Traditional tooth extraction uses lateral forces to expand the alveolus until the irregularly shaped root can be removed. This expansion of the alveolus often does not show obvious damage to the socket on a clinical level, but this method causes widespread fracturing of the bone on a microscopic level and often leads to complete resorption of alveolar walls. The trauma of this method creates significant inflammation in the bone which leads to significant bone resorption. This inflammation also exhibits itself in more postoperative pain for the patient. The following atraumatic extraction method allows removal of a tooth without damaging the alveolus of the extraction socket.
Atraumatic Extraction Method
Tooth #8 is prominent in the ridge and as a result shows minor recession compared to #9. Due to failing endo and significant bone loss, extraction and graft with delayed implant was planned. With a prominent root, the buccal bone will be thin. Any force applied to the buccal bone will result in fracture and loss of the buccal plate.
For an atraumatic extraction, the crown is removed and sulcular incisions are made to separate the gingival attachment.
The root is cut in the buccal-lingual direction. Care is taken to leave a very small amount of root structure on the buccal to assure the buccal bone is not violated. In order to maintain the buccal plate, no buccal and lingual force can be applied. If possible, no mesial distal forces should be applied to enlarge the extraction socket.
If there is enough tooth structure above the alveolar crest, a small elevator is the best instrument to collapse the two halves of the root toward the midline. However, if little or no root is above the alveolar crest, a periotome is used to collapse the sectioned root toward the midline. The periotome is only used interproximally on both the mesial and distal. This method collapses the root inside the socket and puts no force on the buccal wall of the socket. Once the root has been collapsed, the halves can be removed with hemostats or pedo forceps.
Grafting is required to maintain the bone lining the extraction socket. Leaving the extraction socket exposed to the oral cavity results in death of the bone lining the socket, and if any of the walls are thin, this will result in complete loss of the wall. Here Socket Graft Injectable is used to graft the socket.
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