Before beginning the procedure a occlusal template will be fabricated using the modelling wax by placing it over the tooth that is supposed to be extracted and the adjacent tooth in order for the references and the Williams graduated probe is used to calculate the distance between the lower border of the template to the border of the gingiva giving pre extraction gingiva and same probe is placed on the bone tip by a deep prick in order to measure the pre extraction bone height. All the measurements are done at 3 different sites i.e mesio-buccal, disto-buccal and mid-buccal region and the mean of the data is obtained and recorded as pre surgical measurements.

Extractions were done following the standard aseptic surgical protocol. Local anaesthesia containing 2% lignocaine hydrochloride with 1:2,00,000 adrenaline was used to give regional nerve block along with local infiltrations in every extraction using 26 gauge disposable syringe.

 Mucoperiosteal flaps reflection using periosteal elevator was only done in extractions which were to be carried out using conventional forceps. Elevators were not used for luxation of tooth to be extracted. Tooth specific forceps were used for extraction of specific tooth in conventional forceps system. The beaks of conventional forceps were placed at the cement-enamel junction of particular tooth and it was extracted giving the tooth specific movements. The beaks of physics forceps were placed on lingual/ palatal aspect of tooth at or below cement-enamel junction and bumper was placed on buccal alveolar ridge at mucogingival junction and constant controlled traction forces was given until tooth was displaced out of the socket.

Time taken for the extraction was considered from the point of application of the forceps beaks on the tooth to the delivery of the tooth out of the socket, measured using stopwatch and recorded in seconds. Compressions of the sockets was not done following the extractions extracted tooth was clinically examined for the root fracture and adherence of buccal plate to the root and recorded.

Following the extraction the template was again placed over the teeth and distance between the marginal gingiva and lower edge of template was measured which showed post extraction gingival level. Post extraction bone levels was measured by placing the probe into extracted socket and feeling the bone margins, distance was measured from the edge of the template.

 The mean value of pre extraction and post extraction level at three points was then calculated and the difference between these two values suggested the amount of marginal gingiva and bone loss.

The extraction was given success score based on the criteria given by Choi. Et al 12

Score 5: complete success – extraction without crown and root fracture

Score 4: limited success with root tip fracture – extraction involving root tip fracture

Score 3: limited success with root fracture – extraction involving root one or more root fracture or crown fracture.

Score 2: limited success with osteotomy – fracture free extraction and partial osteotomy in case divergent roots and thick cortical bone was present

Score 1: failure to extract