While I suppose you should never say never, here are 4 things I really, truly, honestly never do.
1. Retract the palatal tissue by suturing it.
I know this is a popular retraction technique, but I never do this. I think it is inefficient and unnecessary.
A malleable retractor held by my assistant accomplishes superior protection and takes less time.
This technique also uses up suture that would likely “push me over the edge” and require opening another suture packet.
2. Irrigate with an irrigation line connected to the handpiece.
I always have four 60 cc syringes on my mayo for my assistant to manually irrigate with while I use the handpiece.
Handpiece irrigation drives me bonkers. It never seems to go in the right place. It’s not easy to instantly dial up or down in the moment. And, I can’t stand how the irrigation line feels when I hold the handpiece.
3. Load my own implants or drills.
I honestly can’t even load an implant on the handpiece very well. Why? I’ve never done it.
I always have 2 surgical assistants in the operating room with me (in addition to a CRNA). A chairside assistant to my left for traditional surgical assisting and an assistant to my right in charge of changing osteotomy drills and loading implants.
I prefer my assistant to hand me the drill, loaded and ready to go, so I can keep my eyes on the surgical field at all times.
4. Attempt to make my abutment trajectories parallel.
I have changed my thoughts on abutment trajectories over the past ~2-3 years. I used to prioritize abutment parallelism. I have realized with more experience that parallel abutments are not as important as many make them out to be.
What’s more important is that the case is restorable (a path of insertion is maintained). Restorability does not require parallelism.
Rather than strict parallelism, my focus is on ensuring the access holes are in as ideal a position as possible (which usually requires a divergence of abutment trajectories), while still maintaining prosthetic restorability.
While I always like to focus on what we “should do” in full-arch surgery, I also wanted to take a minute to reflect on what “I never do”.
“The essence of strategy is choosing what not to do.”
Michael Porter