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Quality Resource Guide -

Minimally Traumatic Surgical Extractions in General Practice 2nd Edition

www.metdental.com

they rely on piezoelectric and laser energy, rather

than the force of the operator’s hand, to strip the

PDL around the tooth. The tooth or root can then

be lifted easily out of the socket. An example of a

piezoelectric device and its cutting tip are shown in

Figure 10a and b. At this writing, the author is aware

of five different brands of piezos that can be used

for extractions, ranging from $5,000 to $20,000.

Some of them have several different applications

in the dental office, including periodontal scaling,

removing broken endo files, doing endodontic

surgery, removing implants (instead of a trephine

bur), and various osteotomy procedures. Another

device in this category is the Powertome that utilizes

pneumatic energy and sounds like a “jack hammer”.

Blades of the peizo devices and the pneumatic

device are similar.

Extraction “Systems”

relatively new

category of devices is meant to

disengage

roots

from

sockets

screwing a drill

tightly into the root canal of

broken tooth and

utilizing leverage to pull on the drill. An example of

this type of device is shown in Figure 11. First, a

periotome severs the gingival attachments. Then

the drill, which is engaged into the root canal, is

connected to a leverage apparatus that pulls on

the root with sufficient traction to stretch and sever

the PDL. It is truly “atraumatic” in that adjacent

bone is not compromised in any way.

Even in

those infrequent situations where the root cracks

during insertion of the drill, the tooth typically splits

lengthwise and a luxator can usually take the pieces

out of the socket. Examples of devices are the

Easy X-Trac System, Benex/Messinger System, and

Sapian Root Remover System.

Advantages of all these extraction systems include:

1) no bone is removed around the root; 2) the

device does not violate the soft tissue around the

tooth; 3) they are gentle and atraumatic from the

patient’s perspective, and; 4) they are ideal for

creating sites for immediate implant placement. The

disadvantages of the devices are: 1) they are not as

good for molars as they are for single- rooted teeth

(the clinician usually needs to section a posterior

tooth before using these instruments and they are

somewhat awkward when applied in the posterior

of the mouth); 2) they are costly; 3) they are not as

effective if deep decay is present; and 4) the root can

fracture during the process.

Figure 11

An example of a “tooth extraction system”:

The

Easy X-Trac.

Conclusion

n difficult economic times and especially

if the general dentist has expertise in

exodontia, he/she is going to retain more

procedures in the office and refer less. Patients

will be more often opt for extractions instead of

higher-priced treatment plans.

Unfortunately, between 10-20% of extractions

become “surgical” even though initially they

may not have appeared to be that difficult.

This can be a problem for some dentists with

limited experience.

However, even if dental

school training with extractions was restricted,

that does not need to stop clinicians from

using various means to increase their surgical

proficiency.

Courses in “surgical” extractions

are available to help enhance clinicains’ ability,

efficiency, speed, and comfort level. The author

and others offer didactic, model participation,

and even patient partition courses.

There are

numerous surgical texts to enhance surgical

knowledge.

This Guide has reviewed many surgical

principles, and presented some new devices

and techniques that will help the general

dentist perform exodontia more quickly, more

competently, more predictably, and less

traumatically, as required in today’s clinical

environment.

It is an important step towards

reaching your goals with oral surgery.

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Christensen, GJ. Bone regeneration and/

or ridge preservation. Clinician’s Report

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2. Hupp JR, Ellis E, Tucker MR, Contemp.

Oral and Maxillofac Surg. 5th ed p. 296,

Mosby/Elsevier 2008.

3. Ibid. p. 298, Mosby/Elsevier 2008.

4. Ibid. pp. 127-131. Mosby/Elsevier 2008.

5. Ibid. p. 113. Mosby/Elsevier 2008.

6. Leonard, M.

Essential Dental Handbook,

Edwab, R., editor. Chapter 10: Oral Surgery.

PennWell Corp., 2003.

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JL. Air penetration into the tissues

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Clinical pearls for surgical implant dentistry,

Part 3. Dentistry Today. Oct. 2010.

(Peer

reviewed article for CE credit).

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Dentistry Today. August, 2008.