Grossly decayed mandibular molar removal

# While attempting to remove a grossly decayed mandibular molar, the crown fractures. What is the recommended next step in order to facilitate the removal of this tooth?
A. Use a larger forceps and luxate remaining portion of tooth to the lingual
B.  Separate the roots
C.  Irrigate the area and proceed to remove the rest of the tooth
D. Place a sedative filling and reschedule patient

The correct answer is B. Separate the roots.

This can be done with a chisel, elevator, or most easily with a bur.

Teeth with two or more roots often need to be sectioned into single entities prior to successful removal.

A popular method of sectioning is to make a bur cut between the roots, followed by inserting
an elevator in the slot and turning it 90° to cause a break.

Roots can be removed by closed technique. The surgeon should begin a surgical removal if the
closed technique is not immediately successful.

Indications for surgical extractions:
• After initial attempts at forceps extraction have failed
• Patients with dense bone
• In older patients, due to less elastic bone
• Short clinical crowns with severe attrition (bruxers)
• Hypercementosis or widely divergent roots
• Extensive decay which has destroyed most of the crown

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