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Extraction Tips Part 3

Updated: Jan 8, 2023

Hi everyone and welcome to the final part of my extraction tips series.

Today we will be going over mandibular teeth extraction tips. Mandibular incisors have thin roots. The canines have thicker roots. Generally, a 74 or 151 forcep works well here. You can use a buccal to lingual motion (try to limit buccal motion) with rotation to help luxate the tooth out. When you are dealing with the canines, you need to be more careful as the thin buccal plates often get fractured. I honestly would recommend to use the thin diamond Brasseler burr previously recommended and/or periotome/piezo unit if you don't notice any significant movement to help loosen the tooth.

Mandibular premolars have the same principles as lower anterior teeth, you can use a 74 or 151 forcep and they work well here again in a buccal to lingual motion and rotation to help remove the tooth.

Mandibular first and second molars share common features. The roots of these teeth often diverge. The mesial roots normally curve and more commonly fracture ( ask me how I know ) 150 or cowhorn(23) forceps work well here as long as the tooth is intact. You apply the cowhorn in a buccal to lingual rocking motion while seating the forcep into the furcation. If the teeth do not give, apply the principles of dealing with individual roots. Section the crown to the CEJ and section roots to be elevated with straight elevators or the 30/31(cryer elevators). Sometimes you will need to go again with the thin brasseler diamond burr in the septum bone space between roots to allow space for small elevator. I try to conserve as much of the septum bone if I am planning for an immediate molar dental implant as this will be the bone I require for stabilization of my implant.

Cowhorn(23) forcep in action

Root Tips require luxation for removal. Again I would recommend the use of the Brasseler burr in combination with root picks to gently around root tips. AVOID any bone removal on buccal aspect. TAKE YOUR TIME. Although frustrating, avoid raising flaps and buccal bone removal for extractions even when not considering implant placement. Gently create room around each separated root. Allow for bleeding to occur, as the blood flow around the PDL helps in removal of the roots.

FINAL TIP: If you are planning to place implants at time of extractions, an alternative is to prep your implant osteotomy through the roots using the roots as the guide followed by removal of roots after. Although this can dull your implant drills faster, it does create room for elevation of the roots and allows a path for drilling as the roots provide drill stability which can often be a challenge in cases of thin septums and attempt at implant placement.

Drill through the root technique. Courtesy of Dr. Waji Khan

Immediate molar dental implant stabilized using osseodensification protocol in septum. Dr. Mark Bishara

Hope you have enjoyed this series on extraction tips.

Coming up next: emergence profile management around dental implants.

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