李锋（2016.4.5及4.12留学生实验课用）Tooth Extraction

Tooth Extraction
Li Feng M.D.
School and Hospital of
Stomatology
1
overview
1. Equipment, Instruments, and Materials
2. Simple Tooth Extraction
3. Surgical Tooth Extraction
2
1. Equipment, Instruments, and
Materials
1.1 local anesthetics, syringes, needles
3
Materials
1.2 Scalpel (Handle and Blade)
Scalpel and various types of scalpel blades (nos. 11,

12, 15) commonly used in oral surgery. Scalpel is held in a pen grasp.
Correct way to load

the scalpel blade on
the handle of the
scalpel.
4
Materials
1.3 periosteal elevator
Various
types of
periosteal
elevators.
a Seldin
b Freer
c No. 9 Molt
The most commonly used periosteal elevator in intraoral surgery is the no.9 Molt, which has
two different ends: a pointed end, used for elevating the interdental papillae of the gingiva,
and a broad end, which facilitates elevating the mucoperiosteum from the bone.
The Freer elevator is used for reflecting the gingiva surrounding the tooth before extraction.
The elevator may also be used for holding the flap after reflecting, facilitating manipulations
during the surgical procedure. The Seldin elevator is considered most suitable for5 this
purpose.
1.4 desmotomes Materials
Dental probe
These instruments are used to sever the soft tissue attachment, and are
either straight or curved. The straight desmotome is used for the anterior
teeth of the upper jaw and the curved desmotome for the rest of the teeth of
6
the upper jaw as well as all of the teeth of the lower jaw.
Materials
1.5 handpiece and burs
The handpiece functions at high speeds and has great cutting ability.
It does not emit air into the surgical field.
It may be sterilized in the autoclave.
It may receive various cutting instruments. 7
1.6 elevators
Materials
Straight Bein elevator
Straight White elevator

with slightly curved
blade, suitable for
extracting posterior
maxillary teeth 8
1.6 elevators
Materials
Pair of elevators with

crossbar or T-shaped handles
Sharp-tipped angled
elevators suitable for
removal of root tips
9
1.7 extraction forceps
Materials
Maxillary Extraction Forceps for the Six Anterior Teeth of the Maxilla.
Beaks that are found on the same level as the handles characterize these
10
forceps, and the beaks are concave and not pointed.
Materials
Maxillary Universal Forceps or No. 150 Forceps.

The forceps used for premolars have a slightly curved shape and look like
an S. 11
1.7 extraction forceps Materials
Maxillary Molar Forceps, for the
First and Second Molar.
There are two of these forceps: one
for the left and one for the right side. Maxillary right molar forceps, for the first and second
Just like the previously mentioned upper molars of the right side
forceps, they have a slightly curved
shape that looks like an S. The
buccal beak of each forceps has a
pointed design, which fits into the
buccal bifurcation of the two buccal
roots, while the palatal beak is
concave and fits into the convex
surface of the palatal root.
Maxillary left molar forceps, for the first and second

upper molars of the left side
12
Materials
Maxillary Third Molar Forceps.

These forceps have a slightly curved shape, just like the aforementioned
forceps, and are the longest forceps, due to the posterior position of the
13
third molar.
Materials
Maxillary Root Tip Forceps.

The handles of the root tip forceps are straight, while the beaks are
narrow and angle-shaped. The ends of the beaks are concave and
without a pointed design. 14
Materials
Mandibular Forceps for Anterior Teeth and Premolars

or Mandibular Universal Forceps or No. 151 Forceps.
15
Materials
Mandibular
Molar Forceps.
These forceps are used for both sides of the jaw and have straight handles
while the beaks are curved at approximately a right angle compared to the
handles. Both beaks of the forceps have pointed ends, which fit into the
bifurcation of the roots buccally and lingually. These forceps are used for the
removal of both the first and second molar of the right and left side of the
16
lower jaw.
Materials
Mandibular
Third Molar Forceps.
These forceps also have straight handles, while the beaks, are also curved at a
right angle compared to the handles. The beaks are a little longer compared to
the previous forceps, due to the posterior position of the third molar in the
dental arch. Because this tooth varies in size and shape and because there is
usually no root bifurcation, the ends of the beaks of the forceps are concave
17
without a pointed design.
Materials
Mandibular Cowhorn Molar Forceps.

The lower cowhorn forceps or no. 23 forceps are a variation of the mandibular
molar forceps. In comparison to the standard forceps, the beaks have a
semicircular shape with sharply pointed ends so that they can fit into the
18
bifurcation of the roots and firmly grasp the tooth.
Materials
Mandibular Root Tip Forceps.

The handles of the root tip forceps are straight, while the beaks are
curved at a right angle. Their ends are very narrow and meet at the
19
tip when the forceps are closed.
1.8 periapical curettes
Materials
These are angled double-ended, spoon-shaped instruments. The

most commonly such used instrument is the periapical curette, whose
shape facilitates its entry into bone defects and extraction sockets.
The main use of this instrument is the removal of granulation tissue,
20
small cysts, bone chips, foreign bodies, etc.
Materials
1.9 surgical forceps
Surgical forceps are used for

suturing the wound,
firmly grasping the tissues
while the needle is passed.
The angled forceps are used

for picking up loose fragments
of tooth, amalgam, or other
foreign material, and for
placing or removing gauze
21
packs.
1.10 hemostat
Materials
The hemostat may grasp

the vessel and stop
bleeding.
Hemostats may also be
used for firmly holding
soft tissue, facilitating
manipulations for its
removal.
22
1.11 needle holder Materials
The correct way to hold the needle holder is to place

the thumb in one ring of the handle and the ring
finger in the other. The rest of the fingers are curved
around the outside of the rings, while the fingertip of
the index finger is placed on the hinge or a little
23
further up, for better control of the instrument.
Materials
1.12 local hemostatic drugs
Alginic Acid Natural Collagen Sponge Gelatin Sponge

24
2.1 patient and dentist position
Position of dental chair during extraction. a Maxilla: angle between dental

chair and the horizontal (floor) is 120.
b Mandible: angle between dental chair and the horizontal (floor) is 110
25
2.1 patient and dentist position
Position of dentist during extraction. For all

maxillary teeth and posterior mandibular
teeth, the dentist is to the front and right
(and to the left, for left-handed dentists) of
the patient. For the anterior mandibular teeth
(teeth 3342 for right-handed, and teeth 32
43 for left-handed, dentists), the dentist is
positioned in front of or behind and to the
right (or to the left, for left-handed dentists)
of the patient.
26
2.2 extraction
Separation of tooth from soft tissue
Extraction of tooth using extraction forceps or an
elevator
Postextraction care of tooth socket
27
2.2.1 Separation of tooth from soft tissue
Desmotomes.
a Straight. b Curved
Dental probe
28
2.2.1 Separation of tooth from soft tissue
29
2.2.2 Extraction of tooth using extraction forceps
the correct way to hold the forceps and the tooth itself, the forces applied to
the tooth, and the direction of movement during the extraction.
The beaks of the forceps are positioned at the cervical line of the tooth,
parallel to its long axis, without grasping bone or gingivae at the same time.
30
Extraction of maxillary anterior

tooth
31
Extraction of maxillary
premolars
32
first and second molars
33
third molars
34
Extraction of mandibular
anterior teeth
35
Extraction of mandibular premolars
36
Extraction of mandibular
molars
37
2.2.2 Extraction of tooth using an elevator
The straight elevator must be held in the dominant hand and the index finger
placed along the blade, leaving its anterior end exposed, which is used to
luxate the tooth or root.
This instrument must always be used buccally, and never on the lingual or
palatal side.
The concave surface of the blade must be in contact with the mesial or
distal surface of the tooth to be extracted, and be seated between the tooth
and alveolar bone. 38
When the instrument is placed between the maxillary posterior teeth, it must
be perpendicular to their long axis. As for the rest of the teeth of both the
maxilla and mandible, it may be perpendicular, parallel, or at an angle.
During luxation, a cotton roll or gauze should be placed between the finger
and palatal or lingual side, to avoid injury of the finger or tongue in case the
elevator slips.
39
During luxation, the adjacent tooth

should not be used as a fulcrum,
but only the alveolar bone.
Otherwise, there is a risk of
damaging the periodontal ligament
fibers.
The straight elevator should not be
used to extract multi-rooted teeth,
because there is a risk of fracturing
their roots if they have not been
sectioned previously.
40
extraction of single-rooted teeth with destroyed crown
41
extraction of multi-rooted teeth with destroyed crown
42
extraction of root tips
43
2.3 postextraction care of tooth socket
After extraction of the tooth, the bottom of the socket is curetted (as long as the
tooth is nonvital) with a periapical curette, to remove any periapical lesion from
the area.
Periapical curette
Afterwards, and only if considered necessary (e.g., there are sharp bone edges), the
alveolar margin is smoothed using rongeur forceps or a bone file, and then the lingual
and buccal plates are compressed using finger pressure. This is done to restore the
expansion of the socket caused by the extraction, and also for initial control of
hemorrhage. Hemostasis is also aided by the patient applying pressure on gauze
44
placed over the socket for 3045 min.
Postoperative Instructions
Rest: After surgery, the patient should stay at home and not go to work for
1 or 2 days, depending on the extent of the surgical wound and the
patients physical condition.
Analgesia: Take a painkiller (but not salicylates, aspirin), every 4 h, for as
long as the pain persists.
Edema: After the surgical procedure, the extraoral placement of cold
compresses (ice pack wrapped in a towel) over the surgical area is
recommended. This should last for 1015 min at a time, and be repeated
every half hour, for at least 46 h. 45

Bleeding: The patient must bite firmly on gauze placed over the wound for
3045 min. In case bleeding continues, another gauze is placed over the
wound for a further hour.
Antibiotics: These are prescribed only if the patient has certain medical
conditions or inflammation.
Diet: The patients diet on the day of the surgical procedure must consist of
cold, liquid foods (pudding, yogurt, milk, cold soup, orange juice, etc.).
46
Oral hygiene: Rinsing the mouth is not allowed for the first 24 h. After this,
the mouth may be rinsed with warm chamomile or salt water, three times a
day for 34 days. The teeth should be brushed with a toothbrush and
flossed, but the patient should avoid the area of surgery.
Removal of sutures: If sutures were placed on the wound, the patient must
have them removed a week later.
47
Bibliography
Fragiskos F.D. (2007). Oral Surgery.

48
Tooth Extraction
Li Feng M.D.
School and Hospital of
Stomatology
49
overview
1. Equipment, Instruments, and Materials
50
Surgical extraction is the method by which a tooth is removed from
its socket, after creating a flap and removing part of the bone that
surrounds the tooth.
Steps:
1. Creation of a flap.
2. Removal of bone and exposure of an adequate part of the tooth or
root.
3. Sectioning of the tooth.
4. Extraction of the tooth or root with elevators or forceps.
5. Postoperative care of wound and suturing. 51
3.1 Extraction of an Intact Tooth with Hypercementosis of the Root Tip
52
3.2 surgical extraction of roots or root tips
Removal of the buccal plate along the

Incision Reflection of the flap
length of the root using a round bur
luxation of the root in the outward direction using a

Suture
straight elevator 53
3.3 surgical extraction of impacted tooth-------impacted premolar
Creation of
trapezoidal flap
54
Removal of
buccal bone to
expose tooth.
Partial sectioning of
the crown from the
root of the tooth
using a bur, in the
buccolingual
direction. 55
Separation of the
impacted tooth into
two segments
using the straight
elevator.
Removal of the
crown using Seldin
elevator or elevator
with T-shaped
handles.
56
removal of the root

from the socket
Smoothing of
bone edges of the
wound using a
surgical bur.
Suturing of
57
incision.
3.3 surgical extraction of impacted tooth------impacted maxillary 3rd molar
Incisions and
Types of Flaps
for Extraction
of Impacted
maxillary
Third Molar
58
Triangular
incision
Reflection of
flap
59
Luxation of
the impacted
tooth using
elevator.
60
Surgical field after

placement of
sutures.
61
3.3 surgical extraction of impacted tooth---impacted mandibular 3rd molar
Flaps ----- Triangular flap

The incision for this type of flap begins at the anterior border of the ramus (external
oblique ridge) with special care for the lingual nerve and extends as far as the distal
aspect of the second molar, while the vertical releasing incision is made obliquely
downwards and forward, ending in the vestibular fold.
62
Flaps ----- Triangular flap

In certain cases, e.g., when impaction is deep, to ensure a satisfactory surgical
field or when the impacted tooth conceals the roots of the second molar, the
incision may continue along the cervical line of the last tooth while the
vertical incision begins at the distal aspect of the first molar.
63
Flaps ------ Horizontal flap
The incision for the flap also begins at the anterior border of the ramus and
extends as far as the distal aspect of the second molar, continuing along the
cervical lines of the last two teeth, and ending at the mesial aspect of the first
molar. This type of flap is usually used in cases where impaction is relatively
superficial.
64
Removal of Bud of Impacted Mandibular 3rd Molar
Bud of mandibular
third molar.
a Radiograph and b
clinical photograph
of the relevant area
Triangular incision
using a scalpel with a
no. 15 blade.
65
Reflection of the flap
and use of a surgical
handpiece to remove
part of the bone over
the crown of the
impacted tooth.
Removal of bone from the

buccal and distal aspects of
the crown of an impacted
tooth, to ensure a withdrawal
pathway that will facilitate
luxation (pathway of removal) 66
Placement of the
straight elevator
between the mesial
aspect of the impacted
tooth and alveolar bone.
Luxation of the tooth

with rotational
movement distally.
Contact between the
elevator and the distal
surface of the second
67
molar is avoided.
a Removal of follicle
using a hemostat and
periapical curette
b Smoothing of bone
edges of the wound
using a bone file
Tooth and follicle

after removal.
Operation site
after suturing 68
Extraction of impacted 3rd molar in horizontal position
Radiograph &
clinical photograph
showing impacted
mandibular third
molar in the
horizontal position.
Horizontal incision
using a scalpel with
a no. 15 blade.
69
Removal of bone using

a round bur, to expose
the crown of the
impacted tooth.
Sectioning tooth at the

cervical line using a
fissure bur.
70
Separation of crown
from the root, with
rotation of the elevator
in a groove created on
the impacted tooth.
Removal of the
crown of the tooth
using a straight
elevator.
71
Luxation of the root

of an impacted tooth
using an angled
Seldin elevator
Operation site
after removal of
tooth.
Surgical field
72
after suturing
Extraction of 3rd molar with mesioangular impaction
Radiograph &
clinical photo
showing
mesioangular
impacted 3rd molar.
Horizontal incision
(for envelope flap)
using a scalpel
with a no. 15 blade.
73
Reflection of flap.
Exposure of the
crown of the tooth
using a round bur.
Removal of bone.
A groove is created
buccally, which extends
distally to the crown of
the tooth, creating
room that will facilitate
74
its luxation.
Sectioning of the
impacted tooth.
Separation of
tooth with
positioning and
rotation of
elevator in created
groove. 75
Luxation of the distal
segment of the tooth
with rotation of the
elevator distally.
Luxation of the
mesial segment of
an impacted tooth
using a straight
elevator. 76
Extraction of 3rd molar with distoangular impaction
a Radiograph showing
impacted mandibular third
molar (partial bone impaction)
with a distoangular position.
b Clinical photograph of the
area of impaction
The horizontal
incision extends as
far as the mesial
aspect of the first
77
molar.
Reflection of the
mucoperiosteal flap,
and partial exposure
of the crown of the
impacted tooth.
Removal of bone on
the buccal and distal
aspects of the crown of
the tooth. The groove
is created to facilitate
78
luxation.
Sectioning of the distal

portion of the crown of
the impacted tooth
using a fissure bur.
Removal of the distal

part of the crown using
a straight elevator.
79
Luxation of the impacted

tooth in the distal
direction.
Tooth after removal.
Surgical field after

suturing. 80
Rest: After surgery, the patient should stay at home and not go to work for
1 or 2 days, depending on the extent of the surgical wound and the
patients physical condition.
Analgesia: Take a painkiller (but not salicylates, aspirin), every 4 h, for as
long as the pain persists.
Edema: After the surgical procedure, the extraoral placement of cold
compresses (ice pack wrapped in a towel) over the surgical area is
recommended. This should last for 1015 min at a time, and be repeated
every half hour, for at least 46 h. 81

Bleeding: The patient must bite firmly on gauze placed over the wound for
3045 min. In case bleeding continues, another gauze is placed over the
wound for a further hour.
Antibiotics: These are prescribed only if the patient has certain medical
conditions or inflammation.
Diet: The patients diet on the day of the surgical procedure must consist
of cold, liquid foods (pudding, yogurt, milk, cold soup, orange juice, etc.).
82
Oral hygiene: Rinsing the mouth is not allowed for the first 24 h. After this,
the mouth may be rinsed with warm chamomile or salt water, three times a
day for 34 days. The teeth should be brushed with a toothbrush and
flossed, but the patient should avoid the area of surgery.
Removal of sutures: If sutures were placed on the wound, the patient
must have them removed a week later.
83
Move to the clinic for
further study !
84
Bibliography
Fragiskos F.D. (2007). Oral Surgery.

85

李锋（2016.4.5及4.12留学生实验课用）Tooth Extraction

Uploaded by

Document Information

Original Description:

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

李锋（2016.4.5及4.12留学生实验课用）Tooth Extraction

Uploaded by

Copyright:

Available Formats

Tooth Extraction

1. Equipment, Instruments, and Materials

2. Simple Tooth Extraction

3. Surgical Tooth Extraction

Scalpel and various types of scalpel blades (nos. 11,

Correct way to load

Straight Bein elevator

Straight White elevator

Pair of elevators with

Maxillary Universal Forceps or No. 150 Forceps.

Maxillary left molar forceps, for the first and second

Maxillary Third Molar Forceps.

Maxillary Root Tip Forceps.

Mandibular Forceps for Anterior Teeth and Premolars

Mandibular Cowhorn Molar Forceps.

Mandibular Root Tip Forceps.

These are angled double-ended, spoon-shaped instruments. The

Surgical forceps are used for

The angled forceps are used

The hemostat may grasp

The correct way to hold the needle holder is to place

Alginic Acid Natural Collagen Sponge Gelatin Sponge

Position of dental chair during extraction. a Maxilla: angle between dental

Position of dentist during extraction. For all

Separation of tooth from soft tissue

Extraction of tooth using extraction forceps or an

Postextraction care of tooth socket

2.2.1 Separation of tooth from soft tissue

2.2.1 Separation of tooth from soft tissue

Extraction of maxillary anterior

Extraction of mandibular premolars

During luxation, the adjacent tooth

extraction of single-rooted teeth with destroyed crown

extraction of multi-rooted teeth with destroyed crown

1 or 2 days, depending on the extent of the surgical wound and the

patients physical condition.

Analgesia: Take a painkiller (but not salicylates, aspirin), every 4 h, for as

long as the pain persists.

Edema: After the surgical procedure, the extraoral placement of cold

compresses (ice pack wrapped in a towel) over the surgical area is

every half hour, for at least 46 h. 45

wound for a further hour.

flossed, but the patient should avoid the area of surgery.

have them removed a week later.

Fragiskos F.D. (2007). Oral Surgery.

1. Equipment, Instruments, and Materials

2. Simple Tooth Extraction

3. Surgical Tooth Extraction

Removal of the buccal plate along the

luxation of the root in the outward direction using a

removal of the root

Surgical field after

Flaps ----- Triangular flap

Flaps ----- Triangular flap

Removal of bone from the

Luxation of the tooth

Tooth and follicle

Removal of bone using

Sectioning tooth at the

Luxation of the root

Sectioning of the distal

Removal of the distal

Luxation of the impacted