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British Journal of Oral and Maxillofacial Surgery 53 (2015) 387–389

Technical note

Extraction of single-rooted mandibular canines and premolars in linguoversion by a modified technique: technical note N. Chhabra, S. Chhabra, A. Kaur, Kanak Nandini Jain ∗ Department of OMFS, D.A.V. Dental College and Hospital, Yamunanagar, Haryana 135001, India Accepted 13 January 2015 Available online 3 February 2015

Keywords: Mandibular canines; Mandibular premolars; Linguoversion; Extraction

Much has been written about the removal of impacted premolars1–3 and canines,4 but less about the removal of erupted teeth in linguoversion. However, Howe5 described the “broken instrument technique” for the extraction of second premolars that are linguoverted. Removal of canines and premolars in linguoversion is a challenge, as the use of an elevator and forceps is difficult because of the lingual tilt. We describe a technique modified in this department by Dr Naveen Chhabra that incorporates the principles of surgery with those of biomechanics to extract canines and premolars in linguoversion where otherwise the need for surgical extraction would be necessary.

The bur is then detached from the handpiece and inserted into the hole drilled on the root, where it acts as the point of application of force (Fig. 2). The inserted bur is then held firmly as near parallel as possible to the long axis of the tooth, and short, consistent, and intermittent bursts of force applied with a simple or nylontipped mallet. The mallet is tapped on the bur with a force directed upwards and lingually, and the bur helps the tooth to rise out of the socket in an occlusolingual direction (Fig. 3). The bur is engaged in the hole drilled below the cementoenamel junction and force applied (F1) at an angle “␣” (Fig. 4). The principle of this is based on the direction and angulation of the application of the force. The force applied must be as

Operative technique After extraoral and intraoral preparation and local anaesthesia (Fig. 1), the gingival fibrous attachments of the tooth are severed on the lingual side with a Moon’s probe. The cementoenamel junction of the tooth is exposed from its buccal aspect by raising a full thickness mucoperiosteal flap and removal of a minimal amount of bone if necessary. A hole is made in the root just below the cementoenamel junction with a No.8 round bur, and the depth of penetration should be nearly equal to the size of the head of the bur. ∗ Corresponding author at: Department of OMFS, D.A.V. Dental College and M.M. General Hospital, Yamunanagar, Haryana 135001, India. Tel.: +919466302008; fax: +91 01732 227155. E-mail address: [email protected] (K. Nandini Jain).

Fig. 1. Left mandibular premolar in linguoversion preoperatively.

http://dx.doi.org/10.1016/j.bjoms.2015.01.007 0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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N. Chhabra et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 387–389

Fig. 2. Bur hole drilled below the cementoenamel junction of the tooth.

near parallel as possible to the long axis of the tooth. The greater the angle between the long axis of the tooth and the direction of application of force, the greater the chances of fracture of the tooth. As the degree of angulation increases from “␣” to “␤” and further towards 90◦ to the long axis, the direction of force also changes from F1 to F2, thereby increasing the chances of fracture of the tooth.

Fig. 4. Diagram showing the importance of direction and angulation of force along the long axis of the tooth. ␣ and ␤ = angulation of the bur (the head is engaged in the hole drilled below the cementoenamel junction) to the long axis of the tooth (A); F1 = direction of force when angulation of bur is ␣; F2 = direction of force when angulation of bur is ␤; and the red dotted line indicates the proposed fracture line, if the angle is changed from ␣ to ␤.

Result There is minimal risk of damage to the tooth or adjacent bone because there is no inadvertent use of forceps or elevator and minimal bone cutting is required. This decreases the detrimental effects on aesthetics and function after extraction, and favours the placement of future implants or orthodontic treatment, as there is early osseous healing. The technique is helpful when the tooth adjacent to the tipped tooth has a large restoration and there is a risk of its dislodgement if forceps or elevators are used. The technique atraumatic, easy, effective, quick, inexpensive, uses few instruments, and obviates the need for open extraction.

Conflict of interest We have no conflict of interest.

Ethics statement/confirmation of patients’ permission All the patients gave informed consent.

References

Fig. 3. Direction of application of force and the path of delivery of the tooth from the socket.

1. Kalia V, Aneja M. Mandibular premolar impaction. Scholarly Research Exchange volume 2009; Hindawi Publishing Corporation, Article ID 821857.

N. Chhabra et al. / British Journal of Oral and Maxillofacial Surgery 53 (2015) 387–389 2. McNamara C, McNamara TG. Mandibular premolar impaction: 2 case reports. J Can Dent Assoc 2005;71:859–63. 3. Nazir A, Asif S, Akram MA. Surgical removal of trans-alveolar mandibular 2nd premolar impactions by lingual approach. Pakistan Oral Dental J 2013;33:35–7.

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4. Yavuz MS, Aras MH, Buyukkurt MC, et al. Impacted mandibular canines. J Contemp Dent Pract 2007;8:78–85. 5. Howe GL. Minor oral surgery. 3rd ed. Bristol: John Wright; 1985. p. 99–101.

Extraction of single-rooted mandibular canines and premolars in linguoversion by a modified technique: technical note.

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