May 15, 2022
Tooth syndesmotomia is a procedure that dental surgeons perform during tooth extraction. "Syn" means together. "Desmo" refers to a band or group of tissues. "Otomy" describes cutting through something. When put together, we understand it as cutting through tissues that are present together in bands or groups. Many medical dictionaries suggest that syndesmotomy is the surgical division of a ligament. This can also be applied in the dental context.
In order to better understand syndesmotomy, let us first understand the region where it is performed around the tooth.
Around the Tooth
Most of us understand that teeth are affixed in sockets that are present in the bones of the upper and lower jaws. But these sockets form only one of the four tissues that actually keep the tooth firm in the oral cavity. The socket is a part of the alveolar bone which is a hard tissue. The second component are the fibres from the gingiva, that prevents the tooth from rotating at its given position in the oral cavity. The third component are the fibres from the ligament that binds the tooth to the socket. This is called the periodontal ligament (PDL). Finally, we have the cementum, that outlines the root of the tooth and forms an association with the socket walls.
Syndesmotomy objective
Tooth removal is most often pictured as the dental surgeon pulling the tooth out with a pair of forceps in his hand. But that is the second of a two step procedure. Tooth extraction initially focuses on the detachment of the fibres that adhere to the tooth. The upper most margins of the gums which is attached to the tooth is called the marginal gingiva. The part of the gingiva that is not visible clinically and which has a firm adherence to the gingiva is called the attached gingiva. There are also the PDL fibres that connect the tooth to the alveolar bone. These run parallel to the gingival fibres.
Instrument used for syndesmotomy
In order to loosen the tooth initially, the dental surgeon uses a syndesmotomy or a peritome to detach these fibers. This is only done only after a local anesthesia has been administered, so that the procedure remains painless. The syndesmotome is introduced at the gap between the visible gum and the tooth. The instrument is slowly moved downwards towards the alveolar region and gradually near the apex of the root. Once the syndesmotome is moved around the tooth in the said manner, the syndesmotomy step is complete. At times, a scalpel blade may also be used for performing syndesmotomy. However, it does not guarantee if the removal of fibers will occur at the needed help. At times, the scalpel blade might be a more invasive instrument to use.
Advanced techniques involve the use of peritomes that come with an ultrasonic tip. These tips more effectively severe the PDL fibers and have much thinner blades for better penetration. Further advances involves the use of peritomes that use piezoelectric technology that deliver micro-oscillations for cutting the fibers.
Post-syndesmotomy
Following syndesmotomy, the tooth loosens up a bit. There is bleeding around the tooth caused due to then rupture of blood vessels surrounding the tooth. Once the bleeding is controlled, the dental surgeon then uses an instrument called the elevator. It helps to detach the tooth from the socket. Once the tooth is distinctly mobile, the forceps are used to hold and remove the tooth out of the socket.
Advantages of Syndesmotomy
Syndesmotomy helps in minimising the trauma to the tissues during tooth extraction. It also helps in preservation of maximum bone tissue. This helps in retention of bone height after extraction. This feature is particular useful when extraction is to be followed by placement of dental implants. Moreover, the technique also helps in faster healing of the tissues.
In cases when syndesmotomy is not performed, the forces applied through the forceps to pull a tooth out can hamper and destroy the bony plates surrounding the tooth.
Syndesmotomy or syndesmotomia is a significant step in tooth extraction that should be advocated for removing a tooth in the most minimally traumatic manner. It is because of this reason, it is a part of the four principles that dental surgeons follow in order to carry out "atraumatic extractions."