An extraction is a procedure that some dentists may completely avoid and others may entirely prefer to do in house. Whatever the case may be, the exposure and experience practicing prior to facing real cases is invaluable.
Two weeks ago, we were given the chance to practice extractions on pig jaws and learned to suture on pig feet. This sounds morbid and alarming to some but very few programs can provide such an incredible opportunity.
As we entered lab like any other day that morning we kept the procedure in our mind as it was projected on individual screens at each desk. We were taught that a good extraction follows five primary steps. All extractions may not require all five steps but it is important to consider them when making an educated clinical plan. The following was our procedural plan:
1) Loosen soft tissue using a periosteal elevator. We were reminded that this step should typically only take a few seconds, but we learned quickly enough that the pig jaws were not this accommodating. Clinical judgment came into play and we made educated decisions on how long was necessary.
2) Luxate tooth with an elevator. Because of the size of the teeth and the jaw we resorted to medium and large sized elevators which would give us a greater surface area to force ratio. For this step it is important to remember the direction necessary to turn the elevator depending on the location of your fulcrum and opposing teeth. The working concave side should be directed towards the tooth you are extracting.
3) The next step is to adapt the forcep to the root. You want to seat your lingual beak first and ensure that is is below the cementoenamel junction (CEJ.) An important point to remember is to always keep the beak parallel to the roots.
4) Luxate tooth with forcep. This step requires a strong and firm apical pressure. You will alternate buccal and lingual pressure typically placing most of the force buccally. This step will expand the bone and displace the center of rotation apically.
5) Remove tooth from socket. You are finally there! Now is the time to finally displace the tooth from the periodontal ligament and gently tract it out of the socket. Keep in mind you never want to “pull” the tooth, this typically signifies an error in the other steps. With the pig jaws it was a little harder avoiding a pull but with the correct sequence of steps and a little faculty supervision we were all oral surgeons in the making!
Extractions, and oral surgery in general, can be a scary class to anticipate in your dental education. However, with the proper instruction and practice it can be an enjoyable and rewarding experience. Our resident oral surgeon did an amazing job instructing and guiding us in our class. The concept of practicing on pig jaws was unique and allowed for a look into the specialty without comprising patients. It was just another fulfilling day in dental school learning the most up-to-date concepts in our ever evolving field.
~Sadaf Moghimi, Roseman ’16, 2013 Chicago administrative extern
Thanks for sharing the step-by-step process (makes it a little less scary). When will you get to do an extraction on a person?
Awesome article, wonderfully written.
Great job on writing the article. I remember my first time. It was scary, but the more you do it the less scary it becomes.