What Are Forceps with Teeth?

Dental extraction forceps are instruments used to hold crowns or roots and loosen and displace teeth by wedging, shaking, twisting, and traction ^[1] .

Chinese name: Dental extraction forceps
Foreign name: Dental Forceps
Brief introduction: Extraction forceps during tooth extraction

component: Clamping shank, joint and beak
Management category: Class I medical devices
Category Name: Oral forceps

Indications and contraindications for extraction

1. Extraction forceps 1. Indications for extraction

(1) Periodontal disease: Periodontitis is a common cause of tooth extraction. Molar impaction easily stores bacteria and food between gums and crowns to cause periodontitis. To cure radical inflammation, tooth extraction is often required.

(2) Residual root and crown removal: Residual root is caused by most of the tooth crown's defect, while residual crown is only the gum left due to the missing crown.

(3) Extraction of cracked teeth: The most common incisor fracture is the fractured tooth. Occasionally, the tooth can be fractured by biting a hard object.

(4) Residual tooth extraction: Residual teeth refer to the deciduous teeth that have not emerged on time, or the deciduous teeth that have remained in the permanent dentition. Residual tooth extraction is on the rise: most of the patients are young, and personally think that this is related to factors such as children's parents not paying attention to, food additives, more refined food processing, and other factors, resulting in reduced chewing opportunities for children, and deciduous teeth are not easy to fall off.

2. Extraction forceps 2. Contraindications for extraction

(1) Acute inflammation. Tooth extraction can spread the infection, make it worse, and even endanger life;

(2) Hypertension and blood diseases. Extraction bleeding is difficult to stop, so it is necessary to carefully decide whether to extract teeth;

(3) Menstrual period. Women in menstrual period have poor coagulation function, and alveolar bleeding may occur. Some deep-rooted teeth should be postponed. ^[1]

Classification of extraction forceps

According to the shape and size of the pliers handle and beak, the forceps are mainly divided into the following types.

1. Maxillary front teeth forceps. The maxillary anterior teeth forceps are linear forceps and symmetrical beak teeth forceps. They are the longest and simplest teeth forceps of all. As shown in Figure 1. It is suitable for maxillary central incisor to canine extraction. In use, in addition to the lip and tongue swaying force and joint traction force, the torque can be appropriately used according to the tooth position.

Figure 1 Maxillary anterior teeth forceps

2. Maxillary premolar forceps. The maxillary premolar forceps are s -type forceps and symmetrical forceps, which have a long beak, no teeth on the beak, and smooth, and can be easily accessed to various parts of the mouth. as shown in picture 2. In addition to extraction of maxillary bicuspids, it can also be used in other dental positions in special cases. It is also called "universal dental forceps". When the maxillary premolar is extracted, the root anatomical shape is flat root, so the buccal and lingering force and the directional traction force are mostly used. When holding the pliers, the concave surface of the curved part of the pliers handle should be facing the palm of the hand, and the concave surface of the pliers beak should be directly above. The end of the jaw's beak is concave in shape and has no protrusions.

Figure 2 Maxillary premolar forceps

3. Maxillary molar forceps. It is mainly used for extraction of the first and second maxillary molars. Maxillary molar forceps are the only paired dental forceps, which are divided into two types. One is the tip with a beak, which is commonly called the maxillary molar forceps. The other is the three-pronged forceps. Both types of forceps can be used for maxillary molars. removal. As shown in Figure 3. The left and right methods are as follows: Hold the forceps with one right hand and the forceps beak upwards. At this time, the direction in which the single beak points towards the patient is the forceps on which side. The maxillary molar forceps is the one with the largest beak width in the maxillary dental forceps. When using it, you should use the buccal tongue force and the directional traction force and pay attention to whether the crown is properly clamped, otherwise it is easy to damage the adjacent teeth.

Figure 3 Maxillary molar forceps

4. Maxillary third molar forceps. It is mainly used for extraction of the maxillary third molar. This type of forceps is similar to the shape of the maxillary molar forceps, but because the position of the third molar is backward, the length of the forceps is slightly increased compared to the molar forceps. In addition, the design of the beak shape of the forceps is not the same as that of the maxillary molar forceps. The end of the forceps beak is concave, but smooth and free of protrusions. Therefore, this type of forceps can be used universally when removing the third molars on both sides. As shown in Figure 4.

Figure 4 Maxillary third molar forceps

5. Maxillary apex forceps. There are two types of maxillary apex pliers. One kind is similar to a rifle with a bayonet in side view, which is called a bayonet apex. The other is the maxillary apex forceps with an "S" shape when viewed from the side. As shown in Figure 5. The most common of these is the bayonet pliers. Maxillary root tip forceps clamp the tip of the beak and is thin. The tip of the beak can be occluded. It is mostly used to penetrate the alveolar fossa to hold the broken root. Often used rotational and traction.

Figure 5 Maxillary apex forceps

6. Mandibular anterior forceps. The mandibular anterior forceps are eagle-nose pliers, the beak of which is almost at right angles to the handle. As shown in Figure 6. The narrow beak tip is used to extract the teeth before the mandibular bicuspid. However, because the traction direction and the holding direction are at an angle of 90 °, the main force in use is to rotate the right wrist upward, which is not easy to grasp. When the periodontal ligament of the anterior teeth is torn, the resistance suddenly decreases. If the right hand is not forced to retract in time, the jaw of the forceps is suddenly lifted, which easily hurts the maxillary anterior teeth. Therefore, when placing the anterior teeth of the lower mandible, the left hand finger should be appropriately buffered between the anterior teeth of the upper jaw and the forceps beak to provide protection.

Figure 6 Mandibular anterior forceps

7. Mandibular premolar forceps. The mandibular premolar forceps are C shaped from the side view, and the pliers have a slender beak, similar to the maxillary forceps of the same name, except for extraction of the mandibular premolars, and in certain cases can also be used for extraction of the mandibular anterior teeth. As shown in Figure 7. When mandibular premolars are removed, the cheek and tongue are used to displace the teeth toward the tongue. When mandibular anterior teeth are removed, the surgeon is located behind the patient. The right hand holds the forceps from the right into the mouth and placed on the target tooth. The left thumb is placed between the maxillary teeth and the forceps beak to provide protection. Traction dislocation to the party.

Figure 7 Mandibular premolar forceps

8. Mandibular molar forceps. The mandibular molar forceps is a right-angle forceps, with a wide beak, and one beak tip on each side of the middle beak. The beak edge looks like a gourd from the top of the beak. As shown in Figure 8. The beak tip is mainly used to hold the root bifurcation area of mandibular molars. Prevent the forceps from falling out during extraction. In use, the cheek-to-tongue rocking force and joint traction force should be used to dislocate the teeth toward the tongue. Care should be taken to protect the maxilla when dislocating. In addition, when placing the forceps, care should be taken to ensure that the tip of the beak of the forceps is correctly placed in the root bifurcation, to avoid gingival tears caused by clamping the gums and causing bleeding after tooth extraction.

Figure 8 Mandibular molar forceps

9. Mandibular apex forceps. The mandibular apex forceps are right-angled, the beak is similar to the maxillary apex forceps, and the method of use is similar to the maxillary apex forceps. In use, care should be taken to protect the maxillary teeth.

Figure 9 Mandibular apex forceps

10. Horn tongs. The horn pliers, also known as the root pliers, are mostly used for the extraction of mandibular molars with a large portion of the caries (damage) of the crown. As the name implies, the beak is similar to the sharp angle of a buffalo. As shown in Figure 10. During use, the forceps beak is placed in the root furcation area of the posterior teeth, and the forceps handle is squeezed tightly. At this time, under the action of the bilateral beak tip wedge force, the tooth dislocation upwards or the root furcation is split to facilitate removal. In use, care should be taken to ensure that the tooth position is correct and the force is gentle to prevent the adjacent tooth from being pulled out due to the sudden dislocation of the forceps. ^[2]

Figure 10 Horn pliers

How to use dental extraction forceps

The standardized use of dental forceps can be summarized as follows:

1. In order to increase the power arm and improve the extraction efficiency, try to hold the handle of the forceps at the distal end of the forceps as much as possible.

2. When the forceps enters the mouth, it should be opened at an angle so that the distance between the beaks of the forceps is slightly larger than the width of the crown. Avoiding excessive opening of the forceps in the deep part of the mouth can cause the joint side edges to close and pinch the buccal mucosa.

3. After the forceps are in place, the beak of the forceps should hug the crown firmly to avoid point-to-line contact, so as to avoid crushing the crown due to uneven force when applying force. The top of the forceps beak should be located between the alveolar bone and the root of the tooth below the enamel cementum. Make sure that the forceps beak is parallel to the long axis of the affected tooth and that the gums and adjacent teeth are not mistakenly clamped.

4. When extracting the affected tooth, the rotation force and the wedge force toward the root of the affected tooth should be the main part. When using rotational force, pay attention to the principle of moderation, so as not to cause a broken root due to an excessively large rotation angle in the same direction.When operating, you can first rotate a certain angle clockwise, and then rotate a certain angle counterclockwise and continue to deepen into the root. The increase of the looseness increases the amplitude of the rocking force and the angle of rotation, and finally dislocation of the affected tooth by traction.

5. When the operation is intensified, the surgeon should place the thumb and index finger of the other hand on the affected tooth and the adjacent tooth, so as to sense the movement of the affected tooth and the adjacent tooth to avoid damaging the adjacent tooth. Pay attention to observe whether there is a blood bubble-like fluid exudation at the margin of the affected gum during the afterburning process to determine whether the periodontal ligament of the affected tooth is torn. In addition, the finger should also sense whether the looseness of the affected tooth increases during the continuous afterburning process to determine whether the afterburning process is effective.

6. When dislocation of the affected tooth, in order to protect the maxillary teeth, the thumb of the left hand should be located at the joint of the forceps, the affected tooth should be taken out from the weaker side of the bone, and the traction should be controlled to avoid damage to the jaw due to violence. ^[3]

Precautions when using extraction forceps

1. Correctly select dental forceps according to the extraction position.

2. According to the shape of the teeth, try to choose the forceps that can be firmly clamped;

3. The forceps should be properly placed on the neck of the tooth, so as not to hurt the adjacent teeth;

4. Use proper force, combining shaking, twisting and traction.

Dental extraction forceps

[1] Hu Kaijin. Atlas of standard extraction surgery [M]. Beijing: People's Medical Publishing House.

[2] Tian Weidong. Practical dental extraction [M]. Sichuan: Sichuan University Press.

References for extraction forceps

[1] Hu Qinyouyang. Application analysis of dental extraction in oral treatment [J]. Electronic Journal of General Stomatology, 2017, 4 (07): 13-14.

[2] Pan Jian, Zhang Zhuang, Hua Chengyi. Standard extraction instruments and their use [J]. China Journal of Practical Stomatology, 2010, 3 (10): 581-584.

[3] Wang Jingjuan, Liu Chuan, Zhang Shuyin, Hu Kaijin. Selection and Application of Conventional Extraction Instruments [J]. China Journal of Practical Stomatology

2016, 9 (10): 577-580.