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.