Dental extraction forceps

Historical background and the contribution of N.I. Pirogov

The development of surgical instruments, including tooth extraction forceps, is closely intertwined with the history of maxillofacial surgery. In the 18th century, the first manuals in Russian appeared, such as the works of Zacharias Platner (1761) and I.F. Schreiber (1781). However, specialists were extremely scarce: the first "Russian Medical List" of 1809 numbered only 18 dental practitioners (with Ilya Luzgin listed first), and by 1826 their number had grown to only 44 people. The official title of "dental physician" was introduced in 1810.

A massive breakthrough in the systematization of instruments was made by the prominent surgeon N.I. Pirogov. Working in the hospital surgery clinic, he performed over 130 complex operations on the face and jaws (excluding routine tooth extractions), including 36 jaw resections and dozens of plastic surgeries. For the needs of the army, Pirogov developed special battalion kits. These invariably included curved dental forceps, an elevator ("goat's foot"), and a dental key with a handle and screws. At his request, a special instrument backpack was also manufactured, containing apparatus for treating mandibular fractures in addition to the dental key. Historical specimens of the forceps from that era are carefully preserved today in the MSMSU museum collections.

Instruments of the modern surgical office

Today, forceps and elevators form the core of the tooth extraction kit. However, a modern surgical dental office is equipped much more extensively to ensure the safety and efficacy of any procedures.

In addition to forceps, the physician's arsenal includes:

• Instruments for bone tissue management: single-blade and disk saws, bone rasps and rongeurs, trephines, drills. Burs (steel, carbide, diamond) and rotary cutters are widely used for root-tip resection or bone preparation.
• Instruments for soft tissue retraction: Langenbeck, Farabeuf, and Deaver retractors, as well as spatulas and Buyalsky blades.
• Instruments for tissue grasping and suturing: surgical forceps (tweezers), hemostats, needle holders, scissors, and surgical needles.
• Specialized equipment: mouth gags and dental splinting materials.

It is important to note that the office must be equipped with an emergency tracheotomy kit (including a cannula, tracheal dilator, and a sharp single-hook retractor). Working with such a variety of instruments requires compliance with the principles of ergonomics. Optimal working conditions reduce physical strain for the doctor and nurse, maintain their working capacity, and prevent the development of occupational diseases.

Use of forceps in eruption disorders

The choice of a specific forceps model depends on the clinical presentation. A prime example is the surgical treatment of eruption disorders of wisdom teeth—retention and dystopia. These conditions often arise due to a lack of space, underdevelopment of the mandible, or excessively dense mucosa.

Difficult eruption is frequently complicated by pericoronitis. Patients present with complaints of mucosal swelling over the tooth, pain in the second molar, pain upon swallowing, and pain in the tongue. One of the key symptoms complicating the surgeon's work is limited mouth opening.

If the lower wisdom tooth is correctly positioned in the jaw, but the patient cannot open their mouth wide, standard instruments will not suffice. In this case, the doctor chooses:

1. Bayonet forceps, angled on the flat.
2. Bayonet forceps, angled on the edge.
3. A straight elevator or Lecluse elevator.

Treatment tactics (whether to extract the tooth at the first visit, the next day, or after inflammation subsides) depend on the type of inflammation, the patient's desire and condition, and the surgeon's qualification. Often, local antiseptic therapy is required before using forceps: rinsing the space beneath the mucosal "hood" with 3% hydrogen peroxide or a 0.05% chlorhexidine solution.

Class and exam questions

What else to study on this topic

• Causes and clinical presentation of wisdom tooth retention and dystopia.
• Surgical anatomy: the significance of "Pirogov's triangle" for accessing the lingual artery.
• Classification and application of rotary instruments (burs, cutters) in surgery.
• Ergonomics in dentistry: prevention of occupational diseases in physicians.
• The evolution of dental education in Russia in the 18th–19th centuries.

Other topics in the section «Chapter 1. History of the Development of Surgical Dentistry (K.A. Pashkov, A.V. Belolapotkova)»

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.