The Periotome is the instrument that changed the approach to atraumatic tooth extraction in implant dentistry. Before the Periotome became widely adopted, dental extractions — even carefully performed ones — routinely caused buccal bone loss that complicated immediate implant placement or required additional bone augmentation procedures. The Periotome addresses the root cause of that problem directly.
What Is a Periotome?
A Periotome (also called a PDL elevator or luxator in some markets) is a thin-bladed surgical instrument designed to cut through the periodontal ligament (PDL) fibers that attach the tooth root to the alveolar bone. The blade is extremely thin — typically 0.3 to 0.5 mm at the cutting edge — and sharpened on both sides, allowing it to penetrate the PDL space and sever the fiber bundles progressively as it is advanced apically with gentle vertical pressure.
Unlike conventional elevators that work by rotating against the bone to pry out the tooth, the Periotome works with the PDL space rather than against the bone — making it inherently more bone-preserving in its mechanism.
Why Atraumatic Extraction Matters for Implants
Immediate implant placement (Type I placement) requires that the extraction socket maintain the buccal plate integrity and socket dimensions at the time of implant insertion. When a conventional extraction causes buccal plate fracture or significant PDL damage, the socket collapses during healing, and the buccal contour at the implant site is compromised even when the implant integrates successfully.
Studies on conventional versus Periotome-assisted extraction report 20 to 35% less buccal bone height loss at 3 months post-extraction when the Periotome technique is used. For clinics performing significant implant volume, incorporating the Periotome into every extraction that is followed by immediate or early implant placement is a straightforward protocol change with measurable outcome improvement.
Periotome Designs and Blade Configurations
Straight Periotome
Used for anterior teeth (incisors, canines) and upper premolars where straight root anatomy allows vertical insertion without angular compromise. Available in narrow (3 mm blade width) and standard (4 mm) widths.
Curved Periotome (Distal Curve)
The curved blade accesses the distal root surface of posterior teeth and the palatal root of upper molars where the straight blade cannot achieve the correct insertion angle. The curve also helps in lower molar distal root work where the adjacent second molar limits straight instrument access.
Angled Periotome (Offset Blade)
Offset blade design for buccal and lingual root surfaces of lower molars where the standard straight blade approach would require excessive force against the adjacent alveolar crest. The angled version also reduces the fulcrum effect on the alveolar crest during apical advancement.
Periotome Technique — Key Points
The Periotome is used with vertical pressure only — never rotational or lever force. The blade is inserted into the PDL sulcus with the concave side against the root, and advanced 2 to 3 mm apically with firm steady pressure. The blade is then repositioned 90 degrees around the root circumference and the process is repeated. After three to four passes around the full circumference, the tooth is typically mobile enough for forceps delivery with minimal force. Total time added to the extraction compared to conventional technique is 2 to 4 minutes per tooth.
Steel Specification and Edge Maintenance
Periotome blades must maintain a sharp thin edge through 200-plus sterilization cycles. Fizza Surgical Periotome blades are manufactured from high-carbon stainless steel heat-treated to Rockwell C 52 to 56 with a 0.4 mm edge thickness at the cutting margin. The blade is sharpened at the factory to a double-bevel edge and comes with a sharpening guide card for maintenance.
All instruments are manufactured under ISO 13485:2016 with CE marking. Available individually, in matched sets (straight, curved, angled), or as part of complete implant site preparation instrument sets. Contact Fizza Surgical for pricing or to request a sample instrument.
Periotome vs Luxator vs Elevator: Quick Comparison
These three instruments are routinely confused in ordering and in the operatory, and they are not interchangeable. The distinction is edge thickness and intended force vector.
| Instrument | Edge thickness | Intended action | Force applied | Best use |
|---|---|---|---|---|
| Periotome | ≈ 0.3–0.4 mm | Severs PDL fibres | Apical pressure only — never levering | Atraumatic extraction where the socket wall must be preserved for immediate implant placement |
| Luxator | ≈ 0.5–0.9 mm | Cuts PDL and wedges | Apical pressure with slight rotation | Loosening roots where mild expansion is acceptable |
| Straight elevator | ≈ 1.5–3 mm | Levers and luxates | Lever force against bone or adjacent root | Mobilising and delivering roots once the PDL is partly released |
| Periosteal elevator | Blunt | Reflects soft tissue | Lifting against bone surface | Flap reflection — not an extraction instrument |
The single most damaging error is applying elevator-style lever force to a periotome. The thin blade that makes it effective is also what makes it snap, and a fractured blade tip in a socket is a retrieval problem in a site you were specifically trying to keep clean. If a tooth resists after four circumferential passes, escalate to a luxator or elevator rather than increasing force on the periotome.
For the fuller comparison of the wedging instruments, see our guide to dental luxators versus elevators, and for the delivery stage, our dental extraction forceps guide. Where the extraction is planned around an implant, the dental implant instrument kit guide covers the rest of the site preparation sequence.
Frequently Asked Questions
Can a periotome be used as an elevator?
No. A periotome is designed for apical pressure that severs periodontal ligament fibres, not for lever force. The 0.3–0.4 mm blade will fracture under levering, and the fragment then has to be retrieved from the socket.
How many passes around the root are needed?
Typically three to four circumferential passes, repositioning roughly 90 degrees each time and advancing 2 to 3 mm apically on each pass. Most teeth become deliverable with minimal forceps force after that. Adding 2 to 4 minutes per tooth is the normal time cost.
How often do periotome blades need sharpening?
Edge retention depends on use rather than a fixed cycle count, but any blade that requires noticeably more pressure to enter the sulcus has lost its edge. Sharpen to the original double-bevel geometry using the supplied guide; a rounded edge crushes ligament instead of cutting it and defeats the purpose of the instrument.
Does periotome use actually preserve the buccal plate?
It preserves it substantially better than conventional luxation, because the ligament is severed rather than the socket expanded. It does not guarantee preservation — a thin buccal plate, which is common in the anterior maxilla, can still resorb after extraction regardless of technique.
Which blade shape should I start with?
A straight blade for anterior teeth and accessible premolars, curved for the mesial and distal surfaces of posterior teeth, and angled for molars where access is restricted. A matched set of three covers most of general practice.
Where We Serve
Fizza Surgical exports to 50+ countries. Browse our country-specific pages with local regulatory guidance and pricing:
