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DIFFICULT EXTRACTION OF ROOT

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doctor dolittle

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Some days ago I had to extract a canine that was distroyed until down the gingival margin.
On the distal, there was a great bone loss because all the teeth were extracted many years ago.
On the mesial there where the lateral and central incisors and so on..
At the beginning I used an elevator( that of the image) to try to mobilize it on the distal and mesial putting the blame of the
elevator between the proximal bone and tooth.
After about 10 minutes I realize that on the distal there wasn’t enought proximal bone to find a right fulcrum. Then I tried
on the mesial putting the blame horizontally between the proximal bone and tooth but the the tooth started to crack a little bit
when I push on it and so I lost part of tooth to elevate.
After 30 minutes a more expert collegue reach me and using a thinner elevator ( no proximator. Unfortunately we don’t have it)
put it vertically and by pushing on the canine, this one went out in only 5 minutes.

My question is ” How can I go on the PDL space?” Do I have to push on the proximal bone towards the tooth? Because i don’t get to put the blame in the PDL space to reach about the half of the height of root.
Do I have to push with a great force?
Please give me a suggestion to overcome the problem of root that are quite deep under the marginal crestal bone and where is not easy to get a fulcrum.
 

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JPIL

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Hi, luxators are always a great help in such extractions. Also, you need also to get buccally and palatally (with great amount of careful moves) so as to loosen the tooth from all aspects. As you said the instrument should be attempted to be inserted almost vertically towards the PDL/socket space with gentle pressure. Force will not help in such cases as you risk trauma due to slipping instrument etc
 
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DoCt0rPeTe

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I recommend that you read Dental Clinics of North America, January 2012, by Harry Dym- Oral Surgery for the General Dentist.
 

Vicviper

Michael De Coro, DMD - AKA Steve McAwesome
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I used to have a really hard time with teeth like this until I started using Luxators, or similar instruments. I remember trying to use elevators, and it is nearly impossible to get a good purchase. As recommended above, I often find a palatal approach to be much safer, and easier to find a purchase, but you do need to work it all around the tooth. Once you get some mobility, if you have some solid tooth, you can grab a Bird Beak (Ash Forcep) and get that guy out of there quick.
 
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