If a multi-rooted tooth does not move within 90 seconds of controlled luxation, transition immediately to sectioning.

• Multi-Rooted Lower Molars: Section through the furcation buccolingually using a surgical fissure bur under copious sterile saline irrigation. Confirm the split is complete by gently twisting an elevator inside the cut before luxating.

• Upper Molars: Separate the two buccal roots from the single palatal root using a “T-cut” design. Treat each root as an independent single-rooted extraction.

• Irrigation Discipline: Always use surgical saline or sterile water. Never use regular air-rotor high-speed handpieces, which introduce dangerous risks of tissue emphysema.