OutlinePatient and Surgeon PositionSeparation of Teeth from Soft TissuesExtraction ForcepsSurgeon PreparationRequirements of Ideal ExtractionMechanical Principles for Tooth ExtractionsRole of operators` hand
Patient and surgeon Position For a maxillary extraction the chair For the extraction of mandibular should be tipped backward and teeth, the patient should be maxillary occlusal plane is at 60 positioned in a more upright position.degrees to the floor. The height of the the occlusal plane is parallel to thechair should be patients mouth is at floor. The chair should be lower than or below the operators elbow level for extraction of maxillary teeth.
Cont …• For all maxillary teeth and anterior mandibular teeth, the dentist is to the front and right (and to the left, for left- handed dentists) of the patient.• For the posterior mandibular teeth the dentist is positioned in front of or behind and to the right (or to the left, for left- handed dentists) of the patient
Separation of Teeth from Soft Tissues• The first step in removing a tooth using the simple technique is to sever or loosen the soft tissue attachment surrounding the tooth.• Two instruments are required to sever the soft tissue attachment:• (a) the straight,(b) curved desmotomes
Cont…• The straight desmotome is used for the 6 maxillary anterior teeth,• while the curved desmotome is used for the rest of the maxillary teeth and all the mandibular teeth.• straight elevator can be use too.
Components of Forceps• The basic components of the extraction forceps are the handle, which is above the hinge, and the beaks, which are below the hinge
Extraction Forceps• The maxillary incisor teeth are extracted with the upper straight forceps.
Extraction Forceps• The blades of upper premolar forceps are mirror image of each other, and can be used to extract both right and left maxillary premolars.
Extraction Forceps• The buccal beak of each forceps has a pointed design, which fits into the buccal bifurcation of the two buccal roots. Maxillary left molar forceps Maxillary right molar forceps
Extraction Forceps• Bayonet extraction forceps for Elongated beak is designed for extraction of maxillary third molars and roots.
Extraction Forceps• Lower root forceps with fine blades are used to extract lower incisors,premolars, and roots.
Extraction Forceps• Lower permanent molar forceps used for extraction of mandibular permanent teeth.• Point of the beak fits in the furcation of the molars.• Can be used on mandibular right or left side.
Surgeon Preparation• Surgeons must prevent inadvertent injury or transmission of infection to their patients or to themselves.• To prevent this transmission, surgical gloves, surgical mask, and eyewear with side shields are required.
Cont..• For patient:1. A sterile disposable towel drape should be put across the patients chest .2. proper oral hygiene is very important before extraction.
Requirements of Ideal Extraction1. Satisfactory access and visualization of the field of surgery.2. An un-obstructed pathway for the removal of the tooth.3. The use of controlled force to luxate and remove the tooth
Mechanical Principles for Tooth Extractions1. Expansion of the bony socket.2. The use of fulcrum or lever.3. Insertion of wedge or wedges.4. Wheel and axel.
Expansion of the bony socket• Expansion of the bony socket by use of the wedge-shaped beaks of the forceps .• The forceps should be seated with strong apical pressure to expand crestal bones and to displace center of rotation as apically as possible .
Cont…• If center of rotation is not far enough apicaliy, it is too far occlusally, which results in excess movement of tooth apex.• Excess motion of root apex caused by high center of rotation results in fracture of root apex.
Cont…• Buccal or labial pressure applied to tooth will expand the buccal cortical plate toward the crestal bone with some lingual expansion at apical end of the root.• Lingual or palatal pressure will expand lingual cortical plate at crestal area and slightly expand buccal bone at apical area.
Cont…• The initial linguo-buccal movement for extraction of lower second mandibular molar.• Initial rotational forces It is useful for removal of teeth with conical roots; such as maxillary central.
Cont…• Tractional forces are useful for final removal of tooth from socket. They should always be small forces, because teeth are not "pulled."The Final withdrawal movement for Most of the upperand lower teeth is an outward- occlusal direction.Except the lower third molar which should be in alingual- occlusal way and maxillary 3rd molar should bedisto-buccal.
The proper use of forceps in luxation and removal of teeth1. The extraction movements are essentially three movements which are outward, inward, and rotatory movements.2. The movement should be steady and with a reasonable force.
Cont…3. Outward (buccal or labial) movement is the initial movement of all teeth except the lower second and third molar where the buccal plate of bone reinforced by the external oblique ridge.4. Inward (lingual or palatal) movement is the initial movement during the extraction of the lower second and third molars.
Cont…5. Primary Rotatory movement is the initial movement used in upper central incisor and lower second premolar.6. If a resistance is felt in primary rotation, a bucco- lingual movement should be started.7. If rotatory movement continued, a spiral fractured of the tooth root may occur.
Cont…7. The force should be held for several seconds to allow the bone time to expand.8. Once the alveolar bone has expanded sufficiently and the tooth has been luxated, a slight traction force, usually directed buccally, can be used.9. Final movement is the movement by which the tooth is removed from its bony socket. It should be always directed outward and occlusally to avoid traumatizing the opposing tooth,
Cont…10. The extraction forceps blade should be applied to the carious side first, and the first movement made toward the caries.
The use of fulcrum or lever• A lever is a mechanism for transmitting a modest force with the mechanical advantages of a long lever arm and a short resistance arm into a small movement against great resistance.
Cont…• When an elevator is used for tooth extraction, an acquired contact point can be made on the root surface and a liter can be applied by the handle of the elevator to elevate the tooth or a tooth root from the socket.
Insertion of wedge• The wedge principle is useful for the extraction of teeth in several different ways.1. By using the beaks of the extraction forceps as a wedge.2. When a straight elevator is used to luxate a tooth from its socket.
Wheel and axel• When one root of a multiple-rooted tooth is let in the alveolar process, the pennant-shaped elevator is positioned in the socket and turned Triangular elevator• The handle then serves as the axle and the tip of the triangular elevator acts as a wheel and engages and elevates the tooth root from the socket
Role of operators` hand• The opposite hand plays an important role in supporting and stabilizing the lower jaw when mandibular teeth are being extracted.• The opposite hand supports the alveolar process and provides tactile information to the operator concerning the expansion of the alveolar process during the luxation period.
References• Peterson, L. J. Contemporary Oral and Maxillofacial Surgery, 4th ed. Amsterdam Elsevier Science. 2002. ch.7• Sweedan, O. A. Textbook of Oral and Maxillofacial v, 1st ed., 2009.• Fragiskos D. Fragiskos Oral Surger. 2007• Carmen Scheller BASIC GUIDE TO DENTAL INSTRUMENTS