1. Positioning during extraction
Dr. MUMENA

2. REQUIREMENTS BY DENTAL PRACTIONNER
Instruments most appropriate for intended extraction
Positioning
Chair
Patient’s head
Practitioner
Position if facilitated by dividing the dental arches into 6 sextants

3. Upper right sextant (1) Operator position: Chair position:
Standing in front of the patient (7. O clock)
Chair position:
Full tilt, back at 150
Patient position
Mouth at operator’s elbow level
Maxillary arch nearly perpendicular to the floor
Head towards operator

4. Upper anterior sextant (2)
Operator position:
Standing in front of the patient (7. O clock)
Chair position:
Full tilt, back at 150
Patient position
Mouth at operator’s elbow level
Maxillary arch nearly perpendicular to the floor
Head straight or turned toward the operator

5. Upper left sextant (3) Operator position: Chair position:
Standing in front of the patient (7. O clock)
Chair position:
Full tilt, back at 150
Patient position
Mouth at operator’s elbow level
Maxillary arch nearly perpendicular to the floor
Head towards operator

6. Lower right sextant (6) Operator position: Chair position:
Standing behind patient (11. O clock)
Chair position:
Back at 600
Patient position
Mouth slightly below operator’s elbow level
mandibular arch nearly parallel to the floor
Head facing forward

7. Lower anterior sextant (5)
Operator position:
Standing beside the patient’ head (9 or 10. O clock- when using universal), (7-Oclock when using ash forceps)
Chair position:
Back at 600
Patient position
Mouth slightly below operator’s elbow level
Mandibular arch nearly parallel to the floor
Head facing forward

8. Lower left sextant (4) Operator position: Chair position:
Standing at the side the patient (8 or 9. O clock- when using forehand grasp on forceps), or (behind patient 10 or 11-Oclock when using backhand grasp on forceps)
Chair position:
Back at 600
Patient position
Mouth slightly below operator’s elbow level
mandibular arch nearly parallel to the floor
Head facing forward

9. Tooth extraction technique
Dr MUMENA C.H

10. Chair position Important factor for both patient and practitioner
Incorrect position or height lead to discomfort or muscular stress for the operator, this can result
Un necessary fatigue
Possibly failed extraction

11. Chair position cont…
Extraction of upper teeth: Chair positioned such that site of operation at elbow height, and chair tipped back at 450

12. Sextant 3 extraction

13. Chair position cont…
Extraction of teeth lower left quadrant (lower left molars) and lower anterior teeth
Site of operation should be or just below the elbow height, chair tipped back at approximately 300

14. Sextant 5 in sitting position

15. Chair position cont…
Extraction of teeth in the right quadrant (Right molars)
Site of operation should be 6” (15cm) just below the elbow height with chair tipped back only slightly.

16. Sextant 6 extraction

17. Operator position Operator position important like chair position,
Incorrect posture can make
Extraction difficult
Long time back problem for the operator
Position described are the right hand operator.

18. Operator position cont…
Extraction of the teeth in the upper arch, lower left molars & anterior teeth: operator position should be standing and facing the patient on the left of dental chair (Right hand side of patient)
Extraction of lower right molars: operator should be standing right hand side and behind the patient

19. Extraction of teeth in the maxilla
Upper central incisors:
Removed primarily by buccopalatal rotational movement,
Final movement buccal direction

20. Extraction of teeth in the maxilla
Upper lateral incisors:
Movement in the buccopalatal movement
Final removal requires rotational movement/delivery
Upper canines like upper lateral incisors

21. Extraction of teeth in the maxilla
Upper molars:
Primary movement is buccopalatal only

22. Extraction of the mandibular teeth
Lower incisor and canines:
Primary movement is buccolingual with rotational delivery

23. Extraction of the mandibular teeth
Lower molars:
Primary movement is buccolingual with rotational delivery

24. Functions of non-forceps hand
Tooth extraction is a two handed procedure.
Non forceps hand;
Displaces the tongue, lips and cheeks from the operation site improving and visibility to the site of opeeration
Protects the patient from damage from the surrounding structures
Distracts the patient while positioning the forceps on the tooth with such Phrases “ I am just going to firmly squeeze the sides of your tooth”
It also holds/support the jaw firmly

25. Functions of non-forceps hand
After extraction record the following:
The teeth/roots extracted
The method of obtaining local anethesia/analgesia
The quantity and anesthesia used
Any problems encounterd, e.g. fractured roots, perforation of the sinus, e.t.c.
Post operative advice given

26. Requirements of tooth extraction
Local anesthesia
Extraction forceps and elevatore

27. Local anesthesia Topical anesthesia; Preparations includes:
10% Lignocaine Hydrochloride spray
5% Lignocaine hydrochloride gel
20% Benzocaine gel (Usually flavored with attractive tastes e.g bubble gum, preferred by children)

28. Local anesthesia Infiltration/injectable anesthesia
The most common choice of anethesia includes:
2% Lignocaine with 1:80,000 adrenaline
3% Prilocaine (Citanest) with felypressin
4% Articaine with 1:100,000 adrenaline