Small steps that can have a big impact on challenging extraction cases

10 October 2023

Kate Scheer provides advice on how to prepare effectively.

Not all dental treatments go to plan, and extractions are no exception. Experiences of performing dental extractions can vary greatly, with some procedures being straightforward and the procedure going smoothly. However, sometimes, extractions can be much more difficult than expected, resulting in the need to remove bone to access and extract the tooth. In any case, it is important to be prepared to either refer the case or use more complex techniques to remove the tooth without causing the patient unnecessary distress. There are a number of techniques you may consider should you come across a tricky case, but it is important to have the right equipment on hand and prepare adequately.

What to consider when preparing for extraction

It is important not to overlook the importance of local anaesthetic. Of course, this limits the discomfort felt by the patient, but the methods used to deliver the anaesthetic can make the procedure easier. By administering the anaesthetic between the periodontium and bone, hydrodissection can take place, making it easier to lift the soft tissue away from the bone. It is key to wait approximately ten minutes after delivering local anaesthetic to ensure the site is numb.

Flap design is also a key consideration for this type of complex case. It can have a huge impact on the results of the treatment as you can design the flaps at the beginning of treatment to make them easier to replace post-extraction. Clinicians should take into account the effects of shrinkage caused by scarring as well as the need to spare papillae. In some cases, it may be appropriate to use an envelope technique and make buccal incisions for improved aesthetics.

Clinicians should also take care when raising a flap, as this can be a challenging aspect of treatment. However, the process of hydrodissection described earlier can make raising a flap more straightforward. Additionally, when removing the tooth, doing so in sections can make the process simpler. Clinicians should be sure to measure and section the tooth with precision for the best results.

How timing and teamwork can benefit the procedure

Clinicians should not overlook the importance of teamwork when carrying out extractions. By communicating effectively with members of your dental team, you can implement an excellent support system during extraction procedures easily.

For example:

  • Set up the equipment you expect you’ll need before every procedure
  • Allow time periods for the dental nursing team to access
  • Provide an additional scalpel or handpiece if the procedure is not going to plan
  • Keep the team well informed about the potential requirements of the procedure and encourage them to pass instruments that they think will help

By having systems like this in place, you will be able to move through the treatment phases much more quickly.

Choosing the right equipment in each case

Whilst quality equipment is an investment, it can make a big difference to your treatment outcomes. Quality equipment is key to bringing the techniques discussed to life. Piezosurgery, for example, is ideal for carrying out extractions, especially those that are more complex. It allows you to remove sections of bone without risking injury to the surrounding soft tissues. This type of surgery is precise and usually results in less pain and inflammation than conventional surgery using burs.

Clinicians should also consider investing in high-quality luxators, handpieces, burs (for sectioning teeth), and microsurgery instruments. This will provide the best chance of a successful outcome and minimise the risk of complications as the equipment used will be reliable.

Piezomed from W&H provides you with the benefits of innovative piezosurgery. By using the high-quality system, clinicians can remove only the targeted bone with precision, leaving the surrounding soft tissue and bone undamaged. It is an invaluable tool when extracting teeth. Piezomed Plus features innovative automatic instrument detection, which assigns the instrument to the correct power class. This makes surgery safer and reduces the risk of overloading the instruments. It also makes it easier for dental nurses to easily assist by changing the tip. The Piezomed module integrates seamlessly with Implantmed Plus, with a compact design ideal for any space. The unit is incredibly versatile, improving procedures and results for your patients.

When carrying out dental extractions, it is crucial to be prepared for a difficult case. Not every extraction will be smooth sailing, so in the event that you encounter a challenging case, it is important to be informed of the appropriate techniques, have high-quality equipment on hand, and be backed by the support of your dental team.


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