Translated from the German language, Die Quintessenz Volume 47, pages 693-705 May 1996 Berlin, Germany (Partial translation)

The Ögram System - a Contribution to Minimize Trauma for Tooth Extraction

by Prof. Frank Peter Strietzel, Dr. med. dent.

Dept. of Oral Surgery and Dental Radiography

Humboldt Medical University

Berlin, Germany

and

Gunnar Philipp, Bioengineer

Denton, Texas

Zusammenfassung (Synopsis, page 693)

The extraction of teeth or the removal of roots in a modern dental practice is often a traumatic experience for patients. The contribution of The Ögram System establishes with instrumentation and extraction methodology that trauma for tooth removal is minimized. This report of a Clinical Study is the implementation of this System based on 65 tooth removals of 34 patients with varied clinical situations. In not one case was there a post extraction wound healing disorder. The precedence is a non-invasive extraction technique.

Resümee (Summation, page 704)

The Ögram System offers new possibilities for dentists to reduce trauma for procedures of tooth, root, or root fragment removals. This is accomplished by no longer requiring an osteotomy or the need for surgical reflection of gingival tissues and the preservation of the cortical alveolus (for non-impacted removals), through exact technic and the proper manipulation of exact instrumentation for each specific situation. Tooth removal trauma is minimized for each specific situation with reduced extraction times, by application of exact technique and instruments used in the Ögram System, also the elimination of profound hand forces by the practioner, and at the same time reducing stress for the practioner and the patient. With the implementation of The Ögram System, the provision of tooth saving partial hemi-section is far less traumatic. Due to attainable minimizing of trauma in tooth removal using exact instrumentation and easy to apply techniques, adequate alveolar and crestal bone retention will allow for preferable future prosthetics and will also have a special meaning for implants.

Clinical #2

Translated from the German language, Die Quintessenz [Quintessence] Volume 52, pages 863-868 September 2001 Berlin, Germany.

Alveolar Resorption after tooth Extraction

with two different Extraction Methods

A Comparison Study

by

Javier M. Herrera, Dr. med. dent.

Joachim E. Zöller, Prof. Dr. med. Dr. med. dent.

University Clinic and Outpatient Department for Oral and Maxillofacial Surgery

Dept. of Oral and Maxillofacial Surgery University of Köln

Köln, Germany

Helmut Steveling, Dr. med. dent.

University Clinic and Outpatient Department for Oral and Maxillofacial Surgery

Dept. of Oral and Maxillofacial Surgery University of Heidelberg

Heidelberg, Germany

Zusammenfassung (Synopsis, page 863)

An important goal in modern dental medicine is the retention of alveolar bone after tooth loss. Therefore the dental arch can provide esthetic and sound clinical results for implants. The goal of this report is to present two different tooth removal possibilities: the standard method for tooth removal and a new extraction method (Ögram) which is a far less invasive technique and uses instruments that are anatomically correct to the tooth's morphology. This clinical will show, that with the Ögram System the operation yields minimal trauma and that bone resorption can be greatly reduced. So that better results for future implants can be better accomplished.

Patienten, Material and Methoden (Patients, Material and Methods, page 864)

At the beginning of 1997 until mid 1998 170 patients had 198 teeth extracted. Patients were only accepted with the understanding that a 3-month post extraction assessment was required of each patient for the control group. Patients that did not return for the 3-month post extraction assessment were not included. The clinical study therefore was based on 166 extractions from 125 patients.

The 62 female and 63 male patients were between the ages of 15 to 87 years old (average age was 49 years old). The selection process for our patients in this study had the following requirements:

- no local or altogether bone disease for either dental arch so that bone loss values could be properly observed;

- no horizontal bone resorption in the apical third of the root;

- no periodontal pockets;

- no loose teeth.

The planned conclusion to this study is to assess the difference between two tooth extraction methods, with the distribution of the patients into two groups:

- Group A encompasses patient treatment with conventional extraction methods.

- Group B represents patients that received the Ögram System extractions.

The patient base for both study groups were categorized and divided into three Classes with relationship of adjoining teeth:

- Class I: The extracted tooth had mesial and distal neighboring teeth.

- Class II: The extracted tooth had mesial or distal a neighboring tooth (one tooth adjoining only).

- Class III: The extracted tooth had mesial or distal no neighboring tooth

Ergebnisse (Results, page 866, last paragraph)

The results of alveolar resorption 3 months post extraction by the conventional extraction and extractions with the Ögram System shows an average value loss of 2.6 mm [plus or minus 1.48 mm] in Group A and 0.2 mm [plus or minus 0.45 mm] in Group B (Table 1). The minimum value of bone resorption in both Group A and Group B showed 0.0 mm., the maximum value exhibited a significant difference between Group A with 8 mm bone loss, and Group B with 1 mm bone loss. The average of the T-Test proves an important significant statistical difference (p=4.73E-24) and can be confirmed between both Groups.

Diskussion (Discussion, page 867)

It is commonly known, that with tooth removal almost always more or less alveolar bone is resorbed, where as with less invasive extraction technique alveolar resorption can be reduced and even eliminated. The regeneration of bone in the upper arch is slower than the lower arch. While the anatomical change in the lower arch requires a wait of 2 months, one must wait 3 months for the upper arch before continuing with dental treatment.

The here described study of the new tooth removal system shows after our clinical experiences that this new surgery possibility offers far greater results. The observation using both tooth removal possibilities clearly shows the advantage in bone retention. The retention in bone clearly shows for better overall implant results. The new method can for this reason be highly recommended.

The results of this study show, that patient bone loss or bone resorption after tooth removal by traditional methods is substantially higher, than compared with the Ögram System. The presented surgical methods of noninvasive and greater bone retention possibilities clearly shows that this new removal system offers the best prognoses for future prosthetic procedures or implant prosthetic treatments. With complex tooth removals (non-impacted) the Ögram technique is an absolute must as it reduces the need of an osteotomy by 30%!

The Ögram System^TM

Needle Holders and Suturing

Needle holders come in various sizes, shapes, materials, and with different beak types. The most common shape in needle holders has finger ring handles, and these are the most dated. The more modern and easier to use needle holders are the Mathieu style spring handle type, which are held in the hand around the body of the instrument and squeezing the handle to release or lock. Castroviejo style spring mechanisms are used in circumstances that require smaller needle and suture sizes. The position of the hand when using spring handles makes it easier to rotate during suturing.

Common beak material used for all needle holder styles are:

· Stainless steel (least desirable, serrations in the beak loose their edge the quickest)

· Diamond coated (expensive and wears out, as glued on diamonds fall out over time)

· Tungsten Carbide (TC) most desirable, longest lasting, no needle slippage, hardest material (serrations in the beak last the longest)

Conventionally, gold color on both handles on needle holders indicates that the beaks have tungsten carbide insert plates (TC). Only one gold handle on a needle holder indicates that the needle holder is being marketed with variations of other metals/materials that are not necessarily desirable, i.e. tungsten. The advantage of TC needle holders is there is no needle slippage during suturing. Less expensive conventional or standard needle holders are made of stainless steel, which is a softer metal and do not last as long. TC needle holders will last 2-4 times longer than stainless steel ones. Additionally, with stainless steel needle holders you will need to hold needles in the middle of the beak. TC needle holders can hold needles at the tip of the beak, an advantage for tight areas.

Beak sizes depend on needle sizes/suture sizes.

Typical standard needle holder size with finger ring handles:

· Mayo-Hegar for suture sizes 3/0, 4/0

· Crile-Wood for suture sizes 4/0, 5/0

· Micro Ryder for suture sizes 5/0, 6/0

Spring handle needle holders:

· TC Castroviejo small beak for suture sizes 6/0 to 10/0

· TC Mathieu for suture sizes 3/0 to 5/0

Quality made needle holder cost:

· Higher quality stainless steel finger ring handles varieties = $120+

· TC in finger ring handles varieties = $180 to $200+

Quality needle holders with spring handles cost:

· Mathieu TC = $230 to $270+

· Castroviejo TC = $350 to $700

Typically, needle Holders costing less than $100 are made of a lesser quality stainless steel that use softer metal combinations that lose their serration more easily.

Note: Castroviejo needle holders should never be acquired with stainless steel beaks, they will not last long. It is suggested to only acquire them with gold handles (TC beaks).

Suture Needles

The more common suture needles used in dentistry are 3/8 Circle and 1/2 Circle with cutting edge needles that are triangular shaped. Triangular shaped needles should only be used for thick or fibrous tissue, like the palate. These triangular needles are not recommended for use on thin tissue, i.e. interproximal suturing, because of likely tissue tear.

Dentists often resort to using triangular shaped needles because there is less slippage when using stainless steel needle holders.

Most of the tissues that dentists will suture are softer and thinner, which negates using triangular shaped needles. When suturing softer or thinner tissues, taper-point, round-bodied needles are preferred. They are less likely to tear the tissue during penetration, and leave a smooth round hole. TC needle holders should be used for these needles, so there is no needle slippage. If stainless steel needle holders are used for taper-point round-bodied needles, there will likely be needle slippage, as the instrument gets older.

Needle Holder Maintenance Suggestions

Needle holders will last longer when stored in the unlocked position. When stored this way, the tension on the handles is released. Over time, this allows the beak to hold the needle better because the optimally set tension needed for gripping is maintained.

If blood should enter the hinge during use, rinse the hinge with hydrogen peroxide ASAP before the blood dries and before autoclaving to keep the blood from hardening, which can tighten the hinge. Rinsing with water often sets up blood and thickens it. Subsequent autoclaving bakes the blood, which will look like rust. This will negatively affect the hinge. Once blood is baked into the hinge, only friction will unseat it. The heat built up with friction will break up the baked blood. Once the hardened blood is broken up, spray the needle holder hinge with WD40 then rinse with hydrogen peroxide before washing. If the hinge is still stiff, repeat the process.

(If you found this artcle helpful, let us know below. About every month we will submit a new instrument artcle that can advance your instrument useage. If you have a suggestion about a type of dental instrument you would like to know more about in detail, let us know below and we might be able to give you more depth.)