How To Extract Erupted Lower Third Molars | OnlineExodontia.com — Transcript

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1. 0:07erupted lower third molars are some of
2. 0:09the easiest teeth to remove in the mouth
3. 0:11and some of the most difficult teeth to
4. 0:13remove in the mouth and just like any
5. 0:15other tooth now the thing is as we move
6. 0:17posterior lis we need to remember that
7. 0:19the access for these gets more difficult
8. 0:21visibility gets more difficult and we're
9. 0:24getting closer to some of the vital
10. 0:25structures in the jaw now these are
11. 0:27important things to know because if we
12. 0:29run into complications things can be a
13. 0:31little bit more difficult to deal with
14. 0:32and maybe a little more serious so we
15. 0:35need to have good confidence we need to
16. 0:36be very comfortable extracting teeth
17. 0:38before we get into this type of
18. 0:40extraction so we're going to look at how
19. 0:42we do this right away in this video the
20. 0:44first thing to look at is we need a good
21. 0:46pan or a good PA to show us where that
22. 0:48nerve canal is in relation to the roots
23. 0:51of that tooth typically we're in the
24. 0:53clear when they're erupted like this but
25. 0:55we still want to be sure and we want to
26. 0:56make sure we can see the entire apex of
27. 0:58that tooth now as we get going on this
28. 1:01what we're gonna do is we're gonna start
29. 1:02with our periosteal elevator and again
30. 1:05we want to stay fairly clear if the
31. 1:06lingual tissues throughout this
32. 1:08extraction don't crush the tissues make
33. 1:10sure you have good visibility when
34. 1:11you're placing a forceps or when you're
35. 1:13poking with your periosteal we want to
36. 1:16start on the buccal right between the
37. 1:17third molar and second molar I will
38. 1:19often use the concavity of that
39. 1:21periosteal in this direction to sink it
40. 1:25in between the teeth and pry away and
41. 1:27that will move the papilla away from the
42. 1:30bone to allow you to get your elevator
43. 1:32deeper in between these teeth and allow
44. 1:34you to prevent the crushing of that
45. 1:36tissue as you begin to elevate on that
46. 1:39tooth now we're going to encircle the
47. 1:41tooth with this periosteal so basically
48. 1:43we're going to be going all the way
49. 1:44around pushing to bone making sure that
50. 1:47we're severing all those PDL fibers that
51. 1:49we can access with this instrument once
52. 1:52we've done that we're then going to move
53. 1:53to our elevator this is the els x3
54. 1:57elevator I love it I use it all the time
55. 1:59it's a luxating elevator so it has a
56. 2:01very thin tip on it which allows me to
57. 2:03use it like a lock cedar working it
58. 2:05ethically down the route or as an
59. 2:07elevator where I can be more
60. 2:08perpendicular to the tooth it's a great
61. 2:10instrument you can't apply excessive
62. 2:12forces to these because you will chip
63. 2:14them I've got a few in my kits where
64. 2:16I've done that and you get a feel for it
65. 2:18over time so there's no right or wrong
66. 2:20elevator
67. 2:20to use here just use what you're
68. 2:22comfortable with this is what I happen
69. 2:24to use so you've reflected our papilla
70. 2:26we're gonna start elevating we want to
71. 2:28get good access back here we're going to
72. 2:30insert and try to get a purchase on the
73. 2:33mesial aspect of that tooth so it can be
74. 2:35the mesial-buccal it could be the mesial
75. 2:37lingual or straight mesial wherever you
76. 2:39can get to and you're gonna start
77. 2:41twisting that elevator a little bit and
78. 2:43pushing as you move deeper so as you
79. 2:46move deeper what I'm usually doing is
80. 2:47I'm usually rotating the top edge of
81. 2:50that elevator toward the tooth now the
82. 2:53reason that I do that is I try to keep
83. 2:54the bottom edge on the bone and I try to
84. 2:57use the top edge to lever on the tooth
85. 2:59to get it moving when I do that I'm kind
86. 3:02of avoiding leaning back on the adjacent
87. 3:05tooth so I say tend to get less leverage
88. 3:07off the adjacent tooth when I move in
89. 3:09that direction
90. 3:10the final motion of elevation once
91. 3:12things are loose typically then I will
92. 3:14rotate it up and sort of away from the
93. 3:17tooth to lift it out of the socket so
94. 3:19that's something to keep in mind it also
95. 3:22protects that adjacent tooth so we're
96. 3:25gonna start working at this lots of
97. 3:26times you'll get these lifted a little
98. 3:27bit so you're kind of working in this
99. 3:30direction we're making this motion or
100. 3:32removing ethically and we're kind of
101. 3:34twisting and moving almost anteriorly I
102. 3:37guess with our hand as well so doing
103. 3:38this motion and as we do that we're
104. 3:40getting deeper and deeper in there we
105. 3:42start to lift the tooth but maybe it's
106. 3:44not coming what do we do next the next
107. 3:47thing that we do is we can take this
108. 3:48thin edge of this elevator and now that
109. 3:50we have a little bit of clearance
110. 3:51between the tooth and that buccal shelf
111. 3:53of bone which is so sturdy look at all
112. 3:55that bone there we're going to insert it
113. 3:58in that buccal groove and we're gonna
114. 4:00begin to push down in there till we get
115. 4:02another purchase and then we can lift
116. 4:04from the buccal aspect of that tooth and
117. 4:06most times this is all we need to
118. 4:08deliver that tooth out through the
119. 4:10lingual now this is an easy way to do it
120. 4:13it gets you in under the fur keishon of
121. 4:15that tooth to lift it out if we have
122. 4:17elevated and elevated and we're not
123. 4:19getting much for movement and things are
124. 4:20pretty stiff maybe the tooth lifting a
125. 4:23bit but not coming out we can then move
126. 4:25to our force up and our forcep that we
127. 4:27would typically use back here or that I
128. 4:28typically use is the 222 for set now I
129. 4:32like the 23 cow horn typically
130. 4:34four molars and I will use it if I have
131. 4:36a patient that can open really wide but
132. 4:38this forcep has quite an angulation to
133. 4:40the the teeth I guess or to the jaws of
134. 4:43the four set now that allows us to get
135. 4:46good access back there the patient
136. 4:47doesn't have to open as wide as with the
137. 4:49cow horn and it can grip very tightly on
138. 4:51that tooth and lots of times these teeth
139. 4:54may have conical roots or maybe not be
140. 4:57bifurcated and we don't always have an
141. 4:59area for the cow horn to sink into so
142. 5:01what we'll do is we'll apply this on our
143. 5:03tooth it a bit and now we've got good
144. 5:06leverage on there I'll often use that
145. 5:08underhand grip where you can then start
146. 5:09to move and lean it in both directions
147. 5:12buccal lingual and begin our rotations
148. 5:14and then we can typically deliver this
149. 5:16tooth either to the buccal or the
150. 5:18lingual most times molars will deliver
151. 5:21to the lingual because you can see the
152. 5:23difference in the bone the buccal bone
153. 5:25is so thick the lingual is so thin that
154. 5:27you'll usually have it coming to the
155. 5:29lingual doesn't matter just make sure
156. 5:31that you're not forcing it you will feel
157. 5:33as you get going which way that tooth
158. 5:35wants to come out
159. 5:37[Music]