Recent advances in atrumatic extraction techniques


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Recent advances in atrumatic extraction techniques

  2. 2.  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
  3. 3. A “traditional” dental forceps removes a tooth similar to how a pair of pliers removes a nail. A claw hammer uses class I lever mechanics, with the handle one lever, the head of the hammer as the fulcrum, and the claw as the short lever applied to the nail. The Physics Forceps uses a similar action to remove a tooth.
  4. 4.  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
  5. 5. •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
  6. 6. Creep is expanding the bone and rupturing the periodontal ligament. The tooth is rotated slightly and elevated from the socket.
  7. 7. •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.
  8. 8. •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
  9. 9.  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
  10. 10.  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
  11. 11.  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.
  12. 12.  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
  13. 13.  In case of complete ankylosis  time required for RS compared with osteotomy at present seems to be larger  Limited literature
  14. 14. 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
  15. 15.  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.
  16. 16. Powertome® blade advanced in a ”sweeping” fashion. Powertome® blade advanced down PDL. Rotational movement of root with forceps. Atraumatic removal of the tooth.
  17. 17. Note the preservation of gingival and osseous structures. Dental implant fixture delivery. LIMITATIONS May take longer time than conventional technique. Provider fatigue