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.
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