extraction techniques

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bballrules

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Hi, does anyone know a good website where they teach you how to use elevators and other surgery instruments for extractions? Or does anyone have a powerpoint that explains this that they got in school? I haven't done many yet and want to brush up on techniques. My main focus is how to use elevators, for ex: how to wedge them between the tooth and bone, how to apply them(whether apically or horizontally), etc. Thank you for the help!
 
Hi, does anyone know a good website where they teach you how to use elevators and other surgery instruments for extractions? Or does anyone have a powerpoint that explains this that they got in school? I haven't done many yet and want to brush up on techniques. My main focus is how to use elevators, for ex: how to wedge them between the tooth and bone, how to apply them(whether apically or horizontally), etc. Thank you for the help!

This is a skill which requires "Tactile Learning". By that I mean you absolutely need to feel it. Elevator technique CAN NOT be learned from a book or a power point or a video. The only way to learn this one is to get out and do it.

Your Status is listed as Pre-Dental. I would strongly advice you to wait and learn to use elevators under proper tutelage.
 
Have you taken the Oral Surgery portion of your curriculum?

i have. i'm a 4th year now and the only teaching we REALLY got is when rotate through OS clinic and a resident is there to "help".

our course for extractions and basic flap principles last summer was taught online and very poorly done so.

but i'll agree with the above statement, that you just have to DO IT in order to better learn what you're doing.
 
Spend some of your extra time volunteering in the OMFS clinic. The residents/instructors, after getting throught the initial hazing, are the best source for technique and experience. One piece of simple advice, dont be afraid to section teeth. Elevating roots is much easier than elevating multirooted teeth.
 
i second all advice above.

a couple additional tips:
1) separate gingival ct completely, and reflect for proper visualization
--> in other words, don't blindly jab elevator between teeth and rotate

2) small straight elevator is your best friend
--> once you can visualize the tooth and bony interface, place elevator parallel to long axis of tooth at interface and begin to elevate.. strong, slow rotations 10s/each. the reasoning is the pdl has adapted to forces of short duration (chewing) but not long duration

3) learn to section teeth! elevating sectioned roots is a cake walk

hup
 
i second all advice above.

a couple additional tips:
1) separate gingival ct completely, and reflect for proper visualization
--> in other words, don't blindly jab elevator between teeth and rotate

2) small straight elevator is your best friend
--> once you can visualize the tooth and bony interface, place elevator parallel to long axis of tooth at interface and begin to elevate.. strong, slow rotations 10s/each. the reasoning is the pdl has adapted to forces of short duration (chewing) but not long duration

3) learn to section teeth! elevating sectioned roots is a cake walk

hup

Great advice so far! Can't reiterate the importance of sectioning teeth! Pretty much if I can't that that tooth REALLY moving around and/or completely out quickly with just an elevator, I'm reaching for a handpiece and a surgical bur and sectioning that tooth. makes it so much easier for both you and your patient!

Sometimes also having the experience and wherewithall to realize that as a GP there are plenty of cases where even though technically you can do it, referring may very well be in both yours and the patients best interest is paramount! Situations such as the heavy bruxer, or that isolated, non periodontally involved molar, or sometimes even patients of certain nationalities, all situations where you're quite likely to encounter very dense bone, is so much better than having that "oh sh$t, why didn't I refer from the beginning?" moment midway through the extraction 😱 Many times those are cases where the oral surgeon will also have a challenging time with the tooth/teeth inquestion, but since they deal with and/or manage more of those types of cases post operatively than your average GP does, it's quite often more routine and easier on the patient that way. And after all, patient care is what it is all about!
 
i second all advice above.

a couple additional tips:
1) separate gingival ct completely, and reflect for proper visualization
--> in other words, don't blindly jab elevator between teeth and rotate

2) small straight elevator is your best friend
--> once you can visualize the tooth and bony interface, place elevator parallel to long axis of tooth at interface and begin to elevate.. strong, slow rotations 10s/each. the reasoning is the pdl has adapted to forces of short duration (chewing) but not long duration

3) learn to section teeth! elevating sectioned roots is a cake walk

hup

Thank you so much. I'm now a 4th year and I've only done about 10 extractions. I know it takes practice but I'm just trying to refresh and get other ideas on what people do. When I first start with the #9 Molt or any other periosteal elevator, do you try to reflect the papilla as well to get good visualization? Or do you think this is too aggressive? I just wanted to ask you about the elevating part. From what you described, is the elevator sitting horizonally against the tooth? If the pt's bone level is normal, is the concave part of the elevator just sitting around the CEJ where it is touching tooth and bone? Once it's in there, I feel like it always slips off and nothing is grabbing while I'm turning it(like a doorknob motion). Do you have to purposely squeeze it in there as well b/c there might be an adjacent tooth? I've been watching some videos on youtube and sometimes I see the operator wiggle the elevator. Are they just doing this to get a purchase point where they can grab on? Is the point of the elevator to go parallel to the long axis of the tooth or try to go apically while rotating? I know it's a combo of both. When I did mine, I guess I have the mentality of trying to get it very apically, so it looks like it's coming down vertically. When you get mobility, do you go to the other side as well? For ex, if you started mesially do you now go distally? I don't have OS clinic in a while and I was just bored and wanted to learn some more tips. I feel like I'm good with the pdl reflection and forceps. I'm just not sure on how to use the elevator properly. Thanks again!
 
Thank you so much. I'm now a 4th year and I've only done about 10 extractions. I know it takes practice but I'm just trying to refresh and get other ideas on what people do. When I first start with the #9 Molt or any other periosteal elevator, do you try to reflect the papilla as well to get good visualization? Or do you think this is too aggressive? I just wanted to ask you about the elevating part. From what you described, is the elevator sitting horizonally against the tooth? If the pt's bone level is normal, is the concave part of the elevator just sitting around the CEJ where it is touching tooth and bone? Once it's in there, I feel like it always slips off and nothing is grabbing while I'm turning it(like a doorknob motion). Do you have to purposely squeeze it in there as well b/c there might be an adjacent tooth? I've been watching some videos on youtube and sometimes I see the operator wiggle the elevator. Are they just doing this to get a purchase point where they can grab on? Is the point of the elevator to go parallel to the long axis of the tooth or try to go apically while rotating? I know it's a combo of both. When I did mine, I guess I have the mentality of trying to get it very apically, so it looks like it's coming down vertically. When you get mobility, do you go to the other side as well? For ex, if you started mesially do you now go distally? I don't have OS clinic in a while and I was just bored and wanted to learn some more tips. I feel like I'm good with the pdl reflection and forceps. I'm just not sure on how to use the elevator properly. Thanks again!

i'll chime in (albeit rookie mode) ... but what i've been taught is to get the elevator in, rotate the handle and just look to see which tooth moves. this does 2 things 1) you can see if you're perched on bone or the adjacent tooth and 2) if in right spot you're releasing tissue. if you see adjacent teeth move, advance your elevator more apical or just reposition.

i will rotate with elevator pushing on coronal side first (top of concave edge) for a few seconds and THEN rotate the apical side upwards (motion to push tooth out of socket)

once tooth is loose and i see decent mobility i feel its time for forceps. use which ever one fits the tooth in question. use constant force and it typically rolls on out.

i've only sectioned a couple of teeth but i have had help from an OS res doing so. i will say though, once the tooth was sectioned...east/wast popped it out like it was nothing. just saying.

just get in with your OS dept and just watch/assist them. you'll learn a ton!
 
Your school is not getting you enough experience with extractions.

Ten teeth in, I didn't really know how to elevate that well either, but I'd guess that I extracted somewhere in the neighborhood of 200 teeth by the time I graduated. We were also trained by oral surgeons and rarely received instruction from residents.

I don't know how your school's clinic is set up, but if you have a general dentistry clinic and can perform extractions there, do as many as you can before graduation. Tell your professor that you sometimes struggle with the small elevator and see if you can get them to demonstrate for you or give you tips while watching you work.

When you get out you'll be on your own and not have anyone to jump in if you struggle with an extraction so you'll need to learn as much as you can in the next year, especially when to refer.
 
Yea, I know I have little experience. I know I need to watch more and assist. I know that I can't just rely on words and that clinical experience is the best way to learn.

Just wanted to learn some techniques and the way you guys do things so that I can have a better knowledge and gameplan going in to the next surgery block assignements. Thanks for the help.
 
Go to dentaltown and look up tommy murph's thread on extracting teeth. 20,000+ post on extractions and complications. You read through those 2 threads you will know every which way to ext teeth. Won't give you the tactile feel but will give you the book(real world knowledge) of extractions and more importantly complications and how to handle them. The thread title is "I would like to extract teeth" and part 2. He is a genuine doctor who wants to help everyone learn and the thread is very friendly and helpful.
 
don't know if LLU is vastly different from other schools in this regard, but I have done easily 100 extractions both in clinic and at off-site locations. I have no interest in OMFS, but I love extracting teeth (except canines; they are my nemesis). I'm sure this will be different once I am in practice, but I really enjoy the challenge of a tooth that one would automatically say is a surgical extraction and keeping it non-surgical. We get so much more time as students, I guess I take advantage of it to "coax" the tooth out. I have no problem with laying flaps or sectioning teeth, but I would rather just avoid it if I can, and I usually can, so far.

Anyway, I agree with the posts on tactile experience. I had NO idea what the hell I was doing despite all the OMFS lectures when it came time to elevate. My favorite elevators are the ones that look like a cross between a periotome and a 301 or 34 elevator. The thin wedge-shaped head makes getting between the bone and the tooth very easy.
 
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Go to dentaltown and look up tommy murph's thread on extracting teeth. 20,000+ post on extractions and complications. You read through those 2 threads you will know every which way to ext teeth. Won't give you the tactile feel but will give you the book(real world knowledge) of extractions and more importantly complications and how to handle them. The thread title is "I would like to extract teeth" and part 2. He is a genuine doctor who wants to help everyone learn and the thread is very friendly and helpful.


Thanks for the recommendation, this is so awesome!
 
Thank you so much. I'm now a 4th year and I've only done about 10 extractions. I know it takes practice but I'm just trying to refresh and get other ideas on what people do. When I first start with the #9 Molt or any other periosteal elevator, do you try to reflect the papilla as well to get good visualization? Or do you think this is too aggressive? I just wanted to ask you about the elevating part. From what you described, is the elevator sitting horizonally against the tooth? If the pt's bone level is normal, is the concave part of the elevator just sitting around the CEJ where it is touching tooth and bone? Once it's in there, I feel like it always slips off and nothing is grabbing while I'm turning it(like a doorknob motion). Do you have to purposely squeeze it in there as well b/c there might be an adjacent tooth? I've been watching some videos on youtube and sometimes I see the operator wiggle the elevator. Are they just doing this to get a purchase point where they can grab on? Is the point of the elevator to go parallel to the long axis of the tooth or try to go apically while rotating? I know it's a combo of both. When I did mine, I guess I have the mentality of trying to get it very apically, so it looks like it's coming down vertically. When you get mobility, do you go to the other side as well? For ex, if you started mesially do you now go distally? I don't have OS clinic in a while and I was just bored and wanted to learn some more tips. I feel like I'm good with the pdl reflection and forceps. I'm just not sure on how to use the elevator properly. Thanks again!

That previous post is excellent advice.
I'd say it's a lot like shucking oysters. You have to have a purchase before you can rotate.

One detail he didn't clarify that you were asking about is: like he said, position the elevator parallel to the long axis of the tooth. The edge of the elevator should be where the bone and tooth meet. At first it will feel like you describe (slipping off) The thing he didn't mention that I found very helpful is to just push apically for 10 seconds. You will literally feel the elevator sink in, and in many cases, even see the tooth move out a bit.
Once it sinks in a bit, I like to wiggle a bit, and reposition at a slight angle buccaly and push again for 10s. At this point, you should have a pretty good purchase, and you can start to rotate. When you rotate, turn and hold that position for 10 seconds and repeat.

When I rotate, my elevator is tipped to the buccal. I don't elevate when the elevator is straight up and down because that doesn't pull the tooth out, it just pushes it to the side. However elevating vertically does expand the socket.

I put my finger on top of the crown on that tooth and the adjacent one to see which one is moving sometimes. Sometimes you can't tell which tooth is moving just by looking at it.
 
That previous post is excellent advice.
I'd say it's a lot like shucking oysters. You have to have a purchase before you can rotate.

One detail he didn't clarify that you were asking about is: like he said, position the elevator parallel to the long axis of the tooth. The edge of the elevator should be where the bone and tooth meet. At first it will feel like you describe (slipping off) The thing he didn't mention that I found very helpful is to just push apically for 10 seconds. You will literally feel the elevator sink in, and in many cases, even see the tooth move out a bit.
Once it sinks in a bit, I like to wiggle a bit, and reposition at a slight angle buccaly and push again for 10s. At this point, you should have a pretty good purchase, and you can start to rotate. When you rotate, turn and hold that position for 10 seconds and repeat.

When I rotate, my elevator is tipped to the buccal. I don't elevate when the elevator is straight up and down because that doesn't pull the tooth out, it just pushes it to the side. However elevating vertically does expand the socket.

I put my finger on top of the crown on that tooth and the adjacent one to see which one is moving sometimes. Sometimes you can't tell which tooth is moving just by looking at it.

Thanks for the elevating techniques. Do you always reflect the papilla all the way to see? It feels like the elevator is crushing the papilla when it's not reflected, which causes it to necrose? Juniors can't do extractions, when we are on block assignments, we assist the seniors. But, we'll have a lot of block assignments this year during senior year. Summer school is only 12 weeks long and I didn't have any of my blocks yet. A bunch are coming up this fall so I just wanted to refresh. Hopefully I can get a lot done this year. For the guy mocking our school requirements, how much did you do in school? Going to make up a number and say about 500 or something incredible like that huh? Yea, I know you've done a lot but most are probably from your private practice. Well, thanks for all the help, I appreciate everyone's time.
 
Im also wondering what school your at that you have only extracted 10 teeth. I went to university of colorado and by graduation I had ext like 500+ teeth btwn the school and outside rotations. Im not trying to be mean just curious. Also look at dental town they have videos and pictures for surgical ext with flap designs and more, I would research on there before I did impacted thirds at some of my rotation sites as this was not covered well at my school.
 
Great advice so far! Can't reiterate the importance of sectioning teeth! Pretty much if I can't that that tooth REALLY moving around and/or completely out quickly with just an elevator, I'm reaching for a handpiece and a surgical bur and sectioning that tooth. makes it so much easier for both you and your patient!

Sometimes also having the experience and wherewithall to realize that as a GP there are plenty of cases where even though technically you can do it, referring may very well be in both yours and the patients best interest is paramount! Situations such as the heavy bruxer, or that isolated, non periodontally involved molar, or sometimes even patients of certain nationalities, all situations where you're quite likely to encounter very dense bone, is so much better than having that "oh sh$t, why didn't I refer from the beginning?" moment midway through the extraction 😱 Many times those are cases where the oral surgeon will also have a challenging time with the tooth/teeth inquestion, but since they deal with and/or manage more of those types of cases post operatively than your average GP does, it's quite often more routine and easier on the patient that way. And after all, patient care is what it is all about!


I'd say young african american males' bone is mostly very dense and unyielding. I do these cases to relieve them of the pain of course but more often than not the non restorable lower 1st and 2nd molars are sectioned and elevated. Had tuberosity bone come out for Upper wisdoms even after pre-luxating with a periotome all around. Using a periotome is a good idea for the least traumatic/atraumatic extraction specially if you're placing an implant at the same visit.
 
Oral surgery rotation was the most crucial thing I did in dental school. Get in there and get your hands dirty! You can't mess up! Worst case scenario, pt loses the tooth.

IMO it's very crucial to get your hands dirty doing OS while you have someone over your shoulder. If a tooth breaks, keep at it until you can't go anymore. It's all about getting a pivot point and leveraging the tooth (or root) out.
In private practice I've broken teeth off, roots dangling in the sinus
, but having that experience kept me cool and able to avoid complications. Confidence is key.
 
And to comment on above: african Americans' bones are like marble. Not racist, just fact. Hard extractions.
 
the advice on this thread about extraction techniques is very detailed
 
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