Traumatic alveolar damage
Movement of the punch in a medial or lateral plane during repulsion may markedly damage the alveolus and supporting bones. When repulsing a mandibular cheek tooth, the punch may penetrate or even fracture the mandible, lingually or buccally to the tooth. Similarly, when repulsing a maxillary cheek tooth, the punch may penetrate or fracture the hard palate or the buccal aspect of the adjacent maxillary bone. Such damage can predispose to sequestration and/or local soft tissue infection.
Due to the angulation of the caudal cheek teeth reserve crowns and the presence of the facial crest, it is not possible to perform the MITT extraction on all cheek teeth positions. Additionally, when teeth are being elevated (loosened) with a transbuccal elevator and mallet, the elevator will always cause local alveolar bone damage. Additionally, the angle of introduction of the elevator into the alveolar spaces is not always optimal and can cause local alveolar bone damage due to the restriction of using a single cannula site.
The use of partial crown removal (partial coronectomy) to facilitate mesio-distal (rostro-caudal) dental crown movement when using cheek teeth separators (Rice and Henry, 2018) or full sectioning of teeth with damaged clinical crowns, dilacerated roots or apical hypercementosis also carries a risk of causing direct traumatic or thermal (if using non-water cooled equipment) alveolar bone damage. This can cause delayed sequestration and infection of the injured bone.