(d) Upper Molars.—The first upper molar has three roots, one internal towards the palate (palatine), and two external (buccal); of the three the palatine is the largest, sub-cylindrical in form, and often curved. The two buccal roots are placed in an anterior and posterior position, the latter being in a plane internal to the anterior one; both these roots are somewhat flattened, and of the two the anterior is the larger. The roots of the second molar are similar in shape to the first, but are usually smaller. The third molar, when normal, has three roots, but very frequently these are all fused together so as to form an abrupt tapering cone, the point of which is often curved.
Fig. 19.
Owing to the disposition of the roots different forceps will be required for the removal of upper molars on the right and left side. Of the blades, the outer or buccal should possess two grooves, the anterior being the broader and placed in a more external plane. This blade should also have a slight projection between the grooved surfaces to adapt itself to the space between the buccal roots. The inner or palatal blade should possess only one groove. A well-made pair of upper molar forceps should fit the neck of a first upper permanent molar accurately. The blades should be bent at an angle with the handles, so that when in use the latter may clear the lower lip ([fig. 19]). The palatine blade should be applied first, and in bringing the outer blade into place the point should be kept over the groove on the buccal side of the tooth, as this groove is a guide to the space between the outer roots. To sever these teeth from their attachments force must be applied first slightly inwards and then outwards, the movements being repeated if necessary, the removal of the tooth from the socket being carried out by exerting force in a downward and outward direction. Too much outward movement leads to undue bending or fracture of the external alveolar plate.
Fig. 20.
In removing the third molars it is advisable not to have the patient’s mouth opened to the fullest extent, as the tension of the tissues of the cheek will thereby be lessened and a clearer view of the outer side of the tooth thus gained. The application of the forceps is of the utmost importance, as one is liable, unless care is taken, to include some of the soft tissue between the blades and the tooth and so cause a painful laceration. Force applied inwards and then outwards is generally sufficient to loosen these teeth, their removal being carried out by a downward and outward movement.
Forceps similar to those shown in [fig. 19] may be used for the removal of the third molars, but most operators use patterns the blades of which are similar segments of the same circle ([fig. 20]).