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Quality Resource Guide -
Minimally Traumatic Surgical Extractions in General Practice 2nd Edition
www.metdental.com
Proximators/Periotomes
P
roximators, including spear-point instruments,
serve much the same purpose as Luxators and are
also applied interproximally (Figures 4a and 4b).
Their handles are not as large or comfortable to hold
as luxators.
They may be handheld or malleted as
desired by the clinician.
Periotomes are of two types. One variety is double
ended with thin flat blades angled from the shank
(Figure 5). These blades are thinner, flatter, and
weaker than those of luxators. Periotomes can
serve a similar function as Luxators (severing
the periodontal ligament fibers), but the process
is slower and less effective. On the other hand,
they cut gingival attachments from the root very
well, preventing the soft tissue bruising that would
normally occur when using a periosteal elevator
(which is thicker and more blunt) to reflect marginal
soft tissue.
The second type of periotome is like the Proximator
with a straight handle that can be hand-held or
malleted (Figure 6).
Periotome Bur
The “Periotome Bur” (or skinny bur) surgical
concept to remove teeth was introduced when
it became “unacceptable” from a clinical and
esthetic standpoint to remove buccal bone during
extractions yet the operator still wanted to perform
fast and efficient surgery (Figure 7).
The Luxator is
good but is limited to a depth of 3-4 mm depending
on bone density and PDL diameter.
The Periotome
can slowly be worked deeper than 3-4 mm into
the PDF but generally takes more time than other
instruments.
Over the last few years another extraction
method has gained acceptance.
A very thin bur
(700 or 701 fissure bur), not much wider than a
Peritome blade or tip of a Luxator, is inserted
with minimal invasiveness vertically (long-axis
of the root) into the PDL, followed by use of an
equally thin elevator-like instrument
(such as a
3 mm Luxator) in the space.
The Luxator is then
turned clockwise and counter-clockwise enough
to engage the root from different angles, slightly
displacing the root, slightly stretching the bone,
and breaking the ligament fibers – thus allowing
the now unattached root to be easily withdrawn
from the socket.
On the coronal aspect of a
root, use is limited to mesial and distal because
there is usually only thin bone facial and lingual
to a root but deeper in the socket, use can be
circumferencial if needed because bone around
a root tip is wider there.
Other devices are presented further in this article
that can go along side a root to cut it out. One is
the hard-tissue laser.
Another includes the piezo
bone-cutting instruments.
A third type is the
pneumatic periotome device.
All are expensive.
On the other hand, the periotome bur costs only
a few dollars.
Figures 4a and 4b
Proximators from Karl Schumacher Dental
Instrument Company.
Figure 5
Conventional Periotomes from Hu-Friedy.
Figure 6
Straight-handled Periotomes suitable for malleting from Hartzell.
Figure 7
Root requiring use of a Periotome bur for
removal. A straight general dentist’s straight
handpiece was used with a 700 bur where
the white dotted line is shown.
There was
more root removal than bone removal at about
7,000 rpm. The cut was about 5 mm wide
facio-lingually.
