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DENTISTRYTODAY.COM • FEBRUARY 2013

Predictable Emergency Implant Placement:Maintaining the Buccal Plate With the Physics

Forceps Extraction TechniqueTimothy Kosinski, MS, DDS

Practitioners like myself who offer im-plants desire the “emergency implant”situation that arises to be more pre-dictable, starting with a complete atrau-matic extraction that preserves the buc-

cal plate. This is particularly the case when deal-ing with anterior teeth, where the buccal plate canbe very thin. If we are able to start with an extrac-tion technique that preserves the buccal plate on apredictable basis, these emergency cases can be abit more straightforward. Advancements in to-day’s extraction instruments provide far lessstress for us, and more importantly, for ourpatients, and I find the Physics Forceps (with theirassociated technique) to be the best instrument onthe market in these cases.

The Physics Forceps are used to achieve acomplete atruamatic extraction of a tooth where

it is imperative to maintain the buccal plate inpreparation for an immediate emergency dentalimplant. Root fracture would only complicate acompromised situation. Elevation of the tooth isno longer necessary since the Physics Forcepsstretch and eventually break down the periodon-tal ligament fibers by creating a chemical changein the ligament, resulting in release of theSharpey’s fibers. Hyaluronic acid creates thechemical breakdown of the ligament, and thetooth is released from its attachment to the alve-

olus and is easily and atruamatically removed.This is all completed utilizing only wrist rota-tion (no squeezing) in a buccal-only directionwith one instrument.

In this clinical case study, the patient presentedwith a symptomatic fractured root that requiredimmediate attention. Being an anterior tooth, thepatient expressed much emotion concerning itsextraction. Providing the patient with an extrac-tion technique that was simple and relativelynoninvasive created a positive effect for the pa-

Figure 1. Preoperative digital radiograph illustrating symp-tomatic fractured root that required immediate attentionand a potential for an “emergency dental implant.”

Figure 2. The Physics Forceps bumper is placed in theanterior vestibule close to the mucogingival line angle,and its beak is placed approximately 3 mm subgingival onthe palatal aspect of the tooth’s root surface.

Figure 3. Using only wrist rotation in a buccal-only direc-tion with no physical force, the tooth begins to disengagefrom the socket. Once the tooth moves, stop using thePhysics Forceps and deliver the tooth with a conventioninstrument of choice. The forceps operate as a lingualelevator, with no elevation required in advance.

Figure 4. The fractured root is atruamatically removed,maintaining the buccal plate.

Figure 5. A dental implant is threaded into the socket. Tri-calcium phosphate granules were used to fill in any smallgap between the body of the implant and facial plate ofbone.

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tient. In this case, the procedure was completedin a few minutes, and you can see that the PhysicsForceps technique resulted in removal of the en-tire root along with the fractured apical tip.

The resulting clean socket became an appro-priate site for immediate placement of a singledental implant. Sight grafting with tri-calciumphosphate crystals filled in any small areaswhere the implant was not immediately en-gaged into bone. When a proper socket was cre-ated following the atraumatic extraction, imme-diate placement was considered and discussedwith the patient. The osteotomy was madeapproximately 3 mm palatal to the facial planeof the adjacent teeth engaging the palatal bone.This allowed proper facial contours of the finalaesthetic crown and also good blood supply tothe integrating dental implant. The implant wastorqued into place, and a healing abutmentplaced. An Essex retainer was made from thepreoperative cast and used as the transitional ap-pliance while the implant healed.

Utilizing this atraumatic extraction tech-nique, patients are impressed by the ease of theprocedure and lack of trauma to the surgicalsite. The biomechanical design of Physics For-ceps instruments allows minimal fracture ofroots and maintains the buccal plate, essentialto proper healing of an immediately placed den-tal implant.

Figure 6. Postoperative digital radiograph with implant,abutment, and crown completed.