Principles of Tooth Extraction

• Successful tooth extraction:

  • Knowledge of tooth morphology
  • Application of force related to tooth morphology
  • Use of forceps
  • Use of elevators and/or luxators to facilitate
  • Position of patient and operator is vital to success
• Principles of tooth extraction:

  • Expansion of bony socket
  • Disruption of periodontal membrane
  • Removal of tooth
• Extraction instruments:

  • Forceps
  • Elevators
  • Luxators

  The combined use of these instruments will enable the operator to exploit the best qualities of each and thereby develop a gentle progressive technique.
• Forceps:

  • Apply force by gripping tooth root
  • 2 blades/beaks
  • Blades are sharp
  • Cut periodontal fibres
  • Blades are wedge-shaped
  • Dilate bony socket
  • Blades are hollowed on inner surface to fit root shape - designed to fit the tooth root, not the crown
  • Various sizes and designs for different teeth
• Upper straights are used to take out the upper central incisors, lateral incisors and canines.
• Bayonets are used to take out the upper wisdom teeth.
• Elevators:

  • Single-bladed instruments
  • Used to remove whole teeth and root fragments
  • Used to assist in forceps extraction -> cut periodontal fibres -> dilate bony socket
  • Applied to cementum at a point of application where there is alveolar bone to provide a fulcrum
  • Used by rotation (screw driver), not by class 1 lever
  • Leverage gained by ratio of handle to width of blade
• Luxators:

  • Used to move bone away from tooth
  • Similar in design to Couplands elevator
  • Much lighter and sharper
  • Available in various sizes
  • Easily damaged
  • May easily cause damage!
• Maintenance - ensure instruments are in good working order:

  • Sharp edges should be sharp
  • Straight instruments should be sharp
  • Hinged instruments should move freely
  • Worn instruments should be discarded
• Patient and operator positioning:

  1. Safety and comfort of patient
  2. Safety and comfort of operator
  3. Optimal lighting

  All 3 points lead to safe application of instruments and forces for tooth removal.
• The supporting hand:

  • Non-dominant hand
  • Supports jaws
  • Retracts the cheeks and tongue
  • Protects adjacent tissues
  • Confirms correct position of forceps/elevator blades
  • Detects tooth and alveolar bone movement