Instruments for Atraumatic Extraction of Teeth: Are they Helpful?

Dr. W. asks:

I am a general practitioner do a lot of surgery on my patients and I place most of my own dental implants. I was fortunate when I did my military service to have the opportunity to do a great deal of extractions under the supervision of caring and very competent oral surgeons. Recently, I have bought a number of new instruments to do atraumatic extractions to preserve bone so I need to do less bone grafting for implants. However, I find that I do just about as much bone removal for teeth that have splayed or curved roots as before I started using the periotomes and Luxators. If I fracture off a root tip, I like to have good visibility by removing part of the buccal cortical plate, especially in the maxillary premolar and molar region. I really have not found these devices to be much of a help. Is it just me? What has been your experience.

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27 thoughts on “Instruments for Atraumatic Extraction of Teeth: Are they Helpful?

  1. I don’t think it is just you. I routinely extract teeth atraumatically in preparation for immediate or delay dental implants, and sometimes it happens to me and yet I do this for a living. The best way to avoid mishap is to use the periotome as deep as you can possibly go apically, esp if the root is curved, and keep in mind to deliver the tooth in the direction of the curve root. Sometimes you have to section the tooth itself for the socket not to remove bone. or you can refer to me.

  2. I use several methods to extract a root or a broken root: first periotome but than the best choiche for me is to use a tiny ,thin and a long lindemann cutter to remove a little circualar quantity of bone, atraumatic. than you can use a very little bend lever.

  3. I think in this day and age of immediate implants, we should never remove any buccal bone. I do everything possible to keep the buccal plate. Other than periotomes and small surgical burs, the other newer instruments are worthless. Don’t waste your money.

  4. it wouldn’t be a bad idea to perhaps search for a course that focused on atraumatic extractions or has a serious section on socket preservations because those courses will likely highlight their use and tips/tricks to avoid removing bone…even when it seems like the only thing left to do. I agree with ZC that there are ways to avoid removing bone even if the root tip breaks, from Piezo units (that i use in tougher cases) to end cutting burs to create “canals/troughs” in specific points in the socket to avoid any buccal wall disturbance, to sectioning the actual root tip with a bur (like my periodontist colleagues do in my Calgary office), etc.
    I know these guys are about to publish on this and have a draft ready but i can’t share yet. will do in the future though.

  5. I have been doing atraumatic extractions for many years.
    I agree that we should always try to avoid removal of the buccal bone, especially when an implant is to be placed there. I have been using Proximators (by Karl Schumacher) for about 4 years. I had not been happy with periotomes, especially with how long it sometimes took to get a root out. I also tried luxators, but found that the Proximators worked much better. I use the spade Proximator about 95% of the time. It is great for expanding the PDL space and alveolus, then getting apical to the root and displacing it occlusally.
    If I cannot get the Proximator in to the PDL space, I will take a 701 bur and trough around the root. This allows me to get a purchase point in to the PDL space and deliver the root.

  6. Atraumatic extractions are a must in modern implantology.Preservation of the buccal plate is essential in all case of immediate implantations and therefore we can preserve the bone by using:
    1)Luxators- I usually use the Stoma kit.
    2) Always seperate the roots of molars and PM.
    3) Using piezo makes all of these a peace of cake…

    As with all surgical procedures the more experienced you are the easier it will be to preserve that precious bone.

  7. I use piezo surgery(Surgybone from Silfradent, which is excellent!) , cut mesial and distal, and sometimes palatal of the roots with the piezo unit, then “cut” bucal between the bone and the root with a 15 or 11 blade (which will save the bucal bone). Then normal elevators or periotomes. And I always section molars into 3 separate roots. This way potentially difficult extractions are uually easy!

  8. I was using periotomes and luxators with the occasional sectioning of the root with a 701xl or troughing with the 701xl. It took me up to 20 minutes to remove a tough tooth. I have switched to the Physics forceps and they are nothing short of amazing. 5 minutes or less for any tooth (you do have to section molars). I now teach this in my courses.

  9. I must say that I totally agree with Ziv Mazor. However you can still do it without piezo. It will take you a little longer but it will do the job esp. if you are an experienced practicioner. I would like to suggest that the buccal plate should not be removed ever (as much as possible). If you have to remove bone remove the palatal. It’s thicker, more dense and more coronal. you can use the bur to remove tooth and not bone from the mesial and distal. I’ve learned from my mistakes, you touch the buccal plate and you will regret it.

  10. of course buccal plate is very sensetive & week.the concept of extration is changed after the introduction of implantology& most of failuer happened because of invasion & resorption of buccal the concept is save the buccal plate.every case is different & need a flexible way of thinking regarding the bone quaility & anatomy of the root/s.whatever u r going to use be patient.deliver the baby & keep the mother alive.never apply pressure on cortical bone nor try to excessive expande it.

  11. I have utilized Periotomes and Piezo units (Satalec-Implant Centre). But for my money, I prefer the Benex Extractor from Meisinger. Distributed by both Meisinger Germany and USA as well as Salvin.

  12. I just got the Physics forceps and they are a life-changing experience! 87 yr old male, broken down roots, endo treated roots, good hard bone. My first day with the forceps, and I hadn’t even had time to watch the DVD. Following the printed instructions, all 10 upper teeth including two molars were out in 12 minutes. We had planned on waiting a week to do the lowers, but due to the lack of fatigue for both the patient and myself, we went ahead with the lowers. I swear, only 5 minutes total for all 10 lowers. No broken roots, no buccal (or interproximal) bone lost, no elevators, periotomes, etc. I will never do another extraction without them. And in answer to your next question, no, I do not have any relationship to Misch-Golden, the developers of the Physics forcep, at all. Just saw the ad on the web, took a chance and ordered with the 60 day trial period. They ain’t getting them back!

  13. Like some of my other colleagues I have also spent a few decades extracting teeth nearly all with associated pathology and root architecture which would defeat even the most adventurous endodontist. I have just one observation – the beaks and the associated protocols for their use remind me of a Victorian ‘tooth-key’ – instruments which fell out of general use before the First World War. It also bears a good number of simularities with the ‘Pelican’-extractors of Oliver Cromwell’s time. They must be 400 years old. If you ask the BDA London nicely they will show you one dating from the 1600’s. I have to look very carefully at the research which gave rise to the invention that General Medical call ‘Physics Forceps’in their adverts. It might possibly be like the the re-invention of the wheel, or possibly the weight of all those teeth I have extracted will lay heavily on my dental soul?

  14. I have the Physics Forcepts and they work great. The difference with these forcepts and the “hook forceps” you describe is in the fulcrum. It is placed in such a way that the tooth is lifted vertically from the bone. If you follow the protocol correctly and use very little force, do not squeeze the forceps, but merely place it and gently hold the forceps with very little pressure until the tooth “gives”…you can gently lift the tooth out with a hemostat or even your fingers without taking buccal bone. It is a great idea!

  15. hi..
    i am a dentist from india. i just herd about the physics forceps. rare they really worth buying. pls help me if someone using them.

  16. I’ve been using them for over a year. I use them for many cases and they work well for the most part, but be careful to follow the directions and don’t get impatient waiting for the “slip” when the ligament releases. Sometimes it never does, in spite of the marketing. I admit to having a few “atraumatic” extractions turn “traumatic” with broken buccal bone. Of course, that can happen with any technique, but remember they are not a magic bullet, just another tool which helps in some cases. Old fashioned rotation and elevation works pretty good if you’re patient.

  17. thanks dr. ken for helping me out. can you pls help me to how much these forceps costed you. is it that they cannot be used for all the teeth in any condition as marketed by them

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