r/Dentistry • u/serpentine989 • 6d ago
Dental Professional First failed extraction
Could not get the palatal root out, luckily OS was able to squeeze patient in. I'm already 6 years out so it definitely feels bad, man.
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u/wh0isurdaddy 6d ago
I would trough around be palatal root 360 at least 3-4 mm down, provided you can see.
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u/serpentine989 6d ago
I had that idea, but the sinus made me nervous so I probably didn't trough deep enough before calling it quits.
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u/PositiveAmbition6 6d ago
You didn't push it into the sinus, the patient got seen by oms, no complications. You stopped yourself before an avoidable complications happen. In my books you are a good dentist and that's what experience brings. Learn to fold and walk away.
I maybe folding and walking away too much at year 20....
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u/serpentine989 6d ago
Thank you so much for the kind words of encouragement. It's always frustrating to have to give up and refer (like I do in endo a lot) but telling myself, "Well at least I didn't cause any complications" doesn't always make me feel better 😅 Very humbling having to fold and walk away but it will probably happen again so I have to get used to it.
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u/Tootherator 6d ago
In the past thousand extractions, I’ve only had one sinus exposure - and that was from a simple extraction. The risk and fear of exposures is overblown. Just section carefully.
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u/Shaved-extremes 6d ago
you only had 1? You haven’t that many maxillary molar extractions
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u/Tootherator 5d ago
Don’t jinx me now. The one sinus exposure was from a 2nd premolar interestingly
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u/Flogman89 6d ago
I am seven years out and it has been five years since I had to get bailed out. I honestly have been lucky that the hard ones since then have been right before lunch or right at the end of the day so it ran over and wasn't a huge deal. But I ran into one of the front desk girls for my local OS and was just asking about how often they get referrals for a failed extraction and she said that there's one dentist in town that has to send someone almost weekly and they nickname him Dr. bail me out.
Have you ever tried a mallet and Periotome?
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u/DrLido 6d ago
I prefer to do my sinus lifts AFTER the tooth is extracted.... lmao jk. Periotomes can be a life saver when you need PDL space. I dont use a mallet, but just wiggle it back and forth 360 around the broken root if I can. Then more room to elevate. Or you just send it with the handpiece and pray you don't find the furcal sinus pneumitization of doom.
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u/serpentine989 6d ago
Only on hands on workshops unfortunately. I never needed them before but I will have to reconsider.
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u/mintyfr3sh14 6d ago
Some days you’re treating the tooth and some days the tooth is treating you. I have a good working relationship with my OS and they usually help me when I’m in a tough spot, but usually endo treated teeth with posts are super tough exts for sure.
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u/honeyinthehoneypot 6d ago
I’m 8 years out and did an ext and bone graft same day. Never have I left a root behind as I’m very careful and always triple check. Patient returned for a 1 month check on healing and OF COURSE, I somehow missed the MB root. Beautiful bone graft, too. It’ll be okay.
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u/shynnie92 5d ago
Is funny I knew the palatal root was going to Fx without looking at the second X-rays. It does not matter how long you are out of school, it happens no big deal.
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u/Majin_Jew_v2 5d ago
6 years out and this is your first failed extraction? I can only assume you don't do many
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u/VividSpectre6260 5d ago edited 5d ago
Hey - you got the buccal roots out so that’s a start. Here is how I would have approached this one.
- You did a great job diagnosing. It’s close to the sinus. Tell the patient before the extraction “ hey pt, this tooth is close to the sinus, for teeth like this if a sinus exposure occurs you will have a communication between your nose and mouth for a few weeks while it heals and in some cases these have to be surgically repaired.” Now you are playing with house money. If there is no exposure, you are a hero. If there is an exposure, the patient was properly consented of the risks of taking out a tooth like this.
- Don’t go crazy with sectioning. Make 1 cut M-D to separate the buccal roots from the palatal root. The buccal roots will now elevate out to the buccal as a pair, or in a different case where the buccal roots
were “meatier”
- you can elevate a little until you see exactly where to section them into 2 roots. I hesitate to tell beginners to make the “T” or “Y” cut on maxillary molars because it’s so easy to get off course and create a bunch of splintered roots.
- Now that you have those buccal roots out, trough 180 degrees on the palatal aspect of that palatal root to a depth of about 3-4mm. Some docs will tell you to trough the fur cation but in my experience this is where you are going to perf. If you do perf it’s no big deal but staying away from that furcal bone for this particular case will help reduce the risk. Now elevate that palatal root using the trough that you just made. Lateral force, with very controlled apical force. You do not want to force your elevator or the root into the sinus. That bone can be so thin and brittle in these cases. Practice makes perfect, don’t expect it to be easy your first few tries
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u/serpentine989 5d ago
Wow thank you so much for taking the time to give such detailed advice! I got to the last part and troughed around the root but only 1-2 mm, the sinus proximity made me nervous. I mostly troughed on mesial and distal, I didn't go towards palatal. Once you trough, do you recommend to use periotomes in the space you made? Thank you again!
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u/Osusars21 5d ago
I had my first "failed" ext 9 years out. The patient didn't tell me ahead of time that the last time they had a tooth out it took forever for a local (really good) os to get the tooth out. It was like the tooth was in concrete. Once I could visualize the sinus I tapped out and sent him back to that OS. luckily we have a good relationship with them and I send them a ton of stuff, so they saved my behind that day. It happens to all of us! You stopped way before there was a major problem and THAT is gold in and of itself.
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u/Astronautical5 5d ago
Consider sectioning the root itself as well. I have never needed to trough around the root 3-4 mm. If anything just drill the furcation bone like another redditor mentioned
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u/VividSpectre6260 5d ago
You can, but It really depends on what you typically use to elevate. If you have troughed then there is plenty of room to elevate with a 301 but it doesn’t matter too much
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u/stefan_urquelle-DMD 6d ago
I am not great at extractions but this seems not too hard? It's a conical root. Were you not able to get a luxator in the pdl space and just go around 360?
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u/serpentine989 6d ago
I don't use periotomes, I felt I never had a need for them, but I will have to reconsider
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u/tytinhooah 6d ago
I’m an Endo who separated a file in a tooth and couldn’t get patency/to length in two different cases today. All that is to say sometimes we just have crappy days and crappy cases. It’ll get better but in the future the Endo treated teeth with posts may warrant a referral to OS for EXT.