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 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
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 outward- occlusal direction.
Except the lower third molar which should be in a
lingual- occlusal way and maxillary 3rd molar should be
disto-buccal.
 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 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.
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