Dentaltown August 2017 - 34

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Extracting Brittle RCT Teeth
A premolar problem has this Townie asking for advice midtreatment on a broken #29

jmccartney
Member Since: 07/05/12
Post: 1 of 82

Need some tips on extracting RCT teeth. I usually
refer out any complicated extractions/sinus proximity/
wisdoms, etc., but had a RCT lower premolar (#29)
that I thought I could get out and booked in my chair. I
thought I had it moving with luxator/elevator, but it was
just cracking vertically and kept breaking into pieces.
What would be your plan for extracting this tooth?
It was above the bone when I started but broke it in
pieces down to here. This X-ray is midtreatment. I'm a GP. I think I'm too optimistic and don't
get out the drill soon enough. I worked on this for about an hour up to this point, and then
started to trough M/D and V. Thanks for any tips to help with the next one. ■
5/8/2017

nealofgrafton1
Member Since: 09/05/15
Post: 4 of 82

You need either a sharp 301 or something like a spade elevator/proximator.
I also have a surgical high speed. When in doubt, divide and conquer. No teeth to the distal
means a handpiece. ■
5/8/2017

almunk
Member Since: 12/17/05
Post: 6 of 82

Good light, good loupes, tiny suction tip, sharp spade elevator, and a lot of patience. These
take a while. Seldom have to remove bone or flap. ■
5/8/2017

atadentalcenter
Member Since: 02/17/17
Post: 8 of 82

Have an actual Luxator-brand luxator. I would use the smaller one. Or the Tatum surgical
version. I think he calls them luxating periotomes. You need to create space between the tooth and
the bone. Use the luxator vertically, or use a spade-type instrument, or if you must, use a burr on
the distal. Then put the luxator in the space vertically and sort of twist it. The tooth usually pops
out. Honestly, sometimes at this point you may need a buccal flap and to remove a wee bit of bone.
Just depends on how comfortable you are applying force apical with a blade-type instrument. ■
5/8/2017

almunk
Member Since: 12/17/05
Post: 9 of 82

After taking out thousands of teeth, I hesitate to predict actual times. Sometimes a fiveminute job turns into a half hour. I do usually know within 30 seconds how much of a job it will
be. If I see movement with the first elevator placement, then it is going to be a quick job. If there
is no movement whatsoever, then it will take a while. ■
5/8/2017

jmccartney
Member Since: 07/05/12
Post: 18 of 82

Thank you everyone for posting. I do have a light and 4.5 mag loupes, which I couldn't work
without. But I have a lot of older surgical instruments that I think need updating/sharpening.
I did buy a set of luxators and use the one with the green lines a lot. But I feel it is quite dull
compared to when it was new. Any suggestions on specific periotomes to get, burs, or elevators?
Most of the elevators I have are quite large. ■
5/8/2017

AUGUST 2017 // dentaltown.com

http://www.dentaltown.com/messageboard/thread.aspx?a=11&s=2&f=173&t=292247&g=1 http://www.dentaltown.com

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