Maxillary Molar Extraction Technique: Decoronation and Sectioning

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Maxillary molar extractions can often be difficult, as the maxillary molars have 3 roots which are divergent. This poses a challenge to extracting the tooth whole without damaging the surrounding bone and soft tissue. One strategy that works well is the divide and conquer method: First you decoronate the tooth and then aftewards you split the roots into individual roots and take them out one by one, thereby perserving the surrounding architecture. 1 This short video shows 2 cases where this method was employed for a successful extraction. In the first case, Tooth #14 was deemed hopeless and was extracted. Notice in this case how there was no need to raise a flap for extraction of the tooth. In the second case, Tooth #3 with an old root canal, the extraction was followd by an immediate implant. An interesting tip provided in both cases, is to "recreate" the tooth following extraction to make sure that all of the components were properly removed.

References:

1. Extraction of a maxillary molar tooth, Journal of the Irish Dental Association Download, 25/05/2023 19:42:33

2. Decoronation of an ankylosed tooth for preservation of alveolar bone prior to implant placement A Filippi 1, Y Pohl, T von Arx, Case Reports Dent Traumatol . 2001 Apr;17(2):93-5. 

Maxillary Molar Extraction Technique: Decoronation and Sectioning 1

Maxillary Molar Extraction Technique: Decoronation and Sectioning 2

Maxillary Molar Extraction Technique: Decoronation and Sectioning 3

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Did you leave the graft open or cover with a membrane?

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Thanks for your question- this is actually the most common question I receive when showing cases like this. When I place immediate implants where the socket walls are intact and I did not reflect a flap I will typically leave the bond graft without placing a membrane over it.

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If you don’t place an implant how do you keep the bone graft particles from falling out of the socket for the ensuing month or so before the socket totally granulates in. Did you do an internal sinus lift?

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I will usually overpack the bone graft particles to the level of the soft issue so if any particles fall out they are not critical but in my experience, the blood clot is responsible for keeping the graft particles from exfoliating. I did an osteotome in this case as well but did not place and graft material into the sinus lift.