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    How to extract teeth as atraumatically as possible

    Microcopy’s NeoDiamond burs provide multiuse quality with a single-use price to permit advanced and effective extraction techniques that won’t break the bank.

    With the preponderance of published data demonstrating compelling reasons to remove teeth as minimally invasively as possible, the burden of finding and utilizing effective methods of atraumatic exodontia falls upon the clinician as never before. 

    Clinicians often work in regions with thin plates of bone and thin overlying soft tissue, and a shift in thinking has developed to promote tooth removal procedures that demonstrate a remarkable concern for maintaining perfectly intact facial plates with minimal disruption of papillae or the midfacial zenith of soft tissue. 

    One way of achieving this is by sectioning multi-rooted teeth prior to elevation and extraction. Another is by creating space between a tooth and the surrounding bone by troughing around it with a bur prior to employing somewhat more traditional extraction techniques. Both of these unconventional techniques can be made simpler by employing the use of a long diamond needle bur, such as the 1312.11C NeoDiamond bur from Microcopy.

    Related reading: Easy ways to reduce trauma during tooth extraction

    Root trunk length

    A critical factor in sectioning posterior teeth is appreciating the root trunk length, or the distance between CEJ and the furcation entrance. Attempting to remove the roots of a multi-rooted tooth that has been sectioned short of the furcation entrances can lead to an even more traumatic extraction than without sectioning at all.

    In health, the gingival margin lies at or very near the CEJ, and so its distance from the furcation entrance is virtually identical to that of the root trunk length. Different sources cite various average dimensions for root trunk lengths for multi-rooted teeth, but it is critical to recognize that actual values may vary greatly from the reported means.

    The importance of the root trunk length is as follows: Failure to section completely to the furcation can turn what was supposed to be a minimally invasive extraction into one that becomes even more surgically invasive than a traditional extraction—attempting to elevate roots that have been incompletely sectioned more easily results in fracture of the root trunk from the more apical root cone.

    The cutting length of an average barrel-shaped bur is 4 mm long and is sometimes greater than 1 mm wide. Use of such a bur often leaves a wide path that, in many cases, won’t even reach the furcation with a single sweep of the bur. Multiple subcrestal bur sweeps are thus indicated to reach the furcation, and because it is difficult to maintain perfect parallelism and positioning with each sweep, the sectioned area becomes wider than necessary and may present with an irregular profile, hampering efforts to access it with an elevator.

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    Conversely, using an 11 mm long diamond needle bur, such as the 1312.11C NeoDiamond bur from Microcopy, can simplify this task immensely. After either decoronating the tooth or sectioning to the gingival margin with a barrel-shaped or round bur, the diamond needle bur can be sunk to reach the furcation on many teeth by advancing just past halfway its cutting surface. While this bur is 1.2 mm at its greatest diameter, it is only 0.61 mm at the tip and 0.86 mm at the halfway point, permitting clinicians to reach deeply into the subcrestal region while removing only as much tooth structure as necessary to section past the furcation entrance.

    Check out the technique in this step-by-step video: 



    Continue to page two for a step-by-step case study showing how the NeoDiamond 1312.11C bur can be used for extractions.



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