For maxilla tooth extraction, patient’s position relatively a bit higher (above elbow), with seating half-leaning. As for mandibular: the patient is relatively lower, with the seating is straight . The relationships between the wrists straight and position of the elbows closed enough.
Forceps hold with position of the palm facing down for mandibular extraction, and facing up for maxilla extraction.
This technique is used for maxillary tooth. The operator will hold the alveolaris process between thumb and point finger with free hand. This is to help cheek retraction, head stabilization, alveolaris process support, and sensing buccal bone
Sling grasp mandibular is for cheek/tongue retraction and mandibular support. The technique is by holding mandible between thumb and free point finger. To add strength of sling grasp, used shirpyard bite to add more support to the mandible.
Main instrument for incisor extraction is upper universal forceps (no. 150), but others can be used too. The initial movement is slow, steady, and firm in the labial direction, which expands the crestal buccal bone. A less vigorous palatal force is then used, followed by a slow, firm, rotational force. Rotational movement should be minimized for the lateral incisor, especially if a curvature exists on the tooth. The tooth is delivered in the labial incisal direction with a small amount of tractional force.
A, Maxillary incisors are extracted with no. 150 forceps. Left hand grasps alveolar process.
B, Forceps is seated as far apically as possible.
C, Luxation is begun with labial force.
D, Slight lingual force is used.
E, Tooth is delivered to labial incisor with rotational, tractional movement.
The upper universal (no. 150) forceps is the main dental forceps used. the initial placement of the beaks of the forceps on the canine tooth should be as far apically as possible. The initial movement is from buccal aspect with return pressure to the palatal. As the bone is expanded and the tooth mobilized, the forceps should be repositioned apically.
A small amount of rotational force may be useful in expanding the tooth socket, After the tooth has been well luxated, it is delivered from the socket in a labial-incisal direction with labial fractional forces.
A, Hand and forceps position for removal of maxillary canine is similar to that for incisors. Forceps is seated as far apically as possible.
B, Initial movement is buccally.
C, Small amounts of lingual force are applied.
D, Tooth is delivered in labial-incisal direction with slight rotational force
This teeth is the most common fracture tooth in adults. The upper universal (no. 150) forceps and the no. 150A forceps are used for the extraction. Extraction forces should be carefully controlled. Initial movements should be buccal. Palatal movements are made with relatively small amounts of force to prevent fracture of the palatal root tip. Buccal pressures should be greater than palatal. Rotational force should be avoided for this tooth. Delivery of the tooth from the tooth socket is with tractional force in the occlusal direction and slightly buccal.
C, Firm apical pressure is applied first to lower center of rotation as far as possible and to expand crestal bone.
D, Buccal pressure is applied initially to expand buccocortical plate. Apices of roots are pushed lingually and are therefore subject to fracture.
E, Palatal pressure is applied but less vigorously than buccal pressure.
F, Tooth is delivered in buccoocclusal direction with combination of buccal and tractional forces
The recommended forceps are maxillary universal forceps, or no. 150. For some surgeons they prefer the no. 150A. The forceps is forced as far apically as to gain maximal mechanical advantage in removing this tooth. The extraction requires relatively strong movements to the buccal, back to the palate, and then in the buccoocclusal direction with a rotational, fractional force as tooth root is relatively strong and blunt.
A, When extracting maxillary second premolar, forceps is seated as far apically.
B, Luxation is begun with buccal pressure.
C, Very slight lingual pressure is used.
D, Tooth is delivered in buccoocclusal direction
The instruments are the paired forceps no. 53R and no. 53L. These two forceps have tip projections on the buccal beaks to fit into the buccal bifurcation. Some prefer to use the no. 89 and no. 90 forceps, which are sometimes called the upper cowhorn forceps. They are useful if the crown of the molar tooth has large caries or large restorations.
The upper molar forceps is adapted to the tooth and apically seated as far as possible in the usual fashion. The basic extraction movement is to use strong buccal and palatal pressures, with stronger forces toward the buccal than toward the palate. Rotational forces are not useful for extraction of this tooth because of its three roots. It is preferable to fracture a buccal root than a palatal root (because it is easier to retrieve the buccal roots). Try to minimize palatal force, because this is the force that fractures the palatal root.
Second molar is more easily extracted by the same technique described for the first molar. for the erupted maxillary third molar usually we use 210S forceps, which is universal forceps used for both the left and right sides. The tooth is usually easily removed, because the buccal bone is thin and the roots are usually fused and conical. Third molar is frequently extracted by the use of elevators alone.
A, Extraction of maxillary molars. Soft tissue of lips and cheek is reflected, and alveolar process is grasped with opposite hand.
B, Forceps beaks are seated apically as far as possible.
C, Luxation is begun with strong buccal force.
D, Lingual pressures are used only moderately.
E, Tooth is delivered in buccoocclusal direction.
The main dental forcep is the lower universal (no. 151) forceps (main). Alternative choices include the no. 151A or the English style of Ashe forceps.
The forceps beaks are positioned on the teeth and seated apically with strong force. The extraction movements are generally in the labial and lingual directions, with equal pressures both ways. Once the tooth has become luxated and mobile, rotational movement may be used to expand the alveolar bone further. The tooth is removed from the socket with fractional forces in a labial-incisal direction.
B, Forceps is seated apically as far as possible.
C, Moderate labial pressure is used to initiate luxation process.
D, Lingual force is used to continue expansion of bone.
E, Tooth is delivered in labial-incisal direction
Premolars are among the easiest teeth to remove. The lower universal (no. 151) forceps as the main dental forcep. No. 151A forceps and the English style of forceps are both popular alternatives.
The forceps is apically forced as far as possible, with the basic movements being toward the buccal aspect, returning to the lingual aspect, and rotating. Rotational movement is used more when extracting these teeth than any others, except maxillary central incisor. The tooth is then delivered in the occlusobuccal direction
Mandibular first molar is the most difficult of all teeth toextract. Usually the operator will use no. 17 forceps. It has small tip projections on both beaks to fit into the bifurcation of the tooth roots. The forceps is adapted to the root of the tooth in the usual fashion, strong apical pressure is applied to set the beaks of the forceps apically as far as possible. Strong buccolingual motion is needed to expand the tooth socket and allow the tooth to be delivered in the buccoocclusal direction. The linguoalveolar bone around the second molar is thinner than the buccal plate, so the second molar can be more easily removed with stronger lingual than buccal pressures.
for tooth roots that are clearly bifurcated, the forceps used are the no. 23, or cowhorn. They are designed to be closed forcefully with the handles, by squeezing the beaks of the forceps into the bifurcation to create force against the crest of the alveolar ridge on the buccolingual aspects and literally forces the tooth superiorly directly out of the tooth socket. If it is not successful, the forceps is given buccolingual movements to expand the alveolar bone, and more squeezing of the handles is performed. Care must be taken to prevent damaging the maxillary teeth or the lower molar may actually pop out of the socket and thus release the forceps to strike the upper teeth.
A. No. 23 forceps is carefully positioned to engage bifurcation area of lower molar.
B. Handles of forceps are squeezed forcibly together, which causes beaks of forceps to be forced into bifurcation and exerts tractional forces on tooth.
Strong buccal forces are then used to expand socket. Strong lingual forces are used to luxate tooth further. Tooth is delivered in buccoocclusal direction with buccal and tractional forces.
A bifurcation is not likely. As for that, dentist uses the no.222 forceps—a short-beaked, right-angled forceps. most of the extraction forces should be delivered to the lingual aspect and delivered in the linguloocclusal direction.