Steps for extracting an upper fourth premolar

In this video, Heidi Lobprise, DVM, DAVDC, a senior pet advocate and veterinary dental specialist at Cibolo Creek Veterinary Hospital in Boerne, Texas, describes her step-by-step method for extracting an upper fourth premolar. She provides a detailed look at each stage of the technique, from flap design to final closure.

The following is a transcript of the video, lightly edited for clarity and cohesion.

Lobprise: When we make a flap, I usually make a cut at the mesial aspect of the gum tissue to lift it up, kind of a triangle flap. At that point, I have good visualization of the bone. I might take out a little bit of bone so I can see the furcation area. Then I use a crosscut fissure bur to section that tooth. We have 3 roots there. I actually take out a complete V in that tooth to make sure that I can access all 3 of the roots.

I’ll even slim down the crown of the upper 4th premolar on the backside so I have space for my elevators. Once I’ve got those 2 front roots, they’re still together, but with that V-shaped piece of tooth out, I can see where the furcation is, about midway between those 2 roots, to completely section those. After that, I get my smaller elevators, or my luxators, to start elevating out, making sure that I can get that blade of the elevator into the space between tooth and bone.

As I get further along, I go to my winged elevators, a little bit smaller for the ones in front—maybe a number 2, maybe a number 3 or 4 for the distal root, that’s a bit bigger—and put that elevator into the space between tooth and bone. Do a slight rotation and hold; that helps stretch the periodontal ligament. Then rotate the other way and it stretches a little bit more. Work on all 3 roots, or multiple teeth if I have multiple teeth, letting that ligament start to relax and loosen up.

I’ll take my extraction forceps, gently grasp the crown, and again, a little bit of rotation fatigues the ligament back and forth. Then once it’s loose enough, take it out. I will smooth off the bone and suture the flap.