Appendix A: Special Cases Article Swipe
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· 2021
· Open Access
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· DOI: https://doi.org/10.1002/9781119596455.app1
· OA: W4237476394
A.1 Lone-standing Upper First MolarsThe lone-standing upper first molar can be one of the more difficult teeth to extract.This is a common presentation in older adults, where the first molar is the oldest (and often the last posterior tooth) left in the arch.It is typical that the periodontal ligament space is much smaller as a result of a lifetime of functional cycles occurring on the tooth.Additionally, roots may be splayed and a pneumatised sinus lining can extend right to the furcation of the tooth.Simple extraction of upper first molars is ill-advised in these situations, due to the propensity to cause large oroantral communication.A lower threshold should exist for surgical sectioning and root removal.A crestal mucoperiosteal flap must be raised with mesial and distal relieving incisions, and the buccal surface of the crown exposed.Bone removal should be performed as judiciously as is required to expose the cementoenamel junction, but no further.The crown should be decoronated to expose the pulp chamber and visualise the root anatomy, and the roots sectioned, being careful not to drill deeper than the tooth furcation, given the proximity of the sinus lining.Once sectioned, the palatal, mesiobuccal, and distobuccal roots can be gently delivered using a small, straight elevator.Prior to closure, it is wise to examine for the presence of an oroantral communication and manage as necessary.
