MANTHRU NAIK RAMAVATHPG IN DEPT OF ORAL AND MAXILLOFACIAL SURGERY

GDC, VIJAYAWADA

RECENT ADVANCES IN ATRAUMATIC EXTRACTION

TECHNIQUES

While traditional dental extraction techniques encourage minimal trauma, luxated elevation and forceps removal often results in fracture or deformation of the dentoalveolar housing.

This trauma typically results in post extraction ridge defects that may

preclude treatment with dental implants or result in sub-pontic food traps when traditional fixed partial dentures are used.

These problems may be avoided with “atraumatic” extraction techniques.

Atraumatic extraction preserves bone, gingival architecture, and allows for the option of future or immediate dental implant placement

RECENT ADVANCES IN ATRAUMATIC EXTRACTION TECHNIQUES

PHYSICS FORCEPS

A “traditional” dentalforceps removes a tooth similar tohow a pair of pliers removes anail.

A claw hammer usesclass I lever mechanics, with thehandle one lever, the head of thehammer as the fulcrum, and theclaw as the short lever applied tothe nail. The Physics Forceps usesa similar action to remove a tooth.

developed by Golden in 2004

uses first-class lever mechanics

One handle of the device is connected to a “bumper,” which acts as a fulcrum during the extraction .Bumper is placed approxiamately at the level of mucogingival junction.

The beak of the extractor is positioned most often on the lingual or palatal root of the tooth and into the gingival sulcus

•Revolutionary beak and bumper design that allows for efficient atraumatic extractions using only wrist movement based on a Class I lever.

•When this technique is first attempted, a conscious effort must be made to retrain your hands to not squeeze the instruments and to not pull with your arm.

•Applies a steady rotational trauma to the periodontal ligament quantitatively creating a release of hyaluronidase in a shorter period of time than traditional forceps or elevator extractions because the trauma from these conventional techniques is intermittent

Creep is expanding thebone and rupturing the periodontalligament.

The tooth is rotatedslightly and elevated from thesocket.

•Endoscopically assisted root splitting (EARS) is a new technique for root removal wothout ostectomy.

•EARS has revealed to be a valuable tool to avoid alveolar crest trauma during exodontia especially in anterior esthetic zone.

•The surgeon works in a 9 o`clock position observing the operation site on a video screen via a Storz Hopkins support endoscope.

•The support endoscope is placed adjacent to the surgical site using the spatula of the support tube for maintenance of distance

The crown is removed completely via transversal separation at the level of the gingiva.

identification of the root canal

enlargement of the canal

-Gates burs and/ or Lindemann straight burs in a low speed surgical handpiece

RS (Longitudinal root splitting)

-Using straightor angulated elevators

-splitting of the root makes it possible to remove the fragments

without pressure against the surrounding tissues

TECHNIQUE

implosion technique

-fragments are mobilized towards the center of the alveolous

Removal

-under endoscopic control using small Bein elevators or a tissue forceps

If an apical root fragment is present following splitting, it can easily be identified endoscopically and removed separately with a Heidbrink elevator or a root forceps

Applied by Engelke et al. (2011) for removal of fully impacted third mandibular molars via an occlusal approach. They showed, that the buccal bone loss could be reduced to a mean of 2.1mm in situations with complete retention

Fuentes et al. (2012) reported the importance of support endoscopy in the removal of third mandibular molars to avoid inferior alveolar nerve damage and bone defect formation.

no surgical manipulation of the alveolar walls

Avoiding mucoperiosteal flap reflection

no force transmission towards neighbouring teeth

no incision

no osteotomy

reduction of pain andswelling of the surrounding tissues

Endoscopic control of surgical area

ADVANTAGES

In case of complete ankylosis

time required for RS compared with osteotomy at present seems to be larger

Limited literature

LIMITATIONS

Powertome® is an electric unit that has a handpiece with a periotome blade that is controlled by a foot switch.

Employ the mechanisms of “wedging” and “severing” to facilitate tooth removal

Periotomes are composed of very thin metallic blades that are gently wedged down the periodontal ligament (PDL) space in a repetitive circumferential fashion.

In addition to minimally invasive luxation, the periotome blade severs Sharpey’s fibers that secure the tooth within the socket.

Once a majority of Sharpey’s fibers have been separated from the root surface rotational movements allow for extraction of the tooth with minimal lateral pressure.

TECHNIQUE

Powertome® blade advanced in a ”sweeping” fashion.

Powertome® blade advanced down PDL.

Rotational movement of root with forceps. Atraumatic removal of the tooth.

Note the preservation of gingival and osseousstructures.

Dental implant fixture delivery.

LIMITATIONS

May take longer time than conventional technique.

Provider fatigue