Using High School Physics to Extract Teeth Atraumatically by Robert Weller, D.D.S., B.A., Ian Lerner, D.D.S., and April Lim, B.S. Conventional tooth extractions up to this point were achieved by moving the tooth with an elevator then rocking the tooth back and forth with forceps, thereby loosening the tooth in the socket. This frequently caused some fracture of the marginal bone in the socket and some cracking sounds that could unsettle the patient. This new technique using principles taught in high school physics enables us to withdraw the tooth without traumatizing the bone around the socket or creating any cracking sounds. During tooth extractions, retain- ed root fragments are a common occurrence. This can lead to bleeding, pain, infection and then an additional procedure of a flap with a surgical extraction resulting in more bone loss. Extracting teeth as atraumatically as possible by applying controlled tension in the long axis of the tooth will usually empower the dentist to conserve the alveolar bone, avoiding root fracture and causing the least trauma to the patient, allowing faster healing. Preserving the maximum amount of bone allows dentists to create a more ideal site for a bridge pontic or the placement of an implant. A method of achieving this goal is of especial importance in extracting third molars that would otherwise require a fair amount of tooth movement. Avoiding the bucco-lingual luxation and possible tooth depression may prevent trauma of the inferior alveolar nerve, a frequent complication of third molar extractions. This is even more critical in extracting a maxillary first bicuspid, a tooth with two slender roots, in which case bucco-lingual luxation can frequently result in fractured retained root tips, which must be promptly removed to avoid interference with the orthodontic treatment. This technique has been useful in the extraction of any tooth in the mouth. But it is critically important on upper first bicuspids and third molars. Luxation of first bicuspids frequently leads to root fracture. Third molars are difficult to luxate because they are surrounded by a great deal of bone buccally and lingually. Using leverage to elevate the tooth from the socket eliminates the need for luxation. I had been using this technique for eight years to improve the experience for the patient and me. The technique of how to extract third molars and first bicuspids is outlined below. Technique for Third Molars: Insert the periotome in between the gingival tissue and the tooth. Gently sever the tissue connection to the tooth by sliding the instrument on the entire periphery (Figures 1 to 5). Next, an appropriate forceps is applied to the buccal and lingual surfaces of the third molar and a fulcrum is placed under the forceps handle as close as possible to the tooth to be extracted while keeping clear of its “occlusal surface (Figures 6,7).” In my practice, we usually used a rounded hard-wood chopstick sometimes placed on a tongue depressor as the fulcrum. Gentle, slowly increasing pressure is applied to the forceps handles in the direction of the occlusal surface behind the fulcrum until the tooth is elevated (Figures 8,9). Disclaimer: Publication of the below article does not imply endorsement of the techniques discussed therein by Second District Dental Society (SDDS). Readers are advised that there is currently no research on the reviewed techniques and the content is presented solely for educational and informational purposes. There are potential risks in integrating any techniques and procedures discussed into practice without adequate supervised clinical experience to ensure competency. Figure 1 Figure 2 Figure 5 Figure 3 Figure 4 Figure 6 Figure 7 4 SDDS BULLETIN JULY/AUGUST 2023 — VOLUME 40 ◊ NUMBER 4
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