Minimally invasive vertical versus conventional tooth extraction: An interrupted time series study

Modified Surgical Guide for Root Sectioning in the Socket Shield Technique-In Vitro Study

OBJECTIVE

This in vitro study aimed to evaluate the effectiveness of a printed surgical guide for root sectioning in the socket-shield technique.

MATERIALS AND METHODS

A typodont model of the maxilla with augmented filler was used for the upper right central incisor, and CBCT images were obtained. Two types of vertical root sectioning guides were tested: one with a buccal sleeve (Group A, n = 10) and another with a buccal orientation slit (Group B, n = 10). Control group (n = 10) performed freehand cuts on printed models. After crown cutting with diamond burs, root sectioning was conducted using an ultrasonic tip with the guides. Mean and standard deviation were calculated for the remaining root length, width, and volume. Data were analyzed using the Kruskal-Wallis test and Dunn's post hoc test.

RESULTS

Statistical analysis showed significant differences in root width between the control group (2.0 mm) and both Groups A (2.655 mm; p < 0.0001) and B (2.460 mm; p < 0.0001). Group B (5.585 mm) also showed a significant difference in root remnant compared with the control (13.880 mm; p < 0.0043). Groups A and B did not differ significantly from each other.

CONCLUSIONS

The socket shield technique is safe and effective, this study aimed to add improvements through the introduction of surgical guides, facilitating the root section, which is the critical phase so that the parameters that are requisite for success are achieved in terms of width, length, and volume of the root remnant. Both guided techniques effectively facilitated root sectioning, maintaining satisfactory root thickness and length.

CLINICAL SIGNIFICANCE

Sectioning the root is challenging for the correct angulation to remove the palatal portion in the socket shield technique. Therefore, modifying this technique with the use of the presented guides, it is possible to prevent damage to the soft tissues and to plan the surgery with the help of cone beam computed tomography (CBCT) scans to remove the root apex and maintain the root remnant with a thickness greater than 1.5 mm, making the socket-shield technique more predictable.

Investigation of Morphological Changes of the Soft Tissue in the Aesthetic Zone: A 3D Virtual Analysis after Conventional Tooth Extraction and Benex® Extraction

BACKGROUND

Postoperative resorption of hard and soft tissues occurs as a consequence of tooth extraction. The Benex®-Control extractor allows minimally invasive extraction of the tooth without causing pronounced iatrogenic trauma. The aim of this study was to verify whether the resorption of the tissues after extraction can be reduced by using the Benex® system compared to the conventional extraction method.

METHODS

Postoperative intraoral scans were superimposed after surgery (t0), after 7 days (t1), after 14 days (t2), after 30 days (t3), after 60 days (t4), and after 90 days (t5) within the two groups (study n = 14, control n = 16), and defined regions of interest (ROIs) (1-8) and volume changes were analyzed. In addition, the influence of gingival thickness and the thickness of the labial cortical plate was investigated.

RESULTS

The greatest decrease in volume was observed in both groups in ROI3, although there was no significant difference observed between the groups. In the presence of an adjacent tooth, there was less volume loss in the affected ROIs (1, 2 and 7, 8). The thickness of the gingiva and the bony lamella did not significantly influence the change in volume.

CONCLUSIONS

Due to the small cohort, the results are limited, and the hypothesis is rejected.

Minimally Invasive Extraction System Benex-Clinical Evaluation and Comparison

Tooth extraction is one of the oldest and most well-known surgical procedures in dental medicine. It is still routinely performed by general practitioners and dental undergraduates. The Benex extraction system allows for the extraction of teeth in a vertical direction, which avoids most trauma against surrounding alveolar bone and soft tissues. The study included 56 patients who were recruited from the Department of Oral Surgery, Medical University-Plovdiv. The patients were split into two groups of 28 patients-Group I (control group) and Group II (study group). For each group, the success of the extraction, buccal cortical plate preservation, pain experience and early wound healing were assessed. There was no statistical significance between the success of the extractions in both groups. The Benex extractions preserved the buccal cortical plate in 95% of the cases, whereas the forceps extractions preserved it in only 71.8%, which is statistically significant. On the seventh day, patients in Group II reported less pain, without a significant difference. There was a significantly bigger number of completely healed extraction wounds on the 10th day. Atraumatic extractions allow for more hard and soft tissues to be preserved in the extraction site. This is essential for a successful outcome and the aesthetically pleasing results of the following dental restoration.

Radiographic Evaluation Factors That Influence the Decision of the Tooth Extraction Method

INTRODUCTION

A simple tooth extraction method usually involves using elevators and forceps to remove the tooth easily. In contrast, a surgical extraction method requires utilizing a straight handpiece to facilitate the tooth extraction, either removing bone or sectioning the tooth into pieces.

OBJECTIVE

In this research, we aim to diagnose a tooth radiographically before extraction and determine certain factors to observe which extraction method might be more feasible, either simple or surgical.

METHODOLOGY

This study followed a retrospective cross-sectional study design. The x-ray radiographs (periapical (PA) or panoramic) were collected from the R4 system in the university dental hospital for data collection. Different radiographic influencing factors were measured, such as bone density, bone level, endodontic involvement (RCT/post and core), crowned or remaining root, and root morphology. Statistical associations were performed using SPSS (IBM Corp., Armonk, NY) with a one-way ANOVA test.

RESULTS

There were 62 cases with 47 simple and 15 surgical extractions. There was a non-significant (p>0.05) association between the measured factors and the extraction method, either simple or surgical tooth extraction. Although bone density measurements showed a slight tendency toward PA lesions and simple tooth extraction.

CONCLUSION

There was no significant association between the factors and extraction methods. Future research is required to determine whether or not preoperative radiographic evaluation can influence the decision for the tooth extraction method.

A novel atraumatic extraction technique using vestibular socket therapy for immediate implant placement: a randomized controlled clinical trial

PURPOSE

This randomized controlled clinical trial compared soft tissue changes following a novel vestibular atraumatic extraction technique (test group) versus the conventional incisal atraumatic extraction approach (control group) while implementing the vestibular socket therapy for immediate implant placement.

METHODS

Thirty patients with hopeless maxillary anterior teeth requiring atraumatic extraction were randomly assigned into two equal groups to receive either test or control. Vertical soft tissue alterations in mm were measured at baseline and 12 months post-restoration using intraoral digital scans at three reference points, distal papilla, mid-facial gingival margin, and mesial papilla, as well as pink esthetic scores (PESs) after 12 months.

RESULTS

Vestibular extraction technique showed significant soft tissue improvement and creeping when compared to incisal extraction (P < 0.05). The test group showed soft tissue measurements with a mean (± SD) of 0.26 (± 0.58), 0.39 (± 0.64), and 0.05 (± 0.37) mm for the mesial papilla, mid-facial gingival margin, and distal papilla respectively. While the incisal extraction technique demonstrated gingival recession at the distal papilla, mid-facial gingival margin, and mesial papilla of - 0.37 (± 0.54) mm, - 0.32 (± 0.68) mm, and - 0.39 (± 0.59) mm respectively. The overall PESs after 12 months were 12.67 (± 1.59) in vestibular extraction group, while incisal extraction group was 11.40 (± 1.40), with significant difference between them (P = 0.03).

CONCLUSION

This investigation suggests that both studied techniques were successful in the atraumatic extraction of hopeless severely damaged teeth. The novel vestibular extraction technique might be considered an alternative reliable atraumatic extraction approach compared to the conventional incisal extraction when performing the vestibular socket protocol for immediate implant placement with soft tissue enhancement.

Bone grafting techniques and materials for implant dentistry

Bone quality, volume, height and width all play a pivotal role in dental implant stability, success and survival. A lack of adequate bone can be overcome with various bone grafting procedures. Dependent on many factors, including the amount of bone required, the site of implant placement, patient preferences and clinician factors; the type of bone grafting material and procedure undertaken can vary. Supplemental bone can be sourced from a variety of sources, including autogenous, allogenous and xenograft bone. Dependent on the source of the bone, it will have different properties in aiding bone formation, as well as being presented in different formulations, such as bone particles or bone blocks.The aim of this paper is to provide an overview of bone grafting indications, materials and types of bone grafting techniques that can be utilised to aid dental implant provision. It also discusses the properties needed to ensure optimal success of guided bone regeneration techniques.

A novel computationally engineered collagenase reduces the force required for tooth extraction in an ex-situ porcine jaw model

The currently employed tooth extraction methods in dentistry involve mechanical disruption of the periodontal ligament fibers, leading to inevitable trauma to the bundle bone comprising the socket walls. In our previous work, we have shown that a recombinantly expressed truncated version of clostridial collagenase G (ColG) purified from Escherichia coli efficiently reduced the force needed for tooth extraction in an ex-situ porcine jaw model, when injected into the periodontal ligament. Considering that enhanced thermostability often leads to higher enzymatic activity and to set the basis for additional rounds of optimization, we used a computational protein design approach to generate an enzyme to be more thermostable while conserving the key catalytic residues. This process generated a novel collagenase (ColG-variant) harboring sixteen mutations compared to ColG, with a nearly 4℃ increase in melting temperature. Herein, we explored the potential of ColG-variant to further decrease the physical effort required for tooth delivery using our established ex-situ porcine jaw model. An average reduction of 11% was recorded in the force applied to extract roots of mandibular split first and second premolar teeth treated with ColG-variant, relative to those treated with ColG. Our results show for the first time the potential of engineering enzyme properties for dental medicine and further contribute to minimally invasive tooth extraction.

Interproximal Reduction Facilitating Orthodontic Teeth Extraction

Extractions are routinely performed in orthodontics to gain space for teeth alignment. Crowded, malaligned, and overlapped teeth make it difficult for the dental surgeon to engage the beaks of the extraction forceps on the concerned tooth for extraction. An improper grip often leads to complications of instrument slippage, crown fracture, and more commonly, luxation of adjacent teeth. This article aims to help with atraumatic orthodontic extractions and reduce such complications. This case report examines an interproximal reduction technique using standard grit, taper, flat-end diamond bur (Mani TF-20, ISO 171/014, Mani, Inc., Tochigi, Japan) for the tooth to be extracted to create enough space for proper placement of the forceps and to prevent injury to adjacent structures. It can be useful for orthodontic extractions or other cases of tooth extractions with inadequate access.

A Minimally Invasive Technique for the Retrieval of Fractured Root Tips

Exodontia, the removal of a compromised tooth, ideally consists of the painless removal of the tooth or tooth root, with minimal trauma to the surrounding tissues, resulting in complete healing without creating postoperative prosthetic problems. Fractures of the tooth's root tip during exodontia can be common in some cases, such as in teeth with irregular root morphology or severely decayed teeth. The current article presents a technical report in which endodontic files made it possible to remove a fractured root tip from a maxillary third molar without using force.

Comparison between Magneto-Dynamic, Piezoelectric, and Conventional Surgery for Dental Extractions: A Pilot Study

This pilot split-mouth study aimed to evaluate and compare early postoperative discomfort and wound healing outcomes in post-extraction sockets after dental extraction performed with a Magnetic Mallet (MM), piezosurgery, and conventional instruments (EudraCT 2022-003135-25). Twenty-two patients requiring the extraction of three non-adjacent teeth were included. Each tooth was randomly assigned to a specific treatment (control, MM, or piezosurgery). Outcome measures were the severity of symptoms after surgery, wound healing assessed at the 10-days follow-up visit, and the time taken to complete each procedure (excluding suturing). Two-way ANOVA and Tukey’s multiple comparisons tests were performed to evaluate eventual differences between groups. There were no statistically significant differences between the compared methods in postoperative pain and healing, and no additional complications were reported. MM required significantly less time to perform a tooth extraction, followed by conventional instruments and piezosurgery, in increasing order (p < 0.05). Overall, the present findings suggest the use of MM and piezosurgery as valid options for dental extractions. Further randomized controlled studies are needed to confirm and extend this study’s results, facilitating the selection of the optimal method for an individual patient depending on the patient’s needs and preferences.

Technical Skills to Split Teeth During Extraction of Mesiodentes in High Site

PURPOSE

Extraction of mesiodens in high site is complicated. Here we introduce some technical skills to simply the process and achieve high success rate meanwhile.

METHODS

All patients should accept radiographic examination before surgery. According to the position of mesiodens based on cone-beam computed tomography, we choose the appropriate method and tool.

RESULTS

A series of cases have proved that these skills are applicable and convenient.

CONCLUSIONS

Dentists should analyze the inspection results seriously and select the optimal strategy to extract mesiodens in high site.

Collagenase Administration into Periodontal Ligament Reduces the Forces Required for Tooth Extraction in an Ex situ Porcine Jaw Model

Minimally invasive exodontia is among the long-sought-for development aims of safe dental medicine. In this paper, we aim, for the first time, to examine whether the enzymatic disruption of the periodontal ligament fibers reduces the force required for tooth extraction. To this end, recombinantly expressed clostridial collagenase G variant purified from Escherichia coli was injected into the periodontal ligament of mesial and distal roots of the first and second split porcine mandibular premolars. The vehicle solution was injected into the corresponding roots on the contralateral side. Following sixteen hours, the treated mandibles were mounted on a loading machine to measure the extraction force. In addition, the effect of the enzyme on the viability of different cell types was evaluated. An average reduction of 20% in the applied force (albeit with a large variability of 50 to 370 newton) was observed for the enzymatically treated roots, reaching up to 50% reduction in some cases. Importantly, the enzyme showed only a minor and transient effect on cellular viability, without any signs of toxicity. Using an innovative model enabling the analytical measurement of extraction forces, we show, for the first time, that the enzymatic disruption of periodontal ligament fibers substantially reduces the force required for tooth extraction. This novel technique brings us closer to atraumatic exodontia, potentially reducing intra- and post-operative complications and facilitating subsequent implant placement. The development of novel enzymes with enhanced activity may further simplify the tooth extraction process and present additional clinical relevance for the broad range of implications in the oral cavity.

Usefulness of Magnetic Mallet in Oral Surgery and Implantology: A Systematic Review

This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web of Science databases (articles published until 1 October 2021) was conducted, in accordance with the PRISMA statement, using the keywords “magnetic mallet”, “electric mallet”, “oral surgery”, “implantology”, and “dental implant”. Of 252 articles, 14 were included in the review (3 for teeth extraction, and 11 for implant dentistry). Out of a total of 619 dental extractions (256 patients) performed with the magnetic mallet (MM), no complications were reported. Implants inserted totaled 880 (525 patients): 640 in the MM groups (382), and 240 in control groups (133). The survival rate of implants was 98.9% in the MM groups, and 95.42% in the control groups. Seven patients experienced benign paroxysmal positional vertigo after implant surgery, all in control groups. Results are not sufficient to establish the effectiveness of MM in oral and implant surgery procedures. Randomized controlled trials with a large sample size are needed.

Evaluation of post-extraction healing after atraumatic axial tooth extraction using Benex system II versus conventional extraction: Randomized control trial

Background and Purpose

Tooth extraction is critical for dental treatment complications. One of the most discussed topics is socket healing after extraction. The Benex system allows extraction without causing unnecessary socket expansion by removing the tooth vertically, preserving both bone and soft tissue.

Aim

To assess postoperative healing signs, symptoms, and complications using the Benex extraction system and compare it with conventional extraction among patients at Umm Al-Qura University.

Methods

Thirty-eight patients with hopeless single-rooted teeth were included. They were divided into two equal groups: one in which teeth were extracted using the conventional method and one in which extractions were performed by Benex. The Benex system for tooth extraction was performed by drilling into the root canal, followed by screw insertion. Once the extractor was properly positioned, extraction was accomplished by turning the hand screw clockwise. At baseline, the wound size was evaluated. On days 1, 3, and 7 after extraction, telephone interviews were conducted to evaluate pain and post-extraction complications using a pain scale and questionnaire. Socket healing and wound size were evaluated after 2 and 4 weeks of extraction using the healing index and H₂O₂ epithelization test.

Results

The Benex extraction system accelerated early soft-tissue healing and decreased pain and wound size compared with the control group. Conclusion. The Benex system is relatively safe and easy to use, but this does not eliminate the need for a degree of education and training. Proper selection of the case, knowledge of using the device, and implementation of that knowledge in the treatment planning are important factors in ensuring success with this system.

Orthodontic Extrusion vs. Surgical Extrusion to Rehabilitate Severely Damaged Teeth: A Literature Review

The need to rehabilitate severely compromised teeth is frequent in daily clinical practice. Tooth extraction and replacement with dental implant represents a common treatment choice. However, the survival rate for implants is inferior to teeth, even if severely damaged but properly treated. In order to reestablish a physiological supracrestal tissue attachment of damaged teeth and to arrange an efficient ferrule effect, three options can be considered: crown lengthening, orthodontic extrusion and surgical extrusion. Crown lengthening is considered an invasive technique that causes the removal of part of the bony support, while both orthodontic and surgical extrusion can avoid this inconvenience and can be used successfully in the treatment of severely damaged teeth. The aim of the present narrative review is to compare advantages, disadvantages, time of therapy required, contraindications and complications of both techniques.

The Efficacy of Physics Forceps for Exodontia: A Systematic Review

PURPOSE

The aim of this study was to systematically review the literature to investigate the efficacy of physics forceps compared with conventional forceps for routine exodontia.

METHODS

A systematic review was conducted using Embase, MEDLINE, PubMed, Scopus, Web of Science, Dentistry and Oral Sciences Source, Cochrane databases and Google Scholar. Primary outcomes investigated were buccal cortical plate fracture and gingival laceration and secondary outcomes included bleeding, delayed healing, ease of technique, pain, tooth fracture, operating time, and postoperative infection.

RESULTS

Eight randomized controlled trials were included in the review. One study identified a significant difference in buccal cortical plate fracture (P = .001), and 3 studies reported a significant reduction in gingival laceration (all P ≤ .032) from using physics forceps, compared with conventional forceps. Secondary outcomes of bleeding (K = 2) and pain (K = 3), on day 1, were significantly reduced when using the physics forceps (P ≤ .001 and P ≤ .03, respectively). There were no significant differences or inconclusive results found for tooth fracture, operating time, ease of technique, postoperative infection, and delayed healing.

CONCLUSIONS

The review identified that only a limited number of included studies were reported to provide a more atraumatic approach for routine exodontia in terms of buccal cortical plate fracture, gingival laceration, postoperative pain, and bleeding, when compared with conventional forceps. Most studies reported no significant differences. However, studies were associated with a high risk of bias and selective outcome reporting.

Principles of Exodontia

Exodontia services comprise the largest portion of clinical practice for most oral and maxillofacial surgeons in the United States. This article is an overview of the principles of exodontia including the physics principles underlying the appropriate use of dental elevators and forceps. Failure to understand the instrumentation and the physics principles being used can cause prolonged operative time, iatrogenic injury to the patient, and unnecessary fatigue and/or injury to the provider. Advances in materials, technology, and innovative design have produced interesting new instruments for exodontia. New instruments including periotomes, piezosurgery, physics forceps, and vertical extraction systems are introduced and reviewed.

Clinical application of flap or flapless buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact: A comparative study

PURPOSE

To investigate and compare the clinical application of flap or flapless buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact in terms of the average surgery duration, number of root fracture, postoperative pain degree and duration, postoperative swelling degree and duration, degree of limitation of mouth opening.

MATERIALS AND METHODS

The present study was conducted of 28 patients who were examined and underwent bilateral extraction of impacted mandibular 3rd molar. One molar was randomly extracted with flap buccal surgery (Control Group, CG) and the other one with flapless buccal surgery (Experimental Group, EG) in the same patient.

RESULTS

Gender distribution, average age, average surgery duration and number of root fracture between the two groups were not statistically significant (P>0.05). The postoperative pain degree, swelling degree and degree of limitation of mouth opening were all significantly greater in CG than EG. Moreover, the duration of postoperative pain and swelling were all were all significantly longer in CG than EG (0.01<P<0.05).

CONCLUSION

Compared with the flap buccal surgery on the extractions of mesially/horizontally impacted 3rd molar with high or medium position impact, the clinical use of the flapless buccal surgery is a safe and effective method with less swelling, pain and degree of limitation of mouth opening. However, we need further study based on the broader indications, a much larger number of patients included and a follow-up in the longer term to confirm our point.

Restoring the unrestorable! Developing coronal tooth tissue with a minimally invasive surgical extrusion technique

Surgical extrusion is a recognised treatment option for teeth that have insufficient coronal tooth structure remaining due to deep caries, resorption or traumatic injury. However, the technique has not been widely adopted, arguably because extraction of a severely compromised tooth may be difficult to achieve in a gentle and predictable way. In this paper, we present our novel approach to surgical extrusion and subsequent management of teeth using a vertical extraction system (Benex), which has become the method of choice in the authors' practice for many teeth that would otherwise be deemed unrestorable. We describe the clinical procedure in detail and discuss the advantages and disadvantages compared to alternative approaches, including surgical crown lengthening and orthodontic extrusion.