- Open Access
Expandable Micro-motor Bur, design of a new device for least invasive extraction of broken teeth roots
© Shahidi Bonjar; licensee BioMed Central Ltd. 2013
- Received: 13 March 2012
- Accepted: 13 November 2012
- Published: 5 March 2013
Extraction of a broken tooth root is often a traumatic experience for both the practitioner and the patient. To extract broken roots, generally invasive approaches as open window surgeries or mucoperiosteal flap and/or removal of buccal bone are performed.
Presentation of the hypothesis
Expandable micro-motor bur (EMB) is a hypothetical design of a dental instrument proposed for removal of broken teeth roots that cannot be extracted by the routine closed methods and in which common instrumentations cannot afford to accomplish. Implication of EMB would introduce a new technique in removal of broken teeth roots in which surgical trauma is minimized and so post-extraction disorders. It would eliminate surgical invasion to the surrounding tissues; and also it would eliminate profound hand forces by the practitioner, consequently reduces stress for both the practitioner and the patient. It would eliminate high risk aftermaths such as operative morbidity (due to bone loss), maxillary sinus exposure and probable need for additional surgery as are indicative of some conventional open access approaches.
Testing the hypothesis
Further studies are needed to confirm its effect in clinical cases. The effectiveness of EMB should be verified firstly by animal experiments. The likelihood of its negative influence on nearby vascular and nerve system should be well evaluated.
Implications of the hypothesis
Implication of EMB would be of interest to both patients and the surgeon due to the following main achievements: a) no need for mucoperiosteal flap, hence preservation of soft tissue, b) no need for osteotomy, hence retention of buccal bone, c) less risk of sinus exposure, d) minimum chance of post operative infections due to eliminated surgeries in soft tissues and bones and e) in terms of esthetics, it will have a special meaning for immediate placement of dental implants. EMB’s structural components include Bur head, Spacers and Bur base. A micro motor would power its spin. In contrast to conventional surgical approaches, EMB procedure is conservative. It is anticipated that EMB would provide less traumatic and least post-operative complications in extraction of broken teeth roots.
- Tooth extraction
- Complicated root extraction
- Expandable micro-motor bur
The broken teeth roots may be difficult to remove and the dentist should strongly consider performing an open extraction after initial attempts at forceps removal have failed [1–3]. Open extractions include invasive open window surgeries or mucoperiosteal flap and/or removal of buccal bone [4–10]. Occasionally, it is necessary to prepare a purchase point with the bur and to use an elevator as the Crane pick to elevate the remaining root [11, 12]. However, these treatments have aftermaths characterized by post-operative disorders [13–17]. Therefore, seeking an easy and effective method to remove broken teeth roots and resolve the operative and post operative complications is necessary for dental clinicians and the patients.
General information on extractions of broken teeth roots
As a non-invasive treatment, EMB has not ever been reported to be utilized in dental surgery. The hypothesis I propose here is that EMB may be an adjunct treatment for extractions of broken teeth roots. This hypothesis is based on the following points: (1) No need for mucoperiosteal flap, hence preservation of soft tissue, (2) no need for osteotomy, hence retention of buccal bone, (3) reduced invasion to surrounding anatomical structures and less risk of sinus exposure, hence control of operative and post-operative complications.
Proposed parts of EMB
Comparison between "conventional extraction of complicated roots "and "Expandable Micro-motor Bur technique"
Conventional complicated root-extraction
Expandable Micro-motor Bur
Invasion to surrounding anatomical structures (maxillary sinus exposure, nerve injury and innervations disorders)
Need for mucoperiosteal flap and/or osteotomy of buccal bone
No or with less extension
Operative and post-operative complications
Stress of practitioner and patient
Success of immediate implant placement
Considering the application of this treatment, further studies are needed to confirm its effect in clinical cases. The effectiveness of EMB should be verified firstly by animal experiments. The likelihood of its negative influence on nearby vascular and nerve system should be well evaluated. When these concerns are clear, I believe that EMB could be used as a new tool to assist removal of broken teeth roots in humans.
I like to express my deepest thanks for help, scientific advice and support to: Professor M. Yaghmaei, Oral and Maxillofacial Surgeon and Head of the Oral and Maxillofacial Surgery Department; Dr A. Khojasteh, Oral and Maxillofacial Surgeon and Head of Exceptional Talent Center of the College of Dentistry; Dr M. Nouri, Orthodontist and Head of Communication and Information Technology Center; Dr F. Poordanesh, Oral and Maxillofacial Surgeon; Dr M. Ghasemianpour, Orthodontist; Dental School, Shahid Beheshti University of Medical Sciences of Iran.
- Peterson LJ: Principles of complicated exodontia. In Contemporary principles of oral and maxillofacial surgery. 4th edition. Edited by: Peterson E, Ellis E, Hupp JR, Tucker MR. St. Louis: Mosby Inc; 2004:156–183.Google Scholar
- Nageshwar RD: Common incision for impacted mandibular third molars. J Oral Maxillofac Surg 2002, 60: 1506–1509.PubMedView ArticleGoogle Scholar
- Chin Quee TA, Gosselin D, Millar EP, Stamm JW: Surgical removal of the fully impacted mandibular third molar. The influence of flap design and alveolar bone height on the periodontal status of the second molar. J Periodontol 1985, 10: 625–631.View ArticleGoogle Scholar
- Sutherland KJG: Mucoperiosteal flaps in dento-alveolar surgery. Aust Dent J 1963, 6: 317–325.View ArticleGoogle Scholar
- Capuzzi P, Montebugnoli L, Vaccaro MA: Extraction of impacted third molars. A longitudinal prospective study on factors that affect postoperative recovery. Oral Surg Oral Med Oral Pathol 1994, 77: 314–323.View ArticleGoogle Scholar
- Garcia Garcia A, Gude Sampedro F, Gandara Rey J, Gallas Torreria M: Trismus and pain after removal of impacted lower third molars. J Oral Maxillofac Surg 1997, 55: 1223–1226. 10.1016/S0278-2391(97)90172-5PubMedView ArticleGoogle Scholar
- Stephen RJ, App GR, Foreman DW: Periodontal evaluation of two mucoperiosteal flaps used in removing impacted mandibular third molars. J Oral Maxillofac Surg 1983, 41: 719–725. 10.1016/0278-2391(83)90188-XView ArticleGoogle Scholar
- Groves BJ, Moore JR: The periodontal implications of flap design in lower third molar extractions. Dent Pract Dent Rec 1970, 20: 297–304.PubMedGoogle Scholar
- Rosa AL, Carneiro MG, Lavrador MA, Novaes AB: Influence of flap design on periodontal healing of second molars after extraction of impacted mandibular third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002, 93: 404–409. 10.1067/moe.2002.122823PubMedView ArticleGoogle Scholar
- Suarez-Cunqueiro MM, Gutwald R, Reichman J, Otero-Cepeda XL, Schmelzeisen R: Marginal flap versus paramarginal flap in impacted third molar surgery: A prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010, 95: 403–408.View ArticleGoogle Scholar
- Dostalova T, Seydlova M: Dentistry and Oral Diseases for Medical Students. Havlickuv Brod, Czech Republic: Grada Publishing; 2010:74.Google Scholar
- Van der Weijden F, Dell Acqua F, Else Slot D: Alveolar bone dimensional changes of post-extraction sockets in humans: a systematic review. J Clin Periodontol 2009, 36: 1048–1058. 10.1111/j.1600-051X.2009.01482.xPubMedView ArticleGoogle Scholar
- Jakse N, Bankaoglu V, Wimmer G, Eskici A, Petl C: Primary wound healing after lower third molar surgery: Evaluation of two different flap designs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002, 93: 7–14. 10.1067/moe.2002.119519PubMedView ArticleGoogle Scholar
- Clauser C, Barone R: Effect of incision and flap reflection on postoperative pain after the removal of partially impacted mandibular third molars. Quintessence Int 1994, 25: 845–849.PubMedGoogle Scholar
- Garcia Garcia A, Gude Sampedro F, Gallas Torrella M, Gandara Vila P, Madrinan-Grana P, Gandara-Rey JM: Trismus and pain after removal of a lower third molar. Effects of raising a mucoperiosteal flap. Med Oral 2001, 6: 391–396.PubMedGoogle Scholar
- Penarrocha M, Sanchis JM, Saez U, Gay C, Bagan VJ: Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001, 92: 260–264. 10.1067/moe.2001.115722PubMedView ArticleGoogle Scholar
- Retzepi M, Donos N: Guided Bone Regeneration: biological principle and therapeutic applications. Clin Oral Implants Res 2010, 21: 567–572. 10.1111/j.1600-0501.2010.01922.xPubMedView ArticleGoogle Scholar
- Stephens JR, App GR, Foreman DW: Periodontal evaluation of two mucoperiosteal flaps used in removing impacted mandibular third molars. J Oral Maxillofac Surg 1983, 41: 719–725. 10.1016/0278-2391(83)90188-XPubMedView ArticleGoogle Scholar
- Charles AK, Ramfjord SP: Healing of gingival mucoperiosteal flaps. Oral Surg Oral Med Oral Pathol 1960, 13: 89–103. 10.1016/0030-4220(60)90400-XView ArticleGoogle Scholar
- Wadhwani KK, Garg A: Healing of soft tissue after different types of flap designs used in periapical surgery. Endodontology 2004, 16: 20–22.Google Scholar
- Monaco G, Daprile G, Tavernese L, Corinaldesi G, Marchetti C: Mandibular third molar removal in young patients: an evaluation of 2 flap designs. J Oral Maxillofac Surg 2009, 67: 16–21.Google Scholar
- Sanchis Bielsa JM, Bazan SH, Penarrocha Diego M: Flap repositioning versus conventional suturing in third molar surgery. Med Oral Patol Oral Cir Bucal 2008, 13: 138–142.Google Scholar
- Schofield IDF, Kogon SL, Donner A: Long-term comparison of two surgical flap designs. J Can Dent Assoc 1988, 54: 689–695.PubMedGoogle Scholar
- Barone A, Aldini NN, Fini M, Giardino R, Calvo Guirado JL, Covani U: Xenograft versus extraction alone for ridge preservation after tooth removal: a clinical and histomorphomeric study. J Periodontol 2008, 79: 1370–1377. 10.1902/jop.2008.070628PubMedView ArticleGoogle Scholar
- Quee TA, Gosselin D, Millar EP, Stamm JW: Surgical removal of the fully impacted mandibular third molar. The influence of flap design and alveolar bone height on the periodontal status of the second molar. J Periodontol 1985, 56: 625–630. 10.1902/jop.1918.104.22.1685PubMedView ArticleGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.