Atraumatic tooth extraction has become a fundamental pillar of modern oral surgery, particularly when a restorative or implant-based approach is planned afterward. The traditional concept of simply “removing the tooth” has evolved into a much more conservative perspective—one that focuses not only on extracting the tooth itself, but on the meticulous preservation of the surrounding hard and soft tissues, with special emphasis on maintaining the original alveolar bone architecture. This modern approach is not only essential for facilitating future rehabilitations but also for minimizing procedural morbidity and optimizing both bone and soft tissue regeneration.
One of the most relevant challenges in this context is the protection of the alveolar bone walls—especially the thin buccal cortical plates in anterior regions—which, if lost, may compromise not only the possibility of placing an implant under optimal conditions but also the final aesthetic outcome of the treatment. For this reason, any extraction performed with implant placement or future reconstruction in mind must follow a precise surgical protocol that prioritizes the preservation of bone and soft tissues.
In this respect, three-dimensional (3D) planning has revolutionized the surgical approach prior to extraction. Through the use of CBCT (Cone Beam Computed Tomography), the clinician can analyze in detail the root morphology of each tooth: the number and curvature of the roots, the thickness of the surrounding bone, the presence of concavities, the relationship to adjacent anatomical structures (such as the maxillary sinus or the inferior alveolar canal), and even the presence of periapical pathology that may weaken the bone. This information is vital for choosing the most conservative surgical strategy and for anticipating potential complications.
One of the key factors that increases the difficulty of the procedure is the pre-existing condition of the tooth. Teeth that have undergone endodontic treatment or experienced severe attrition over time often develop varying degrees of partial ankylosis to the surrounding alveolar bone. This situation, frequently underestimated, can significantly complicate tooth luxation and increase the risk of root fracture during extraction. Devitalized and brittle dentin, combined with a reduced or absent periodontal ligament, means that these cases require even greater precision and preoperative planning.
For this reason, it is crucial to use advanced and specialized instruments that allow for a controlled and segmented extraction. The use of fine periotomes, high-precision angled luxators, delicate periapical elevators, periotome-adapted forceps, and piezoelectric surgical devices has proven extremely useful in minimizing surgical trauma. In particular, piezosurgery allows for precise bone or tooth sectioning while preserving adjacent soft tissues and reducing the risk of accidental perforation.
A key principle within this surgical philosophy is the preference for odontosection over osteotomy. While osteotomy involves direct sacrifice of alveolar bone to facilitate luxation, odontosection allows the tooth to be divided into strategic fragments that can be removed individually with minimal or no need for bone removal. This technique is especially effective for separating divergent roots or performing cuts that facilitate the removal of retained roots without damaging the surrounding bony contour.
The ultimate goal is not to speed up the procedure, but to perform it with maximum precision and tissue respect, fully aware that every millimeter of preserved bone represents a future advantage in terms of stability, osseointegration, and aesthetic outcomes in any subsequent reconstructive treatment.
In summary, atraumatic extraction is not an isolated technique, but rather a comprehensive surgical philosophy grounded in advanced planning, detailed anatomical knowledge, proper instrument selection, and a conservative mindset. This approach enables the clinician to maximize both functional and aesthetic outcomes in the short and long term, prevent complications, and ensure the success of subsequent treatments—whether implants, bone grafts, or prosthetic restorations. Embracing this philosophy requires training, preparation, and a paradigm shift: from simply “extracting teeth” to preserving architecture and enabling regeneration.