Closed Extraction 410, no flap, open root planing and gingival curettage

Added: 2026-05-24

[00:00:00]This is how I extract a 4010 without making a big flap. So, this is a medium-sized dog and it has a 50% attachment loss on the misial route. And you can see that I can actually move the tooth up and down a little bit. This vertical movement means that you have to extract the tooth. So, what I do is first I gain access with a very sharp luxating blade. This is from Dentonomic and it's so thin that it can easily engage that space between the tooth and bone especially here on the lingual side. It's very important to to start the path with a very thin instrument so you can insert a more bulky a little bit thicker elevator or luxator after that you can twist without bending it. Now I section the crown and I'm using a 701 L surgical length uh crosscut tapered fissure bur and I just section the tooth in a slightly oblique angle cordally so it's easier to gain access towards the path of the actual roots. Now I do some horizontal elevation. So I switched to a luxating elevator from IM3 and just inserting it between the crown parts and gently um prying them apart.

[00:01:27]And this will help get it loose here. I engage this base buckle misio buckle on the miso route. And now I again repeat.

[00:01:37]I go into the spot that my previous uh lock sailing blade created. And I go in with this more bulky lockating elevator to release it. And you can see it's already mobile. So mobile that I could take it out right now. So I continue working on the distal route on the lingual side. And see what I'm doing here. I'm in. I'm putting my luxating handle under that tooth. See, under 204.

[00:02:08]This is what you want to do. You want to get it under that tooth. That is a very nice trick because it means you have a correct angle. If you place it over the tooth, the angle would not be um oblique enough to engage that space. Here I go on the buckle aspect, insert it into that space between tooth and bone and just do a not even a quarter, maybe a 16th rotation to fatigue those sharpies fibers. So the periodontal ligament, those fibers needs to be fatigued and you do that by continuous pressure, not very quick pressure. Now I use this diamondcoated uh extraction for that is very handy for small roots and it doesn't slip. Oh, actually I switched to this one. Um so use whatever you have, right? And this is a standard kind of extraction forceps. I thought this could have a better grip on the crown than the other one. I'm just doing like figure eight uh movements. So it's absolutely okay to do pulling and twisting when the root is the so loose in the elbows that you saw before that mean when it's rocking in the elbow that means that you can actually twist and pull and get it out and now I grip the distal root and when the roots are so loose that you can actually rock it a little bit from side to side in the elus it means that it's already loose enough to do this motion twist and pull because it's just a little bit tight, a little bit snug. Um, but I would recommend to do this on medium to large breed dogs first and then move on to smaller breeds once you master the technique. But it's all about patience, really having a lot of patience for this particular tooth. So you can see that it is possible to get it out in many cases without making a big flap and removing a lot of bone when you have very sharp blades that can engage that space between the tooth and bone. This is the this is the main reason that I was able to get these teeth out so easily is because of better instruments. I wouldn't have been able to pull this off uh let's say 5 years ago because I didn't have these instruments. So the next step is to scrape out this granulation tissue that is uh present here between the distal root of the nine and the meio root of the 10 because you want to create an environment that is has fresh tissue not infected granulation tissue um to promote the healing of um of the gingiva around this distal root. So use some round some carettes, Lucas caretses um to scrape out this tissue and also use some uh gracy caretses. I'm going to show you here how I clean out this part. So this is a gracy caret. It means it's cutting on one side only. So the blue one here is called 1314 and it has a bend on the shank here. So it fits very nicely to those distal teeth because of this bend. You can reach this area. Make sure the sharp side of the caret is engaging whatever surface you are trying to scrape free of tissue. So here now I'm engaging the distal root.

[00:05:53]I'm trying to get this piece of granulation tissue out. It's very important that these are kept very sharp. So you can sharpen them. Um I do have a sharpening master class on my website that you can get to see how to maintain them. Um but you can also like regularly buy new ones if uh like every 6 months or then then make sure you get some new ones nice and fresh. But sharpening them can maintain the sharpness. And here I'm engaging that distal side again. And some of this tissue lumps here are attached to the ginger. So now I switch to another gracy curet. I'm angling the sharp side towards the ginger. See, I'm actually scraping the inside of the ginger. This is called gingerville kuretach. And you see my thumb, I'm pressing the thumb against uh the outside.

[00:06:53]So I'm pressing with my thumb towards the gingiva so that I can kind of engage the inside with that caret. This only works when you have a very sharp ket.

[00:07:05]You see here this is very sharp. I push I I my thumb is serving as a back stop and then I'm pushing the ginger towards the instrument and scraping.

[00:07:18]You can also use a diamond bur, cylindrical bi diamond bur to to do this if you want. Um, so here I'm scraping this all of this stuff out. And it's a good idea to use a mirror towards the end of your procedure just to check that you have all the remnants of calculus and granulation tissue out. So here I'm using a mirror just to check this distal aspect of that tooth to make sure I didn't leave anything in there.

[00:07:54]Okay, so I was happy with this.

[00:07:59]I just took my scaler and just did a little just to make sure there was no small pieces of calculus um left uh right here.

[00:08:11]The next part you want to do is you want to close it. And to be able to close it better, you have to release the lingo side and the buckle side a little bit.

[00:08:22]So before you do that, make sure you take a posttop X-ray to see if you um have got everything out and if the remnant if if there's any root remnants or calculus or anything in the elus before you suture it. All right, I just skipped the suturing part, but you can see here I did some placed a few sutures here to approximate the tissue and this will uh heal very nicely. If you want to boost the healing, you can add some uh hyaluronic acid uh in that um in this pocket. If you are a visual learner like me and you like this type of stepbystep videos to learn procedures, then you can get access to my entire step-by-step surgical library of tons of videos for dogs and cats. Just check out the link in the bio, go to my website and um have a look.