Extraction of the Teeth

by Frank Colyer

As previously pointed out, the roots of these teeth are at times curved a little backwards so that it is often needful in removing the teeth from their sockets to twist the forceps in a curved direction backwards.

In the removal of the second molar too much outward movement is not permissible, as the outer alveolus is often very dense.

The third molar is best removed with a straight elevator. A glance at the illustration of this tooth ([fig. 31]) will show that the roots have a well-marked curve backwards, in addition to which the bone forming the socket of this tooth is stronger than is the case with the anterior molars. The removal of the third molar has therefore to be accomplished by using force in a direction upwards and backwards, in other words, in a curve similar to the arc of the circle formed by the roots. This movement cannot well be carried out with forceps, but is easily accomplished with the elevator as follows (it being assumed that the second molar is in place):—Hold the elevator as shown in [fig. 13], and insert the blade between the anterior surface of the root and the alveolus, keeping the flattened side of the instrument as far as possible parallel with the root surface. Then force the blade downwards in a direction towards the apex of the root; following this, rotate the handle away from the direction in which the tooth is to be moved. This has the effect of both raising the tooth in its socket and displacing it backward. The edge of the elevator which is to be brought into contact with the surface of the root should be sharp so as to cut somewhat into the cementum. Should this prove insufficient the handle should again be raised and the flattened surface of the instrument brought parallel with the anterior surface of the root and the extractive movement repeated until the tooth is completely raised from its socket.

In using the elevator, especial care must be taken to protect the tongue with the fingers or thumb of the left hand, so as to prevent a slip, which might result in puncture of the tongue, or of the operator’s finger.

With the third lower molar there is a tendency for the gum to adhere tenaciously to the posterior part of the neck of the tooth. When this happens it is better to simply raise the tooth from its socket with the elevator or forceps, as the case may be, and then cut the gum away with a curved pair of scissors. By this method a severe laceration of the gum may at times be avoided.

When the third molar is isolated owing to the absence of the second molar, the elevator may still be employed for its removal, on the right side the first finger, and on the left side the thumb of the left hand being used as the fulcrum. In such cases, however, many operators prefer to use ordinary lower molar forceps.

The removal of lower molars when a portion of the crown is standing, but the decay has progressed below the gum on either the buccal or the lingual aspect, is carried out with root forceps of shape shown in [fig. 27]. A condition similar to this in upper molars and the method indicated for their removal were referred to on page 27. The principles enumerated there apply equally to the removal of lower molars, so that it will not be necessary to repeat them. The main points to bear in mind are, to apply the blades of the forceps to the stronger root, and to use the principal force in the direction of the weaker wall.

Where the roots of molars are still united, root forceps should be used, the blade being first applied to the lingual surface of the stronger root. A firm hold having been obtained, the root may be removed by employing force in a manner similar to that employed with ordinary molar forceps. In this way both roots will usually come away together. If, however, only one root is extracted, the remaining one can easily be removed, either with the same forceps or a curved elevator. The curved elevator ([fig. 49]) may be employed either by placing it against the root, and so forcing it into the socket of the root already removed, or by placing the blade in the socket of the extracted root, forcing the point of the instrument through the intervening bone and then elevating the remaining root.

With roots of lower molars which present great resistance, forceps with cutting blades may be used ([fig. 32]). The blades are inserted on the lingual and buccal aspects of the arch in such a manner that the points pass into the space between the roots. The handles are then closed and an attempt is made to remove the roots in the ordinary way, but should this prove unsuccessful the handles must be forcibly closed, so as to divide the roots which can then, as a rule, be removed with ordinary root forceps.