PDF: Atraumatic Tooth Extraction and implant site preservation

Tooth extraction and implant placement may be the treatment of choice for hopeless teeth, i.e., when the periodontal involvement of the tooth or root jeopardizes an adjacent tooth or there is an infrabony defect or caries extending apical to the osseous crest.

Exodontia typically involves an expansion of the alveolar bone and severing of the periodontal ligament, as conducted with a combination of dental elevators, periotomes, and extraction forceps. 

Traditional instrumentation uses principles like simple machines (e.g., levers, fulcrums, and wedges) to separate the attachment apparatus and create tooth mobility through a “prying” motion that is less desirable at the treatment site. Implant treatment today depends on the ability of the treatment team to ideally preserve or supplement the extraction site for implant placement, commonly referred to as “atraumatic extraction”, which includes several important objectives: 

Goals of Atraumatic Extraction: 

• Preservation of buccal bone and cortical plate 
• Maintenance of the periosteal envelope and vascularity at the site 
• Generate less pressure on bony site 
• Prevent root tip fractures

Advances in dental instrument design provide today’s clinician with ideal options for achieving the goals of atraumatic extraction. 

Finely tuned instrumentation, e.g., luxating elevators and periotomes, is key to this process, both in the severing of the periodontal attachment and grasping of the failing tooth below the cervical margin with specially designed apical forceps. 

With the latter, a light yet constant apical pressure is applied onto the mesial and distal PDL space only until the tooth is slightly elevated and mobile for the proper use of atraumatic extraction forceps. 

All granulation tissue is removed using specially designed curettes and the site is prepared for bone grafting, GBR, or implant placement according to the treatment plan.

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