Indications
Rule of dental succession: Never have two teeth of the same
type in the same place at the same time.
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Severe class 2 malocclusion. Note retained 704 and 604 causing
lingual deviation of 304 & 204
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Rostral mandibles showing both temporary and permanent dentition
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Permanent teeth are normally lingual or palatal to their
deciduous precursors. The exceptions are the permanent maxillary
canine, which is rostral, and the permanent maxillary premolar
4, which is buccal and distal to the last deciduous tooth.
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Technique
Take care - Deciduous teeth can be a challenge to remove
and requires great care. They are easily fractured and remaining
root tips may still deflect the erupting permanent tooth into a
malocclusion.
Take care - Avoid over-vigorous deep elevation - this may
cause permanent damage to the developing enamel on the crown of
the succeeding permanent tooth. Be aware of the position of the
permanent tooth (see above).
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The root tends to be long with a similar width for the whole
of its length. Use a small root tip pick, Fahrenkrug elevator
or fine luxator, depending on tooth size.
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Make sulcus incision as for single root tooth.
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Push/probe gently into the periodontal ligament space. If the
space cannot be easily found consider a flap and/or create a
channel for the instrument using a quarter or a half round bur.
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When haemorrhage occurs, pause to allow the hydraulic pressure
of the blood to assist you in your task.
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Incise the periodontal ligament for the whole of the root length
and apply forceps only when tooth is very loose.
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Close flap with sutures if necessary.
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