Course Karma

Over-drying etched dentin is one of the classic reasons etch-and-rinse dentin bonding is technique sensitive.

After phosphoric acid etching, the superficial dentin layer is demineralized, leaving an exposed collagen scaffold that must remain expanded for optimal resin infiltration. Excessive desiccation can cause collagen collapse, reduced resin infiltration, and a compromised hybrid layer.

A few important considerations:
- This concern is most relevant when dentin has been phosphoric-acid etched, as with etch-and-rinse adhesives or universal adhesives used in etch-and-rinse mode.
- Self-etch adhesives, or universal adhesives used with selective enamel etching, are generally less moisture-sensitive in this specific way because dentin is not separately etched with phosphoric acid.
- The goal is visibly moist dentin, not puddled water and not desiccated dentin.
- Postoperative sensitivity is multifactorial, but inadequate dentin sealing remains one possible contributor.

👉 Clinical tip: if etched dentin looks chalky, matte, or frosty white, it may be drier than you think.

References:

Popescu M, Malița M, Vorovenci A, Ștețiu AA, Perieanu VȘ, Costea RC, David M, Costea RM, Ștețiu MA, Drăguș AC, et al. Wet vs. Dry Dentin Bonding: A Systematic Review and Meta-Analysis of Adhesive Performance and Hybrid Layer Integrity. Oral. 2025; 5(3):63.

Kwon J, Kim J, Choi D, Kim DS. The Influence of Drying Time, Application Mode, and Agitation on the Dentin Bond Strength of a Novel Mesoporous Bioactive Glass-Containing Universal Dentin Adhesive. J Funct Biomater. 2025 Jul 5;16(7):247.

Bourgi R, Kharouf N, Cuevas-Suárez CE, Lukomska-Szymanska M, Haikel Y, Hardan L. A Literature Review of Adhesive Systems in Dentistry: Key Components and Their Clinical Applications. Applied Sciences. 2024; 14(18):8111.

A palatally impacted upper third molar completely changes your flap design.

A routine buccal flap with a vertical release can leave you fighting poor visibility and difficult access from the beginning.

In these cases, a palatal approach gives broader reflection and significantly better exposure around the impaction.

But as you extend posteriorly, anatomy becomes critical.

The greater palatine artery and nerve can quickly turn this into difficult bleeding if violated, which is why the approach should stay conservative at first: Start small. Elevate gradually. Work from known to unknown.

Want to be mentored on third molar extraction cases?
Our 10-week Third Molar Mentorship Program starts next Saturday.

Apply what you learn in clinic with mentorship and accountability from two oral & maxillofacial surgeons. A program that pays for itself.

Starts Satarday!

Link in bio.

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Bloopers at the end...

This is based on a lecture I gave at the Course Karma Summit that got a surprisingly strong response.

It’s the inspiration behind MAP: Mentorship and Accountability Program.

The idea is simple:

Stop trying to change everything at once.

Focus on the week ahead of you.

Learn something.
Apply something.
Build momentum.

That’s how you actually get better.

Not by collecting more information, but by turning what you already know into action.

That’s what MAP is built for.

EXPIRES TONIGHT: Comment “Replay” and I’ll send you the replay to the Third Molar Masterclass.

The lingual nerve is usually where you expect it.

Until it isn’t.

Most of the time, the lingual nerve sits below the alveolar crest on the lingual side of the mandible. But anatomical variations do exist, and in lower third molar surgery, those variations can matter a lot.

Studies have reported the lingual nerve at or above the alveolar crest in 4.6% to 21% of cases, and within the retromolar pad region in 0.15% to 1.5% of cases.

That’s why, during lower third molar surgery, a buccal incision approach without unnecessary lingual flap reflection is often preferred.

Less manipulation of the lingual tissues.
Lower risk of lingual nerve injury.
Fewer surprises when removing impacted wisdom teeth.

Because in third molar surgery, the nerve you don’t respect is usually the one that humbles you.

The Third Molar Masterclass replay comes down today.

Learn How to Flap, When to Section and When to Stop

Comment “Replay” and we’ll send it to you.

Don’t worry we’ve got you covered 💪. Great to see such a high turnout but we were caught a bit unprepared. Zoom room capacity maxed out 👀

Free Replay available till Sunday!

Link in bio for Third Molar Masterclass

The ADA has officially released its updated Sedation & Anesthesia Guidelines, the first major revision in nearly a decade.

One of the biggest takeaways?

Minimal sedation is not simply defined by the route of administration. Dose, drug combinations, patient response, and physiologic effect all matter.

The updated document also reinforces expectations for:
— Monitoring and emergency preparedness
— Documentation and recovery protocols
— Fasting recommendations
— Emergency drills and team readiness
— Managing patients who unintentionally enter deeper sedation levels

Another important clarification is the role of the Maximum Recommended Dose (MRD) for unmonitored home use, and how exceeding it during a single appointment moves enteral sedation into moderate sedation guidelines.

⚠️ This post is only a simplified educational summary of selected updates and should not replace formal sedation training or review of the complete ADA document.

Sedation remains one of the highest-risk areas in dentistry, and providers should always follow current state regulations, licensure requirements, and appropriate training standards.

🔗 Full ADA guideline document:
Versaci, M. B. (2026, April 20). Ada releases updated sedation and Anesthesia Guidelines. Mary Beth Versaci. https://adanews.ada.org/ada-news/2026/april/ada-releases-updated-sedation-and-anesthesia-guidelines/

Image Credits:
Narcisa Olteanu (Canva), Herzstaub (Getty Images), ChaNaWit (Getty Images)

We’re going LIVE today with our Third Molar Masterclass. Comment “Class” and I’ll DM you a link to register.

When you approach a third molar, flap design is one of the earliest decisions you make, and it often determines how controlled and straightforward the surgery will feel.

For maxillary thirds 👉 I will do a buccal sulcular incision distal to the mesial papilla of the second molar and carry it over the crest of the impacted tooth with a distal/buccal release up the tuberosity.

For mandibular molars 👉 I will also do a papilla sparing sulcular incision around the second molar with a very slight crestal extension distally with a a distobuccal release.

⚠️ Keep the extension buccal, to avoid injury to Lingual nerve and possible tongue paresthesia.

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🎁 FREE EXTRACTION SET (worth $2000)

We’re giving away a full extraction set from SOSA and K&S Instruments to one dentist who attends our Third Molar Masterclass.

How to enter:
👉 Share this post to your stories (any slide) and tag
👉 Register and attend the Masterclass on Wednesday (link in bio)

*Open to dentists in Canada and the contiguous U.S. only.
*Winner announced after the Masterclass Kit ships directly to you.

Between the two of us, these are our go-to instruments we’ve used to remove 15,000+ third molars.

If the tooth doesn’t need sectioning, this combo does most of the work 👉 15 blade + Periosteal elevator + Spade elevator

And when sectioning or bone removal is needed we opt for 👉 702L / 703 fissure bur

Join Dr. Ben Johnson & Dr. Sohaib Soliman on May 6 for a Free Third Molar Masterclass on “How to Flap, When to section, When to stop.” Link in bio.

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Comment “GUIDE” and I’ll DM you NUMB: A Guide to Local Anesthesia!

Whether it’s a resto, endo, crown or anything in between, the guide covers:
👉 Maxillary LA techniques
👉 Mandibular LA
👉 Tips when it doesn’t go NUMB
👉 Supplemental anesthesia
👉 Simplified LA max dose chart

LA can make or break any case. Failed numbness is also one of the most common reasons patients get referred out. So here’s our exact routine for third molar exos:

Upper third molars: PSA block + palatal infiltration Fair warning: palatal hurts. The mucoperiosteum is tightly bound to the hard palate and does not enjoy being separated from it. For sedation cases Dr. Ben Johnson skips the palatal.

Lower third molars: IANB + long buccal nerve block IANB: syringe angled above the contralateral premolars, bone contact and LA deposited into the pterygomandibular space. Long buccal goes in distal and buccal to the most distal molar.

LA of choice: Marcaine + Lidocaine for most cases. Using Exparel? Marcaine only. Exparel is liposomal bupivacaine, slow-release, long postop analgesia from a single infiltration. Highly recommend.

Learn about these techniques and more in NUMB: A Guide to Local Anesthesia.

Comment “GUIDE” and I’ll slide it into your DM’s 😉

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Plz let us know if you are finding these guides helpful.. Or if we should go back to posting cute selfies 😉🍑

Horizontal impactions demand a very deliberate flow once adequate exposure is achieved.

First 👉 the crown is separated from the roots with a vertical crown–root section. The cut is kept precise to avoid creating a crown segment that is wider apically and difficult to deliver.

*If the crown cannot be removed as a single unit 👉 it is further divided into mesial and distal halves, allowing each segment to be removed with less resistance and without unnecessary bone removal.

With the crown out of the way 👉 attention shifts to the roots. Because the previous step already defines the mesial–distal split, purchase points are placed on the superior aspect of the upper root first, followed by removal of the lower root. Elevation is controlled, methodical, and space-driven rather than force-driven.

Throughout every step, the bur cut is kept strictly within tooth structure to protect the lingual tissues and the inferior alveolar canal.

Hungry to learn more?

Join Dr. Ben Johnson & Dr. Sohaib Soliman on May 6 for a Free live Masterclass on Third Molar extractions.

👉 Link in bio.

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