Closed and Open Tooth Extraction

Instruments

Dental luxators have sharp and often thin-tipped blades designed to penetrate into the narrow periodontal space and cut periodontal ligament fibers. Dental elevators should closely fit the size of the tooth or root segment being elevated. The blade of the instrument is gently worked into the space between the tooth and the alveolar bone. A well-controlled rotational motion on the shank’s long axis between the root and a fulcrum point is performed to create a slow, gentle and steady pressure on the tooth held for at least 10 seconds to break down the periodontal ligament fibers. The elevator can also be placed perpendicular to the tooth or root segment to lever it out of the alveolus through the line of least resistance, with a fulcrum point preferably on alveolar bone, unless an adjacent tooth used as a fulcrum is to be extracted as well. Extraction forceps should fit the tooth as closely as possible and be applied as far apically on the tooth as possible to reduce the chances of root fracture. They should only be applied when the tooth is very loose.

Basic Principles

In the dog the incisors, canines, first premolars, and mandibular third molars are single-rooted teeth. In the cat, the incisors, canines, and commonly the maxillary second premolars are single-rooted. The cat’s maxillary first molars may be treated as single-rooted teeth even though they have more than one root (the roots are usually fused together). Teeth are anchored to the alveolar bone of the mandible, incisive bone and maxilla by soft tissue components of the periodontium, the gingiva and periodontal ligament. It is essential that the client has approved extraction of any tooth. The entire tooth must be removed, without leaving any root structure in the alveolus. Extractions can be performed using a closed technique (without raising a mucoperiosteal flap) or an open technique (raising a mucoperiosteal flap and alveolectomy). [...]