Dental Extraction
Prepared By:
L/O/G/O
Nelly Hammouda
Ass. Pof. – OMFS Department
Assumed Knowledge
It is assumed that at this stage you will have
knowledge competencies in the following areas:
1 Anatomy 50%
2 Morphology 30%
3 Diagnosis 20%
Intended Learning Outcomes
To position yourself &
Select Suitable forceps suitable for the patient for extraction
extracting a particular tooth & hold them & use your supporting
in an efficient and safe position in the hand effectively for a
hand given extraction
2
To assess the case 3
difficulty in basis of the
clinical & radiographic 1
findings. 4
List and justify Describe the directions of
postoperative instructions to displacement of teeth
be given after tooth during extraction
extraction
Contents
Dental Extraction
Patient Position
Preoperative assessment Dentist Position
History
Chair Position
Clinical Examination
Illumination
Preoperative Radiographs
Rest, Guard & Support
Choice of Anesthesia
Assessment for Case Difficulty Principles of Forceps Use
Extraction Movement
Instruction
Preoperative
Assessment
L/O/G/O
History
The Patient may give a history of
1 2 3
Previous Wound Medical
factors
difficult healing interfering
extraction. problem with their
fitness to
extraction.
Clinical Evaluation
You should evaluate the patient for:
1) Age.
2) Accessibility.
3) Tooth Orientation.
4) Tooth Integrity.
5) Bone Bulk.
Preoperative Radiographs
Values of Dental Radiographs:
The dental radiographs reveals the
following:
1) Caries extending to the root.
2) Abnormal number, shape or pattern of roots.
3) Indicate fracture, resorption or hypercementosis of
the roots.
4) Indicate ankylosis of the roots and bony sclerosis
of the alveolar bone.
Preoperative Radiographs
Values of Dental Radiographs:
The dental radiographs reveals the
following:
1) Indicate geminations.
2) Indicate Impacted Teeth.
3) Indicate approximation to the maxillary sinuses &
inferior alveolar canal.
4) Indicate Intra-bony Pathology.
Preoperative Radiographs
Requirements of Pre-extraction Radiographs:
1) It should show the whole root structure.
2) It should show the bone investing the whole tooth.
3) It should show the relation to any important
anatomical structure.
Preoperative Radiographs
Types of Commonly Used Radiographs
Intra-Oral Radiographs:
1) Periapical Film.
2) Bite Wing Film.
3) Occlusal Film.
Extra-Oral Radiographs:
4) Panoramic View.
5) PA- Film.
6) Occipito-mental View.
7) CT-scan.
Preoperative Radiographs
Indications:
1) where necessary to confirm the diagnosis or
to ensure an adequate treatment plan.
2) where it is likely, on the basis of the clinical
features, that the extraction will be difficult.
3) where the patient has a history of difficult
extractions.
4) where a mucoperiosteal flap will be raised to
gain access.
5) Presence of apical infection.
Preoperative Radiographs
Indications:
1) Root-filled teeth.
2) Heavily restored teeth.
3) Any tooth related to maxillary antrum.
4) All third molars.
5) All partly erupted or impacted teeth.
6) Teeth with abnormal crown form.
Preoperative Radiographs
Indications:
1) If sedation or a GA is to be used and where it is
not possible to take radiographs in the middle of
the procedure.
2) If difficulty is experienced during extraction.
3) Longstanding isolated teeth.
Maxillary Teeth . . . Anatomical Considerations
Maxillary Nasal Cavity
Sinus
The Mandible . . . Anatomical Considerations
Inferior alveolar canal
Vital Mental Foramen
Structures
The Mandible . . . Anatomical Considerations
The Mandible . . . Anatomical Considerations
The inferior alveolar canal
Loss of cortical outline
Grooving
The Mandible . . . Anatomical Considerations
The inferior alveolar canal
Narrowing Deviation
Choice of Anesthesia
Teeth may be
extracted under
G.A. L.A. Sedation
Assessment of Difficulty
Easy Patient
Easy Case
60%
5%
Difficult Patient
10%
25% Difficult Case
Difficult Patient
Easy Patient Easy Case
Difficult Case
Dental
Extraction
L/O/G/O
Contents
Definition
Position (patient, Chair & Dentist)
Dental Extraction Forceps
Extraction Procedures
Postoperative Instruction
Intended Learning Outcomes
To position yourself &
Select Suitable forceps suitable for the patient for extraction
extracting a particular tooth & hold them & use your supporting
in an efficient and safe position in the hand effectively for a
hand given extraction
2
To assess the case 3
difficulty in basis of the
clinical & radiographic 1
findings. 4
List and justify Describe the directions of
postoperative instructions to displacement of teeth
be given after tooth during extraction
extraction
Definition
Tooth Extraction
A surgical operation of painless removal
of whole tooth or root from their bony
alveolar sockets in the oral cavity with
minimum discomfort &trauma to the bone
&surrounding soft structures in order to
allow wound healing without post operative
complication.
Position of the Patient
The patient should be seated comfortably in the
dental chair to gain his cooperation.
The back rest is fixed according to the
patient’s height in the level of the
scapula.
The head rest is adjusted with the
patient head resting under the occipital
protuberance
The patient’s head, neck &
trunk should be in the same
vertical plain
Follo This Arranged Manner
w
Position of the Dental Chair
For lower Teeth Extraction
For Upper Teeth Extraction
Position of Dental Chair
1
For All Upper Teeth Extraction:
Chair height:
It should be adjusted so that the
angle of the patient mouth at the
level of the operator shoulder or 2
– 3 inches below that level.
Chair back:
It should be adjusted so that it
makes an angle of 120º - 135º to
the floor.
Position of Dental Chair
2
For Lower Left Teeth Extraction:
Chair height:
It should be adjusted so that the
angle of the patient mouth at the
level of the operator elbow or 2 –
3 inches below that level.
Chair back:
It should be adjusted so that it
makes an angle of 90º to the floor.
Position of Dental Chair
3
For Lower Right Teeth Extraction:
Chair height:
It should be adjusted so that the
angle of the patient mouth at the
level of the operator elbow or 2 –
3 inches below that level.
Chair back:
It should be adjusted so that it
makes an angle of 110º to the
floor.
Extraction of Maxillary Teeth . . . Chair Position
About 60o to the floor 120o
60o
Extraction of Maxillary Teeth . . . Patient Position
45o
Chin should be slightly
raised up.
Extraction of Maxillary Teeth . . . Patient Position
45o
Chin should be slightly
raised up.
Extraction of Mandibular Teeth . . . Operator Position
Stance “Proper Doctor Position”
The dentist should stand as nearly erect as possible.
The dentist should distribute his weight on both feet.
For Extraction of All Upper Teeth & Lower Left Sided teeth
The operator should stands in front & to the right side of the dental chair
For extraction of Lower Right Sided Teeth:
The operator should stands to the back & to the right side of the dental chair
For Right handed Operator
Position of the Dentist
For Lower Teeth Extraction
For Upper Teeth Extraction
Dentist Seated Position
Patient is positioned as low as possible so that mouth is
level with surgeon's elbow
Summery
1
For maxillary extractions:
stand on the right, up close, upright, legs well spaced
chair tipped back by 45°–60°
tooth should be at height of shoulder.
2
For mandibular extractions:
left: position as uppers but chair lower
right: stand behind, to the side, with chair lower & back
by 40°–45°
Illumination
Overhead Light
Head Light
Sterile Field
Dentist Attire:Gloves, mask, cap & protective eye
glasses. Patient with sterile drape: Chest towel &
head cap.
Good
Best
Wrong
Extracti
on
Forceps
Definition:
Double bladed double handled hinged
instrument used for luxation & removal of
the teeth or remaining roots from their
sockets along their path of withdrawal.
Parts:
Types:
1) According to the surgical school:
British School Extraction Forceps.
American School Forceps.
2) According to the chronology of the tooth to be
extracted:
Pediatric Extraction Forceps.
Adult Extraction Forceps.
3) According to the use:
Anatomical Forceps.
Remaining Root Forceps.
4) According to design: Upper & Lower.
5) According to the tooth to be extracted: (Anterior, PM &
M).
Maxillary Extraction Forceps
Anterior Premolar
LOGO
Molar (Rt & Lt) Bayonet
Upper Premolar Forceps
Upper Anterior Forceps
Upper Premolar Forceps
Upper Molar Forceps
Lower Anterior Forceps Lower Premolar Forceps Lower Molar Forceps
Universal Forceps
Baynot Forceps
Remaining Root Forceps
Pediatric Extraction Forceps
Mechanical Principles Of Extraction :
[Link] of the bony
socket
This is achieved by using the tooth itself as a dilating instrument.
So, sufficient tooth mass must be firmly grasped by the forceps.
2. Wedging
Insertion of a wedge between the root & the bony
socket wall, causes the tooth to rise in its socket.
3. First Class
Lever
The use of lever and fulcrum is used to force a tooth
or root out of the socket along the path of least
resistance.
Forceps Extraction
Procedures
Incision:
Many dentists depends on
the forceps blades to strip
the gingival attachment
from the tooth neck.
However, to avoid
laceration & stripping of the
gum, incision should be
carried by No. 11 scalpel
running around the gingival
crevice.
Gripping the Forceps
Description of the contents
On gripping upper The little finger is When the tooth
The forceps is
premolars & molars placed between is properly
held in the palm
forceps: the the handles & gripped the little
of the hand with
concave side of the used to open the finger should be
the thumb
handle should be forceps during placed outside
supporting it at
held in the palm of application to the the handles.
the joint.
the hand. tooth.
Gripping the Forceps
Mandibular Extraction Forceps
Maxillary extraction forceps
Common Errors in Gripping the Forceps:
1 2 3
Placing the Gripping Gripping the
the forceps too
index
far from the
finger just forceps
joint
below the too near
joint
The Role of Left Hand
Rest, Guard & Support
The Use of Left Hand
The Use of Left Hand
Dangerous
Double Hand Forceps Grasping
No Rest nor Guard at all
Role of the Opposite Hand . . . Mandibular Right
Side
Glenoid Fossa
Articular Eminence
Closed Position Open Position
Role of the Opposite Hand . . . Mandibular Right
Side
Unilateral:
Inability to close the mouth
Deviation of the jaw
Bilateral:
Inability to close the mouth
Dislocated Anterior open bite
Condyle
Gripping the Tooth
Root Gripping
Forceps beaks should
grip the root & never the
crown of the tooth.
The tooth should be
gripped below CEJ. Failure to seat forceps apically results in a
more coronal center of rotation during the
movements of the extraction. This
increases the degree of movement of the
root apex and predisposes to its fracture
Deep Root Grip
Extraction forceps should be seated with
strong apical pressure to expand crestal
bone and to displace center of rotation (*)
as far apically as possible
Rule Of Parallelism
The forceps blades should be
applied in a direction parallel
to the long axis of the tooth to
be extracted.
Extraction of Deciduous Teeth
Extraction of deciduous molar with forceps.
Forceps are positioned mesially or distally
Deciduous mandibular molar with on the crown and
subjacent permanent tooth not the center of the tooth
Rule of Two-Point Contact
Ideally; the inner surface of the blade
should fit the root surface.
However, this is practically not possible
due to great variation in the root size,
shape & location.
Rule of 2-Point
Contact Practically:
Their should be 2-point contact
between the blades & the root surface.
If there is only linear contact between
the blades and the root, as with using
forceps with large blades, the tooth will
fracture due to stress concentration
Rule of 2-Point Contact
Extraction Movements
Extraction of Maxillary Central Incisor
Extraction of Maxillary Anterior Tooth
Extraction of Maxillary Premolar
Extraction of Maxillary Molar
Extraction Movements for Lower Molars
1. Lower molar forceps are positioned with beaks engaging the bifurcation
buccally and lingually.
2. Buccal and lingual (b & c) excursions are made, with increasing force as the
tooth begins to become mobile.
3. A figure of eight movement independently dilates the mesial and distal
sockets.
4. Tooth is delivered in a bucco-occlusal direction.
Lower Anterior Teeth Extraction Movement
Summery of Extraction Movements
Upper Premolars:
Conical Rooted BL-movement
Teeth: rotate around & 2ry rotation
long axis of tooth downward through
1 2 socket.
5 Upper Molars:
move buccally
Lower incisors: only
BL then 2ry 3
rotation, buccally
Lower molars:
As a Rule:
LB, round-and-round, 4 Feel what the tooth ‘wants’ to do
& 2ry rotation
Postoperative Care & Instructions
Post operative care ( Care after extraction of tooth
)
Examine the extracted tooth to be sure that there is no
fracture in the root .
Examine the socket for any loose fragments of bone or roots
or foreign materials e.g. calculus ,amalgam or pathology.
Smoothen any sharp bone or inter- radicular bone .
The expanded bucco-lingual plate should be compressed or
squeezed back to their original configuration or shape in
order to reduce any distortion of the supporting tissues to
reestablish the normal contour before extraction .
Make sure that the socket is fill of blood to form blood clot .
Place a properly shaped and size 2 x 2 inch gauze piece
over the socket .
Postoperative instructions to patients
Keep biting on the gauze for 1 hour.
Avoid excessive exercise & alcohol for the remainder of
the day (they can cause bleeding to restart).
Eat and drink normally, but try not to get food jammed into
the socket, and be careful not to bite or burn yourself
while you are numb.
Some discomfort is likely. You may take any pain killers
that you can buy over the counter in the chemist
according to the directions on the packet. It is often better
to take pain killers early, before the pain has become
severe.
Postoperative instructions to patients
Hot salt-water mouthwashes (a teaspoon of salt in a
mug full of hot water – but not hot enough to burn)
every few hours may ease some of the discomfort
and help to keep the mouth clean.
A trace of blood in the mouth is likely for at least a
few hours, but if there is significant bleeding, sit up,
roll up a clean cotton handkerchief (or gauze), place
it over the socket and bite down to put pressure on
the wound, for an additional 1 hour.
Thank You!
L/O/G/O
