Extractions 101: Tools of the Trade
Extractions. This could be one of the most feared words by patients sitting in the chair (the other being needles). Whilst at CDP we aim to help our patients keep their teeth for as long as possible, sometimes there is just no other viable option. Maybe the financial cost of a root canal plus crown is too high, the tooth is just too heavily damaged to be restored to a satisfactory degree. Either way, the tooth needs to come out. Rest assured the decision to remove your tooth is not reached lightly and you will be completely numb before any of these tools are used. We can also refer you to a specialist oral surgeon for your extraction if it looks too difficult or you wish to have a general anaesthetic.
Some people may think that all adult teeth can be yanked out fairly quickly like a wobbly baby tooth. If only it were that simple! Just like the people whose mouths they sit in, teeth and their roots come in all shapes and sizes; long or short, thick or thin, straight or curved. Some roots are even bulbous or have multiple curves. And this is just for a single root! Many back teeth often have two, three or even four roots and it gets tricky when those roots decide to all curve in different directions. To deal with all these variations, the dentist has to have a wide range of extraction tools at their fingertips, some of the more common ones which will be shown here.
Luxators and Elevators
These are single bladed instruments for extracting teeth and roots and are the first tools to be used during a procedure. These tools are used by wedging the tip between the root surface of the tooth and the surrounding bone, to help create space. At the same time, the luxator/elevator severs the periodontal ligament fibres that bind the root surfaces to bone. The end result is the tooth becomes looser in the socket. Once in place down the root surface, the luxator/elevator can then be used to elevate (lift) the tooth with a turning motion. Depending on the task at hand, the luxator/elevator tip can vary in shape and size. Often luxators/elevators are used to loosen up the tooth before forceps are used to take it out but in some cases the luxator/elevator alone can be sufficient to deliver the tooth.
Straight/Curved Luxator: The basic luxator that dentists will usually start the procedure with. They come in a few different sizes and luxators specifically for back teeth have a slight bend near the tip. Strictly speaking, luxators are elevators with a fine sharp tip mainly for wedging down the root surface and severing the periodontal ligaments (most other elevators have blunt tips). In practice though most luxators can also be used for elevating the teeth.
Cryer’s Elevators: Curved elevators with pointed tips. Used to remove roots or parts of roots with a turning motion.
Root tip elevators: Very fine pointed elevators. Used to deliver small root tip fragments that have broken inside the socket.
Forceps are specialised tools for gripping onto the tooth. Ideally enough space should have been created between the tooth and surrounding bone beforehand via luxation that the forceps can grip as far down onto the root as possible for maximum support. A lot of teeth that need to be extracted have heavily decayed crowns (the visible part of the tooth above your gums) so if you only grab onto the crown chances are they will break! Once the forceps have gripped onto the tooth, a range of motions (depending on what tooth it is) from rotating to wiggling back and forth to vertical pulling is applied to remove the tooth from the socket. Depending on the tooth in question, the forceps used will vary in shape and size.
Upper Straights: Used for the top front teeth to canines or for broken roots for other top teeth. The gripping tips can be long, short, wide or fine. Upper straights for canines especially are shorter and wider at the tip and are often nicknamed ‘stubbies’.
Upper Universals: Used for premolars. The gripping tips can be long, short, wide or fine.
Upper Molars: Used for molars. Divided into those used for top left or top right molars. You can tell as the gripping tip that is pointier should be on the side closer to the patient’s cheek.
Bayonet forceps: Used for upper wisdom teeth. Comes in different sizes.
Lower Universals: Used for all bottom teeth from the front to the premolars. The gripping tips can be long, short, wide or tine.
Lower Molars: Used for bottom molars. Unlike upper molar forceps, both gripping tips are pointy and lower molar forceps can be used on teeth on both sides.
Root Tip Forceps: Used for grasping broken root tips left inside sockets. Have much finer tips than other forceps.
These are just a fraction of the different luxators, elevators and forceps designs out there. As you can tell by now, extractions can be deceptively difficult and don’t be surprised if the dentist’s tray becomes more and more filled up with different instruments during a tricky procedure! We at CDP will be here to support you all the way for your required treatment.
By Dr Joe Wei