In oral and maxillofacial surgery, odontotomy, the deliberate sectioning of a tooth, is a critical technique used to facilitate difficult extractions, especially for impacted molars, ankylosed teeth, and retained roots. When performed correctly, odontotomy can preserve surrounding bone, reduce surgical trauma, and shorten operative time. This article explores the key clinical principles, indications, and instrumentation required for safe and efficient odontotomy, blending current best practices with the tools modern surgeons rely on.
What Is Odontotomy?
Odontotomy refers to the surgical division of a tooth into sections to aid in its removal. This procedure is often necessary when:
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The tooth’s roots diverge or curve around anatomical structures
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The crown is trapped beneath cortical bone or adjacent teeth
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There is risk of excessive bone loss if the tooth is removed intact
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The patient presents with impacted third molars, especially in the lower arch
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There is a need to preserve alveolar bone for future prosthetic or implant rehabilitation
Unlike routine extractions, odontotomy demands surgical precision, anatomical awareness, and the right choice of burs and instrumentation.
Clinical Indications for Odontotomy
Dentists and oral surgeons may perform odontotomy in cases such as:
1. Horizontally Impacted Third Molars
Lower third molars impacted against the second molar often require sectioning to avoid damaging adjacent teeth.
2. Divergent or Curved Roots
Sectioning the crown allows each root to be extracted along its path of least resistance, minimizing root fracture.
3. Ankylosed or Retained Roots
Teeth fused to the bone or retained roots may be segmented to reduce the amount of surrounding bone removal.
4. Endodontic Surgical Failures
When apical surgery or non-surgical retreatment fails, sectional removal may be required during extraction or apicoectomy.
Surgical Technique Overview
A step-by-step protocol for odontotomy may include:
Step 1: Pre-Operative Assessment
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Radiographic imaging (e.g., CBCT or panoramic X-ray) is essential for evaluating root anatomy and proximity to the inferior alveolar nerve or sinus floor.
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Medical history and bleeding risk must be reviewed.
Step 2: Flap Design and Bone Removal
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A triangular flap or envelope flap provides surgical access.
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Minimal buccal bone removal is recommended to expose the crown while preserving support structures.
Step 3: Tooth Sectioning (Odontotomy)
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Sectioning is performed along the developmental grooves or between roots using long-shank carbide burs.
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Irrigation is critical to prevent overheating and thermal necrosis.
Step 4: Delivery of Segments
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Elevators are used to gently luxate each segment.
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Root tips are removed with root forceps or periotomes.
Step 5: Wound Closure and Post-op Instructions
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Smooth any sharp bone edges.
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Irrigate thoroughly and suture the flap.
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Post-op care includes antibiotics, analgesics, and instructions to minimize infection and dry socket risk.
Choosing the Right Bur for Odontotomy
Bur selection is critical. Key features include:
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Length: To reach posterior or deeply impacted teeth, use long-shank burs (~25–28mm).
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Blade Design: Cross-cut carbide flutes are ideal for rapid sectioning of enamel and dentin.
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Durability: The bur must resist bending or breaking under lateral pressure.
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Speed Compatibility: Should match surgical FG handpieces operating at high speeds with copious irrigation.
Recommended Bur: Zekrya Series Carbide Surgical Bur FG
For odontotomy procedures requiring precision and power, the Mr. Bur Zekrya Series Carbide Surgical Bur FG is a top choice among oral surgeons. These burs feature:
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Extended working lengths (up to 28mm) for access in deep posterior regions
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Cross-cut carbide blades for clean, efficient sectioning of enamel and dentin
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High resistance to fracture, even under surgical torque
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Compatibility with surgical FG handpieces, ensuring high-speed performance and safety
Their slim profile and aggressive cutting flutes make them ideal for sectioning third molars, retained roots, and ankylosed teeth with minimal bone trauma.
Clinical Tips for Success
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Always irrigate with sterile saline during sectioning to reduce heat generation.
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Use surgical suction to maintain visibility and prevent debris buildup.
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Have backup burs on hand, especially during long or difficult cases.
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Avoid excessive pressure, let the bur do the cutting.
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Confirm root separation radiographically if visibility is compromised.
Conclusion
Odontotomy is a cornerstone technique in surgical dentistry, empowering clinicians to remove difficult teeth while preserving critical anatomy. Success relies not just on skill, but on informed case selection, anatomical planning, and choosing high-performance tools like the Zekrya Series Carbide Surgical Bur FG by Mr. Bur. With the right protocol and instrumentation, surgeons can achieve faster procedures, better healing, and more predictable outcomes.
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