Atraumatic Extraction Technique
Directa Dental Luxator® instruments for efficient procedures and optimal results
An atraumatic extraction causes the least amount of damage to the surrounding tissue. This procedure came about because of the need to preserve bone during an extraction, primarily the all-important buccal plate. When this bone is destroyed, the socket collapses and compromises future implant placement, fixed crown-and-bridge esthetics, and the stability of removable prosthetics.
To be in control of the atraumatic extraction procedure, you must use instruments and techniques that give you the best overall advantage. I have found the most efficient instruments to be those that focus all the work of an extraction on the roots. These instruments are able to navigate the periodontal ligament (PDL) space and sever the ligament while slightly expanding the socket, which is the first step.
Although there are many options, my choice over the years for atraumatic extractions has been the Directa Dental Luxator®. These instruments are very sharp and can navigate the PDL space easily. I like to call it “cut & feel, push & nudge.” As you enter the PDL space, you cut the ligament as you feel for an advantage in leverage on the root surface. Once you feel resistance, you then push the root and nudge it with a slight twist. If the root moves, you can then work deeper into the PDL space with the same motions and dislodge the root, or move to another location on the root and repeat.
As you work the sharp, stainless steel instrument apically, you sever the ligament, and when you are pushing a root on one side, you are crushing the ligament on the other. This results in a bleeding ligament, which hydraulically helps push the root out of the socket. Also, the steel blade is harder than bone and tooth, so as you work it apically, the bone expands and the harder steel displaces the root. The best extraction advice I was given was to never place a forcep on a tooth unless it was loose. Now once it’s loose, it’s time to extract the root with a forcep.
Although lagging behind other areas of dentistry, oral surgery instruments are nevertheless undergoing a rapid evolution to improve patient care. The old elevators and forceps were not very efficient and the technique of rolling to the buccal resulted in a lot of buccal plate fractures and crown fractures. Personally, I haven’t used an elevator in over 10 years—they all went to scrap metal.
The “cut & feel, push & nudge” technique is the same for every tooth; for multi-rooted teeth, I loosen first then section, if needed, and then work my instruments on the sectioned roots. In conclusion, if you follow simple techniques and use instruments that give you the most control over the procedure, you will be better able to perform atraumatic extractions.
• Features a fine-tapered bladethat compresses the alveolar, cutting the membrane, and gently easing tooth from its socket
• A real alternative to traumatic forcep extractions, providinggreat patient safety
• Ergonomically-shaped handles provide optimal access
• Preserves bone integrity with minimal tissue damage
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JS Dental Manufacturing, Inc.
About the Author
Eric Schuetz, DMD, graduated from The University of Florida College of Dentistry in 1996. Dr. Schuetz is always trying to make the dental experience, especially extractions, easier and gentler on his patients. After 15,000 extractions, all on conscious patients, he shares his experiences.