If you're not making progress removing the tooth, then after 1-2 minutes switch tactics. If elevating from the mesial doesn't seem to be working, then elevate from the distal. If that doesn't work then remove some bone and go back to elevating, etc. I generally try to remove interproximal bone first on a tooth like this. If I'm still getting nowhere than I will start to cut away buccal bone. ■ mooredge Member Since: 04/22/08 Post: 24 of 82 5/8/2017 jmccartney Preop image. Thanks for the tips. ■ Member Since: 07/05/12 Post: 25 of 82 5/10/2017 These endo-treated teeth are a contest. To win the contest, you must deliver the tooth in the fewest number of pieces-hopefully one. ■ almunk Member Since: 12/17/05 Post: 26 of 82 5/10/2017 If I can't get the coronal section out within five min with simple extraction, I go straight to handpiece and go deep. You have nothing on the distal, and mesial there's a lot of space to work with. Don't be afraid to go aggressive and then take a root tip pick and fling that sucker out. If no movement, then get that handpiece back out. We all have hard ones that put us in our place, but you should use the handpiece quicker. It's better to have a more midroot left and a deep trough to fling it out than to mess around with a 1-2mm apical portion left because it kept breaking halfway through due to not enough space to pop the tip out. Loupes help a lot. I use 3.5 expanded field. I know where I'm drilling into at all times. I don't know how some do OS without loupes ... but to each his own. ■ jsk070 Member Since: 10/03/13 Post: 42 of 82 5/12/2017 FREE FACTS, circle 33 on card dentaltown.com \\ AUGUST 2017 35http://www.dentaltown.com