Positioning during extraction Dr. MUMENA

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

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

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

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

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

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

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

Tooth extraction technique Dr MUMENA C.H

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

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

Sextant 3 extraction

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

Sextant 5 in sitting position

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.

Sextant 6 extraction

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.

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

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

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

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

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

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

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

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

Requirements of tooth extraction Local anesthesia Extraction forceps and elevatore

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)

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