extractions bit of, you know, I want to remember this lecture, this oral surgeon. At the front of the podium. And she said that atraumatic extractions is bs. And she said this because all extractions by nature should be atraumatic. So why do we have this entire separate field called atraumatic? Another thing I wanna just mention as a buildup to this is I remember being in DF1 and an extraction was, okay, we can do this. But if you wanted atraumatic extraction, it was gonna cost you a little bit more. Can you believe that? So, tell us, what do you think about that statement about, you know, there’s no such thing because all extractions should be atraumatic, and then also what actually is an atraumatic extraction?

[Diyari]
So shall we agree on something, atraumatic extraction? Should it cost more? Because, I mean, the question here is this, I was thinking you know what, Jaz, seriously, I was thinking the other day. When you sent me the question, I said I want to talk about atraumatic extraction. I’ve got a series of lectures that’s, they’re called The Dreaded Extraction, you know, so atraumatic extraction, I thought this is a very interesting question. Who is this atraumatic two or four? Is it to the patient or is it the bone and the surrounding tissue? Or is it to the dentist? Because, I mean, nobody wants to do a difficult extraction on a Friday night, you know, and usually they happen Friday. That’s why I don’t work Friday. So, I don’t see any patients with extractions, it’s just laws of universe. So, I think the definition of atraumatic extraction we can all agree on, it’s probably the best definition or the most clinical, clinically accurate definition will be atraumatic to the surrounding tissue. Bone, soft tissue, everything else because, and then depends what you wanna do with that socket. I saw a video of yours. You were doing some extraction, and I know you’re a big fan of separating roots, and I totally agree with you. Sometimes. I mean, in the old days we used to sit down and try with a root and wrestle with it. And in the end, after half an hour, 40 minutes, people say, oh, let’s get the drill out. Well, why didn’t get the drill out after two minutes? Or from the beginning, why didn’t you-?

[Jaz]
It took me years to actually gain the confidence and the awareness. Actually, why don’t I just skip the trauma inducing part and actually go straight to make my extractions easier? But by sectioning the teeth. So, I’m a huge fan of that. So atraumatic extraction, as you said, is making it kinder to the bone, to the soft tissues for the patient. And so, when we are training at dental school, the way I was taught was we had to only use forceps. We weren’t even allowed to use luxators because what if it slipped and the luxator went through the floor of the mouth or something? Right? So, loads of us were breaking crowns off and then we were being rescued by the tutor who’d come and then, you know, razor flagged, draw some bones section, et cetera. So that’s our background. Obviously, you learn to use luxators and stuff, so if we want to be atraumatic in our extractions, what are the additional skillset that we need and additional tools that we need to be able to achieve that?

[Diyari]
Very good question. Now, my story with atraumatic extraction started with luxators. And you’re right I mean, the whole notion of atraumatic extraction is that instead of horizontal wiggle, you try to lift the tooth out vertically. So, it’s through vertical forces and whatnot. So that then comes the separation of roots. I mean, I sometimes in the past had to separate an incisor root going from distal to mesial so I can separate so I’ve got more control of the buccal. Or sometimes in implantology lately there was this trend to do this leave as like a flake of the root buccally so that you don’t, I mean, that proved to be not such an exceptionally successful thing and mine has evolved over the years. So, I completely agree with what you did on that video, and I think that’s amazing because I think it was upper molar that you were separating the roots. Taking them out one by one. And I was looking at where you were keeping your fingers very accurately, you know, especially that buccal wall. I mean, until you take CT scans of the mouth case after case for implants and things, sometimes you just don’t realize, or you forget how thin this buccal bomb plate is. I mean, it’s just paper thin sometimes. So, at all times that finger has to be there, whether you use a luxator or anything. But lately I’ve gone into Piezosurgery, and I’d like to talk a little bit more about that because I think that’s something which is doable because you are talking about tools. That’s something that’s doable. It’s actually very cheap to buy a device nowadays. I mean, I remember my first device ever that I was like 15,000 pounds. Now, in the old days, most of Implantologists and you know, bone pickers, we all bought these big devices. They used to be coming in a big box and device, but they were pretty much useless. And that’s why most of us, the device ended up in a drawer somewhere. I was actually thinking, where’s mine? You know, I’m sure it’s not in the eBay. But we don’t even know where it is because they were slow. They were hard. It was actually hard work. So sometimes the extraction took me like 10 minutes with the peers that was taking me 45 minutes. I’m like, what’s the point in this? Now they’ve changed and I had the fun and the privilege of being part of a study with my good friend, Professor Angelo Troedhan from Vienna, who’s the president of the International Ultrasonic Surgery Association and or academy rather. We were doing a research study in at University of Bordeaux few years ago, just before covid. And the beauty of that was that we had some human cadaver specimens that we were working with. So, it was a real deal, but also, we had every single, I think this was 2019, and we are supposed to be publishing a paper at some point. But that got delayed because of Covid. We had every single Piezo machine out there that’s available on the market now. We had about 12 of them. I mean, by the way I told you in the beginning of the whole talk tonight, I’m doing something for the first time ever in my life and that is talking without my slides.

So, we have to describe things now, because there’s a photo of me on my lectures when I, there’s a photo of me there with all 12 machines in front of me. So, it was a bit like a top gear kind of thing. And it was nice. I mean, it was me, two other professors. We were having all these toys and we found out that they were not all the same. No wonder why some people get frustrated. So, this is the problem. If we buy the wrong one, we might end up frustrated on losing, you know, our enthusiasm and everything. So, I’m not-

[Jaz]
Excuse my ignorance here, but just want to bring this in. I mean we recently doing up the surgery where I work in, at the practice and my nurse said that ‘Oh, Jaz, you won’t be having a Cavitron anymore. You’re gonna have a Piezon.’ I’m like okay, fine. Can I still do what I’m gonna do with it? She says, yeah, you can do what you want. So, but now will I be able to use that Piezon unit, which is primarily there for your scale and polish kind of stuff, and to remove calculus. Is that the same Piezon I can use for surgery or is it different?

[Diyari]
Excellent question. No, that’s not because it’s all in the frequency. We need to know which frequency are we using. The ones we are using. So basically, a at the end of testing all of these, we found out that three of them were top, you know, got top mark and the one I use. Without mentioning names, I mean, I’m happy to say it if you push me, but-

[Jaz]
You can mention it. It’s fine. It’s cool. It’s cool. You can mention it.

[Diyari]
Yeah. So, it’s called The Cube. It’s from a company called Acteon. It’s a nice little cube. It looks like it was designed by Apple. I mean, if Steve Jobs designed Piezo, it was designed yes. It’s all little Bo and I call it the Jackie Chan because it’s very cute, but very powerful. So that works with a frequency of between 24 56 kilohertz and what it does. So, what they do, the one you mentioned about you might get away with certain things, but definitely not bone cutting and all that. And I hope not. So, the way these work, they work in two ways. They work through ultrasonic vibrations. Okay. So, they’ve got ceramics inside that vibrate through a transducer, and then that translates into the vibrations and the ultrasound or ultrasonic into their tip, and that’s how you cut. But then there’s water coming out as they do, and the water creates this cavitation effect. And the cavitation effect is like micro explosions. You know, when water, it’s almost like micro boiling phenomenon happening in the liquid that’s hitting the hard surface. I call the micro explosion basically. So, what it does, it gives you better visibility, it gives you hemostasis, and also it has a antibacterial property. Why? Because it can break down bacteria, cells, walls, that in that vicinity, which is amazing. You get three, four things, which means it’ll decrease morbidity and increase predictability. Now what are you gonna do without socket, that’s your business. Okay. Are you leaving it? Hope not. Are you putting some collagen plugs in there? I hope so. Are you putting graft material in there just to keep that bone architecture, wonderful. Or are you placing an implant? And of course, I develop this technique called the 360 technique, which has been trademarked and all that. And that is exactly to show how you go about because it’s not just kind of sticking this tip into the periodontal ligament space and hoping that things will break down because after all is designed to break, to cause like micro shattering of the mineralized tissue. The mineralized tissue definitely is not the periodontal ligaments. So why are we breaking here? So, we are actually breaking the bond between the periodontal ligaments and the roots and the momentum. And that’s where these paradigm, you can imagine, you know, if you can imagine a certain five rocket in the days of Apollos, you know how this whole scaffold will come off before it takes off. So that’s what we are trying to break down all these ligaments. So, then the tooth, I had teeth and upper left two, I think it was, if I remember it was beautiful. After we finished all this, it actually popped out. I didn’t even need to listen. Because the water got underneath it just like a, the pressure made the tooth come out, and that was beautiful. Now then after that, obviously, you have the thickness of the bone that you have to then preserve because depending where you do with it, so going back to atraumatic extraction to simplify everything. It’s any extraction that allows you to keep the surrounding structure intact to quite an extent. So, then you could do what you are planning to do with it. Now you do that through separation. Wonderful. And luxators. I’ve done hundreds of those and they’re amazing. Whether you do that through the-

[Jaz]
And that’s about my limit, Diyari I dunno what I couldn’t tell you what a perton looks like. I’ve heard great things about them. Maybe you can tell us about it. But my limit at the moment, my knowledge base is luxators, and sectioning. And those are my skill sets that I use to make my extractions atraumatic, but also just for me to make my extractions predictable more than anything. Atraumatic is actually a secondary outcome for me and being preserving of the soft tissues and the hard tissues. So, I dunno much about Piezotome. I dunno if you’re gonna go in that direction. Are they useful?

[Diyari]
Piezotome are just like the nicer cousins of luxators, you know, they are just kind of a bit more final. They go in that ligament space. Easier, better maybe than narrow. And they have different shapes so you can use it for various you know, corners and things like that. It’s a bit finicky and a bit more fiddly, but there’s a job, you know. But-

[Jaz]
Do you use them much or do you just use your box standard luxators?

[Diyari]
I used to use them. I tell you exactly why I do. I use my for every extraction. And now Dylan, my son, he also uses the piezo for every extract. Every single extraction, so we are fighting over it. We have to buy a new one now. And so, no extraction.

[Jaz]
Let me just make this really tangible. Sorry, Diyari, I just wanna make it really tangible, right? So yeah, the patient’s numb. Let’s say we’re taking out a lower molar, lower first molar, patient’s numb. You’re gonna take your Piezo on, it’s probably a specialized tip of some sort, and you’re gonna use it. I guess in the PDL space all the way around and just describe, because again, I’ve never seen this before. It’s something new to me, so-

[Diyari]
Absolutely fine.

[Jaz]
Yeah. Explain.

[Diyari]
Absolutely fine. One piece of advice is, so if somebody gets excited and they say, let’s get one, the trick is not to- you don’t have a scalpel. So, even the tip looks very aggressive and pointy. The idea is when you go into that PDL space, you don’t go back and forth. You actually go in a pumping direction. So basically, continuously you’re going up and down into that space. Why? A) you wanna allow the water, the spray to go in. That’s where the cavitation happens. And also, the idea is you don’t wanna cut these because if you wanna cut them, you might as well grab it looks later. You grab something else, you know, so you go around them and then you notice how all of a sudden, the tooth becomes slightly looser, then you go back to your luxators. That’s absolutely fine. And you do that, or even sometimes I use the Piezo, I go with my luxator, I go with a separation, and then I go back to my Piezo a little bit and this whole dance could take no more than seven minutes, you know? But it just happens quickly. Everything happens predictably that you said the word predictable before. That’s the name of the game, my friend. Whatever we do, whether it’s a simple humble buccal filling to, I dunno what, is predictability. And so that’s where you do, you go, the machine patient is numb, it’s a lower right, let’s say six. And it’s amazing if you break a root. So, remember when, if we broke a root automatically the bone drill comes out and the whole thing and this entire army of tools will come out. Well, no more. I mean, sometimes Dylan shows me where a tooth came out, but the tooth, the tip was a little bit curved or something and he just grabs the piezo. And because of that cavitation, there’s so much water going in. Sometimes the water actually just lifts that, that root, as long as you create that space around it and when you look down, I’m sure it cuts a little bit of the bone, but nothing that the normal human eye can see. But that’s enough for the tooth to be loose a nd come out. Yeah. So gone the days when I used to lose, I mean, if I didn’t do many 360 socket preservations, I wouldn’t actually go and trademark the name, you know, 360 socket preservation protocol because you can’t be trading a name or trademark a name where it only happens 50% of the time and the other 50%, it doesn’t happen. It’s a bit like Apple saying, well we are apple sometimes we are oranges as well. It doesn’t happen. You have to be consistent. So, in that case, I saw-

[Jaz]
Are there any studies to show how much difference it actually makes? Like, you know, is there studies of teeth are extracted without using techniques that didn’t involve the piezon versus techniques that. Did involve the piezon how much more bone you preserved?

[Diyari]
Absolutely. I mean, there’s so much study out there. There are actually so many books nowadays on the topic and if at some point your audience would love to see a list of things. I’m happy to provide you and then you can put on the telegram or on the chat or somewhere that they can see.

[Jaz]
Sure.

[Diyari]
Because it’s great, because there’s so many, we can’t even talk about them now. But one thing, let me just tell you a funny story is all this is are wonderful. We are all clinicians at heart, but also a practice builder. And I tell you why. One day I see this patient coming, lovely gentleman, and he is sitting in the chair. I look, he got an upper right canine, broken completely. So just a root there, but it’s a bit of a, you know, that nasty diagonal fracture. So I look there and I say, ‘Yeah, so what can I do for you? He said, ‘Well, I would like to take this tooth out, but I wanna preserve the socket. Now all of a sudden, alarm bell starts to ring, preserve the socket.’ Is he a dentist? Was he going on? How does he know about the socket? Did he have a bad experience before? Anyway, long story short, he told me I’m in Cambridge, as you probably know. This guy came from North Cumberland. Now I think that was a good seven-hour drive and I said, ‘Why here?’ He said, ‘Oh my general dentist said that he was at one of the dental shows and he heard this guy lecturing about Piezo and he showed case after case and slide after slide, how he managed to scoop out these roots outta these most difficult areas and he preserved the bone for later on to use with an implant. And he said, because we need to place an implant and he doesn’t do it. He said, so he said to me, you should go to see that guy.’ I said, ‘Well, that’s wonderful, but how did he find me?’ He said, well, I had to ask him. He had to look up, you know, to see who lectured at on that day, what happened. And then he sent other people. And then people send people because they say, oh, it’s so easy. I didn’t feel a thing. And Dylan has a little trick. I like it. He takes a tooth out, he finishes everything, and then he’ll say, so now you might feel a little bit of pressure as we do this. And the patient says, okay. And he says, no, I’m joking with you. The tooth is out. I love that line because it just puts people at ease.

[Jaz]
That’s such a Dylan trick. I know Dylan and that’s such a Dylan thing to do and I love it.

[Diyari]
And to me that’s like handing a referral card to somebody and say, could you refer other people to be, you know, it’s amazing. Seriously. It’s a practice builder and you are talking about your level of expertise in the separation. I would love to invite you one day to my clinic and just show you a few cases and we can get some models. You have a go at it. You just find that it’s so much easier than doing other things.

Now, I did this test, which I shouldn’t have done. I know probably this is gonna be on the internet as they say, or the www’s. But we were doing this clearance down here, so it didn’t really matter that much. Implants were already, we had a two kilos of graft material already. So, and I told the patient, I said I will do two things here. One side of the mouth with this, one side with that. And he said, okay, that’s fine. So signed it all and that was all cool. So, I did one side with a piezo. This is just my own clinical thing, one side with the piezo and I did the other side just with luxators and this is, by the way, is not a secret. It’s all of our lectures. And on the other side, I broke the buccal bone on one of them and on this side I didn’t. Now whether, because I’m now used to the piezo, and I use it before the luxators because like I said, my luxators are complimenting my piezo, that’s a different story, but just pure luxators. And that bone was so thin, it broke. So of course, that was the area that we had to grow most bone and the case was successful later and we placed the 8 implants for him. And he’s happy. But what I’m saying is that whatever works in your house-

[Jaz]
That was a good opportunity for a split mouth study. And I’m glad you did it.

[Diyari]
Exactly. With the patient’s permission and I knew that we are not risking anything. So the effect will be good. Anyway, so the idea is once you do this 360 socket preservation and let’s say that you are an implantologist. A) if you are not an implantologist and you are just doing it, patient broke teeth. General practitioner doesn’t do implants, they have to do the extraction. Well, instead of sending a mess later on to the implantologist, they will love you, if you send them a nice healed socket, beautiful with beautiful height, everything, and if you’ve done some nice cleaning and decontamination of the socket, then even better. So, I think we ought to do it. We have to do something. With any socket that we take a tooth out. And we have different levels of grafting. We say, look, even if you don’t do wanna do anything, because some people don’t wanna do anything, we say, look, why don’t we just play some collagen plugs for you? At least it’ll act like a kind of mini scaffold. It’s good for a while. Until you figure out what’s what. Okay. So-

[Jaz]
I’m glad you said that cuz my next question was gonna be, most dentists listening to this won’t have a piece on, but they’re now gonna, you know, their interests will be peaked, and they’ll be like, whoa, okay, this is something new for me and they’re gonna look into it. And any papers you send, I’m happy to link to ’em. So that’s really good. But I was gonna ask you. For a tip or some advice that you can give for the everyday dentist, young dentist who can, who wants to be atraumatic, and you’ve just given it there. So, to use a collagen plug, just tell us a little bit about that. Does it matter which brand it is? How does it actually work?

[Diyari]
Okay, so the brand, I would say to an extent, stick to a well known brand. You got things like Bio-Oss like Geistlich Company, you got Biohorizons. They do the BioPlug, which we are big fan of it. I use it a lot, Dylan uses it all the time and they look like root shape. They look like a bullet. So, all you need is just to form slightly, and it just goes down. And it keeps us shaped. So basically, what happens, it’ll integrate with the coagulation and becomes an extra scaffold, obviously is not bone grafting per se, but still it’ll buy time and it doesn’t allow the crystal margins to collapse on themselves. Because as we all know when you leave a socket to heal as is trying to heal over, over time, we lose the margins because they come down as part of that healing. And before we know we lost 3, 4, 5 millimeters and then patient might knock your door again. You know, Mr. General Practitioner? I love you, but I now like to have an implant. What can we do? And you say, and that’s why I’m saying. I had people being referred to me and when I look at the bone, obviously you don’t, you have to be careful what you say, but I’m like I just wish that you place something here just as scaffold, you know? And they’re cheap. I mean, those collagen plugs, I think you’re looking at probably 10, 15 pounds a plug, or 20 pounds a plug, so, they’re not that expensive.

[Jaz]
Is this different to the one that I have in my clinic whereby it’s a cube and then we sometimes cut it into two and put it into the mesial root and the distal root. But I don’t think they’re, these ones are that expensive? I mean, not that expensive rule, but it is much cheaper than the 20 pounds. So, are they a different brand, a cheaper brand, you think?

[Diyari]
I think the cubes are made in such way, they’re very sponges. Whereas if you have the two of them and you play with them, you notice with the cube, if you squeeze it, it becomes like a almost like paper. You know, you can squeeze it all the way.

[Jaz]
This has flattened. It’s like flattening a carbo box. Yeah.

[Diyari]
This one is woven in a different way, so it has a bit of a resistance. I mean, some of them go as far as they’re woven in such way that even if you press it, it’s almost like it bounces back a little bit to its shape and that’s something you need compared to those. Listen, at the end of the day, something is better than nothing, and even the cubes, probably half of my career, I used to place those cubes and they’re fine, but just leaving a socket. But one thing is very important. We’ve done the extraction, we’ve done everything, and I hope, sincerely, I hope that everybody grabs that curator or something and just clean the heck out of that socket. That’s the problem. Sometimes we take the tooth out, it took us half an hour. We are shattered. We just wanna send the patient home. No, clean it. And nowadays we have these saline in a little kind of injectable tube kind of thing. I don’t know. It cost probably pennies. Just kind of wash it, rinse a few times, and then put this thing maybe couple of stitches, maybe not. And then you send the patient home. Everybody happy. And they thank you later. And Plantologist will thank you. And going back to our-

[Jaz]
Diyari at the moment, I use just a basic, something basic, the spoon end of a Mitchell’s trimmer. Something as basic as that. And I really spend my time to clean it. And I feel as though over the years I’ve got less dry sockets. Since I started to clean the socket, and this is something that I didn’t always know. It took me five years I’ve done school, a neurosurgeon. I met who helped me taught me to do this. And then because it was over the shoulder teaching, I then inherited it. And now I passed it on to the other dentist. When I went by the chair side, I said no, we are not done yet. Pick up the Mitchell’s trimmer, get the spoon in, clean it. Do I need anything more fancy than that or is that okay?

[Diyari]
That’s perfectly all right. And I think you’re doing a great job there. You just mentioned a word that I forgot. I, since I used the new Piezos, which is about seven years now, or eight years for every extraction. I haven’t had one dry socket, none, zero. Because-

[Jaz]
See, before I would never believe that. But now that I’ve had such a decrease in myself, I totally believe you.

[Diyari]
The thing is, it is not, it’s not me. It’s a technique. It’s a device. Because what happens, because it has this antimicrobial property whereby the microorganisms cell walls break down. Remember through that cavitation, through that micro boiling, so your chance of success is much better, much higher.

Now, I must admit that maybe another reason I don’t see many dry sockets is because probably eight or nine out of my extractions end up with an implant because that’s what I do most. And therefore, by the time they’re referred to me or they’re in my chair, but you asked Dylan the same thing and he will tell you the same thing. I don’t think I’ve ever heard him say about dry socket at all. So yeah, these are the things. So, if anybody is using just forceps, that’s a big no-no. So, the takeaway from here is that either follow your technique, which is amazing. The separation. I still do it today. Or you can add another tool. And hey, we are dentists. We love tools, we love gadgets. You know, anything that you could plug in a wall and use it, I’m all for it. So, try to get to any company really. But one of the good ones is, like I said, is the cube from Acteon. There is-

[Jaz]
I’ve had great things about Acteon. I mean if I’ve always considered, actually before when I was doing a more root canals, they had these really cool instruments for tips for root canals and stuff. So, if I buy a unit, for example, if I was to get a piece on unit for example, from Acteon, is there a such thing as you use it for the surgery, but also you have restorative uses as well, cuz or is it exclusively for surgery?

[Diyari]
There are so many tips that you will probably fall in love with all of them. I mean, you’ve got prep, smoothing tips. You got this tip you got, obviously I use it a lot for bone.

[Jaz]
Now we’re talking, now we’re talking.

[Diyari]
So for prep, smoothing for perio, you know, for root planning, for all kind of stuff. Every time they come up with package of these tips. I’m like, oh my God, here we go again. So now we have to get more tips. So, but it’s seriously, it’s unbelievable. It’s unbelievable. My sinus list, okay. All of them are done with a cube. So why I call it the Jackie Chan, you know, it does it with a smile, but it’s very powerful. It does everything from the small thing to the big thing, so it can kick one person, it can kick a whole gang. So, that’s on atraumatic surgery, so I hope, and because of that, obviously it’ll be atraumatic for the dentist. Hopefully, you know, that’s what we said.

[Jaz]
Yes, and more predictable and less failures and less dry sockets as you said then that’s good.

[Diyari]
So next time, next thing. I think if somebody finds in a dental show anywhere. Go speak to them, talk to them, see what they have, what they show you. And then maybe they run courses. There are courses all over the place for these kinds of things. We run it as well. So go and get that technology. It’ s not expensive, it’s just a bit more expensive than a top end descaler really nowadays.

[Jaz]
No, I mean, it is great. I mean, I knew there were users, for endodontics and preps and stuff, but then the way you described this is all new information in terms of the 360 technique and how much of a difference it can make. So, I’m sure lots of dentist listening have gained from that. You mentioned your courses and stuff. So, Diyari, tell us about Implant teaching that you do. Whereabouts do you do that? How is it run? There’s lots of courses out there, but what is special about yours?

[Diyari]
Sure. No, thank you for that. So, I’ve been teaching and lecturing all over, and for the last probably 10, 15 years, I lost, I think probably I’ve been talking over 250, 300 times in different places, both in the states here and all over Europe. Mainly it was about techniques, you know, certain techniques I teach or certain things. And I always had this idea of this academy at the back of my head. So, it’s been, my academy’s been in the making for 10 years now, and I thought if you do something, which is part of your legacy, I better do it perfectly and not just half the league. So, it’s been 10 years in the making. And finally, before Covid I started the academy, but then Covid happened, and then, because most of the things I teach there are all hands on. So, I found it very difficult or challenging, rather to do it online. And I thought, I just wait. I know this will pass. So, to kill time, I wrote a book that became a bestseller. It’s called Business Not As Usual during Covid, and that went on Amazon.

[Jaz]
Wow. I didn’t know this. I had no idea. Is it specific to the dental niche?

[Diyari]
No, this is for small business owners. You know what to do in times of turn down economics and stuff like that, because few years before that I did an MBA, and right now I’m halfway through my PhD on the back of that. So, I thought, you know-

[Jaz]
Like you said the learning never stops. You are a perpetual student.

[Diyari]
It never stopped. No. So basically this, so then I spoke to a few friends, and I said, listen I need to do something that I always find in courses. There are many courses out there, like you said, and there are some amazing courses. But what I found a lot of time there was this information, fire hose and then you go back and it’s like, okay, now where do we start? What do we do? So, I thought first and foremost, I’m gonna give the each one a roadmap. what is expected to do till next session so that they start doing it, number one. Number two, the other problem with some courses, they last six months or seven months or eight months now, I mean, God knows I’ve been on in courses for that last of the year. I thought I need something that it gives enough breaks to people, but before they forget the knowledge before, we need to get cracking again. So my course is done within five weeks, so like three weekends, Fridays and Saturdays, and then two weekends you know, there’s a break and then Friday. But there’s some work to do in between and that way the information stays fresh. So that was my next thing. So, I had to look a lot into teaching because I used to teach well, currently I’m a faculty, I’m an adjunct faculty at University of Illinois, at Chicago, at the Periodontology department. And also, I did some stuff with work as well after, you know, on the master course. So, I had this ability to teach and make big things, smaller pieces. But then I thought, how do we do this in the accelerator format? So I’ve kind of created this method where, you know, I just give you enough information that is super, super important. That’s used rather than just kind of painting this entire picture for you. Because people can get that information. They wanna know what can I do i n the safest possible way. And again, few I’m expert witness for Implantology as well in course of England and Wales. I did that law certificate few years ago, so I thought, okay, and what is it that keeps ’em out of trouble? You know, let’s do this. So, combining all this knowledge, basically it’s an accelerated learning format for the busy dentist. As long as they dedicate six weekends of the span of five weeks. That’s what the course about. So, at the moment, it has many courses in there on the DA Academy website, and that’s just DA Academy

[Jaz]
I’ll be sure to share that in the comments below and on the show notes so for those who wanna check it out. Can check it out. Did you get to place any implants?

[Diyari]
Well, at the moment, I was about to say that. Now, at the moment, the pinnacle of the whole thing is this accelerated dental implant course that we are doing and the way it works, that I will distill every knowledge that’s out there to be given in practical terms. So, we are ready to place implants. Now in this country, what we do, we place implants on real models. So, these are not human beings, but these models are so real that you have soft tissue, you have to cut it, you have to do all these things, you have to suture it. They’re amazing models. Very super expensive ones. And then from there, the idea is when people want each one, each candidate is actually invited to be with me for a full day looking over my shoulder and they can ask as many questions as they want, we have cameras, we have screens. They’ll be right above my shoulder. They can assist me if they want to and that’s one of the best learning.

[Jaz]
I a 100% agree. That is the most powerful learning I’ve had. It’s always been over the shoulder.

[Diyari]
And you know, they’re not stressed. They’re not stressed. Them doing it while not sewing. And you have to have all these codes between each other. You know, go left, go right, do this, do that. They watch me do it. They learn everything in five weeks, then they come and wash, redo it. And I try not to put two people together. Every dentist will has the right to come for a full day by himself or herself. So, they get full benefit of this. I mean, that is priceless. And then, because sometimes people put two, three people together now on top of that, then if they wanna place implants, I encourage either if they’re close, they can bring their own patients to us and then they can place the implants while under my supervision, which I think is brilliant because we have all the tools and everything around. Or we can arrange to go to their practice for the first few implants. Obviously, there’s some that’s outside the course parameters, but I encourage anybody who wants to place implants the safest possible way and predictable way to go and visit this, you know, the Accelerated Dental Implant course. And you know, Jaz, I’ve always heard great things from Dylan about you. Seriously. And when I met you my respect just grew. And I know this community is very close to your heart. I know that. And now they’re-

[Jaz]
Absolutely the Protruserati. You’re very welcome.

[Diyari]
I would love to extend obviously we have the super early birds on normal pricing, whatever the price is, I would like to extend 10% discount at any stage they wanna join. To them, as long as they mention your name. That’s my gift to all of them, and I hope they take on.

[Jaz]
Amazing. I really appreciate that. It’s funny, actually my buddy Clifton I went see him in Brighton and he said to me ‘Jaz, do you get a lot of course organizers and dentists who teach? Do you get a lot of stick from them? Do you get any hate from them? Because the things that you gave away on the podcast, I paid so much money to get that information and you are giving it away for free.’ He said I said, ‘Listen, I think the podcast serves to help identify people who realize, you know what, I’m inspired, and I want to learn more. So, I actually think course organizers have benefited from the podcast because it’s inspired people who’ve identified, and you know what I want to do better? I want to do different. I’ve now decided that I want to niche in this respect. So, if anyone’s looking into the implant world than I’m sure you’ve learned a lot from Dr. Diyari today in terms of what is possible in an accelerated program and from his wealth of experience and your very interestingDiyari, I have to say with the MBA and this Emmy producer Award and authorship, you are a very fascinating man. So that’s pretty cool. So, just tell us the website again. I’ll put in the show notes.

[Diyari]
So the website is Accelerated Dental Implant Course. That’s the main course at the moment we are running. You can also go to daacademy.co.uk that has different courses, and we are working on the days, but the main one’s accelerated dental implant course. And by the way, you can also give them my email. I’m more than happy to answer questions. And the other thing we do after the course for an entire year, we run this diagnostic and treatment planning WhatsApp kind of connection so that if somebody’s stuck on something, they can always ask me anytime and I’ll be more than happy to plan the case with them. So, my main thing is I want the way I was taught by some people and they made a big influence and impact my life. I want to impact lives of my dental colleagues.

[Jaz]
Absolutely. And that’s very clear. That’s very clear. Well, thanks so much for sharing all that we ran out of time for peri-implantitis. We’ve can definitely in some months but yeah, absolutely. But atraumatic extractions that was really fun. I learned a lot. I’m gonna be looking at the Jackie Chan of the Piezo World. I’ll be finding the Cuban and having a look. Actually, you’ve definitely piqued my interest there. More for, yes, the surgery sounds amazing, but as a restorative geek, I’m remembering all the tips, the preps tips that I saw to take my preps to next level. So, that’s got me very excited actually. This one more thing I can now justify to my wife. Anyway, thank you so much, Diyari. I really appreciate you coming on. Thanks for time.

[Diyari]
My pleasure. Thank you very much. Thanks for having me here. It’s been a pleasure and a privilege.

Jaz’s Outro:
Thank you. Well, there we have it guys. Thank you so much for being a true Protruserati and making it all the way to the end. I always really appreciate you. If you’ve resonated with what Dr. Diyari Abdah had to say, and you have the appetite to learn more from someone who’s so experienced and fascinating as Dr. Diyari Abdah is, then check out his academy, daacademy.co.uk again, I’ll put all the notes in the show notes so you could check out his complete range of courses. Also, the case that I shared with you on Instagram and Facebook where I showed about the whitening case with Enlighten Smiles. That case actually also did a canine riser. So, I’ve got full video showing exactly how I did step by step that canine riser, and dunno if you remember, but I’ve gotten occlusal series every month I’ll send you one occlusal tip. Over 400 of you join my email list for that. It’s completely free and the way you join that occlusion.wtf. The website is actually occlusion.wtf. You just type in your email address, and I’ll email you the tip. So, when you get the email for the canine riser, I’ll also include the video that you might have missed, the very first occlusal tip, which was how to adjust a resin bonded bridge after you re-cement it for the correct occlusion. So, RBB, recementation and occlusion. And then the next one coming is canine riser full-blown technique. I’ve checked out the whole of YouTube. There’s nothing this clear and this on canine rises out there. This is gonna be quite comprehensive and I hope you enjoy it. So do check out occlusion.wtf to sign up for that and be sure to share this with a friend if you found it interesting. Thank you so much.