Do you have a “hopeless” retained root you’re ready to extract?



Think implants, dentures, or bridges are the only way forward?



What if there’s a way to save that tooth — predictably and biologically?



In this episode, Dr. Vala Seif shares his experience with the Surgical Extrusion Technique — a game-changing approach that lets you reposition the root coronally to regain ferrule and restore teeth once thought impossible to save.



Jaz and Dr. Seif dive into case selection, atraumatic technique, stabilization, and timing, all guided by Dr. Seif’s own SAFE/SEIF Protocol, developed from over 200 successful cases.




https://youtu.be/2TyodqgAP9w
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Protrusive Dental Pearl: When checking a ferrule, consider height, thickness, and location of functional load. Upper teeth: prioritize palatal ferrule. Lower teeth: prioritize buccal. Tip: do a partial surgical extrusion, rotate the tooth 180°, then stabilize.



Need to Read it? Check out the Full Episode Transcript below!



Key Takeaways




Surgical extrusion is a technique-sensitive procedure that requires careful planning.



Case selection is crucial for the success of surgical extrusion.



A crown-root ratio of 1:1 is ideal for surgical extrusion.



Patients are often more cooperative when they see surgical extrusion as their last chance to save a tooth.



Surgical extrusion can be more efficient than orthodontic extrusion in certain cases.



The importance of ferrule in dental restorations cannot be overstated.



Proper case selection is crucial for successful outcomes.



Atraumatic techniques are essential for preserving tooth structure.



The 'Safe Protocol' offers a structured approach to surgical extrusion.



Patient communication is key to managing expectations.



Flowable composite is preferred for tooth fixation post-extraction.



Understanding root morphology is important for successful extractions.




Highlights of this episode:




00:00 Surgical Extrusion Podcast Teaser



01:07 Introduction



02:38 Protrusive Dental Pearl



05:53 Interview with Dr. Vala Seif



08:57 Definition and Philosophy of Surgical Extrusion



15:30 Indications, Case Selection, and Root Morphology



21:37 Comparing Surgical and Orthodontic Extrusion



25:54 Crown Lengthening Drawbacks



28:39 Occlusal Considerations



33:53 Midroll



37:16 Definition and Importance of the Ferrule



43:07 Clinical Protocols and Fixation Methods



01:00:01 Post-Extrusion Care and Final Restoration



01:05:04 Learning More and Final Thoughts



01:09:29 Outro




Further Learning:




Instagram: @extrusionmaster — case examples, papers, and protocol updates.



Online and in-person courses in development (Europe + global access).




Loved this episode? Don’t miss “How to Save ‘Hopeless’ Teeth with the Surgical Extrusion Technique” – PDP061



#PDPMainEpisodes #OralSurgeryandOralMedicine #OrthoRestorative



This episode is eligible for 1 CE credit via the quiz on Protrusive Guidance. 



This episode meets GDC Outcomes C.



AGD Subject Code: 310 ORAL AND MAXILLOFACIAL SURGERY



Aim: To understand the biological and clinical principles of surgical extrusion as a conservative alternative to orthodontic extrusion or crown lengthening for managing structurally compromised teeth.



Dentists will be able to -




Identify suitable clinical cases for surgical extrusion, including correct root morphology and crown–root ratios.



Describe the step-by-step SAFE Protocol for atraumatic surgical extrusion, fixation, and timing of endodontic treatment.



Evaluate the advantages, limitations, and biomechanical considerations of surgical extrusion compared with orthodontic extrusion and crown lengthening.








Click below for full episode transcript:



Teaser: I always had a problem with extracting teeth. Not a problem technically, ethically. If highly damaged teeth get properly treated and correctly maintained, they are always going to outlive implants.



[Teaser]So what I'm referring to here is that the most sophisticated and complicated solutions are not always the smartest one. It's not about most expensive. It's not about most advanced. It's not about most complicated. It's about the best possible for the patient. We must keep that in mind that there is no such thing as a master key that opens up all of the doors for us.



Surgical extrusion, over the years... it actually was presented to dentistry in the early eighties. They were really trying to work on surgical extrusion. And guess who comes out? I have done over 200 cases with a follow-up of up to six, seven years. That is something that you can rely on. In such cases, I take out the tooth and rotate it and put it back in.



No way.



Jaz's Introduction: Yeah, so you have a retained root and you think this is hopeless and you're headed towards an implant, denture, a bridge or whatever. But then this episode comes along and reminds you about the power of the surgical extrusion technique. In plain terms, you are partially extracting the root, and now you have the most important thing in restorative dentistry. You have ferrule, you have tooth structure, you can now crown. Whereas before everything was subgingival and it was impossible to restore.



Hello, Protruserati, I'm Jaz Gulati and welcome back to your Favorite Dental Podcast. This is the podcast where you make dentistry tangible and make you fall in love with dentistry again.



Four years ago, with Dr. Peter Raftery, the endodontist, we spoke about this very topic, the surgical extrusion technique. I'll put that episode in the show notes ’cause that was really valuable as well. But in this episode it is special because it's an update from someone who's done more than 200 cases.



So what he believes, and what I also believe, is he is the most experienced clinician in the world when it comes to the surgical extrusion technique. I haven't seen anywhere in the literature the kind of numbers that he's done—so, so much.



We can learn from Dr. Vala Seif from Iran, and Protruserati, you're gonna absolutely love him, right? His storytelling, his analogies. I actually really geeked out and had a great time, and I know you're gonna love him. Even all the way to the end, the last few seconds, he still gave another tip of how to stop bleeding when you do this technique so you can then add your composite splint to secure the root. He'll give you that right at the very end. So make sure you don't miss any of this episode.



Dental PearlNow, every PDP episode I give you a Protrusive Dental Pearl. This one’s an occlusion conceptual one, a biomechanical one when it comes to restorative dentistry, but it's also very relevant to this episode ’cause a really cool, fascinating technique was advised by Dr. Seif, which I really am excited to share with you.



So firstly, conceptually, the pearl I'm giving is to remember the following: that when you have supragingival structure all the way around 360 degrees, we call that the ferrule. Something a crown can grab onto, and it's important that this ferrule is as tall as possible vertically—ideally two millimeters plus—but it's also important that the tooth structure remaining is thick because if it's very, like, if it's paper thin, that's not really a ferrule, that's not really contributing biomechanically.



Now the conceptual pearl I'm giving to you is to think about the position of the ferrule. If you have three millimeters on the palatal side and one millimeter on the buccal side, then this is still pretty good, especially for upper teeth, because the location of the ferrule is actually really important.



Think of the way that the upper incisors are loaded in a class one and class two patient. When a patient is chewing, the palatal of the upper incisors is taking load in clenching, is taking load in mastication and chewing as the food is pushed into centrals, and as you are cutting and incising, the crown is kind of going in a buccal direction.



The tooth, the crown of an upper incisor, is heading in a buccal direction, and so it is trying to grip onto that palatal tooth structure. And in a lower incisor, the buccal part of tooth structure is gonna be under more strain because the lower incisor is trying to bend inwards.



So why is this important? Well, pragmatically speaking, if you have a scenario where you're trying to restore a canine and you've got lots of tooth structure palatally and not very much tooth structure buccally, then probably you're gonna still be okay because that palatal tooth structure for an upper tooth, that's usually more valuable and more precious. It just helps us to remember how teeth are loaded in a biomechanical way.



Now, the absolutely fascinating thing that Dr. Vala Seif spoke about is: let's say you have a scenario where we have a retained root, like a crown–root fracture, and let's say you have loads of tooth structure buccally but you don't have much palatally for an upper incisor. Remember: upper incisor, we want more palatal tooth structure.



Well, the fascinating thing that he spoke about is: let's say you do the surgical extrusion technique. You partially extract this tooth out, and so now you've got more tooth structure to work with. And don't worry, the entire protocol will be broken down in this episode. But the thing he said which really wowed me was: okay, you have this scenario.



But how about now? You partially extract it and then you basically twist it 180 degrees, and that's the new position of this tooth. Suddenly you've gone from a situation where you had a lot of buccal tooth structure and not much palatal, to now rotating the tooth 180 degrees, and so now you've actually created ferrule palatally for this upper incisor.



I thought, wow, that's really clever, because guess what? The PDL don't care if it's the buccal or the palatal. The PDL don't know. The healing mechanism will still be the same,