The Utility of the Electric Mallet Roberto Crespi, MD, MS, Giovanni B. Bruschi, MD, DDS, Paolo Cappare ´, MD, and Enrico Gherlone, MD, DMD Abstract: The aim of this study was to evaluate the efficiency of electrical mallet for tooth extraction evaluating the integrity of fresh sockets walls. From July 2009 to February 2012, 427 hopeless teeth were extracted in 156 patients: 96 males and 60 females, with a mean age of 53.2 T 26.4 years. Two hundred fifty teeth were extracted from the maxilla and 177 from the mandible. Extractions were performed using an electrical mallet. It pushed blade in a longitudinal movement along central axis, moving up and down toward the periodontal ligament space in a repetitive manner, providing a driving mechanism of longitudinal movements. Intraoral digital radiographic examinations were performed before and immediately after dental extractions to evaluate the lamina dura setting. No fracture or loss of cortical bone plate was observed in fresh sockets of teeth extracted by electrical mallet. All the alveoli revealed full soft tissue secondary healing 2 weeks after complete root extraction. During the healing period, there were no signs of inflamed tissue or exposed bone in any of the cases. As reported in this clinical study, maximum preservation of the alveolar housing and related gingival structures may be achieved following assisted atraumatic tooth extraction by electrical mallet. Key Words: Dental extraction, electrical mallet, bone healing (J Craniofac Surg 2014;25: 793Y795) A lthough the use of osteotomes and periotomes represents es- sential tools for extracting teeth, 1,2 trauma to the supporting tissues takes place in the vast majority of cases, with destruction of the surrounding osseous structure. Consecutively, a forceps is used to remove root surface, and during this procedure, fracture of the root may then occur. Occasionally, an ankylosis may be present between root surface and the bone; consequently, more aggressive surgical procedures are used. These may include sectioning of the roots or the use of a chisel and mallet to remove sufficient amounts of sur- rounding bone to allow extraction of the root; however, fracture of the buccal cortical plate may occur simultaneously with the removal of the root. 3 These factors can create bone defects that may have negative consequences, especially as they relate to subsequent or simultaneous implant placement. 4Y7 Several techniques have been proposed for minimally invasive tooth removal including an atrau- matic method approach with a screw engaging the root, achieving more secure retention. Instead of relying on the surgeon’s muscle power to provide the extractive force, it uses a simple mechanical device. It lifts the screw and the root, while simultaneously dis- tributing force over the adjoining oral structures. 8,9 Ultrasonic sur- gery, also known as piezosurgery, has been introduced recently in the field of oral surgery. 10Y12 Vibrating syndesmotomes are among these recently developed tips for tooth and root extraction. They are brought through the gingival sulcus into the space occupied by the periodontal ligament (PDL) fiber, between the root and socket to cut the PDL fibers surrounding the tooth socket. Thus, when the roots or teeth are mobilized after severing the most apical fibers, the coronal portion of the socket has not been submitted to a violent ‘‘rip.’’ At this stage, a nearly atraumatic extraction can be achieved. 13 However, with this procedure, the tips were brought into the sulcus over a 4- to 5-mm depth, without first separating the gingiva from the tooth around the entire tooth circumference. Another technique has been proposed combining the atraumatic extraction advantages of the periotome with mechanized speed. 14 It is an electric unit that has a handpiece with a periotome blade that is controlled by a foot switch. The mechanized periotome blade is controlled by a solenoid within the handpiece. In the present clinical study, a new electrical mallet, Magnetic Mallet (Meta-Ergonomica, Turbigo, Milano, Italy), was used for dental extraction procedure. The purpose of this clinical study was to evaluate the efficiency of Magnetic Mallet for tooth extraction examining the integrity of fresh sockets walls. MATERIALS AND METHODS From July 2009 to February 2012, 427 hopeless teeth were extracted in 156 patients. There were 96 males and 60 females, with a mean age of 53.2 T 26.4 years. Two hundred fifty teeth were extracted from the maxilla and 177 from the mandible. Of the maxillary extracted teeth, 145 were located in the anterior maxilla (canine to canine), 60 were premolars, and 45 were molars. Man- dibular teeth were extracted: 67 located in the anterior maxilla, 58 in premolar region, and 52 molars (Table 1). One hundred seventy-eight roots presented ankylosis between root surface and the bone. The local ethical committee approved the study, and all patients signed an informed consent form. The diagnosis was made clinically and ra- diographically. The patients were treated by 1 oral surgeon at the Department of Dentistry, San Raffaele Hospital, Milan, Italy. Surgical Procedure Extractions were performed using electrical mallet (Magnetic Mallet; Meta-Ergonomica) (Fig. 1). The Magnetic Mallet is a magnetodynamical device assembled into a handpiece energized by a power control defining forces and timing of application (Fig. 1B). A thin metallic blade is connected to the handpiece sending a magnetic wave on the tip. The magnetic wave and the subsequent shock wave are calibrated regarding the timing of application of the force and induce axial movements applied on the tip of the blade, with a fast force of 130 daN/8 Hs. The Magnetic Mallet imparted to blade a longitudinal movement along central axis, moving up and down toward the PDL space in a repetitive circumferential fashion, providing a driving mechanism of longitudinal movements. After ORIGINAL ARTICLE The Journal of Craniofacial Surgery & Volume 25, Number 3, May 2014 793 From the Department of Dentistry, Vita Salute University, San Raffaele Hospital, Milan, Italy. G.B.B. is in private practice in Rome, Italy. Received November 1, 2013. Accepted for publication November 11, 2013. Address correspondence and reprint requests to Roberto Crespi, MD, MS, Department of Dentistry, San Raffaele Scientific Institute, Via Olgettina 58 20132, Milano, Italy; E-mail: robcresp@libero.it The authors report no conflict of interest. Copyright * 2014 by Mutaz B. Habal, MD ISSN: 1049-2275 DOI: 10.1097/SCS.0000000000000523 Copyright © 2014 Mutaz B. Habal, MD. Unauthorized reproduction of this article is prohibited.