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Extraction Tips Part 2

Updated: Jan 8, 2023

Hi everyone and welcome to part 2 of the extraction tips series. We covered maxillary incisors, laterals and canines last time. In this blog today, we will continue extraction techniques covering the maxillary first and second premolars and first and second molars.

Maxillary First Premolar: These teeth generally have two roots. The roots split at the apical third or half and often are thin ! The easiest way to remove these is with the 150 forcep in a traction motion and trying to grab as far apically as possible. You can try luxating as well with straight elevators but be careful of adjacent teeth and restorations.

AVOID excess buccal to lingual motion so that you do not break the thin root tips. If you have difficulty with the forcep or the crown fractures, its often best to split these multi-rooted teeth into individual roots using a surgical burr or the recommended Brasseler burr (859.36.010) I mentioned in my last post . You will want to section the teeth in a mesial to distal direction and then elevate the individual roots separately.

Sectioning a first premolar in a mesial to distal direction

Maxillary second premolars: These are often single rooted teeth. Can use 150 or 150A forcep seated as far apically as possible. Can rock the tooth buccal to lingual with slight rotation until its luxated. As always AVOID excess pressure on the buccal plate so you don't risk the potential of fracture. Its best to support the buccal plate with firm finger pressure.

Maxillary First Molars: I normally recommend to always section these teeth. The tripod effect of the three roots can make removal of these in one piece often very difficult unless the teeth are periodontally involved. You can attempt to use a 53R or 53L pushing apically in a figure 8 pattern to luxate the roots but if you find that the tooth is not giving, its best to section the crown to the CEJ level with a surgical burr first and deal with individual roots. The roots are sectioned in a Y shape pattern and you can use thin elevator or periotomes next.

TIP: for immediate molar implant placement cases, I switch from the surgical burr after sectioning crown off to the recommended Brasseler burr to preserve as much bone as possible in the septum region for stability of implant.

NEVER attempt removal of single standing molar with sinus proximity in one piece-can cause large sinus communication.

Sectioning of an upper molar for removal

Maxillary second molars: These teeth have anatomy that is similar to the first molars. The roots often converge which makes them easier to remove. Can try with a 150 forcep or again the 53R 53L. Sometimes you can even use straight elevators to luxate the teeth if the roots are conical or converging.

I hope you have enjoyed this second part of my extraction tips series.

To read part 3 of our blog on this topic, click here: Part 3

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