During extraction of an endodontically treated, grossly carious tooth #18, the crown fractures below the gingival margin but above the furcation. What is the BEST approach?

Correct answer: B. Section the roots and remove each root separately with elevators

• A. Deliberately retaining infected, endodontically involved roots risks continuing infection and is not appropriate when the tooth was being removed for pathology.
• B. CORRECT. Once the crown is lost, the multi-rooted tooth should be SECTIONED through the furcation with a surgical handpiece, converting a divergent, non-extractable multi-rooted unit into individual single-rooted segments that can be elevated along their own paths of withdrawal. This is far more controlled than applying increasing force, and it protects the buccal plate, the inferior alveolar nerve, and the adjacent teeth. Raise a flap and remove buccal bone as needed for access.
• C. Grafting over retained infected roots is contraindicated.
• D. Rongeurs are designed to trim BONE, not extract teeth. Using them to grip roots crushes tissue, fractures the fragments, and worsens access.

Note: Sectioning is the answer whenever roots are divergent, dilacerated, or the crown has been lost — do not just increase force.