Indications for extraction
The procedure is indicated when it is impossible to preserve the tooth or when it becomes a source of systemic infection. General and local indications are distinguished.
General indications are associated with chronic intoxication of the body from an odontogenic focus, which can cause sepsis, myocarditis, endocarditis, or rheumatism.
Local indications are divided into emergency and elective:
- Urgent: purulent periodontitis, acute odontogenic infections (osteomyelitis, phlegmon, sinusitis), as well as a longitudinal fracture or a crown fracture with pulp exposure.
- Elective: unsuccessful endodontic treatment, severe destruction of the crown, grade III mobility, retention and semi-retention with inflammation, supernumerary and malposed teeth, orthodontic indications.
Contraindications and preparation
Contraindications are divided into general and local; most of them are relative and temporary.
- General: acute stages of cardiovascular, mental, and infectious diseases, liver and kidney diseases, blood coagulation disorders.
- Local: acute radiation sickness, stomatitis, specific infections of the oral mucosa (tuberculosis, syphilis, HIV), allergic reactions.
If comorbid pathology is present, the intervention is postponed until the patient's condition stabilizes. Extraction may be performed in a hospital setting after consultation with a specialist.
Preparation for surgery:
- Examination: clinical examination and radiography (assessment of root condition, bone tissue, and anatomical features).
- Psychological and pharmacological preparation: sedation, antibiotic prophylaxis.
- Preparation of the operative field: antiseptic treatment of the oral cavity with chlorhexidine or potassium permanganate, removal of dental deposits.
- Anesthesia: the choice of anesthesia depends on the tooth and the duration of the procedure; extraction must be completely painless.
Instruments: extraction forceps
The main instrument for tooth extraction is forceps. They consist of beaks (working part), handles (shanks), and a lock. The shape of the forceps depends on the tooth they are intended for.
Characteristics of forceps:
- For the upper jaw: the axis of the beaks and handles coincides, is parallel, or forms an obtuse angle (S-shaped, straight, bayonet-shaped).
- For the lower jaw: beak-shaped — the beaks and handles are located at a right angle (or close to it).
- By beak width: narrow (for incisors, canines, premolars, and roots) and wide (for molars).
- By convergence: crown forceps (do not converge) and root forceps (converge).
- Side feature (spike): forceps for upper molars have a spike on one beak (left/right), while forceps for lower molars have spikes on both beaks.
Briefly: answers to topical questions
What are the stages of tooth extraction with forceps?
The process of tooth extraction with forceps consists of a strict sequence of actions. The following stages are distinguished:
- 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 — under the gingiva to the tooth neck or alveolar margin.
- Closure of forceps — tight gripping of the tooth to transmit force.
- Luxation of the tooth — destruction of periodontal ligaments using luxation or rotation methods.
- Extraction (traction) of the tooth — removal of the tooth from the socket.
- Curettage of the socket — revision and cleaning of the alveolus.
For which specific maxillary teeth are straight forceps used, and for which are S-shaped forceps used?
The choice of forceps shape for the upper jaw depends on the group of the tooth being extracted.
- Straight forceps — used for extracting central and lateral incisors, as well as canines.
- S-shaped forceps — used for extracting premolars and molars.
S-shaped forceps without a spike are used for premolars, while those with a spike on the buccal beak are used for molars.
How to determine the side (right or left) of forceps for upper molars by the position of the spike?
In forceps for upper molars, the spike is located on only one beak. When properly positioned, it should face the buccal side and enter the bifurcation between the two buccal roots. Forceps for the right and left sides differ according to this arrangement.
What types of dental elevators exist for tooth extraction?
The main types of elevators include:
- Straight elevator — used for extracting single roots of maxillary teeth and separated roots of maxillary molars.
- Angle elevator — has a working part curved along the edge; used for extracting roots of mandibular teeth. Available with an oval, spear-shaped, or asymmetric beak.
- Bayonet elevator (Lecluse elevator) — has a bayonet-shaped shaft bend and is used for extracting the mandibular third molar.
- Pott's elevator — has an elongated connecting shaft.
- Elevators for root fragment removal — equipped with thin spear-shaped beaks.
What types of movements are used when luxating a tooth from the alveolus?
When luxating a tooth from the alveolus, two main types of movements are used:
- Rocking (luxation) — pendulum-like movements in which the tooth is alternately shifted outward (bucally) and inward (orally). The first movement is always directed toward the side of least resistance.
- Rotation — turning the tooth around its longitudinal axis by 20–25° first in one direction and then in the other.
Movements should be smooth, gradual, and performed without jerking.
Class and exam questions
In which cases is tooth extraction performed for emergency indications?
Emergency extraction is indicated for progressive purulent periodontitis, acute odontogenic infections (osteomyelitis, phlegmon), and severe dental trauma that cannot be restored.
What is the difference between root forceps and crown forceps?
When closing the forceps, the beaks of root forceps converge, whereas those of crown forceps do not converge, leaving space to grip the crown.
Why are there projections (spikes) on the beaks of the forceps?
Spikes are designed for fixation in the root bifurcation of molars. Forceps for upper molars have a spike on one side, while forceps for lower molars have them on both beaks.
What else to study on this topic
- Elevator technique
- Root sectioning using a dental bur
- Management tactics for patients with hemorrhagic diathesis
- Methods and agents for local anesthesia
- Anatomic features of tooth roots and their impact on extraction
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Other topics in "Chapter 14. Tooth Extraction"
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