Clinicians work in regions with thin plates of bone and thin overlying soft tissue. Recently, 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 more traditional extraction techniques. Both of these unconventional techniques can be made simpler by employing the use of a long diamond needle bur, like the 1312.11C NeoDiamond from Microcopy.
Using an 11 mm long diamond needle bur, such as the 1312.11C NeoDiamond, 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.
The 1312.11C NeoDiamond can assist in making extractions simple, effective and minimally invasive. Microcopy’s single-paitent-use price makes this method cost effective.
Circumferential Troughing around Teeth and Roots
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.
Sinking the 1311.12C into the PDL space around a tooth, subcrestal fibrous attachments are obliterated and space is created for both gaining better purchase points and more efficient luxation. Care should be taken to focus circumferential bone removal at the proximal surfaces and away from the facial and lingual/palatal socket walls, which may be thinner, more fragile and thus more susceptible to fracture and/or resorption.
STEP 1 The 1312.11C sunk into the distal sulcus of tooth #12, exhibiting loss of the buccal half of the supragingival tooth structure, and drawn along the entire distal proximal surface.
STEP 2 Tooth #14 was determined to have a subcrestal fracture and was sectioned along furcal paths with 1312.11C.
STEP 3 After elevating the tooth segments off of one another, the DB root is easily delivered with forceps, despite having only the thinnest sliver of supragingival tooth structure to grab onto.
STEP 4 The MB root is extracted revealing the immensity of the socket and the palatalization of the M furcal bone. The palatal root is elevated from its socket.
The 1312.11C was then drawn along the entire distal proximal surface.
Tooth #14 was sectioned along the furcal paths. Notice how the cut corresponding to the M furcation is palatalized because the MB root is so large that it displaces the furcation palatally.
DB root is easily delivered with forceps.
The gingival margin remains virtually intact around the circumference of the socket.
