DentaltownUK May 2017 - 75

He's coming in around 2 p.m. Maybe I'll try to get in with cowhorn at first and then section
if it's not coming out. I'm never really sure if I'm using cowhorn right. From what I understand,
it's more like a pumping motion (up/down) instead of a buccal/lingual movement, correct? ■

Lil Toof
Member Since: 06/18/15
Post: 9 of 16

3/15/2017

Yes, get the tips in the furcation. Start with small figure 8 motion, lightly. Read the tooth
feedback, increase figure 8's distances as the tooth shows positive feedback, while also squeezing
the grips tighter and tighter into furcation lifting it out as you go.
Figure 8's, circles, squares, whatever you want. Just a constant controlled movement that
increases in magnitude as the tooth tells you it is OK to do so. ■

Jeromy Thornton DDS
Member Since: 06/15/11
Post: 10 of 16

3/15/2017

I've extracted hundreds and hundreds of teeth just like this. Radix paramolaris (or entomolaris, depending on B vs. L) is extremely common in the Yupik Eskimo population that I treated
for my first four years out of dental school.
These teeth will make you regret attempting them if you don't know what you're doing (or
have X-rays, which we didn't many times).
As Jeromy said, first thing is to get a cowhorn on it. Seventy-five percent of the time this
tooth is going to come right out and be looking good for a nice picture to show. Two-minute
EXT. You'll know if this is possible in about the first 30 seconds though. If you squeeze and
figure 8 the cowhorn and it's instantly loose, you're going to get it out whole. If it feels like it's
sitting in cement, drop the cowhorn and pick up the handpiece.
The other 25 percent you need to section M and D roots (B to L section) and then section
the two distal roots. Get the M root out first if you can. 301 and forceps extraction, usually
pretty easy. Use your B to L section to your advantage but putting a 301 in there and gently
luxating the M and D roots. You're just trying to get a little mobility on the D roots while the
M is still present. Then get your usual purchase on the M of the M root and remove (important
to purchase here so you don't break D roots). Then section the D roots. Your section is M to D.
Get down there to where you see the bone between the roots, don't hope to split it, you'll just
break that distal lingual root off way down there and then be digging for it.
Be aware, the DL root many times has a curve at the apex to the buccal, meaning it wants to
roll out buccally. You should remove the DB root first, then the DL root.
Straight forward, but I've watched these teeth crush even experience exodontists. Here's
your flow: 23 forceps for 30 seconds ---> section M and D roots ---> luxate M and D root gently
within the section you've created---> remove M root ---> section DB and DL roots --->remove
DB ---> remove DL
I think it's very unlikely, but that DL root looks a little shorter and usually that means its
curved. They just want to hold in there when they are like that. Or worse, you break off the last
3mm that's curved, look down the socket and see nothing.
Take X-ray, see there's still a piece in there, look in socket again and see nothing. You're like
what is going on here, then realize, "Oh yeah, it's a curve to the buccal and that little piece of
root is hiding under bone." You have to prep the "roof" of bone off to retrieve it. Probably going
to come out with a cowhorn, but be ready in case it doesn't. ■

HuntNFishNW
Member Since: 12/13/11
Posts: 11 and 13 of 16

Join this
discussion
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search:
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Curious to see how this
case turned out? What
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This thread will be the
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3/15/2017

Lil Toof

Thank you both for your advice! I will update once I'm done. ■
3/15/2017

Member Since: 06/18/15
Post: 15 of 16

dentaltownuk.com \\ MAY 2017

75


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Table of Contents for the Digital Edition of DentaltownUK May 2017

On Dentaltown.com
Mike Gow Editorial
Meet the Team
Howard Speaks
Dental Aid Network
Titanium vs. Zirconia Implants
NASDAL Goodwill
Golden Nuggets
Orthodontist Case Study
Poll—Pediatric Dentistry
Technology: The True Foundation of Your Practice
Continuing Education
Timeout: Chris Barrow
Progressive Bites
Walt Disney's Hollywood Smiles
Dental Imaging: Elaine Halley
MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
The Art of Diagnosis in Endodontics
MESSAGE BOARD: 2nd Distal Root on 36
Social Media Fails
Operation Smile
THROUGH THE KEYHOLE: SURGERY— HOME AND AWAY
Lifestyle Section
History of Dentistry
Student Section
Wish List
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DentaltownUK May 2017 - MANAGING SYSTEMIC DISORDER: STEPHEN HUDSON
DentaltownUK May 2017 - 69
DentaltownUK May 2017 - The Art of Diagnosis in Endodontics
DentaltownUK May 2017 - 71
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