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Extraction of single-rooted mandibular canines and premolars in

linguoversion by a modified technique: Technical note

Article  in  British Journal of Oral and Maxillofacial Surgery · February 2015

DOI: 10.1016/j.bjoms.2015.01.007

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British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx

Technical note
Extraction of single-rooted mandibular canines and
premolars in linguoversion by a modified technique:
technical note
N. Chhabra, S. Chhabra, A. Kaur, Kanak Nandini Jain ∗
Department of OMFS, D.A.V. Dental College and Hospital, Yamunanagar, Haryana 135001, India

Accepted 13 January 2015

Keywords: Mandibular canines; Mandibular premolars; Linguoversion; Extraction

Much has been written about the removal of impacted
premolars1–3 and canines,4 but less about the removal of
erupted teeth in linguoversion. However, Howe5 described
the “broken instrument technique” for the extraction of sec-
ond premolars that are linguoverted. Removal of canines and
premolars in linguoversion is a challenge, as the use of an
elevator and forceps is difficult because of the lingual tilt.
We describe a technique modified in this department by Dr
Naveen Chhabra that incorporates the principles of surgery
with those of biomechanics to extract canines and premo-
lars in linguoversion where otherwise the need for surgical
extraction would be necessary.
should be nearly equal to the size of the head of the bur.
The bur is then detached from the handpiece and inserted
into the hole drilled on the root, where it acts as the point of
application of force (Fig. 2).
The inserted bur is then held firmly as near parallel as
possible to the long axis of the tooth, and short, consistent, and
intermittent bursts of force applied with a simple or nylon-
tipped mallet. The mallet is tapped on the bur with a force
directed upwards and lingually, and the bur helps the tooth to
rise out of the socket in an occlusolingual direction (Fig. 3).
The bur is engaged in the hole drilled below the cementoe-
namel junction and force applied (F1) at an angle “␣” (Fig. 4).
The principle of this is based on the direction and angulation

Operative technique

After extraoral and intraoral preparation and local anaesthesia

(Fig. 1), the gingival fibrous attachments of the tooth are
severed on the lingual side with a Moon’s probe.
The cementoenamel junction of the tooth is exposed from
its buccal aspect by raising a full thickness mucoperiosteal
flap and removal of a minimal amount of bone if necessary.
A hole is made in the root just below the cementoenamel
junction with a No.8 round bur, and the depth of penetration

∗ Corresponding author at: Department of OMFS, D.A.V. Dental College

and M.M. General Hospital, Yamunanagar, Haryana 135001, India.

Tel.: +919466302008; fax: +91 01732 227155.
E-mail address: drnandinijain@gmail.com (K. Nandini Jain). Fig. 1. Left mandibular premolar in linguoversion preoperatively.

http://dx.doi.org/10.1016/j.bjoms.2015.01.007
0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Chhabra N, et al. Extraction of single-rooted mandibular canines and premolars in linguoversion by a
modified technique: technical note. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.01.007
YBJOM-4429; No. of Pages 3
ARTICLE IN PRESS
2 N. Chhabra et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx

Fig. 2. Bur hole drilled below the cementoenamel junction of the tooth.

of the application of the force. The force applied must be as

near parallel as possible to the long axis of the tooth. The
greater the angle between the long axis of the tooth and the
direction of application of force, the greater the chances of
fracture of the tooth. As the degree of angulation increases
from “␣” to “␤” and further towards 90◦ to the long axis,
the direction of force also changes from F1 to F2, thereby
increasing the chances of fracture of the tooth.
Fig. 4. Diagram showing the importance of direction and angulation of force
along the long axis of the tooth. ␣ and ␤ = angulation of the bur (the head is
engaged in the hole drilled below the cementoenamel junction) to the long
axis of the tooth (A); F1 = direction of force when angulation of bur is ␣;
F2 = direction of force when angulation of bur is ␤; and the red dotted line
indicates the proposed fracture line, if the angle is changed from ␣ to ␤.
Result

There is minimal risk of damage to the tooth or adjacent

bone because there is no inadvertent use of forceps or eleva-
tor and minimal bone cutting is required. This decreases the
detrimental effects on aesthetics and function after extraction,
and favours the placement of future implants or orthodontic
treatment, as there is early osseous healing.
The technique is helpful when the tooth adjacent to the
tipped tooth has a large restoration and there is a risk of its
dislodgement if forceps or elevators are used.
The technique atraumatic, easy, effective, quick, inexpen-
sive, uses few instruments, and obviates the need for open
extraction.

Conflict of interest

We have no conflict of interest.

Ethics statement/confirmation of patients’ permission

All the patients gave informed consent.

References

1. Kalia V, Aneja M. Mandibular premolar impaction. Scholarly Research

Fig. 3. Direction of application of force and the path of delivery of the tooth Exchange volume 2009; Hindawi Publishing Corporation, Article ID
from the socket. 821857.

Please cite this article in press as: Chhabra N, et al. Extraction of single-rooted mandibular canines and premolars in linguoversion by a
modified technique: technical note. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.01.007
YBJOM-4429; No. of Pages 3
ARTICLE IN PRESS
N. Chhabra et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx 3

2. McNamara C, McNamara TG. Mandibular premolar impaction: 2 case
reports. J Can Dent Assoc 2005;71:859–63.
3. Nazir A, Asif S, Akram MA. Surgical removal of trans-alveolar mandibular
2nd premolar impactions by lingual approach. Pakistan Oral Dental J
2013;33:35–7.
4. Yavuz MS, Aras MH, Buyukkurt MC, et al. Impacted mandibular canines.
J Contemp Dent Pract 2007;8:78–85.
5. Howe GL. Minor oral surgery. 3rd ed. Bristol: John Wright; 1985. p.
99–101.

Please cite this article in press as: Chhabra N, et al. Extraction of single-rooted mandibular canines and premolars in linguoversion by a
modified technique: technical note. Br J Oral Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.01.007

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