MECHANICAL
PRINCIPLES
INVOLVED IN
TOOTH
EXTRACTION. DR. HAMZE CAAGANE
Cosmetic dentistry at Leeds Dental College in EGYPT.
Orthodontics at Asker Orthodontic academy in EGYPT.
BDS at IUA in SUDAN.
PATIENT POSITIONED FOR
MAXILLARY EXTRACTION.
o The chair is tilted back so that the maxillary occlusal plane is about 60-
degree angle to the floor.
o The height to the chair should ensure that the level of the patient’s mouth
is slightly below the surgeon’s elbow.
o Extraction of teeth in the maxillary right quadrant, the surgeon turns the
patient’s head toward self.
EXTRACTION OF ANTERIOR
MAXILLARY TEETH
o The patient looks straight ahead.
o Patient with head turned slightly toward surgeon for extraction of maxillary
left posterior teeth.
FOR MANDIBULAR
EXTRACTION
o The patient is more upright so that the mandibular occlusal plane of the
opened mouth is parallel to floor.
o The height of the chair is also lower to allow the operator’s arm to be
straighter.
o Patient with head turned toward surgeon for removal of mandibular right
teeth.
FOR EXTRACTION OF
MANDIBULAR ANTERIOR
TEETH.
o The surgeon stands at the side of the patient, who looks straight ahead.
o When English-style forceps are used for extraction of anterior mandibular
teeth, the patient’s head is positioned straight ahead.
FOR EXTRACTION OF
MANDIBULAR POSTERIOR
TEETH.
o The patient turns slightly toward the surgeon.
o Behind the patient approach for extraction of posterior right mandibular
teeth.
o This allows the surgeon to be in comfortable, stable position.
o The surgeon’s hand is positioned under the forceps.
o In the surgeon-seated position, the patient is positioned as low as possible
so that the mouth is level with the surgeon’ elbow.
o For extraction of maxillary teeth, the patient is reclined back approximately
60-degrees.
o Hand and forceps positions are the same as for standing position.
o For extraction of mandibular teeth, the operator holds the forceps in the
underhanded position.
o For removal of mandibular posterior teeth, the surgeon’s hand can hold the
forceps from above.
o For removal anterior teeth, the surgeon moves to a position behind the
patient so that the patient’s mandible and alveolar process can be
supported by the surgeon’ other hand.
o The behind the patient position can be used for removal of mandibular
posterior teeth.
o The surgeon’s hand is positioned under the forceps for maximum control.
PRINCIPLES OF ELEVATORS
AND FORCEPS USE
o The first-class level transforms small force and large movement to small
movement and large force.
o In removal of mandibular premolar teeth, the purchase point has been
placed in the tooth, which creates a first-class lever situation.
o When the crane pick is inserted into the purchase point and the handle is
depressed apically, the tooth is elevated occlusally out of the socket with
bucco-alveolar bone used as the fulcrum.
CONT…
A wedge can be used to expand, split and displace portions of the
substance that receives it.
The beaks of the forceps act as wedges to expand alveolar bone and
displace the tooth in the occlusal direction.
Small, straight elevator, used as wedge to displace tooth root from it’s
socket.
CONT…
Triangular elevator in the role of the wheel-and-axle machine used to
retrieve the root from the socket.
Extraction forceps should be seated with strong apical pressure to expand
crestal bone and to displace the center of rotation as far apically as
possible.
PRINCIPLES OF USE OF
ELEVATORS
Wedge principle
o Some elevators are designed primarily to be used as a wedge e.g.: Apexo
and coupland.
o This elevators are forced between the root of the tooth and the investing
bony tissue parallel to the long axis of the tooth.
CONT…
Wedge expands, splits, and displaces portion of substance that receive it.
WHEEL AND AXLE
Triangular elevator.
