Dentaltown July 2021 - 24

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Patience With Extractions
(A Walkthrough and a Few Tips)
This seasoned Townie shares tips on how to successfully complete a variety of extractions
palmers31
Member Since: 07/30/08
Post: 1 of 36
I'd like to share some tips I've learned over the past few years of doing more extractions than
I ever have before. (I've been in practice for 13 years and have experience with extractions, but
this is the fi rst time I've done this many, this often.)
A little more background: Two years ago I started helping out a local denturist by doing
extractions at her offi ce. It's evolved into me working there up to four to fi ve days a month,
extracting up to 80 teeth a day sometimes. I'm sure many of these tips have been discussed ad
nauseum, but here goes anyway:
1. I play a little game in my mind each time I seat a patient. I see how gently, and with
minimal pressure and minimal alveolar bone/tissue disruption, I can take out a tooth.
My goal is to have the patient not even be aware I'm doing anything. That doesn't always
happen, of course! But that's what I work toward.
2. Most times, I immediately go to forceps. Even on teeth broken to the gumline. I'm using
Karl Schumacher apical retention forceps and they are a beautiful thing. Ninety percent of
the time, I can remove the tooth without sectioning, using an elevator or fracturing a buccal
plate. Here are a couple examples of teeth that, with enough patience, came out in one piece.
[Editor's note: In the online version of this thread, " Palmer31 " included a video and links to his
preferred type of forceps for each situation he describes below. To access the links and view this entire
conversation online, hold your cameraphone over the QR code we've placed on page 27. Or, go to
dentaltown.com/magazine and fi nd this thread in the Message Boards section.]
For upper anteriors:
Grasp the root as apical as possible with the forceps (preferably apical retention forceps). With
your nondominant hand, stabilize the maxilla and the buccal plate-this way you can offset any
force applied with the forceps so the net result keeps the patient's head in place. Next, twist left
and right, gently. Don't rock buccal lingually yet. And here's an important note about twisting:
Start by twisting with your wrist-sometimes the tooth comes right out. But if not, lock your
wrist and twist from your forearm. If the tooth still doesn't come out, lock your forearm and
shoulder and move your entire body left and right. Slowly and gently. These aren't big movements
here; they are quite small, actually. But with each " locking " (wrist, forearm, shoulder, body) you
increase the force applied to twist the root out of the socket. I sit for extractions, so moving my
body means rolling my chair left and right to get the maximum rotational force on the tooth
while my arm is completely locked. It's kind of like putting a breaker bar onto a torque wrench
when working on a car.
For upper premolars:
Again, grasp the root as far apically as possible. Upper premolars often have two roots, so
you have to be careful not to fracture them. And again, rotate the tooth left and right using the
mechanics described above. Most times this will feel like it doesn't do much, but keep at it. Put
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