1. The document provides guidelines for positioning patients and dentists for different types of tooth extractions. It describes positioning patients upright for mandibular extractions and tilting the chair back for maxillary extractions. 2. Techniques for extracting different types of teeth are outlined, including using desmotomes to sever soft tissue, various types of forceps, and elevators to leverage teeth from sockets. 3. Proper movements and application of controlled force are emphasized to safely luxate and remove teeth without root fractures. Initial movements vary by tooth type, but final extraction movements should always be outward and occlusal.

1. By
Kampa.mini alekya
Group 4
International school of medicine
Submitted To
Dr.ilshat Yuldashev

2. For the extraction of mandibular
teeth, the patient should be
positioned in a more upright
position. the occlusal plane is
parallel to the floor. The chair
should be lower than for
extraction of maxillary teeth.
For a maxillary extraction the chair
should be tipped backward and
maxillary occlusal plane is at 60
degrees to the floor. The height of
the chair should be patient's mouth
is at or below the operator's elbow
level

3.  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

4.  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 .

5.  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.

6.  The basic components of the extraction forceps
are the handle, which is above the hinge, and
the beaks, which are below the hinge

7.  The maxillary incisor teeth are extracted with
the upper straight forceps.

8.  The blades of upper premolar forceps are
mirror image of each other, and can be used to
extract both right and left maxillary premolars.

9.  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

10.  Bayonet extraction forceps for Elongated beak
is designed for extraction of maxillary third
molars and roots.

11.  Lower root forceps with fine blades are used to
extract lower incisors,premolars, and roots.

12.  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.

13.  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.

14.  For patient:
1. A sterile disposable towel
drape should be put across
the patient's chest .
2. proper oral hygiene is very
important before extraction.

15. 1. 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

16. 1. Expansion of the bony socket.
2. The use of fulcrum or lever.
3. Insertion of wedge or wedges.
4. Wheel and axel.

17.  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 .

18.  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.

19.  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.

20.  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.

21.  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
upper and lower teeth is an outward- occlusal
direction. Except the lower third molar which
should be in a lingual- occlusal way and maxillary
3rd molar should be disto-buccal.

22. 1. 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.

23. 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.

24. 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.

25. 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,

26. 10. The extraction forceps
blade should be applied to
the carious side first, and
the first movement made
toward the caries.

27.  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.

28.  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.

29.  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.

30.  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
 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
Triangular
elevator

31.  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.

33.  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