Dentaltown August 2017 - 36

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4th molar
Member Since: 09/12/15
Post: 43 of 82

I'd rather take out most wisdom teeth any day than RCT'd anything. Do what's predictable
and comfortable for the patient. Pushing, pulling and repeating the same insanity (elevating the
same spot over and over and over) is not better for the patient. Flap that sucker (neatly with a 15
blade), do a conservative trough around it, and see if you get more movement. Sometimes you
get lucky and most the time you don't. Kept troughing or section the root.
Some will disagree, but often you just need a little freedom in another direction to pop that
thing out. And again, the more conservative thing to do is just make it quick for the patient.
Your patients will thank you and if you kept things neat you'll be surprised how good it looks,
even with sutures, after all's said and done. ■
5/17/2017

davidpalmer
Member Since: 04/14/00
Post: 70 of 82

I was discussing these two separate approaches with my assistant just a few days ago as I
broke out a thin proximator and kept wiggling until the stubborn root tip cried uncle. I stated
your average OS would never spend the time. He would've already laid a flap, broke out the
surgical bur, removed bone and been done. Yes, it took a little longer my way and Almunk's
way, but if you were the patient which would you prefer? I would prefer to keep my alveolar
bone, thank you. I think the main reason many don't wedge these tips out is because they don't
have good enough vision and the right instrument. Spade and straight thin proximators are
invaluable in cases like this. ■

5/30/2017

4th molar
Member Since: 09/12/15
Post: 71 of 82

I think patients like the procedures to be quick and painless. Most dentists hear "drill" and
think trauma, but I feel just the opposite. If you use a 701 around root tips, that bone is coming
back. Working in the same area for too long and using pressure affects the recovery. I can't
imagine life without my drill. ■
6/1/2017

Mikehanna
Member Since: 03/22/10
Post: 72 of 82

All really good advice above that will help you get many more teeth out quicker, but I would
like to add that even as you get better at extractions and have more years of experience, you will
always have that extraction case that will look easy to others or even to you when you look at the
X-ray two weeks later.
Sometimes it is not so much the tooth but a combination of where the extraction falls in
your schedule, day of the week, demeanor of patient, your assistant's mood, the alignment of the
planets or stars, etc. There will always be that extraction that just does not feel right even though
you eventually get the tooth out.
Have this in your mind and plan to have a few of these in your career; do not overanalyze
them, just roll with the punches and keep going. Be prepared and accumulate as much knowledge as you can, but also be aware that sometimes it is just a bad day and we all have them. ■
6/1/2017

davidpalmer
Member Since: 04/14/00
Post: 73 of 82

380Dental
Member Since: 07/22/11
Post: 74 of 82

So, quick question. Your mouth, wiggle out the root tip Almunk's and my way or have us lay
a flap and remove buccal bone just so we can get it out faster? Be honest. ■
6/1/2017

Or Option 3, take a thin surgical bur, remove ~1mm of cancellous bone all around the
tooth, and accomplish both at the same time: faster and don't touch the buccal/lingual plates,
and still do it flapless.
The more time you put pressure on a tooth, the more postop pain the patient is going to
have. The longer you work on a tooth, the more postop pain the patient will have.
Most simple terms: You have a tooth and a hole. The object you are removing needs to be

AUGUST 2017 // dentaltown.com

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