Simple extractions of maxillary

teeth
Armamentarium & techniques
 Simple tooth extraction or
closed technique
or
uncomplicated exodontia

Presented by:
Dr.Ahmed Ghazi
Supervisor
Dr Hashem Hassouna
Lecturer Oral Maxillofacial
Learning objectives
You should:
• understand the indications for removal of a tooth
• know how to complete the preoperative
assessment
• know the techniques available for extraction
• be aware of the potential complications
following extraction and their treatment.
Presurgical Medical Assessment

Clinical Evaluation Of Teeth For Removal

Access To Tooth
Mobility Of Tooth
Condition Of Crown

Radiographic Examination Of Tooth For Removal

Relationship Of Associated Vital Structures
Configuration Of Roots
Condition Of Surrounding Bone

Patient And Surgeon Preparation

Chair Position For Forceps Extraction

Mechanical Principles Involved In Tooth Extraction

Principles Of Forceps Use

Procedure For Closed Extraction

Role of Opposite Hand Role of Assistant During Extraction
SPECIFIC TECHNIQUES FOR REMOVAL OF
EACH TOOTH

Maxillary Incisor Teeth

Maxillary Canine
Maxillary First Premolar
Maxillary Second Premolar
Maxillary First and Second Molars
Maxillary Third Molars

Post Extraction Care Of Tooth Socket

 Set Of Instruments Necessary
For Simple Tooth Extraction

1. Local Anesthesia Syringe, Needle, And Ampule.

2. Desmotome Or Freer Elevator
3. Retractor Or Mouth Mirror
4. Extraction Forceps
(Depending On The Tooth To Be Removed).
5. Surgical Or Anatomic Forceps.
6. Elevators.
7. Sterile Gauze.
8. Periapical Curette.
9. Suction Tip.
10. Towel Clamp.
11. Needle Holder.
 Extraction Forceps

The simple intra-alveolar extraction is accomplished with the
help of extraction forceps and elevators.

Each extraction forceps is composed of two parts, which are
the handle, which is above the hinge, and the beaks, which are
below the hinge.
The forceps is held in the hand by the handle, upon which
pressure is exerted during the extraction.
The beaks are the functional component of the forceps and
grasp the tooth at the cervical region and remove it from the
alveolar socket.

Because tooth anatomy varies, extraction forceps with
specially designed beaks have been manufactured, so that they
may be used for specific teeth. So, according to the size and
shape of the handles and beaks, the following types exist.
 Maxillary Universal Forceps
Or No. 150 Forceps (Mainly Used For Upper
Premolars)
 Maxillary Right Molar Forceps,
For The First And Second Upper Molars Of
The Right Side
 Maxillary Left Molar Forceps,
For The First And Second Upper Molars Of
The Left Side
Maxillary Third Molar Forceps
Maxillary Root Tip Forceps

 Patient Position
 Dentist Position
 Extraction
 Post extraction Care of Tooth Socket
 Postoperative Instructions
The basic requirements for a successful outcome in
simple tooth extraction are as follows:
Informing and reassuring the patient, so that stress
and fear levels are minimized, and so to ensure
desirable cooperation during the procedure.
Knowing tooth anatomy well, which can be
variable.
Detailed clinical and radiographic examinations,
since these provide important information pertaining to
procedure planning and selecting the appropriate
technique.
Preparation of the patient, which includes: (1)
rinsing the oral cavity with various antiseptic solutions,
and (2) correct positioning of the dental chair.
 Position Of The Patient

Maxilla: Angle Between Dental

Chair And The
,-.°Horizontal(floor) Is

For the extraction of a maxillary tooth, the patient’s mouth must

be at the same height as the dentist’s elbow and the angle
between the dental chair and the horizontal (floor) must be
approximately ,-.°Also, the occlusal surface of the maxillary
teeth must be at a 23° angle compared to horizontal when the
mouth is open.
 Position of dentist during extraction.

In this and all other figures, positions for right-handed

dentists are illustrated.
For all maxillary teeth the dentist is to the front and right
(and to the left, for left-handed dentists) of the patient.
 Extraction of maxillary teeth

Extraction Technique Using Tooth Forceps

The correct way to hold maxillary extraction forceps

 Guidelines for extraction
1.Correct way to hold the forceps and the tooth
2. Forces applied to the tooth
3. Direction of movement during the extraction
4. Role of the nondominant hand in the extraction
procedure
After reflecting of the gingiva, the beaks of the forceps are positioned at
the cervical line of the tooth, parallel to its long axis, without grasping
bone or gingiva at the same time.

The initial extraction movements applied are very gentle. More

specifically, the dentist applies slow steady pressure to move the tooth
buccally at first, and then palatally or lingually.
Movements must become greater gradually and the buccal pressure is
greater than the corresponding palatal or lingual pressure, because the
labial or buccal bone is thinner and more elastic compared to that of the
palate.

If anatomy of the root permits (single, conical roots), rotational force may
be applied in addition to buccopalatal or buccolingual pressure. These
movements expand the alveolar bone and also sever all the periodontal
fibers.
Slight traction is also employed at the same time, facilitating the tooth
extraction.
Extraction of Maxillary Incisors &
canine
Extraction Forceps Should Be Seated With Strong Apical
Pressure To Expand Crestal Bone And To Displace Center Of
Rotation As Far Apically As Possible.
 Video_3.flv

Extraction movements:
i) initial labial (L) pressure ; ii) the tooth is brought back to its original position, with
direction of motion continuing to the palatal (P) side ; iii) the final extraction movement is
curved, with the concave part facing upwards
Extraction of maxillary premolars
Extraction Of Maxillary First
And Second Molars
Extraction Of Maxillary Third
Molars
ON THE DAY OF TREATMENT
1.Do not rinse your mouth for at least 24 hours.
2.Avoid hot fluids, alcohol, hard or chewy foods. Choose cool drinks and
soft foods.
3.Avoid vigorous exercise.
4.Smokers should avoid smoking.
5.Should the wound start to bleed, apply a small compress.
This can be made from some cotton wool in a clean handkerchief. Place this
on the bleeding point and bite firmly on it for 5-10 minutes or longer if
necessary.
If you cannot stop the bleeding yourself, please seek professional advice.
6. Any pain or soreness can be relieved by taking the prescribed medication.
If none was prescribed, take tablets such as paracetamol (Panadol) 2 tablets
every 4 hours as required. Do not take more than the recommended number
per day.
STARTING 24 HOURS LATER
• Gently rinse the wound with hot saltwater mouth rinses (or other rinse as
recommended) for a few days. This should be carried out three times a day
after each meal.
 Assumed Knowledge
,. Anatomy (including radiographic features) of •
structures surrounding the teeth.
-. Root morphology including common •
variations.
7. Relation of the roots to the maxillary sinus.

2. Impact of medical status of the patient on •

surgery
3. Anxiety and stress reduction protocol. •
Thanks a lot for not sleeping !