This procedure is based on eliminating the alveolar bone, generally vestibular, until the place where the dental piece or radicular remain to be removed is. This can be done using a bur, a scapula or rongeur forceps, the most common is the surgical bur that is done under a constant irrigation of saline solution, the process starts with a rounded tungsten bur Nº8. Extreme care must be taken when reaching the areas in which neighboring structures can be damaged: second area superior premolar, and first molar vicinity in the maxillary bed, in the jaw the premolar zone and mental foramen and in the third molar area the dental conduct. High-speed surgical turbines can be used but always accompanied with great irrigation.

Osteotomies must be as economical as possible, eliminating the least amount of bones structure, although nowadays there are techniques to regenerate bone structure in a very efficient manner (mention in other web chapters) using plasma rich in growth enhancers (Dr. Eduardo Anitua. Vitoria).

This is the most common case, while extracting a dental piece this one may fracture leaving the roots inside the dental socket. The difficulty in the extraction of radicular remains will depend on where the fracture line lays. In uniradicular pieces, if the fracture is over the bone or supra gingival, then with the help of an inferior roots forceps or a bayonet place in the superior they can be extracted easily.

In the case where the fracture is inside the bone, this is more complex, either place an elevator inside and use it as a lever, and if this is not possible then use a bur to introduce the elevator and use it as a lever.

In case an alveolar extraction is not possible then the flap must be raised and proceed with a surgical extraction.

In multiradicular pieces, if the coronal fracture has left the roots joined, proceed to an ondontosection using a bur, separate and with the help of forceps or a bayonet extract the root. In case interradicular wall remains between the roots, then they can be eliminated to facilitate access to the roots.

There are special techniques, for example, making a notch using a burin the fractured fragment with the intention of placing an elevator in T or S and raising the fractured part. Another is to make the extraction of apical remains with endodontics instruments inserted inside the incision and make traction.

In all cases it is not admissible to leave radicular remains inside the alveole, but if faced with impossibility of extracting or for those less trained it is better to leave them inside than to cause greater injury. If rests remain, if the dental piece was vital it is advisable to eliminate the remains of radicular pulp using endodontics instruments, making the recovery less painful. The dentist must inform the patient of the existence of radicular remains that have not been extracted.

If the remains are visible, generally they are very easy to extract, since they have already suffer and expulsive extrusion.

In case the remains are inside, they can be submucoseus or intraoseus. The submucoseus, with a simple incision can be made visible and the extraction can be performed. If they are intraoseus, an surgical extraction can be done, raising the flap, making an osteotomy until the radicular remain is visible and then proceed to extract.

The extraction of radicular remains and dental pieces deeply inserted and even more when in patients with thin and atrophic jaws, then they must be referred to oral surgeons highly trained.