To be honest with you, after literally thousands of extractions(do a GPR at a hospital without an affliated oral surgery program and then practice in a rural setting), I really don't think about what to do right to get a tooth out, but what can go wrong. Is the patient on an anti-coagulant, or have they downed a bottle of aspirin in the last 2 days due to pain. Is the PDL space still visible, or are the root(s) potentially ankylosed. Are the roots divergent or relatively convergent in shape. Has the tooth had endo, is the tooth heavily restored and prone to crown fracture. Should I do the extraction surgically or with just elevators and forceps.
After all that, then it's just get into my normal pattern: 2 to 3 carpules of anesthetic depending on type of anesthetic agent, location, patient weight. Wait 5 to 10 minutes for anesthesia onset. Release the gingiva, elevators, forcep delivery of the tooth, socket debridement, guaze packs for hemostasis, post op instructions, pain med/antibiotic scrips if needed.
The best thing once you get comfortable with extractions is to try and follow a set protocol, and always ask yourself after a simple, successful extraction what you would have done if something went wrong. By constantly planning for, and thinking about what to do if something goes less than routine, it will quickly become routine.
