Hi everyone and welcome to this 3 part series covering extraction tips specifically related to immediate implant placement.
Atraumatic extraction is a key element for immediate implant placement. We know that raising a flap compromises the blood supply to the buccal plate. Flapless techniques may cause less bone resorption and reduce postop patient discomfort. Ideally maintaining a minimum of 2mm of buccal wall thickness has been recommended for long-term stability of implant restorations especially when dealing with the aesthetic zone. The literature tells us that most of the time we DO NOT have 2mm of buccal bone thickness to start off with !
With the popularity of immediate dental implants comes an increased patient satisfaction of not having to wait an extended period of time for teeth replacement. Especially when dealing with immediate dental implants in the aesthetic zone it is important to perform extractions with as little trauma as possible.
Maxillary incisors:
These teeth typically have long conical roots. The lateral incisors have a curvature sometimes in the apex and are more slender. If the crown is intact, extraction forceps are all you need for removal of these teeth by adapting the beak of forceps on buccal-lingual contours as far apically as possible and using a rotation + traction motion.
DO NOT push in a buccal -lingual direction as you can break off the thin buccal plate. USE your fingers to support buccal plate. Common forceps include the 99C or 150.
Maxillary canines:
TAKE YOUR TIME ! you will need to use rotational forces with a buccal-palatal movement. Here are some of the tools I would recommend here: periotomes -help to expand the socket by placement against the root and tapping apically around the tooth circumference (DONT DO IT ON THE BUCCAL )
FASTER ROUTE: if you have access to a piezo unit or are able to use a long thin diamond burr , my GO TO tool most of the time to help create space for elevation is the Brasseler (859.36.010). Common forceps if you are able to use one is the 150
To read part 2 of our blog on this topic, click here: Part 2
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