Extraction force and its determinants for minimally invasive vertical tooth extraction

Thränhardt, Dietrich; Schmid, Ivan; Locher, Miriam A.; Addison, Owen

doi:10.1016/j.jmbbm.2020.103711

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…Furthermore, it was highlighted that this device can be reused several times. The results were consistent with previous findings, which measured vertical tooth extraction forces in real patients, and found that the amount of force required strongly depends on root anatomy and dental status [ 25 , 26 ]. Based on the reports of the dentists, after some minor modifications, our device could be potentially used in real-life conditions.…”

Section: Discussionsupporting

confidence: 93%

Manufacturing a First Upper Molar Dental Forceps Using Continuous Fiber Reinforcement (CFR) Additive Manufacturing Technology with Carbon-Reinforced Polyamide

et al. 2021

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3D printing is an emerging and disruptive technology, supporting the field of medicine over the past decades. In the recent years, the use of additive manufacturing (AM) has had a strong impact on everyday dental applications. Despite remarkable previous results from interdisciplinary research teams, there is no evidence or recommendation about the proper fabrication of handheld medical devices using desktop 3D printers. The aim of this study was to critically examine and compare the mechanical behavior of materials printed with FFF (fused filament fabrication) and CFR (continuous fiber reinforcement) additive manufacturing technologies, and to create and evaluate a massive and practically usable right upper molar forceps. Flexural and torsion fatigue tests, as well as Shore D measurements, were performed. The tensile strength was also measured in the case of the composite material. The flexural tests revealed the measured force values to have a linear correlation with the bending between the 10 mm (17.06 N at 5000th cycle) and 30 mm (37.99 N at 5000th cycle) deflection range. The findings were supported by scanning electron microscopy (SEM) images. Based on the results of the mechanical and structural tests, a dental forceps was designed, 3D printed using CFR technology, and validated by five dentists using a Likert scale. In addition, the vertical force of extraction was measured using a unique molar tooth model, where the reference test was carried out using a standard metal right upper molar forceps. Surprisingly, the tests revealed there to be no significant differences between the standard (84.80 N ± 16.96 N) and 3D-printed devices (70.30 N ± 4.41 N) in terms of extraction force in the tested range. The results also highlighted that desktop CFR technology is potentially suitable for the production of handheld medical devices that have to withstand high forces and perform load-bearing functions.

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Section: Discussionsupporting

confidence: 93%

Manufacturing a First Upper Molar Dental Forceps Using Continuous Fiber Reinforcement (CFR) Additive Manufacturing Technology with Carbon-Reinforced Polyamide

et al. 2021

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“…Despite the clear reduction in force, the dispersion of maximum force of the same root type in the different jaws was relatively high. This is due to the considerably large degree of variability in the physiological and morphological characteristics of PDL, thus corroborating observations in human jaws [ 15 , 32 ].…”

Section: Resultssupporting

confidence: 85%

“…Figure 1 summarizes the entire process, from jaw preparation to the root extraction with a loading machine. Our preliminary analysis revealed that, owing to anatomical properties, such as considerable root divergence and fragility of the examined teeth, splitting the premolars comprises an essential step to reduce the extraction force to a strength comparable to that of humans [ 32 ]. Otherwise, the magnitude of the tooth extraction force in the porcine jaw resulted in premature root or crown fracture.…”

Section: Resultsmentioning

confidence: 99%

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

Tohar

Alali

Ansbacher

et al. 2022

JFB

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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.

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“…Similarly, pliers should not be used as they require forceful eccentric movements, which distort and damage the alveolar bone. Instead, extraction systems where, for example, a post is screwed into the root and then pulled out of the socket vertically with a lever arm system and without touching the bone are recommended (Figure 20) for atraumatic tooth extraction (Easy X‐Trac System, A.Titan Instruments, Orchard Park) 15 …”

Section: The Predictable Immediate Implant Conceptmentioning

confidence: 99%

“…A silicone index of the prepared tooth serves as guide for atraumatic tooth extraction (Easy X-Trac System, A.Titan Instruments, Orchard Park). 15…”

Section: Atraumatic Extractionmentioning

confidence: 99%

Predictable immediate implant placement and restoration in the esthetic zone

Gamborena

Sasaki

Blatz

2021

J Esthet Restor Dent

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This article describes a comprehensive step‐by‐step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long‐term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.

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Extraction force and its determinants for minimally invasive vertical tooth extraction

Cited by 18 publications

References 22 publications

Manufacturing a First Upper Molar Dental Forceps Using Continuous Fiber Reinforcement (CFR) Additive Manufacturing Technology with Carbon-Reinforced Polyamide

Manufacturing a First Upper Molar Dental Forceps Using Continuous Fiber Reinforcement (CFR) Additive Manufacturing Technology with Carbon-Reinforced Polyamide

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

Predictable immediate implant placement and restoration in the esthetic zone

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