JIACD
The Journal of Implant & Advanced Clinical Dentistry
Periotomes vs Proximators vs Luxators
Sun, 03/08/2009 - 10:04 — DrGretzky
Everyday there seems to be new instruments coming out to make taking out a teeth easier and less traumatic. I'm looking for opinions on what Doctors are using these days and what is their indication for use. Im also looking for specific companies and instrumentation they prefer when taking out a tooth
JIACD
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Periotomes vs Proximators vs Luxators
I myself use a combination of these with piezo to extract the tooth. Never had an issue and preserves the bone nicely.
Powertome- Whats the advantages
I am reading about it but want to hear for users of it. What are the advantages is it expensive to buy?
Powertome- Whats the advantages
Essentially zero bone loss with an extraction. Since it does not cut bone like a drill or piezo no irrigation is necessary to rinse debris or cool the field. Can remove teeth a bit faster but I like the fact that bone does not have to be removed. Also most teeth that I remove are done flapless because of the powertome. Less post-op pain and swelling for the patient. Less fatigue on my part as well.
Powertome technique===== Apical pressure??????
Do you use much apical pressure to bush the tip down the PDL or do you find it just goes apical with the rocking motion?
Have you ever broke a tip? How long does the tips last? And what is the price of the tips?
Powertome: Looking for answers to my question?
Anyone have any questions on this:
Do you use much apical pressure to bush the tip down the PDL or do you find it just goes apical with the rocking motion?
Have you ever broke a tip? How long does the tips last? And what is the price of the tips?
Powertome: Looking for answers to my question?
I have been using the powertome for about 2 years. The amount of pressure that I use is about as much as what I use with a hand periotome. The powertome has some weight to it so there is little or no reverse force when using it. The difference is that the powertome works the tip down the pdl faster and with less effort than a hand periotome. As far as tips breaking, as long as you keep the instrument moving in a rocking motion it is rare. In my time using the powertome I have broken 2 tips. Both were in the periodontal ligament space and easily retrieved after the tooth was removed. Keep in mind I have done close to a thousand extractions with the powertome and I have broken far more of the hand periotome tips than the powertome tips.
powertome
I have broken one tip early on, got it out with the tooth. I have taken out about 200 teeth with it in one year. I find that my hand gets tired with the periotome. I use the periotomes to get the "lay of the land", then as I get more familiar I go to the powertome. I got to use a prototype curved one....it was great. I hope they make some to sell. I got my powertome plus ten tips for $3100.
The powertome is bulky, heavy and hard to get into the distal of molars. I have bent the tips with ortho pliers to help with access. I section most molars.
Osteogenics conference looks like a good one
Saw the advertisement in JIACD and the line up looks fantastic.
Osteogenics
I want to encourage all of you who are using the powertome to look into attending the Osteogenics meeting in Scottsdale in 2010. I went two years ago to their first meeting and that is where I really developed my passion for socket preservation. The powertome definitely is a key tool in the whole technique to preserve the socket. I use all of their products--excellent results. I have alot of pictures from all my cases if you'd like to check some out. I am not paid or have any connection to the company. I just take pride in dental companies that develop quality products that truly make our lives more efficient in the operatory. So check it out. I will definitley be going again this year.
Dr. White can you review your powertome technique?
Can you review the technique you use? Do you use it like a periotome where you rock it back and forth using apical pressure to slip down the PDL or do you do something different?
Thank you for your comments and article.
Technique
I always start on the mesial aspect of the tooth and move around the tooth counterclockwise. Rocking the tip back and forth letting it guide me down the root. Just like an endo file--too much pressure will result in breaking the tip. I usually have the powertome set 7-8. I just found that this technique works best for me and I'm sure you can do it several other ways. I usually only have to go around the tooth a couple of times. Thanks for the good comments and questions. Have a great day!
Dr. White thanks for your comments. A few more questions
Dr. White I agree with you on the advantages of the powertome:
1) doesnt removed any bone,
2)there is no risk of heat damage to the bone
3) and it is very tissue friendly.
A question for you, how are you removing molars without sectioning them? Any issues you see in endodontically treated teeth? How long do the tips last?
I really enjoyed your article.
Endodontically treated teeth
I absolutely get the handpiece out and section most of the molars that have been treated endodontically. However, once I have made my section I use the powertome around the tooth and sometimes down the area of the roots I already sectioned. With the powertome, I am not as invasive with the handpiece. As for the tips, I have only had one tip break and it was probably my fault applying to much pressure and in a rush...you know how that can be!
Powertome vs Piezo vs Periotome vs Scalpel
I have used all of these instruments for extracting teeth. My tool of choice is the Powertome. I have literally taken out teeth (atraumatically) in under 30 seconds with the Powertome. For single rooted teeth, the Powertome wins hands down. If I am taking out multi-rooted teeth, I still section with a handpiece (unless the roots are fused). Simply put, the flare of the roots makes it too dangerous to remove without sectioning. I am in the business of preserving bone at all costs. I will run the Powertome around the PDL of the molar, initiate movement, and then section. The tooth comes out easily and the bone is kept pristine.
Middle aged, big guy with an old endodontically treated tooth...powertome works wonders.
The 15c was my original tool of choice for atraumatic extraction. The piezo was good, but not as fast as the Powertome. Plus, I have seen some cases of overheated bone with the piezo.
The only drawback to the Powertome is that some patients say it feels like a small jackhammer is going off in their head. A quick joke usually alleviates this concern and the patient and I have a good laugh when all is finished.
Powertome-Dr. White
Thank you for your comments on the article and my cases. The powertome really has changed my extraction techniques. I was only a few weeks away from buying the Peizo before my friend brought me the powertome to try it out. I feel I should buy him a very nice Christmas present for the money I saved by purchasing the powertome over the peizo. I am hoping that other tips are developed for the powertome that will make it useful for all the same techniques that are used with the peizo unit. The three key points for using a powertome over the peizo is the fact that we don't removed any bone, there is no risk of heat damage to the bone, and it is very tissue friendly. I have been recently using the powertome to retract tissue from the bone for placing my membranes. I have found that the powertome works 8 out of 10 cases. There are still times where you shouldn't force it and get the handpiece out. I had a colleague work on a tooth for nearly an hour before the patient findly said "I can't take this anymore". So no product should blind you from all other techniques and common sense. As for the tips breaking, I have had one tip break off half way down the PDL space but it safely came out once the tooth was extracted. After using the powertome around the tooth once or at most two time, i use a forcep to slip the tooth out. I say "slip" because that's really what happens. Bottom line: The powertome is user friendly, cost friendly and patient friendly.
I agree with Dr. X on Powertome article
Would love to get more feedback on this. I am currently using the piezosurgery unit but would love to get opinions on other devices.
Powertome article in JIACD: Dr. Whites thoughts
I have to say that the article was very interesting. Me being a piezo user I am curious to get some feedback on the powertome. I would love to get some thoughts from Dr. White in this thread.
His case layout in the article was great.
Periotomes for atraumatic extractions
I usually use periotomes for atraumatic extractions. Would be interested in learning about the powertome as it sounds very similiar to a periotome. I think piezosurgery has a multitude of literature to prove it out. Just bought an osada unit and will let you know how it works for extractions as I use it.
Hall Handpiece, periotome, for extractions: More powertome info
I use Hall Handpiece, periotome, luxators, 77r for extractions. I have not had a problem with bone loss or implant placement. Its all in the handling and grafting of the site.
The powertome is interesting but there needs to be way more data to justify the expense. Ill wait to more info comes out and see it more in lectures.
The ultrasonic works but is pricey
I use the piezo for extractions and luxators
I am more of a tradionalist. I do atraumatic extractions with a 15c and forcepts from A-titan.
I bought a piezo recently and have been doing more that way with luxators as well.
Piezosurgery made things easier, but still favor the 15c.
options to choose for extractions
I specialized in prostho, but work in emergency dental office in Russia as oral surgeon(it was my "people university". I got great experience as every second patient was with abscess,saw 40-60 patient per night shift ,for three years did thousand extractions. From 1996 work in US as GP. It is a pleasure to work in America ,where you have so many options to choose(instruments,techniques)for extraction
Periotomes and Piezo: Answer for shriram
Dr. Shriram A periotome can make an extraction easier and atraumatic which is the main point. With the advent of implant therapy the goal is to cause less trauma when taking out a took, thereby causing less bone resorption. By working the periotome done the pdl space you are loosening it and causing less pressure on the bone since you dont have to expand it as much to get the tooth out.
My preference is not to use a periotome, I like to use a piezo to take out the tooth, actively cuts the pdl and much faster.
periotomes
how to use periotomes to make extraction fast
Course for extractions and the powertome
I am interested in taking a course on extractions and the powertome are there any out there?
Powertome Courses
The following courses feature the Powertome:
The Pikos Implant Institue - "Contemporary Soft Tissue Grafting For Implant Reconstruction" - Dr. Pikos presents cases on the Powertome and shows its use in live surgeries.
http://www.pikosinstitute.com/stg.htm
USC School of Dentistry CE - "Oral Surgery for the General Practioner" - Dr Bach Le will present extraction cases and use of the Powertome
https://uscsd03.usc.edu/ce/course_calendar_detail.asp?ID=816
USC School of Dentistry CE - "Atraumatic Extraction and Minimally Invasive Implant Site Development (Module IA & IB)" - Dr Bach Le will present extraction cases and use of the Powertome. Powertomes will be used for extractions in a hands on cadaver lab section.
https://uscsd03.usc.edu/ce/course_calendar_detail.asp?ID=863
The Pikos Implant Institue - "Advanced Bone Grafting I" - Dr. Pikos presents cases on the Powertome and shows its use in live surgeries.
http://www.pikosinstitute.com/abg1.htm
The Pikos Implant Institue - "Advanced Bone Grafting II" - Dr. Pikos presents cases on the Powertome and shows its use in live surgeries.
http://www.pikosinstitute.com/abg2.htm
Arrangements are being made for more Powertome courses. Please email info@westportmedical.com for more detail as courses are added.
Powertome cuts down my surgical time.
The powertome has cut my surgical time in half. Works very well. Great review article in JIACD by White.I would not go back to my old way.
Powertome: How does it work and whats best technique?
Can someone explain to me the science behind the powertome and the technique in which it is used?
Powertome: Function and Technique
The Powertome uses a periotome tip to expand the socket and sever the pdl fibers. The Powertome taps only on the down stroke with an action similar to tapping a manual periotome with a mallet. The Powertome does not use a reciprocating action. The best technique for use of the Powertome is to locate the tip in the interproximal space, along the mesial facial or distal facial line angle where the bone tends to be the thicker. Once the tip is positioned, apply power to the device and sweep the hand piece along the face of the tooth while advancing the tip. The sweeping motion used is similar to the motion used to advance a periotome manually or the motion used once a manual periotome was advanced by tapping it with a mallet. Once the tip has been advanced to the apex of the socket, it can be swept across the facial side or the palatal side of the tooth. The tip can also be removed and repositioned. The tooth should be easy to remove with forceps once the tip has been swept completely around the tooth.
Periotomes from Osseous Technology
I love using periotomes from osseous tech. The are pretty sharp and work very well. I easily move them done th PDL space and have not had a problem. The handles are very nice.
http://www.osseoustech.com/instrumentation.html
Ill stick with Piezo to taking out teeth.
I been using Piezo for a while now and its great for taking out teeth. I get teeth out pretty fast and atraumatically. Changed my practice for the better.
Powertome article in JIACD
Very nice article in this months JIACD by White. Great case presentations.
Some questions I have is:
How long do the tips last? Is there any advantage over a piezo unit? My thought is no difference since you are cutting the PDL in both cases.
Once you go around the tooth with the powertome does one use a proximator or just a forcept to remove the tooth?
TY
Powertome is Great!
I have extracted thousands of teeth. I have used just about every product on the market. I recently got a Powertome and it is very nice.
I am not kidding you, I am getting teeth out in under 30 seconds (singe root). No scalpel. No flap. Just the Powertome and a quick use of the forceps.
Best product on the market for extractions hands down.
Powertome advantages
The tips are made thin enough to bend and contour to the shape of the tooth root...and even fit between the tooth and buccal plate. You can straighten the tips if needed. How long the tips last is going to depend on the difficulty of cases you use it on. The Powertome does not cut bone like the Piezo, only thru the PDL. Because of the ultrasonic vibrations of the Piezo, the delicate interproximal bone and papilla may not be preserved as well as when using the Powertome. Dr. White doesn't use luxators or elevators at all when using the Powertome...only the Powertome and forceps. The last case featured in the article, took less than 5 minutes (including time spent taking the pictures) after using the Powertome to cut thru the PDL. So it saves alot of chairtime.
The Powertome doesn't require irrigation. And you can sterilize the handpiece in an ultrasound and autoclave. Another advantage of the Powertome is cost, in some cases it isn't even a third of the cost of a Piezo.
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Powertome: Takes out teeth very easily
I have a 1 oral surgeon and one periodontist in my area that I refer that use the powertome. They both say it has enhanced there surgery taking out teeth. Very easy to use so I hear.
The Powertome is pretty sweet
I just bought it and I like it. The Powertome automated periotome is similar to the Piezo in it does remove teeth atraumatically without cutting bone. The tip shoots in and out like a small jackhammer, but only applies force on the downstroke, eliminating the uncertainty of a periotome and mallett as JASE commented. It is definitely changing my practice.
Its worth the money.
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Powertome: Whats the story on this?????
Jase can you give me some background and your experience with the powertome? Is it similiar to a piezo. Is it worth the money?
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Look at the Powertome
Look at the Powertome automated periotome manufactured by WestPort Medical on their website: www.westportmedical.com. It is designed specifically for atraumatic extractions and does not cut bone nor does it need irrigation. And it is ALOT easier on the wallet.
Karl Schumacher Proximators for atraumatic extractions are best
I have been doing atraumatic extractions for many years. I always try to avoid removal of the buccal bone, especially when an implant is to be placed there. I tried luxators, but found that the Proximators worked much better. I have been using Proximators by Karl Schumacher for about 2 years. The spade Proximator is in my hands about 90% of the time. It is great for expanding the PDL space and alveolus, then getting apical to the root and displacing it occlusally.
If I cannot get the Proximator in to the PDL space, I will take a 701 bur and trough around the root. This allows me to get a purchase point in to the PDL space and deliver the root
Combination of luxators and periotomes for atraumatic extraction
As an oral surgeon by trade I use alot of 301, 34 and a hall handpiece, but thats for 3rd molars. For atraumatic extractions I use a combination of luxators and periotomes. Stoma has a nice set as well as Karl schumaker.
I tend to use the periotomes with a mallet to move it down the pdl with gentle tapping.
I do a mixture of Periotomes and Piezo depending on the case
I have a piezo unit from Osada, I tend to favor that when doing multi rooted teeth extraction. I use periotomes more for single rooted teeth extractions.
Periotomes are the best way to do a atraumatic extraction
I stick to the basics. My Periotomes are working fine for me. I bought several sets through Osseous tech. They are sharp and I can easily move them done the PDL to atraumatically extract the tooth.
Piezo much easier for extractons (for me)
I've used everything over the years for extractions. 15 blades, periotomes, you name it. For me, the piezo is the fastest and easiest.
The next time you have a heavy set 45 year old man with an old root canal treated molar, try the piezo. You will have tooth out in minutes.
Atraumatic extraction using Piezo tips
I am strictly doing atraumatic extraction using the piezo. It work really well, and is fast. I used to us periotomes, but now us the piezo. It cuts right through the PDL fast and I use the forceps once the tooth is mobile.
Atraumatic Extraction techniques: Periotomes vs Proximators etc
I like periotomes, I favor the ones made by osseous technologies. I to use the periotome with a mallet and work it down the PDL.
I disagree with the piezo burning the bone. I think thats a blanket statement. There are many different piezo units, some irrigate better then others. To hedge my bet I have my assistant self irrigate which also help in preventing burning the bone.
Extraction techniques
I have used periotomes, luxators, and piezo to do atraumatic extractions. For me the periotome and a mallet work the best. The piezo tends to "burn" the bone because the water spray cannot get into the small space where the tip is active in the PDL space. Luxators work well, but they are a bit large. I have had good success with periotome/mallet technique and then sectioning the tooth aggressively in multirooted scenarios. Also in fractures at the alveolar housing level I have successfully sectioned the root internally (from pulp chamber out), then imploded the root in on itself with the periotome and extracted easily.
Peritomes vs. Luxators
I use both. The peritomes from Salvin are great. I just started using the Tatum Luxators from Tatum Surgical 888-360-5550. I used the Tatum Luxators to extractt some endodontically treated teeth (we all know how difficult they can be) with great ease! You cannot use the luxators like an elevator.
Piezotome extractions
Formerly, I was doing all of my atraumatic extractions with a simple 15c scalpel blade. Worked just as well as a periotome.
Now, I am doing all of my extractions with a piezotome. Very fast, very atraumatic and the patients seem to report very little pain.