I am a final year student in my dental college and we get to treat and help various types of patients every day. I would like to recount my yesterday’s case so that my experiences might help someone else too.

So yesterday I was alloted a jolly old man in the oral surgery department for extraction of his left maxillary (upper) canine. The patient was very poor and refused to get the tooth radiographed because of shortage of money and insisted to get it removed without an IOPA (X ray of teeth).

He was very cooperative and was well versed with the whole extraction procedure as he already had most of his teeth extracted. I prepared the patient’s mouth with Betadine and Saline and administered the local anaesthetic (Infraorbital and Nasopalatine block).

After the anaesthesia was effective I raised the Periosteal flap and applied the forceps. Till now I was unaware of the dilaceration of the tooth. For those of you who don’t know what dilaceration is, here’s an image to explain dilaceration in easy words:

So now, I started giving buccal and palatal movements to the tooth and slowly the tooth started moving in the socket. It seemed like an easy extraction and now since the teeth was mobile I felt proud and happy. 

But my happiness was soon crushed when I tried giving rotational movement to the tooth and it didn’t budge. I tried harder but wasn’t rotating.

Little drops of sweat were forming on my forehead but I didn’t give up. I picked up straight elevator to luxate the tooth. After a few minutes of applying force with the elevator, I picked up the forceps again. I had an idea this time. I thought maybe if instead of applying force for rotatory movement, I kept applying force labially and palatally with a constant tractional force (pulling force) and after about 10 minutes the tooth popped out of the socket and I was ecstatic when I saw that the canine was dilacerated!

Now I knew that it wasn’t my fault that the tooth wasn’t coming out, it was dilacerated and was supposed to be difficult to pull out from the socket. Surely I was over the moon because this was my first dilacerated tooth extraction and I felt like a prestigious surgeon!

So , here are a few important points to keep in mind for the extraction of a dilacerated tooth:

  • Always advise a radiograph because once you see the condition, you can prepare appropriately. Without a radiograph it’s like working blind.I was lucky that the root didn’t fracture but you might not be that lucky.
  • Once you know that the tooth is dilacerated, explain to the patient about the condition and the risk of fracture during extraction before beginning the procedure.
  • Don’t apply force against resistance or the root may fracture. Had I applied more force while giving the rotational movement, the root could have fractured.
  • After extraction check the apical region of the tooth to ensure that no broken pieces are left in the socket and whole tooth had been removed.

This was a huge experience for me and I learned a lot. I hope my experience was useful to you and I would love to hear your experiences too. Leave your comments below. 😃