Sharp, thin and appropriately designed instruments make oral procedures more predictable and ultimately rewarding. It is important to select instruments specifically designed for our canine patients or for the smaller, more delicate teeth of our feline patients. Mucoperiosteal flap creation, buccal alveolar bone removal, multirooted tooth sectioning, root elevation and flap closure all require a more exacting touch to perform successfully. Precise instrumentation will help, but throughout the extraction process the operator must treat the fragile root or roots with care to prevent the complications of root fracture.

The primary cause of tooth root breakage is excessive force applied too far coronally. To alleviate this problem, the most important instrument is the high-speed handpiece. Extractions should not be attempted without a high-speed handpiece and a carbide bur. The bur is an indispensable instrument for precise removal of bone, sectioning of multirooted teeth and for shaping the crown of the tooth to facilitate extraction of the root. By reducing the crown height of canine or feline teeth, it is possible to create a tooth shape that permits direct access to the periodontal ligament space with the root elevator or luxator while preventing leverage force on the crown.

When a root fractures, the operator should obtain an intraoral radiograph to assess the amount and location of the remaining root material. Use the high-speed bur to remove more buccal bone. The additional bone is removed to gain better visualization and isolation of the retained root tip. The mucoperiosteal flap can be retracted further to help facilitate this.

Once the root tip has been carefully exposed, a fine-tipped root tip pick may be helpful to tease the root tip away from the alveolar walls. The root tip pick is more delicate than a root elevator and it forces the operator to use more finesse. It is similar to the nut picks we use to retrieve broken bits of nut from inside a walnut shell. The force of the pick should be up and out of the alveolus, instead of the apical pressure that a root elevator requires. The operator must guard against forcing a retained root tip into the mandibular canal or nasal cavity of the maxilla. Patience is often rewarded with a whole root tip delivery from the alveolus.

When a root breaks, it may be tempting to use the high-speed handpiece to drill out or “atomize” the root. This is not a good idea. The results are either it doesn’t remove the entire root and leaves retained root to cause problems in the future, or it removes root in addition to too much surrounding bone. When the bone at the apex of the tooth in the mandible is removed, the neurovascular bundle that lies in the mandibular canal is damaged. When the bone at the apex of the tooth in the maxilla is removed, there is significant risk of entering the nasal cavity and creating an oronasal fistula. 

The art and science of surgical extractions in our patients is perfected by gentle tissue handling, delicate bone removal, careful elevation of tooth roots and tension free flaps. These are facilitated by using appropriately designed instruments and intraoral radiography. Dentistry requires planning, patience and thoughtful execution to give our patients the best outcome; fastest healing, postoperative pain relief and a comfortable functional mouth.