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Endo tips    Better Endo    Endo abstracts    Endo discussions

  Rubber Dam Extraction

The opinions and photographs within this web page are not ours. Authors have been credited
for the individual posts where they are. Photos: Courtesy of Terry Pannkuk -

From: Terry Pannkuk
Sent: Friday, August 05, 2005 5:12 AM
Subject: [roots] Rubber Dam Extraction

Unless the tooth is the most distal one, I do most extraction under
a dam and itís a cinch. Hereís a sectional removal of a molar I'ím 
planning for a possible two stage. - Terry

Dear Terry,  Thanks for the post.  There is something comforting about 
having the RD in place, you make it so easy to section the tooth that 
way :)  I would assume you also do some extractions with flap a 
surgical procedure.  How many extractions do you think you do a month?  
How do you charge if you are in the middle of a surgery and determine 
a crack that requires extraction?  I would assume that your patients 
really appreciate the ease of not having to run around for
the extraction - Matt

Terry, What burs do you use, that allow you to get so far down the root 
while still  allowing you visual access with the scope?   I assume you 
are using a turbine for these sectionings?

I am about to buy a scope and have had two on trial.  One of the problems 
I have is the conflict between the mirror, the handpiece and the line 
of vision of the scope for some of the procedures.- Ken

Usually a surgical length round carbide gets you close and you can then 
scoop the tip out with a root pick or curette. The bicuspid I drilled out 
for the buried immediate case a week ago had a root that was at least 
20mm deep from the gingival meaning it was 28-31mm long!  It kind of 
freaked me out so I put the implant twist drill on with the bur
extender and got the tip.  I could still see the base of the socket 
with the scope when I dried it. This also explains why I placed the 
implant about 2-3mm deeper than I may have had to, but I also knew 
going a little deeper would be fine and allow a very nice emergence profile.

This stuff is very fun and interesting especially with the safe guidance 
of several mentors.  A local periodontist has taken a special interest 
to help me also.  I've watched him.  He's very smart and knows that as 
nice as he's been I'd never do an implant on one of his patients.  
The patients always get the third degree about any periodontists or oral
surgeons they've seen in the past.  If it was a crappy one that I never 
work with, they're all mine :):):) - Terry

It kind of freaked me out so I put the implant twist drill on with the 
bur extender and got the tip.- Terry

Thanks, Terry , I am still not clear about the handpiece you are using.  
Are you using a turbine or a contrangle? I have used some long FG carbides 
but I am always a bit uncomfortable about the stress these long burs are 
placing on the turbine bearings.- Ken

On many of the bicuspids I section them buccolingually with the high speed 
so the elevator won't stress the buccal plate of bone. Turbine high speed 
for most all root removals and if it gets deep go with the implant drills, 
although I try to avoid them since they are obscenely expensive and 
I hate to dull them on a routine extraction. - Terry

Your comments please
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