Flapless sectioning

Sir, teeth requiring surgical extractions are commonplace in the dental surgery. Extracting teeth via sectioning of the crown and roots is a well-recognised surgical technique.¹ This method frequently requires buccal bone removal to identify the root bifurcation in order for the tooth to be sectioned in an upwards direction. However, bone removal can delay healing and cause an increased risk of postoperative complications.^2,3

An alternative and more conservative approach is to use the pulp chamber which is exposed following sectioning of the crown of the tooth with a fissure bur (Figs 1,2). Removal of the contents of the pulp chamber will help to identify the position of the root canals. This axial view of the root anatomy of the tooth can then be used to determine the location and angulation of the bucco-lingual cut needed to accurately section the roots (Fig. 3). Starting from within the tooth, a surgical fissure bur can precisely section the tooth downwards to separate the roots for elevation and delivery (Figs 4,5). Third molars may require a mucoperiosteal flap to be raised in order to visualise root sectioning whereas in general this described technique should enable flapless sectioning to be performed. We believe that this method is a quick and easy approach for the surgical removal of teeth, which avoids further buccal bone removal and improves accuracy in root sectioning. This technique also enables the conservation of buccal bone and therefore minimises postoperative pain and swelling.

Figure 1

The pulp chamber exposed following sectioning of the crown of the tooth with a fissure bur

Figure 2

The pulp chamber exposed following sectioning of the crown of the tooth with a fissure bur

Figure 3

This axial view of the root anatomy of the tooth can be used to determine the location and angulation of the bucco-lingual cut needed to accurately section the roots

Figure 4

A surgical fissure bur can accurately section the tooth downwards to separate the roots for elevation and delivery

Figure 5

A surgical fissure bur can accurately section the tooth downwards to separate the roots for elevation and delivery