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Walk Through Critical Steps in a Challenging Third Molar Extraction

August 2, 2022 11:57 am Published by

Follow along as Dr.Koerner walks us through some of the most critical steps in easily, efficiently and predictably removing a challenging third molar.

This Tooth Won’t Budge!

xray of a difficult third molarHere is an x-ray showing a lower erupted third molar that would not succumb to luxation with reasonable (moderate) pressure and time. We don’t want to spend too much time using one technique if it’s not working.  Here is how my student moved through the techniques and protocols to extract this third molar efficiently, safely and predictably.

The patient was 38 and the tooth was not about to budge with elevator/luxation. Having an arsenal of techniques, protocols and armamentarium at your disposal gives you plenty of options to save time and avoid unnecessary trauma for the patient.

What you DON’T want to do is: 1) use too much force that fractures bone or tooth, or 2) take too much time.

Choose Your Elevatorschoose an elevator

Use a 77R or a 301 elevator. There is not wrong answer here. Choose your elevator based on your preference. After luxation, the tooth was still not coming out. It was time to move on to the next tool in our arsenal.

KCSI instructors always say “make the tooth smaller or the socket bigger”. We ultimately did both.  After a few minutes of work with an elevator, a triangular flap was made (some may have just used an envelope). Always make your flap large enough to fully visualize and access the site. As it was a 3rd molar, a buccal trough was made for two reasons: 1) from which to luxate and 2) to lessen the body’s grip. (Buccal bone was removed because it is a 3rd molar, otherwise we always want to preserve buccal bone.)

Section the Tooth

section the toothThe tooth was sectioned (3rd picture). Previous efforts had created some loosening. The distal half was first removed then the mesial root rolled out to the distal. The trough and section cuts were with a 702 bur (some may have used a 703).

We also buffered LA to a pH of 7 to enhance the LA. Onset and Anutra are preferred but if strict asepsis is maintained, the non-proprietary method can be used (pictures 4,5).

This extraction, although more challenging, is easy if you know the steps.

Get the Steps:

Learn these techniques and more about getting comfortable with impacted third molars in KCSI’s Continuum 4 (Impacted Third Molar Course with Hands-On Model Surgery).  Our next course happens in September, so register now. To get the course details, visit KCSI.  To receive 10% off this course, take our quick Educational Needs Survey online.

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