how can you get the tooth moving w/ an elevator in less than 30 sec 😱
Now that I come to think of it, I think I always cut connective tissue between teeth and gum instead of PDL. Maybe I should try and see if I can actually cut PDL. I think I have been stop cutting things as soon as I hit the bone.
Is PDL cutter thin enough to cut PDL between teeth and the bone? I am asking this because I had been stopping as soon as I hit the bone.
And if I cut PDL really well, can straight elevator fit there well?
If I fail to cut PDL w/ PDL cutter, is it even possible to fit the straight elevator?
It's really pretty simple. If with regular motions with my elevator, I don't see the tooth starting to move noticeably, quickly, then in my mind atleast either from the root anatomy or sometimes just the presence of a decent amount of good quality bone around that tooth, then prolonged use of the elevator *might* loosen up the tooth eventually, but is more likely to cause more post op damage and discomfort for my patient. I've seen it (and caused it
😱 ) many, many, many times over the years. So now, via having seen what I can do with those instruments in my own hands in my own operatories, I learned over the years that sometimes, the surgical approach is far easier than the simple approach. Also, I will say that just from having looked at the radiographs prior to starting the extraction, I usually have a pretty decent idea about when I'll be going surgical vs. simple in my extraction technique. Lets be honest, if you've got a molar with little radiographic bone loss around it, it's almost always going to come out easier and quicker when it's sectioned as opposed to when it's whole.
is there a guide to how to trough tooth? And if we can trough the tooth, why do some people trough interseptal bones or buccal plate instead?
Yesterday, I sectioned #30 buccolingually, I was able to easily remove distal part of the tooth but not the mesial. Mesial part had no crown and I couldn't fit my elevator. My dentist troughed the interseptal bone and I just couldn't understand why.
And if I have another #30 sectioning case like yesterday, do you think I should just put the elevator at the sectioned area and twist so I can move both pieces together instead of taking distal one out and can't take advantage of distal piece fulcrum?
Troughing and sectioning, that's also something where you need to have a decent idea of both the natural anatomy (alveolar bone, nerve, sinus (if applicable), etc, etc) and also the tooth anatomy (concavities, number of roots, etc, etc). After you've got a grasp on the anatomy, then it comes down to what do you need to do to allow you to get a good purchase point, ON SOLID TOOTH STRUCTURE, with which to use your elevator in an effective way. Sometimes that will mean a big buccal trough, sometimes that will mean troughing out the interseptal bone, sometimes you'll end up troughing literally 360 degrees around the root. You never really know what your surgical access will end up looking like until all of the tooth is out of the patients alveolus and resting on your instrument tray
😀
I will also say that in my own practice, nowadays i'm referring out more and more extractions, not because I don't feel that I can't get the tooth out, but because after I asses the clinical situation (radiographs, clinical mobility, quantity of both solid tooth structure and existing restorations in areas of the tooth that i'm likely to use as purchase points for elevation, etc, and sometimes even the disposition of the patient where I feel that sedation might be in the patients best comfort interest) I make the assesment that it's better for both my bottomline and the patients comfort to refer out. I've done my share of "tough" extractions over the years, so i've got nothing to prove to myself and my extraction skills
