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

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.

Keywords: expert consensus; minimally invasive tooth extraction; operation procedure; standardization.

图1

切割拔牙法 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.

图2

牵引拔牙法 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.

图3

截冠留根法 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.

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微创牙钳与微创牙挺 Fig.4 Minimally invasive dental forceps and elevators.

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颊拉钩、牙龈分离器、骨膜分离器、吸引器和开口垫 Fig.5 Minnesota retractor, gingival margin trimmers, periosteal elevator, suction and bite block.

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45°仰角冲击式气动手机及外科车针 Fig.6 45-degree inclined impact air handpiece and surgical burs.

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

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种植机 Fig.8 Implantological surgical unit.