DentaltownUK April 2018 - 27
message board
I'm Getting Myself Hyped Up About an Ext.
A Townie looks for tips on a molar extraction
Hoosh
Member Since: 10/11/11
Post: 1 of 30
I've been tiptoeing into the world of surgical extractions. I've had a lot of great, successful
cases so far. But I have a patient coming in on Friday for the extraction of #19 and I'm getting
nervous for it. It's heavily decayed, thin/curved mesial root-see pic.
I have some thoughts on how I'm going to approach this, but I would appreciate a convo and
advice from all of you. How would you guys go about this? I prefer to go the flapless route. n
1/3/2018
DoctorHowie
Member Since: 02/11/16
Post: 2 of 30
See if you can get some movement by luxating, then cowhorn in furcation. The roots are
fairly straight and along the same axis, so I bet you could get it out in one piece. n
1/3/2018
Rance Davis
Member Since: 01/22/01
Post: 5 of 30
I would luxate 360 degrees, then in the furcation. Go directly to sectioning the tooth (B/L)
and remove the distal root. This can be accomplished in less than five minutes. Use the remaining time to remove the mesial root which may be a little bit of trouble. The key is to not hesitate
on the sectioning. To help conceptually, measure your surgical against the X-ray. If you begin on
the buccal and show caution as you approach the lingual, you'll be fine. n
1/3/2018
Thomasaurus
Member Since: 03/05/13
Post: 6 of 30
I've found that if I can get at least some movement with luxators and elevators before sectioning, the roots will move easier once separated. Also make sure to do a deep section so the pieces
have room to move. If I section shallow and the tooth isn't moving, that is when I've gotten in
trouble with the roots just breaking off trying to elevate. n
1/3/2018
rpiotrowski
Member Since: 01/11/02
Post: 9 of 30
Here's my two cents. Go in a stepwise fashion.
Step 1: Luxate all around the tooth and into the furcation with either a luxator or spade
proximator. Try to get some mobility.
Step 2: Do the same thing with a 301 elevator. (I don't have Tommy Murph's hands and I
can't go straight to a 301.) Try and get some mobility.
Step 3: Cowhorn forceps, squeeze and pump, and figure 8 motions. Try and get some
mobility. (Mobility will make it easier to remove the roots when you go to the next step.)
Step 4: If it still hasn't come out, then section buccal lingually and elevate out each individual root. Hopefully each root is loose by this point and they come out easily.
Step 5: You didn't get enough mobility (or the tooth didn't allow it) and now you are troughing in between the roots to make a space for your elevator to hopefully get some mobility. At
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