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Photos: Courtesy of Terry Pannkuk - www.rxroots.com
From: Terry Pannkuk
To: ROOTS
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 it’s a cinch.
Here’s a sectional removal of a molar I’m 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
Rubber Dam Extraction
