Changes

Dental elevators should not be placed directly mesially and distally but rather on the mesiolingual and distolingual aspects of the tooth. This is to avoid fracture of the rostral mandible.

Dental elevators should not be placed directly mesially and distally but rather on the mesiolingual and distolingual aspects of the tooth. This is to avoid fracture of the rostral mandible.

==Extraction of the Maxillary Fourth Premolar Tooth==

==Maxillary Fourth Premolar Tooth Extraction==

#A pedicle flap provides optimum visibility for extraction of the maxillary fourth premolar tooth.  

#A pedicle flap provides optimum visibility for extraction of the maxillary fourth premolar tooth.  

When making a vertical releasing incision mesial to the maxillary fourth premolar tooth, care must be taken not to incise through the infraorbital neurovascular bundle. A perpendicular rather than divergent incision is less likely to damage the infraorbital vessels and nerve.  

When making a vertical releasing incision mesial to the maxillary fourth premolar tooth, care must be taken not to incise through the infraorbital neurovascular bundle. A perpendicular rather than divergent incision is less likely to damage the infraorbital vessels and nerve.  

#Each root is then gently luxated and extracted individually.

#Each root is then gently luxated and extracted individually.

==Extraction of the Maxillary First Molar Tooth==

==Maxillary First Molar Tooth Extraction==

#The 2 buccal roots are long and slender when compared with the palatal root, and are therefore easily fractured.

#The 2 buccal roots are long and slender when compared with the palatal root, and are therefore easily fractured.

#With the patient in dorsal recumbency, a sulcular incision is made and extended 1-2 mm mesially. Taking care not to damage the zygomatic papilla, a vertical releasing incision can be made into the mucosa, creating a triangle flap.   

#With the patient in dorsal recumbency, a sulcular incision is made and extended 1-2 mm mesially. Taking care not to damage the zygomatic papilla, a vertical releasing incision can be made into the mucosa, creating a triangle flap.   

#If a vertical releasing incision was made, it should be sutured. Otherwise, tension-free closure of the gingiva may not be possible without extensive flap development, and the site may be left to heal by second intention.

#If a vertical releasing incision was made, it should be sutured. Otherwise, tension-free closure of the gingiva may not be possible without extensive flap development, and the site may be left to heal by second intention.

==Extraction of the Maxillary Second Molar Tooth==

==Maxillary Second Molar Tooth Extraction==

*Following appropriate radiography it may be evident that the 3 roots of the maxillary second molar are  fused, making sectioning unnecessary for extraction of the resulting short, conical tooth. In this case, the tooth may be removed intact with an elevator.

*Following appropriate radiography it may be evident that the 3 roots of the maxillary second molar are  fused, making sectioning unnecessary for extraction of the resulting short, conical tooth. In this case, the tooth may be removed intact with an elevator.

*If the roots are not fused, they may be curved and therefore fracture easily. If visibility allows, the tooth may be sectioned as described for the maxillary first molar, and each root removed separately.   

*If the roots are not fused, they may be curved and therefore fracture easily. If visibility allows, the tooth may be sectioned as described for the maxillary first molar, and each root removed separately.   

*Luxators and elevators must be used with extreme caution, as there is often a minimal amount of bone distal to this tooth, and inadvertent dorsal slippage of a luxator can easily lead to orbital trauma or laceration of the maxillary artery.

*Luxators and elevators must be used with extreme caution, as there is often a minimal amount of bone distal to this tooth, and inadvertent dorsal slippage of a luxator can easily lead to orbital trauma or laceration of the maxillary artery.

==Extraction of the Mandibular First Molar Tooth==

==Mandibular First Molar Tooth Extraction==

#This is a very large tooth, the roots of which are often adjacent to the mandibular canal.  

#This is a very large tooth, the roots of which are often adjacent to the mandibular canal.  

#Extraction of a periodontally-sound mandibular first molar tooth is difficult, and may result in iatrogenic fracture. In addition, dilacerated roots may make extraction even more challenging, with an increased risk of root or mandibular fracture.

#Extraction of a periodontally-sound mandibular first molar tooth is difficult, and may result in iatrogenic fracture. In addition, dilacerated roots may make extraction even more challenging, with an increased risk of root or mandibular fracture.