How Do You Perform Efficient (and Profitable) Extractions?

dentist dentistry dr. aaron nicholas dr. mark costes efficiency Nov 03, 2020

Using the same general efficiency principles, of course!

This case, large buccal carious lesion #14 and completely decayed crown #15. So no chance to use forceps here.  To be fair, most of the time I’m sectioning and extracting individual roots with maxillary first molars anyway.   Gives me more control and I’m not digging for root tips in the last third of the root.

Efficiency principle #1.  When you pick up an instrument, use it to completion on all teeth you’re working on before putting it back down.  

Handpiece, elevator, luxator.  Doesn’t matter. Plan the work so this can happen.  A lot of time is wasted switching back and forth between instruments.

So #15 just needs to be elevated out.  Also, I want to remove #15 before #14 so that if a root fractures, #14 isn’t bleeding into the socket of #15 while I’m trying to remove the root tip(s).    However, If I start here, then I’ll use an elevator and/or luxator and then put it down before working on #14.  I also run the risk that the debris from the removal of the crown on #14 ends up in the socket of #15. Instead, I’ll start with #14 and once I have an elevator/luxator in hand, I’ll remove  #15 first, then #14

So, now for the procedure.  Remove Crown.  Cut remaining tooth structure to 2mm above soft tissue. Remove loose caries on both teeth. 

Section tooth #14. Elevate roots out starting with #15.  Bone graft and suture both sites.  All done.   

No back and forth.  Everything is used just once and done.

Total treatment time after the patient was numb was 20 minutes.  

Efficient and Profitable!