Recent advances in atrumatic extraction techniques
MANTHRU NAIK RAMAVATH
PG IN DEPT OF ORAL AND MAXILLOFACIAL SURGERY
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
A “traditional” dental
forceps removes a tooth similar to
how a pair of pliers removes a
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.
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 the
bone and rupturing the periodontal
The tooth is rotated
slightly and elevated from the
•Endoscopically assisted root splitting (EARS) is a new technique for root removal
•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
identification of the root canal
enlargement of the canal
-Gates burs and/ or Lindemann straight burs in a low speed surgical
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
-fragments are mobilized towards the center of the alveolous
-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
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
reduction of pain andswelling of the surrounding tissues
Endoscopic control of surgical area
In case of complete ankylosis
time required for RS compared with osteotomy at present seems to be larger
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
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
Powertome® blade advanced in a
Powertome® blade advanced down PDL.
Rotational movement of root with forceps.
Atraumatic removal of the tooth.
Note the preservation of gingival and osseous
Dental implant fixture delivery.
May take longer time than conventional technique.