Sectioning teeth can be essential when the root configuration prevents straightforward extraction. Roots may be dilacerated, widely splayed, or curved, making it impossible to extract the tooth in one piece. When a tooth is broken down to the bone with no structure to grasp, sectioning becomes necessary.
Key Techniques for Sectioning and Extraction
- Evaluate the Root Configuration: Before sectioning, assess the tooth’s root structure using radiographs. Look for any dilacerations or curvatures that could complicate the extraction.
- Section Early: It’s often better to section a tooth early rather than later in the extraction process. This can prevent complications and make the extraction smoother.
- Create Space by Removing Bone: Remove bone up to two-thirds of the root’s length to create enough space to push the roots into. Ensure you’re aware of anatomical structures like the sinus and the buccal and lingual plates.
- Sectioning in the Lower Jaw: When sectioning in the lower jaw, be mindful of the buccal and lingual plates, especially near the mental nerve. Use a bur tipped towards the center of the tooth to avoid damaging these structures.
- Sectioning in the Upper Jaw: In the upper jaw, consider the sinus proximity. Section through the tooth carefully, ensuring you don’t perforate the sinus. Use a sharp elevator or luxator to expand the bone around the tooth after sectioning.
- Using the Right Instruments: Not all elevators are suitable for every situation. Ensure your 301 elevators or luxators are thin enough to slide down the periodontal ligament (PDL) space effectively. Sharpen or replace old, worn instruments regularly.
Practical Tips for Sectioning
- Feel the Difference: Get accustomed to the tactile differences between cutting tooth and bone. This helps prevent “over-sectioning” and ensures precise bone removal.
- Elevator Techniques: Use sharp elevators to slide down the PDL space. If the roots are still encased in bone after sectioning, use the bur to remove additional bone around the roots.
- Dealing with Root Tips: When root tips break off, create space by removing or condensing the bone around them. Use luxators or thin elevators to wiggle down the PDL space and loosen the root tips.
These techniques can significantly enhance your efficiency and success rate with surgical extractions. Practice these tips, and you’ll notice a smoother, quicker extraction process, leading to better patient outcomes and increased confidence in handling complex cases.
If you found this helpful and want more insights on advanced techniques, feel free to reach out or check our resources on the Dental Success Network. Join me in Ocala, FL, on October 5th for our Efficient Extractions Hands-On Course.
Sincerely,
Dr. Aaron Nicholas
Dental Success Blackbelt Coach
Founder Monday Morning Dentistry
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