The order in which multiple teeth are extracted deserves some discussion. Maxillary teeth should usually be re
moved first for several reasons. First of all, an infiltration anesthetic has a more rapid onset and also disappears more rapidly. This means that the surgeon can begin the surgical procedure sooner after the injections’ have been given; in addition, surgery should not ‘be delayed because profound anesthesia is lost more quickly in the maxilla. In addition, maxillary teeth-should be removed first, because during the extraction process debris such as portions of amalgams, fractured crowns, and bone chips may fall intothe empty sockets of the lower teeth if the lower surgery is performed first. In addition, maxillary teeth ate removed with a major component of buccal force. Little or no vertical, traction force is used in removal of these teeth, as is commonly -required with mandibular teeth. ‘ Therefore mandibular extractions that follow maxillary extractions are usually easier to perform. A single minor ‘. disadvantage for extracting maxillary teeth first is that if
hemorrhage is not controlled in the maxllla’ before’ mandibular teeth’ are extracted, the hemorrhage mayinterfere with visualization during mandibular surgery. Hemorrhage is usually not a major problem, because
hemostasis should be achieved in one area before the.surgeon turns, his or their attention to another area of surger~ and the surgical assistant should be able to keep the surgical field free from blood with adequate suction. Extraction usually begins with extraction’ of the most posterior teeth first. This allows for the more effective use of dental elevators to luxate and mobilize teeth before the forceps is used to extract the tooth. The two teeth that are the most difficult to remove, the molar- and canine, should be extracted last. Removal of the teeth on either side weakens the bony socket an. the mesial and distal side of these teeth, and their subsequent extraction is – made easier. In summary, if a maxillary and mandibular left quadrant” is to be extracted, the following order is recommended: (1) maxillary posterior teeth, leaving the first’ molar; (2) maxillary anterior teeth, leaving the canine
This patient’s remaining teeth are to be extracted. The broad zone of attached gingiva is demonstrated in adequate vestibular depth. 8, After adequate anesthesia is achieved, soft tissue attachment to teeth is incised with no. 15 blade. Incision is carried around necks of teeth and through interdental papilla. e, Woodson elevator is used to reflect labial soft tissue just to crest of labioalveolar bone. 0, Small straight elevator is used to luxate teeth before forceps is used. Surgeon’s opposite hand is reflecting soft tissue and stabilizing mandible. E, Teeth adjacent to mandibular canine are extracted first, which makes extraction of remalntnq canine tooth easier to accomplish. (3) maxillary molar; (4) maxillary canine; (5) mandibular” posterior teeth, leaving the first molar; (6) mandibular anterior teeth, leaving the canine; (7) mandibular molar; and (8) mandibular canine.