Tried a new extraction technique

 After seeing Tom Giblin's example of sectioning the premolar during a difficult extraction I decided to try the same today. He sectioned the tooth when the crown fractured off to avoid fracturing the buccal plate as he was grafting the site for a future potential implant. Today I had a carious upper premolar that fractured when I put forceps on it. The patient was elderly and the arch was slightly crowded so the premolar was lingually placed. What this meant was that althought I could fit forceps on the tooth, the force to the buccal was hindered as it pushed against the adjacent teeth. In hindsight I would've just gone straight to cutting the interproximal contacts to give space for the tooth to move into and avoid pressure on the adjacent teeth. Instead, the crown fractured off. In hindsight this is a benefit as it removes the interference of the adjacent teeth and allows an elevator to fit 360 degrees around the tooth. In my eagerness to try the new technique I went straight for the bur and sectioned the tooth in the centre from mesial to distal. Tom had sectioned more buccally and at an oblique angle to remove a wedge of tooth from the buccal aspect. This was to make room to elevate into and reduce pressure on the buccal plate at the thin crestal bone area. My sectioning went awry as I sectioned vertically and in the middle of the tooth so when I cracked the section the palatal section came out. The idea of sectioning and removing the buccal section is that you can still have a point of elevation on the solid parts of the bone i.e mesial, distal and palatal and you remove the stress on the weakest part of the bone i.e buccal.

What I learned is that this technique can preserve buccal bone if done correctly but makes the whole procedure a lot more technically difficult as you can't fit forceps properly around the tooth. My palatal removal of tooth made the procedure ridiculously difficult as my only proper elevation point was gone, the mesial and distal elevation points were useful but as there was interproximal bone loss I was putting pressure on the adjacent teeth and causing pain there. Eventually I raised a flap and removed all the buccal bone anyway defeating the purpose of sectioning the tooth in the first place. 

What I would do different:

-Don't jump straight to sectioning, luxate the tooth first once the crown fractures off you see if it can be done that way. If preserving buccal bone is important, do this gently at first and if you think you are stressing the buccal plate too much then proceed to section

-Anaesthetise the adjacent teeth when extracting any tooth. There is pressure on those teeth althought it is ideal if there is not and this can cause stress to your patient

-Section the tooth more buccally and at a slight angle to ensure the buccal section is the part that is removed

- Don't be so eager to try out new techniques at the first opportunity. Make sure the procedure is appropriate and try more traditional techniques first if they are more appropriate