Extraction Forceps & Elevators

7/22/2019 Extraction Forceps & Elevators

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EXTRACTIONFORCEPS



INTRODUCTION

Instruments which are used for removing tooth from the alveolar bone

Designed in many styles and configurations to adapt to adapt the variety of teeth forwhich they are used



BASIC COMPONENTS OF ANEXTRACTION FORCEPS

Comprises of three components

HandleHinge / joint

Beaks



HANDLE

Usually of adequate size to be handled comfortablyand to deliver sufficient pressure and leverage toremove the required tooth

Have a serrated surface to allow a positive grip andprevent slippage

Are held differently depending on the position of the tooth to be removed



Maxillary forceps are held with the palmunderneath the forceps so that the beak isdirected in a superior direction

Mandibular forceps are held with the palm an top of the forceps so that the beak is pointeddown towards the teeth

Handles are usually straight but may becurved to provide a sense of “better fit”



HINGE

It is merely a mechanism to connect the handle to the beak

Transfers and concentrates the force applied to the handle to the beak

American type of forceps has a hinge in a horizontal

direction whereas the English preference is for a verticalhinge and corresponding vertically positioned handle



BEAKS

Are the source of greatest variation among forcepsDesigned to adapt to the tooth root at the junction

of the crown and root Are designed for single rooted teeth, tooth rooted teeth and three rooted teeth

The design variation is such that the tips of thebeaks will adapt clearly to the various rootformation, decreasing the chance of root fracture



The more clear beaks adapts to the tooth roots themore effective will be the extraction and the less

chance for untoward complications

The final design variation of the beaks lies in thewidth of the beak

Some forceps are narrow because they are used toremove narrow teeth such as incisor teeth

Broader forceps are designed to remove teeth whichare substantially wider such as a molar teeth



TOOTH PULLING PLIERS-HANDLE THEORY

• Surface

Smooth

Serrated

Grooved



UPPER LOWER



TOOTH PULLING PLIERS-HINGE THEORY

VERTICAL-ENGLAND HORIZONTAL-THECOLONIES



MORE TOOTH PULLERS-BEAKS THEORY

UNIVERSAL



THE BARBI CONCEPT Anatomically Correct



FORCEPS



FORCEPS

Universal Anatomical







STILL MORE TOOTH PULLERS-REALITY

Mandibular

151 Ash 222 Cowhorn

(23)



FELSENFELD’S RULE OF

SURGICAL INSTRUMENTATION

When you pick up a knife, be careful!!



























MAXILLARY FORCEPS

Removal of maxillary teeth requires the use of instrumentsdesigned for single – rooted teeth

Maxillary incisors canine teeth and premolar teeth areconsidered to be single rooted since its root is bifurcated at the apical one-third

Even though the 1st premolar is bifurcated it is considered as

single rooted since it is bifurcated at the apical one-thirdThe maxillary molars are usually three root so that theyrequire forceps which will adapt to the configuration



SINGLE

Are numbered as 150

Slightly curved when viewed from side and ore essentially straight whenviewed from above

Beaks of these forceps curve to meet only at the tip

Slight curve of the forceps allows the operator to reach not only theincisors but also the bicuspid tooth

Slight modification of this 150 forceps is the 150A forceps which can beused for the maxillary premolar tooth

NO 1 forceps which are straight forceps can be used for maxillary incisorsand canine



THREE ROOTED

Maxillary molar tooth has a single palated root which abuccal bifurcation

Therefore a maxillary molar forceps should have one beak

which should be smooth, concave surface for plated rootand a back which pointed design for the bucal bifurcationroots

Paired- the left, the right

Are numbered as NO 53



A design variation of no.53 forceps is NO 88 rightand left forceps which have a longer more

accentuated and pointed beak formation they areunknown as upper cowhorn forceps

Used to remove maxillary molar with severely

decayed crowns

They sharply pointed beans may reach deeper in to the trifurcation to sound donation

Disadvantage - They remove large amount of bucalalveolar bone along with the extracted tooth





Are numbered as No 286 forceps which aredesigned to remove broken molar tooth

and narrow premolars

Are named as root tip forceps

Smaller version of No.150 is No 150s which is usedfor remaining primary teeth

Adapt to all primary teeth and they can be used all10 teeth



MANDIBULAR FORCEPS

Used for both single rooted extraction of mandibularincisiors canines and premolar teeth and two rooted teethsuch as molars

Forceps which is used for extraction of single rooted teethare the universal forceps or the No 151 forceps

Handles are similar to no.150 but the beaks are pointedinferiorly for the lower teeth

Beaks are smooth and relatively narrow and meet only at the tip to fit adequately at the cervical line of the tooth andgrip the root.



No 1514 have slightly modified for the extractionof mandibular premolar tooth

Should not be used for the other lower teeth due to their adaptation to the roots of other tooth.Mandibular molars are bifurcated two rooted teeth

that allow the use of forceps that automaticallyadapt to the toothBecause of the bifurcation is on both the buccal +lingual slides only single molar forceps arenecessary for the left and right molarsUseful lower molar forceps are the No 17 forceps



10.They are straight handled and the beaks are setobliquely downward.

11.The beaks have bilateral pointed tips in the centre to adapt in to the bifurcation of the molar teeth.

12.Due to the pointed nature of the beaks they cantbe used for the molar teeth with conical roots.

13.For this the molar No 222 have be designed withshorter beaks with no pointed tips for extraction oferupted mandibular third molar.

14.The major design variation is lower molar foreignis the No 23 forceps so called crown-horn forceps.

15 They have two pointed heavy beaks they enter



15.They have two pointed heavy beaks they enterinto the bifurcation of the lower molar.

16.After the forceps are seated in to the correctposition the tooth is elevated by squeezing in to the bifurcation using the buccal and lingualcortical plates as fulcrums and the tooth is literally

squeezed out of the socket.17.The No 1515 forceps is in the same design of

No.151 lower called for the extraction of all 10

teeth.



ELEVATORS



THE USE OF ELEVATORS

INDICATIONS:

Reflect mucoperiosteal membranes

Luxate and to remove teeth which cannot beengaged by the beaks of forcepsEg. Impactions and Malposed teeth

Remove roots, fractured or carious teeth

Remove intra radicular boneLoosen teeth prior to application of forcepsSplit teeth that have grooves cut in them



DANGERS

To be used with utmost caution:

May damage or even extract adjacent teethFracture maxilla or mandibleFracture alveolar process

Slipping and plunging the instrument intosoft tissue with perforation of blood vesselsand nerves



Penetrating max. antrum or forcing a root or

a third molar into the antrum

Forcing the apical third of the lower third

molar into mandible

Canal or through lingual plate into sub

maxillary or pterygomandibular space



RULES

Never use an adjacent tooth as fulcrumunless that also needs extraction

Never use buccal plate at the gingival line asfulcrum, except where odontectomy isperformed, or in the third molar areas

Never use lingual plate at the gingival line asfulcrum



Always use finger guards to protect thepatient in case the elevator slips

Be certain that the forces applied by theelevator are under control

When cutting through interseptal bones takecare not to engage the root of an adjacent tooth thus inadvertently forcing the samefrom its alveolus



PARTS OF AN ELEVATOR

Handle – May continuation of the shank orat a right angle to it

Shank

Blade – Part that engages the crown



HANDLE

BULBT-HANDLE CROSS-BAR



BLADE

TRIANGLE/ PENNANTSTRAIGHT/ GOUGE PICK





ACCORDING TO USE

Elevators designed to remove roots broken off at the gingival line (30-4-5)

Designed to remove roots broken off half way toapex (30-4-5 or 14L-14R or11L or 11R)

Designed to remove apical third of the root (apical

fragment ejectors no1,2 & 3)

Designed to reflect mucoperiosteum (Periosteal

Elevators)



ACCORDING TO FORM

Straight : Wedge type (straight apex)

Angular : Right and left

Cross bar : Handle at right angle to shank



STRAIGHT AND ANGLED



WORK PRINCIPLES

Lever

Wedge

Wheel and axle

Combination of more of these



LEVER PRINCIPLE

Using elevators work principles most commonly

applied is lever

Elevator is a lever of first order

Position of fulcrum is between effort (E) andresistance (R)

Again a mechanical advantage effort arm must belonger than the resistance arm

FORMULA FOR LEVERS : RXSA = LAXE



WEDGE PRINCIPLE Wedge elevator is forced between the root of the

tooth and the investing bone parallel to long axisof the root by hand pressure or by mallet force

Frequently used in conjunction with lever principle

Wedge in its simplest form, as a chisel, is a movableinclined plane,which overcomes a large resistance at

right angles to the applied effort

Effort is applied to the base of the plane and theresistance has its effect on the slant slide



Some wedges are movable double inclined planes

May also be regarded as 2 inclined planes placedbase to base

Sharper the angle of the wedge, the less effortrequired to overcome a given resistance

FORMULA FOR WEDGE : EXI = RXH OR R/E C= I

/HWedge may be a single or double inclined plane



WHEEL AND AXLE PRINCIPLE

Wheel and axle is a simple machine, being really modifiedform of the lever

Effort is applied to the circumference of the wheel which

turns the axle so as to raise a weight

Effort arm is RW & resistance arm is “ra” while the wheel &axle principle can be, & is used as the sole work principle inremoving the tooth, it is also used in conjunction with thewedge principle and in some cases with the lever principle

Formula for the wheel & axle principle is : R/E = Rw/ra



PROTECTION OF PATIENTSDURING USE OF ELEVATORS

Two principles:

Jaws must be supported to preventdislocations

Soft tissues must be protected from potentialdamage

PROTECTION IS BEST



PROTECTION IS BEST ACCOMPLISHED

Careful and continuous control in the directionforce so that it is directed into the bonesurrounding the tooth or against the tooth beignluxated

Surrounding the immediate operculature area with

fingers

In mandible thumb should be placed beneath themandible



Adjacent teeth should never be used as fulcrum

Placing the fingers buccally, labially and linguallyfor protection of adjacent teeth and soft tissues

To prevent fracture of maxillary tuberosities andmandible contaning teeth- Determination of howmuch pressure can be safely applied before thedanger point of fracture is essential

Beaks of the forceps are angled so that can be



a p a a g d a aplaced parallel to the long axis of the tooth with

the handle comfortable position

Beaks of the maxillary forceps are usually parallel to the handles whereas the beaks of the man

Forceps are perpendicular to the handles for betterreach and control position



DENTAL ESCALATORS

STRAIGHT 190



MILLER CRYER



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Extraction Forceps & Elevators

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