Extraction lifesaver

 Today I had difficulty with the extraction of a lower premolar. It was part of a lower dental clearance and I had removed all the teeth except this one. The lingual, mesial and distal tooth structure was remaining but there was deep caries subgingivally on the buccal. I mobilised the tooth initially by elevating it against the adjacent roots but this purchase point was removed as I wanted to focus on removing the canine as I predicted this would cause me more headaches to remove. The remaining premolar was mobile and I knew it would be easy to remove i I gould get a firm grip on it but due to the deep caries, it kept crumbling when placing the forceps. Due to the angle the caries sheared off, there was no parallel or undercut tooth tissue for the forceps to grip onto. I struggled with this for a while but after a moment of realisation, I just turned the forceps 90 degrees and grabbed onto the tooth on the mesial and distal aspect and made short work of the tooth from there on out. The reason this hasn't come up for me before is because there is usually an adjacent tooth present. I think this is quite a useful tip to have handy when there is deep buccal or lingual caries and you are struggling to get a forcep purchase point on the tooth. My concerns with this is that the forcep shape wouldn't be designed to fit the inteproximal surfaces as the location of the forcep beaks wouldn't allow you to make the ideal movements to extract the tooth. Rotational movements wouldn't be no issue but buccolingual movements won't be easily performed.

Other potential solutions in this case would be:

-To use alternative forceps with serrations or points which are designed to grip onto the tooth structure better

-Use a system such as the Benex system which is designed to remove roots but drilling a post into the tooth

-Section the tooth with a bur and elevate the pieces out

-Raise a flap and remove the tooth surgically