Simple Tooth Extraction

Technique
Amin Abusallamah

Outline
Patient and Surgeon Position
Separation of Teeth from Soft Tissues
Extraction Forceps
Surgeon Preparation
Requirements of Ideal Extraction
Mechanical Principles for Tooth
Extractions
Role of operators` hand

Patient and surgeon Position

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

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

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 forcepsMaxillary 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 patient's chest
.
2.

proper oral hygiene is

very important before
extraction.

Requirements of Ideal
Extraction
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

Mechanical Principles for

Tooth Extractions
1. 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 upper and lower teeth is an outwardocclusal direction. Except the lower third
molar which should be in a lingual- occlusal
way and maxillary 3rd molar should be distobuccal.

The proper use of forceps

in luxation and removal of teeth
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.

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 multiplerooted tooth is let in the
alveolar process, the pennantshaped 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

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.

Cont

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