Expert consensus on standardized clinical applications of minimally invasive tooth extraction techniques

doi:10.12122/j.issn.1673-4254.2024.05.24

Abstract

Abstract:

Tooth extraction is a common and widely employed therapeutic procedure in oral and maxillofacial surgery. Minimally invasive tooth extraction can reduce both physical and psychological trauma to the patients, and is widely recommended as a first-line clinical treatment. But currently no guidelines or consensus has been available to provide a systematic introduction of minimally invasive tooth extraction to guide the clinical practices. To address this issue, this consensus, based on a comprehensive literature review and clinical experiences of experts, systematically summarizes the indications, target patients, and contraindications of minimally invasive tooth extraction, the overall workflow of this procedure (preoperative preparation, surgical steps, postoperative management, postoperative instructions, medications, and follow-up), and its common postoperative complications to provide a comprehensive guidance for clinical application of this technique.

Key words: minimally invasive tooth extraction, standardization, operation procedure, expert consensus

Bo JIA, Qin WANG, Jun CHEN, Guangsen ZHENG, Song FAN, Qingsong YE, Yan HE, Fugui ZHANG, Yadong WU, Feng LIU, Kexiong OUYANG, Leitao ZHANG, Xiaozhi LV, Jianjiang ZHAO. Expert consensus on standardized clinical applications of minimally invasive tooth extraction techniques[J]. Journal of Southern Medical University, 2024, 44(5): 1004-1014.

Figures/Tables 9

Tab.1 Comparison of minimally invasive tooth extraction and conventional tooth extraction

Item	Minimally invasive tooth extraction	Conventional tooth extraction
Surgical approach	Surgical extraction, Orthodontic traction, Coronectomy	Chisel osteotomy
Surgical instruments	Diverse range of instruments and equipment (minimally invasive dental forceps, elevators, 45-degree inclined impact air handpiece, surgical burs, piezosurgery, medical laser, implantological surgical unit, minimally invasive orthodontic traction extraction devices, minimally invasive tooth extraction auxiliary instruments, etc.)	Uniform variety (standard dental elevators, forceps, bone chisels, etc.)
Postoperative suturing technique	Tightly suture, drainage suture, retension suture	Non-suture
Postoperative filling material	Hemostatic agents and site preservation materials	No additional filling
Integrity of socket	Relatively intact	Injured
Root fracture rate	Low	High
Post-operative complications	Less	More
Post-extraction socket healing status	Good	Poor
Preservation of socket site	Good	Poor

Fig.1 Tooth extraction by sectioning technique. A: Mandibular wisdom teeth with proximal-medial obstruction and complete osseous impact. B: Bone removal and crown splitting in sequence. C: Removal of the crown after splitting. D: Root splitting should start from the distal-medial root to avoid damages of the mandibular neural tube. E: After root splitting, a tooth extractor is inserted along the splitting line from the upper part of the tooth, and the proximal-medial root is removed first. F: Removal of the remaining distal-medial root.

Fig.2 Tooth extraction by traction technique. A: Mandibular wisdom tooth impacted in a low position with no maxillary opposing teeth. B: Removal of the bone tissues around the mandibular wisdom tooth. C: Exposure of the crown of the mandibular wisdom tooth. D: Bonding orthodontic brackets on the buccal surface of the dental tissues. E: Implanting micro-implant anchorage screws between the mandibular second and third molars or in the distal alveolar bone of the mandibular third molar. F: Extraction of the tooth bonded with brackets using elastic traction.

Fig.3 Coronectomy. A: The mandibular wisdom tooth root is close to the mandibular neural tube. B: Bone removal and crown splitting. C: Removal of the split crowns sequentially. D: Root surface trimming to 3-4 mm below the alveolar ridge.

Fig.4 Minimally invasive dental forceps and elevators.

Fig.5 Minnesota retractor, gingival margin trimmers, periosteal elevator, suction and bite block.

Fig.6 45-degree inclined impact air handpiece and surgical burs.

Fig.7 Piezosurgery. A: Overview of the piezosurgery apparatus. B: Different types of piezosurgery working tips.

Fig.8 Implantological surgical unit.

References 65

1	胡开进, 杨擎天. 微创拔牙理念及技术操作[J]. 国际口腔医学杂志, 2011, 38(3): 249-52, 264. DOI: 10.3969/j.issn.1673-5749.2011.03.001
2	Vettori E, Costantinides F, Nicolin V, et al. Factors influencing the onset of intra- and post-operative complications following tooth exodontia: retrospective survey on 1701 patients[J]. Antibiotics, 2019, 8(4): 264.
3	Brånemark PI. Osseointegration and its experimental background[J]. J Prosthet Dent, 1983, 50(3): 399-410.
4	郑雪妮, 刘平, 刘川, 等. 微创拔牙发展史[J]. 中国口腔颌面外科杂志, 2019, 17(6): 560-5.
5	胡开进, 王静娟, 薛洋. 国际牙及牙槽外科发展史[J]. 中国口腔颌面外科杂志, 2017, 15(1): 80-5.
6	张雪洋, 周磊, 徐世同, 等. 常用的微创拔牙器械[J]. 广东牙病防治, 2007, 15(1): 44-5.
7	Yalcin S, Aktas I, Emes Y, et al. A technique for atraumatic extraction of teeth before immediate implant placement using implant drills[J]. Implant Dent, 2009, 18(6): 464-72.
8	丁凤, 吴娴, 杨细虎, 等. 超声骨刀微创拔牙法与传统拔牙法拔除下颌水平阻生牙的效果比较[J]. 中国口腔颌面外科杂志, 2019, 17(5): 431-5.
9	Dietrich T, Schmid I, Locher M, et al. Extraction force and its determinants for minimally invasive vertical tooth extraction[J]. J Mech Behav Biomed Mater, 2020, 105: 103711.
10	Kilpatrick HC. Removal of impacted third molars utilizing speeds up to 200, 000 R.P.M[J]. Oral Surg Oral Med Oral Pathol, 1958, 11(4): 364-9.
11	汪湧, 徐颖, 杨驰. 微创技术在牙及牙槽外科中的应用[J]. 中国实用口腔科杂志, 2012, 5(8): 459-65. DOI: 10.3969/j.issn.1674-1595.2012.08.004
12	Checchi L, Alessandri Bonetti G, Pelliccioni GA. Removing high-risk impacted mandibular third molars: a surgical-orthodontic approach[J]. J Am Dent Assoc, 1996, 127(8): 1214-7.
13	杨擎天, 胡开进, 薛洋, 等. 阻生下颌第三磨牙2种拔除方法的比较[J]. 实用口腔医学杂志, 2010, 26(1): 71-4. DOI: 10.3969/j.issn.1001-3733.2010.01.016
14	汪湧, 何冬梅, 杨驰, 等. 牵引拔除压迫下牙槽神经的下颌第三磨牙[J]. 中国口腔颌面外科杂志, 2010, 8(6): 521-4.
15	Ecuyer J, Debien J. Surgical deductions[J]. Actual Odontostomatol, 1984, 38(148): 695-702.
16	Knutsson K, Lysell L, Rohlin M. Postoperative status after partial removal of the mandibular third molar[J]. Swed Dent J, 1989, 13(1/2): 15-22.
17	Pogrel MA, Lee JS, Muff DF. Coronectomy: a technique to protect the inferior alveolar nerve[J]. J Oral Maxillofac Surg, 2004, 62(12): 1447-52.
18	洪飞若, 陈飘飘, 俞雪芬, 等. 中国成年人牙科焦虑症患病率的Meta分析[J]. 华西口腔医学杂志, 2023, 41(1): 88-98. DOI: 10.7518/hxkq.2023.01.012
19	秦菁, 山雯婷. 微创术和锤凿术拔除老年人残根残冠的临床疗效分析[J]. 中华老年口腔医学杂志, 2016, 14(2): 99-101, 124. DOI: 10.3969/j.issn.1672-2973.2016.02.008
20	Wang ZW, Chen Z, Zhang LF, et al. Status of hypertension in China: results from the China hypertension survey, 2012-2015[J]. Circulation, 2018, 137(22): 2344-56.
21	Yu H, Jin FY, Liu D, et al. ROS-responsive nano-drug delivery system combining mitochondria-targeting ceria nanoparticles with atorvastatin for acute kidney injury[J]. Theranostics, 2020, 10(5): 2342-57.
22	苏勤, 田立华, 金松, 等. 微创拔牙即刻种植技术在前牙修复中的应用效果观察[J]. 中国美容医学, 2023, 32(3): 147-50.
23	赵彦霞. 微创拔牙术后即刻种植修复与延时种植修复对美学效果及预后的影响[J]. 中国美容医学, 2021, 30(2): 136-9.
24	谢乙加, 胡洲, 赵青, 等. 正畸治疗中非常规拔牙的临床应用分析[J]. 华西口腔医学杂志, 2017, 35(2): 176-82. DOI: 10.7518/hxkq.2017.02.013
25	Guo RZ, Zhang LW, Hu ML, et al. Alveolar bone changes in maxillary and mandibular anterior teeth during orthodontic treatment: a systematic review and meta-analysis[J]. Orthod Craniofac Res, 2021, 24(2): 165-79.
26	董菁. 基于语料库的术前谈话风险沟通探析[J]. 医学与哲学, 2019, 40(8): 66-71.
27	胡开进, 李永锋, 吴迪. 微动力系统在牙拔除术中的应用[J]. 华西口腔医学杂志, 2015, 33(1): 1-5.
28	雷飞, 倪菁, 王丹杨. 微创拔牙技术在下颌埋伏阻生智齿拔除过程中的应用研究[J]. 临床口腔医学杂志, 2020, 36(6): 338-41. DOI: 10.3969/j.issn.1003-1634.2020.06.006
29	Bailey E, Kashbour W, Shah N, et al. Surgical techniques for the removal of mandibular wisdom teeth[J]. Cochrane Database Syst Rev, 2020, 7(7): CD004345.
30	汪湧, 徐颖, 杨驰, 等. 微创拔除压迫下牙槽神经的第三磨牙方法分析[J]. 中国口腔颌面外科杂志, 2018, 16(1): 48-51.
31	王留宏, 杨惠, 王一霖, 等. 正畸牵引拔除下颌低位阻生第三磨牙对患者张口受限情况的影响[J]. 河北医学, 2022, 28(6): 977-83. DOI: 10.3969/j.issn.1006-6233.2022.06.022
32	Kalantar Motamedi MR, Heidarpour M, Siadat S, et al. Orthodontic extraction of high-risk impacted mandibular third molars in close proximity to the mandibular canal: a systematic review[J]. J Oral Maxillofac Surg, 2015, 73(9): 1672-85.
33	Ma ZG, Xie QY, Yang C, et al. An orthodontic technique for minimally invasive extraction of impacted lower third molar [J]. J Oral Maxillofac Surg, 2013, 71(8): 1309-17.
34	刘建捷, 王雪涛. 截冠留根法在下颌阻生智齿拔除中的应用效果评价[J]. 中国临床医生杂志, 2020, 48(8): 992-4. DOI: 10.3969/j.issn.2095-8552.2020.08.037
35	Cosola S, Kim YS, Park YM, et al. Coronectomy of mandibular third molar: four years of follow-up of 130 cases[J]. Medicina, 2020, 56(12): 654.
36	Pogrel MA, Lee JS, Muff DF. Coronectomy: a technique to protect the inferior alveolar nerve[J]. J Oral Maxillofac Surg, 2004, 62(12): 1447-52.
37	Ali AS, Benton JA, Yates JM. Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-a comparison of two techniques and review of the literature[J]. J Oral Rehabil, 2018, 45(3): 250-7.
38	胡开进. 微创技术在牙拔除术中的应用[J]. 口腔医学, 2015, 35(2): 81-4.
39	李国威, 胡开进, 周宏志, 等. 其他拔牙设备和技术的选择及应用[J]. 中国实用口腔科杂志, 2016, 9(10): 588-91.
40	李燕香, 闫利君, 凌小婉, 等. 微创器械与微动力设备在牙拔除术中的应用进展[J]. 中国口腔颌面外科杂志, 2023, 21(2): 191-6.
41	Muska E, Walter C, Knight A, et al. Atraumatic vertical tooth extraction: a proof of principle clinical study of a novel system[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2013, 116(5): e303-10.
42	Babbush CA. A new atraumatic system for tooth removal and immediate implant restoration[J]. Implant Dent, 2007, 16(2): 139-45.
43	胡开进. 现代标准拔牙术新理念[J]. 中国实用口腔科杂志, 2010, 3(10): 577-81. DOI: 10.3969/j.issn.1674-1595.2010.10.001
44	Karthik R, Cynthia S, . Use of calibrated periosteal elevators in maxillofacial surgery: a technical note[J]. Br J Oral Maxillofac Surg, 2021, 59(5): 609-10.
45	孙湘钊. 牵拉及吸引器械的选择和使用[C]// 第十三次全国口腔颌面外科学术会议暨中华口腔医学会口腔颌面外科专业委员会成立30周年纪念活动论文汇编. 沈阳, 2016: 290.
46	孙湘钊, 胡开进, 胡曼, 等. 辅助拔牙器械的选择及应用[J]. 中国实用口腔科杂志, 2016, 9(10): 585-7, 591.
47	万丽, 夏熙彦, 曾宁碧, 等. 高速涡轮机结合微创拔牙挺在下颌阻生牙治疗中的应用效果及对疼痛的减轻评价[J]. 中国医疗设备, 2020, 35(S2): 43-5.
48	骆碧珠, 陈映铭, 尹路, 等. 电动牙科手机与涡轮气动牙科手机在贴面预备后的对比研究[J]. 口腔医学研究, 2022, 38(10): 950-3.
49	白希婧, 吕东升, 周贤, 等. 增速手机配合种植机与高速涡轮机在下颌低位阻生智齿中的应用比较[J]. 广东医学, 2020, 41(4): 349-52.
50	王梦梦, 马宇锋. 激光在埋伏阻生第三磨牙拔除中的应用及研究现状[J]. 中国实用口腔科杂志, 2022, 15(5): 625-8, 633.
51	张英豪, 赵宁, 赵爱杰, 等. Er: YAG激光与涡轮手机去骨拔除下颌低位水平阻生智牙的效果比较[J]. 上海口腔医学, 2023, 32(1): 75-9.
52	郑颖, 蔡兴伟, 杨永进, 等. Nd: YAG激光联合Er: YAG激光对阻生齿拔除术后处理的疗效研究[J]. 应用激光, 2015, 35(5): 618-22.
53	林权泉, 王峰, 王佩, 等. 下颌中低位阻生第三磨牙拔除后出血的风险因素研究[J]. 实用口腔医学杂志, 2021, 37(4): 545-9. DOI: 10.3969/j.issn.1001-3733.2021.04.022
54	郭海峰, 赵汉华, 代全红. 拔牙创缝合预防干槽症临床观察[J]. 郑州大学学报: 医学版, 2002, 37(4): 534.
55	王俊成, 刘洪臣. 口腔种植常用缝合技术[J]. 口腔颌面修复学杂志, 2019, 20(1): 55-7.
56	乔峰, 隋磊, 张健. 龈瓣缝合类型对下颌阻生智齿拔除术后生活质量的影响[J]. 天津医药, 2015, 43(9): 1000-2.
57	惠镠玲, 李冰, 张栋华, 等. 两种缝合方式对下颌低位阻生智齿拔除术后并发症的影响[J]. 口腔医学, 2016, 36(11): 1006-10.
58	王静娟, 胡开进, 刘平, 等. 拔牙窝止血类覆盖及充填材料的选择及应用[J]. 中国实用口腔科杂志, 2017, 10(10): 586-9.
59	赵子慕, 姜瑶, 吴雨, 等. 拔牙止血方法研究现况综述[J]. 口腔医学, 2019, 39(4): 380-4.
60	王了, 郭晓东. 止血材料对牙槽窝愈合的影响[C]// 第十四次中国口腔颌面外科学术会议论文汇编. 重庆, 2018: 699.
61	朱敏燕, 王海燕, 袁银银. 不同种植材料牙槽窝保存术对后牙区牙槽嵴吸收的影响[J]. 中国口腔颌面外科杂志, 2023, 21(4): 403-6.
62	崔云, 马力, 宋天喜, 等. 拔牙窝位点保存的填塞类骨修复材料研究现状[J]. 口腔材料器械杂志, 2023, 32(1): 54-9. DOI: 10.11752/j.kqcl.2023.01.10
63	地力努尔·克然木艾力麦尔旦·艾尼瓦尔, 尼加提·努尔穆罕默德, 王玲. 不同方法及生物材料在位点保存中的应用[J]. 北京口腔医学, 2022, 30(2): 149-52.
64	潘剑, 薛洋, 赵吉宏, 等. 口服抗栓药物患者门诊拔牙围手术期管理的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 255-63. DOI: 10.7518/hxkq.2022.03.002
65	叶丽娟, 俞雪芬, 戴莉. 电话回访在微创拔牙术后的应用体会[J]. 护理与康复, 2013, 12(8): 800-1. DOI: 10.3969/j.issn.1671-9875.2013.08.038