Extraction forceps for upper and lower jaw teeth
The design of extraction forceps is strictly adapted to the anatomical features of various tooth groups.
For mandibular teeth, instruments bent on the flat surface are typically used, as well as forceps with a pronounced bend in the handles (shanks). A key feature of forceps for extracting lower molars is the presence of fixing projections (spikes) on both beaks simultaneously, from both the vestibular and lingual sides. These spikes are inserted into the bifurcation area of the mesial and distal roots, ensuring a secure grip. The handles of such instruments usually have no bends and lie in the same plane. The instrument is universal and suitable for both the left and right sides.
For the extraction of maxillary molars, forceps are used in which the spike is located exclusively on one (vestibular or buccal) beak. Massive and curved non-approximating beaks are designed to grasp the wide crown, while the spike is fixed in the groove between the two buccal roots. Due to this asymmetric structure, these instruments have strict specificity: they are suitable only for the right or only for the left side.
A separate group consists of bayonet forceps, in which the longitudinal axis of the beaks is offset but parallel to the axis of the handles, as well as bone rongeurs, which feature an elongated lock joint, extended handles, and a double joint.
Instruments for primary (deciduous) dentition
To extract deciduous teeth, either specialized pediatric forceps or instruments intended for the removal of permanent tooth roots are used.
Special forceps are divided into:
- Universal — allow the extraction of any teeth within a single jaw. For example, universal maxillary forceps have smooth, rounded non-approximating beaks without spikes.
- Profiled — used strictly for a specific group of teeth.
The main difference between pediatric profiled forceps and their adult counterparts lies in their dimensions: the working part of the instrument for deciduous teeth is significantly smaller and narrower, which fully corresponds to the compact anatomical parameters of primary crowns.
Elevators: classification and design features
Elevators are used for the extraction of roots (single-rooted or separated multi-rooted teeth), as well as for the removal of impacted and dystopic teeth. The instrument consists of a handle, a connecting shank, and a working part (beak).
Straight elevators In this type, the handle, shank, and beak are located on a single straight line. The working surface facing the root has longitudinal grooves and a trough-like depression, while the back side remains smooth. The shape of the beak can be oval, rectangular, spear-shaped, or asymmetric. Straight elevators are used for roots and atypical maxillary teeth, and occasionally for mandibular third molars.
Angled elevators Their main feature is the deflection of the beak from the long axis of the instrument (by an average of 60°). Due to the lack of bilateral symmetry, they are produced in pairs: with the beak turned to the left ("towards oneself") and to the right ("away from oneself"). The main area of application is the roots and decayed teeth of the lower jaw.
Special elevators for mandibular third molars These include instruments with a perpendicular or angular arrangement of the handle relative to the shank:
- Lecluse elevator: the shank is perpendicular to the handle and has a bayonet bend, the working part is flame-shaped and pointed.
- Winter elevator: T-shaped, the connecting shank is straight and strictly perpendicular to the handle, the beak is triangular.
- Barry elevator: similar to the Winter elevator, but the connecting shank is angled relative to the handle.
For working with separated root fragments, elevators with thin arrow-shaped beaks are also used, the handle of which is fixed in the hand like a fountain pen (for small-amplitude movements).
Auxiliary surgical instruments
In addition to extraction instruments, devices for working with soft tissues and bone are widely used in dental surgery.
Tissue separation:
- Scalpels: most often dismountable, consisting of a handle and a blade. In maxillofacial surgery, microscalpels with a reduced working part size are actively used to avoid iatrogenic vascular and nerve injuries.
- Scissors: used for bilateral tissue access. They can have a direct ratio of blades and handles, an S-shape, or a bend on the flat or edge. Specialized Wagner scissors have a serrated cutting edge for fixing dense tissues.
Separation and revision:
- Syndesmotomes and plastic instruments: needed to separate the periodontal ligament, which prevents gingival trauma and reduces tissue resistance during tooth extraction.
- Periosteal elevators: used to separate the mucoperiosteal flap from the bone.
- Curettes (curettage spoons): necessary for the revision of the socket after tooth extraction. They are used to remove small root fragments, pathological granulation, and bone tissue to ensure normal healing.
- Chisels: used with surgical mallets for sharp bone dissection and creation of ostomies.
Spikes on forceps: UPPER molars — one spike (like a single mountain peak), LOWER molars — two spikes (symmetrically for two roots).
Class and exam questions
What is the main difference between Winter's elevator and Barry's elevator?
In Winter's elevator, the connecting shaft is straight and located strictly perpendicular to the handle (T-shape). In Barry's elevator, the shaft has a bend relative to the handle.
What is the purpose of the spike on the vestibular beak of forceps for upper molars?
The spike is designed for precise fixation in the bifurcation between the two buccal roots of the upper molar, which guarantees a reliable grip on the crown during luxation.
What is the main function of syndesmotomes during tooth extraction?
Syndesmotomes are designed to separate the circular periodontal ligament. This protects the marginal gingiva from tears and reduces tissue resistance when extracting a tooth from the alveolus.
Why are profiled instruments needed for the extraction of deciduous teeth?
The working part of such forceps has significantly smaller dimensions, which anatomically corresponds to the parameters of small primary crowns and prevents their damage or instrument slippage.
What else to study on this topic
- Features of using curettage spoons with angular and axial positioning
- Biomechanics of using the Pott elevator (lever principle)
- Modifications of scalpel handle holders with a double-sided blade fixer
- Specifics of using scissors for cutting surgical ligatures
- Differences in the structure of periosteal elevators for the marginal gingiva
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