The maxillary first molar has three large and relatively strong roots. The buccal roots are usually relatively close together, and the palatal root diverges widely toward the palate. If the two buccal roots are also widely divergent, it becomes difficult to remove this tooth by closed, or forceps, extraction. ‘Once again the overlying alveolar bone is similar to that of other teeth in the maxilla the buccal plate is thin and the palatal cortical plate is thick and heavy. When evaluating this tooth radiographically, the dentist should note the size, curvature, and apparent divergence of the three roots. Additionally the dentist should look carefully at the relationship of the tooth roots to the maxillary sinus. If the sinus is in close proximity to the roots and the roots are widely divergent, sinus perforation caused by removal of a portion of the, sinus floor during tooth removal is increasingly likely, If this appears to be likely after preoperative evaluation, the surgeon should strongly consider a surgical extraction.
The paired forceps no. 53R and no. 53L are usually used for extraction of the maxillary molars . These two forceps have tip projections on the buccal beaks to fit into the buccal bifurcation., Some surgeons prefer to’ use the no. 89 and no.90 forceps, which are sometimes called the upper cowhorn forceps. These two forceps are especially useful if the crown of the molar tooth has large caries or large restorations.
The upper molar forceps is adapted to the tooth and apically seated as far as possible in the, usual fashion (Fig. 7-64). The basic extraction ‘movement is to use strong,buccal and palatal pressures, with stronger forces toward the buccal than toward the palate. Rotational forces are not useful for extraction of this tooth because of its three roots. As mentioned in the discussion of the extraction of the maxillary first premolar, it is preferable to fracture a buccal root than a palatal root (because it is easier to retrieve the buccal roots). Therefore if the tooth has widely divergent roots and the dentist suspects that one root may be fractured, the tooth should be luxated in such a way as to prevent fracturing the palatal root, The dentist must minimize palatal force, because this is the force that fractures the palatal root. Strong, slow, steady, buccal pressure expands the buccocortical plate and tears the periodontal ligament fibers that hold the palatal root in its position. Palatal forces spould be used but kept to a minimum.
The maxillary second molar’s anatomy is similar to that 01 the maxillary first molar except that the roots tend to be shorter and less. divergent, with the buccal roots more commonly fused into a single root. This means that the tooth is more easily extracted by the same technique described for the first molar.
The erupted maxillary third molar frequently has conic roots and ·is usually extracted with the no. 210S forceps, which is universal forceps used for both the left and right sides. The tooth is usually easily removed, because the buccal bone is thin and the roots are usually fused and conical. The erupted third molar is also frequently extracted by the use of elevators alone. It is important to clearly visualize the maxillary third molar on the preoperative radiograph, because the root anatomy of this tooth is quite variable and often small, dilacerated, hooked roots exist in this area. Retrieval of fractured roots in this area can be very difficult.