Extraction forceps
Tooth extraction with forceps is a basic method in oral surgery. The shape of the instrument beaks always corresponds to the anatomy of a specific tooth or group of teeth.
Criteria for choosing forceps:
- Width of the beaks. For narrow crowns (incisors, canines, premolars, individual roots), instruments with a beak width of less than 0.75 cm are chosen. For wider ones (molars) — more than 0.75 cm.
- Shape of the beaks (side sign). There are universal forceps (with identical beaks) and specific ones. For example, for maxillary molars, which have two buccal roots, forceps with a spike (pointed end) on one of the beaks are used. The spike must fit between the roots from the vestibular side, so such instruments are divided into right and left.
- Bend and length (angle sign). For maxillary forceps, the longitudinal axes of the beaks and handles coincide or are parallel (straight, S-shaped, bayonet). For mandibular forceps, these axes form a right or obtuse angle (beaked).
Maxillary forceps
Instruments are selected depending on the group of teeth to be extracted:
- Incisors and canines: straight forceps with short beaks.
- Premolars: S-shaped forceps without a spike.
- Molars (first and second): S-shaped forceps with a spike on the vestibular beak.
- Roots of all teeth: universal bayonet (bayonet) forceps. Sometimes they are also used to extract roots of mandibular anterior teeth.
- Third molars: bayonet forceps with elongated and more curved beaks, or forceps curved along the plane.
Mandibular forceps
For the mandible, beaked forceps curved along the edge are used.
Depending on the integrity of the tooth crown, the following are used:
- Forceps with non-converging beaks (for teeth with an intact crown).
- Forceps with converging beaks (exclusively for extracting roots of all mandibular teeth).
Note: In case of limited mouth opening, forceps curved along the plane (designed for maxillary molars) can be used to extract mandibular molars.
Elevators
Elevators are used when extraction with forceps is impossible or ineffective. The instrument works on the lever principle and consists of a massive handle, an intermediate shank, and a working beak.
Types of elevators:
- Straight elevator. Has a trough-shaped beak with a pointed end. Used in the maxilla for extracting single roots (the beak is wedged between the root and the socket wall, rotational movements are performed). In the mandible, it is used for luxation of third molars. Important: the fulcrum must be solely the alveolar wall; resting on adjacent teeth is strictly prohibited!
- Angled elevators (side elevators). Their beaks are curved along the edge at an angle of 60–80° to the instrument axis. The main purpose is the extraction of mandibular tooth roots (predominantly molars).
Briefly: answers to topical questions
What types of dental elevators are used in oral surgery?
In oral surgery, straight, angled, and bayonet elevators are used.
- Straight elevator — the handle, connecting rod, and working part are located on a single straight line (the rod may have a bayonet-like bend or an obtuse angle bend).
- Angled elevator — the working part is curved along the edge at an angle of about 120° to the longitudinal axis. Instruments with oval, spear-shaped, and asymmetric beaks are distinguished.
- Bayonet elevator (Lecluse elevator) — the connecting rod has a bayonet-like bend, and the handle is located perpendicular to the rod and the working part.
What successive clinical stages does the tooth extraction operation with forceps consist of?
The tooth extraction operation with forceps consists of a strict sequence of clinical stages.
- Detachment of the circular ligament — separating the ligament from the tooth neck and the gingiva from the alveolar margin.
- Placement of forceps — performed in an open position.
- Advancement of forceps — the beaks are advanced under the gingiva.
- Closing of forceps — tight fixation of the instrument.
- Luxation (luxatio) — rocking the tooth using luxation or rotation.
- Traction — extracting the tooth from the socket.
- Curettage of the socket — the final stage of wound management.
For extracting which teeth is the Lecluse bayonet elevator intended?
The Lecluse bayonet elevator is intended for the extraction of mandibular third molars.
The design features of the instrument (the bayonet-like bend of the connecting rod and the perpendicular position of the handle) provide optimal access to the distal sections of the mandibular dental arch. This allows for the most efficient luxation (luxatio) of the lower wisdom tooth, including cases of limited patient mouth opening. The instrument is designed for bilateral use.
Class and exam questions
What is the main difference between maxillary and mandibular forceps?
In maxillary forceps, the handle axis and beak axis coincide or are parallel (straight, S-shaped). For the mandible, they form an angle (beaked).
What is the purpose of the spike on the forceps beak?
The spike is designed for tight fixation of the instrument by entering between the two buccal roots of maxillary molars. The beak with the spike is always positioned on the vestibular side.
Can a straight elevator be used with the adjacent tooth as a fulcrum?
Categorically no. The fulcrum when working with an elevator can exclusively be the bone wall of the alveolus.
What are bayonet forceps used for?
These are universal bayonet-shaped forceps designed primarily for extracting the roots of all maxillary teeth.
What else to study on this topic
- Stages of tooth extraction with forceps (placement, fixation, luxation, traction)
- Rules for positioning the doctor and patient during tooth extraction
- Methods of holding extraction forceps in the hand
- Functions of the surgeon's left (free) hand during surgery
- Features of tooth luxation in the upper and lower jaws
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