Strategies for Extracting when Roots Curved Towards Buccal?

Not specific to one case, but I was wondering how you deal with extracting teeth with roots that are curved bucco-lingually? It seems most of our elevator, luxator/proximator, east-west, etc. are all designed to deal with root curvature mesial-distally. I’ve been seeing a lot of them lately on mandibular teeth, and have had several maxillary premolars with the buccal root curved and fenestrating the buccal plate. My strategy has been to remove bone mesial-distally and palatal (if applicable), trying an elevator, breaking the root tip and so on and so forth until it finally wiggles free. I am against the approach of removing the buccal plate to get the thing out. Any other strategies for this scenario? I’d love to get these things out more efficiently.

7 thoughts on: Strategies for Extracting when Roots Curved Towards Buccal?

  1. michael dds says:

    Tough question. Its hard to evaluate degree and complexity of a B/L dilaceration on a saggital view radiograph. A CBCT view would be more beneficial. Clinically significant B/L dilacerations are uncommon.
    Probably best to go with standard figure 8 rotate strategy.

  2. rubia says:

    Hard question. After almost 20 years out of dental school I still follow the same path -periosteal elevator/elevator /spade elevator/forceps (figure 8 rotation) on everything. Of course if I see a tooth that will break down or if I do not have enough to hold, after elevator I go to the flap and handpiece with surgical bur.
    I would also recommend try to rotate as much as you can first. If gets hard, and you think you are not getting anywhere, take a 5 min break, go check hygiene, then come back and give one more try.
    Usually it will get better since you are giving a little bit of time for all the inflammation to build up in the PDL around that root. I rarely have to remove too much of buccal bone, if any.

  3. BJdds says:

    Rubia is right on. Also try to rotate incisors and premolars with a good fitting bird beak type forcep before the appropriate extraction forcep that has a long slender tip. Get purchase by driving the thin beak spirally. Try placing the index finger and thumb on the buccal and lingual as you move the tooth around. Be patient. Graft and barrier with appropriate fees.

  4. OralsurgeryJJ says:

    The most time-efficient approach for me is root dissection mesiodistally.
    insert elevator in the dissected area and single rotation action will do the trick.
    Sometimes root fragments could be left and that could be pain in the ass if you are to search for it. Waste of time, lose of confidence, lose of rapport.
    But guess what, leave it be and 2 months later inflammatory reaction seperates root from
    bone and then root fragment removal is easy peesy.
    The only thing matter is that sometimes root fragment makes quite an inflammatory reaction
    that it makes socket bone melt down.
    Just do some socket preservation at that time and try delayed implant approach. Final result is nothing but fine compared to ‘clean extraction at once + delayed installation’.
    Just make sure you notify to patient prior to extraction.

  5. CRS says:

    The extraction path will follow the root curve. Need to figure out where the tooth is getting hung up. Sectioning it will work but difficult to do with a contra angle hand piece and “ surgical burr”. Would not recommend posted techniques and previous advice. Forceps are great way to fracture roots and buccaneers plate rarely use them. Hope you don’t spend a lot of chair time doing this, not much profit with that.

  6. ljo, DMD says:

    I section all molars as well as any other tooth that looks strange on the radiograph. Even single rooted teeth are easier if split MD or BL as space is created in the alveolus that allow the other fragment to move. This approach saves buccal bone and makes site development easier.

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