CHAIR POSITION FOR FORCEPS EXTRACTION
The positions of the patient, chair, and operator are critical for successful completion of the extraction. The best position is one that is comfortable for both the patient and surgeon and allows the surgeon to have maximal control of the force that is being delivered to the patient’s tooth through the forceps. The correct position allows the surgeon to keep the arms close to the body and provides stability and support it also allows the .surgeon to keep-the wrists straight enough to deliver the force with
the arm and shoulder and not with the hand. The force delivered can thus be controlled in the face of sudden loss of resistance from a root or bone fracture.
Dentists usually stand during extractions, so the positions for a standing surgeon will be described first. Modifications
that are necessary to operate in’ a seated position will be presented later.
For a maxillary extraction the chair should be tipped backward so that the maxillary occlusal plane is at an angle of about 60 degrees to the floor. The height of the chair should be such that the height of the patient’s mouth is at or slightly below the operator’s elbow level (F.ig.7-20). During an operation on tile maxillary right quadrant, the patient’s head should be turned substantially toward the operator, so that ‘adequate access and visualization ‘can be achieved (fig. 7-21). For extraction of teeth in the maxillary , anterior portion of the arch, the patient should be looking straight ahead (Fig. 7-22), The position for the maxillary left portion of the arch is similar, except that the patient’s head is turned slightly toward the operator (fig, 7-23).
For the extraction of mandibular teeth, the patient should be positioned in a more upright position so that when the mouth is opened widely, the occlusal plane is parallel to the floor. A bite block should be used to stabilize the mandible when the extraction forceps is used. hen though the surgeon will support the jaw, the additional support provided .by the bite block will result in less stress being transmittedto the jaws. The chair should be lower than for extraction of maxilary teeth and the surgeon’s arm is inclined downward to .approximately a L.V degree angle at the elbow (Fig. 7-24), which provides a comfortable, stable position that is more controllable than the higher position. During removal of the mandibular right posterior teeth the patient’s head should be turned severely toward the surgeon to allow adequate access to the jaw, and the surgeon should maintain the proper arm and hand position (rig. 7-251. When removing teeth in the anterior region of the mandible the surgeon should rotate around to the side of till patient (Figs. 7-26 and 7-27). When operating on the left posterior mandibular region, the surgeon should stand in front of the patient, but the patient’s head should not turn quite so severely toward the surgeon (Fig. 7-28).
Some surgeons prefer to approach the mandibular teeth from a posterior position. This allows the left hand of the surgeon to support the jaw better, but it requires that the forceps be held opposite the usual method and that the surgeon view the field with a more upside-down perspective. The left hand of the surgeon goes around the patient’s head and supports the jaw.The usual-behind the patient approach is seen in figures 7-29 and 7-30.
If the surgeon chooses to sit while performing extractions’ several modifications must be made. For maxillary extractions, the patient is positioned in a reclining position similar to that used when the surgeon is standing, However, the patient is not reclined quite as much therefore the maxilIary occlusal plane is not perpendicular to the floor as it is when the surgeon is standing. The patient should be lowered as far as possible so that the level of the patient’s mouth is as near as possible to the surgeon’s elbow (Fig. 7~31)..The arm anti hand position for extraction of the maxillary anterior and posterior teeth is similar to the position used for the same extractions performed while standing (Fig. 7-32).
As when the surgeon is standing, for’ extraction of teeth in the lower arch, the patient is a’ bit more upright than for extraction of maxillary teeth. The surgeon can work from the front of the patient (Figs. 7-33 and 7-34) or from behind the patient (rigs. 7-35 and 7-36). When the English style of forceps is used, the surgeon’s position is usually behind the patient (Fig. 7-.17.). It should be noted that the surgeon and . the assistant have hand- and arm’ positions similar to those used when the surgeon is in the standing Position.