The mandibular premolars are among the easiest teeth to remove. The roots tend to be straight and conic, albeit sometimes slender. The overlying alveolar bone- is thin on the buccal aspect and somewhat heavier on the lingual side.
Extraction of mandibular left posterior teeth. Surgeon’s
left index finger is positioned in buccal vestibule, .reflecting cheek,
and second finger is positioned in lingual vestibule, ‘reflecting
” tongue. Thumb is positioned under chin. Jaw is grasped between
fingers and thumb to provide support during extraction
Jo provide support for the mandible to prevent f’XCP<
sive temporomandibular joint (TMJ) pressures, a rubber bite block
can be placed between the teeth on the contralateral side.
The lower universal (no. 151) forceps is usually chosen for the extraction of the mandibular premolars. The no. 151A forceps and the English style of forceps are both popular alternatives for extraction of these teeth.
The forceps is apically forced as far as possible, with the basic movements being toward the buccal aspect, returning to the lingual aspect, and, finally, rotating.Rotational movement is used more when extracting these teeth than any others, except perhaps the maxillary central incisor. The tooth is then delivered in the occlusobuccal direction (Fig. 7-68). Careful preoperative radio graphic assessment must be performed to assure the operator that no root curvature exists in the apical third of the tooth. If such a curvature does exist, the rotation all movements should be reduced or eliminated from the extraction procedure (Fig. 7-69).
A,When extrac~ing mandibular anterior teeth, no. 1Sl forceps is used. Assistant-reflects lip,
and surgeon stabilizes jaw with left hand. 8, ForcepS is seated apically as far as possible. C, Moderate
labial pressure is used to initiate luxation process. 0, Ungual force is used to continue expansion of
bone. E, Tooth is delivered in labial-incisal direction.
A, Extraction of mandibular premolar. Jaw is stabilized, soft tissue is reflect-
-ed, and no. 151 forceps is positioned. B, Hand position is modified slightly for behindthe-
patient technique. C, English style of forceps can also be used.
0, Forceps is seAted apically as far as possible to displace center of rotation and
to begin expansion of crestal bone. E. Buccal forceps is applied to begin luxation process. F, Slight lingual
pressure is used. G, Tooth is delivered with rotational, tractional force.
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