Forceps selection directly influences the efficiency, safety, and predictability of dental extractions. Evidence shows that matching the correct instrument to the tooth anatomy, root morphology, and bone density significantly reduces complications such as root fracture, alveolar bone damage, and postoperative pain.
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✅ Introduction
Tooth extraction remains a core procedure in clinical dentistry. The choice of forceps must consider crown morphology, root curvature, bone density, and the periodontal condition of each tooth. A correct forceps selection enhances mechanical advantage, minimizes alveolar trauma, and improves overall procedure efficiency and patient outcomes.
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1. Maxillary Teeth (Upper Teeth)
➤ Maxillary Incisors
▪️ Recommended forceps: No. 1 or No. 99C
▪️ Key features: Straight beaks adapted to conical roots.
▪️ Technique notes: Labial-lingual rocking with minimal rotation.
➤ Maxillary Canines
▪️ Recommended forceps: No. 150
▪️ Key features: Stronger root requiring controlled luxation.
▪️ Technique notes: Avoid excessive rotation because of long root length.
➤ Maxillary Premolars
▪️ Recommended forceps: No. 150A
▪️ Key features: Thin beaks fit narrow neck morphology.
▪️ Technique notes: Buccal forces are preferred due to thin cortical bone.
➤ Maxillary Molars
▪️ Recommended forceps: No. 53R/53L or No. 210S (third molars)
▪️ Key features: Curved beaks designed to engage diverging roots.
▪️ Technique notes: Buccal traction with controlled figure-eight motion.
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➤ Mandibular Incisors
▪️ Recommended forceps: No. 151
▪️ Key features: Narrow beaks for compressed cervical area.
▪️ Technique notes: Labial traction, minimal rotation.
➤ Mandibular Canines
▪️ Recommended forceps: No. 151 or No. 13
▪️ Key features: Strong root anchorage.
▪️ Technique notes: Luxation must be slow to avoid root fracture.
➤ Mandibular Premolars
▪️ Recommended forceps: No. 151A
▪️ Key features: Versatile angulation for narrow necks.
▪️ Technique notes: Gentle rotation is possible due to single-root anatomy.
➤ Mandibular Molars
▪️ Recommended forceps: No. 17 or No. 23 ("cowhorn")
▪️ Key features: Deep beaks fit furcations in multirooted molars.
▪️ Technique notes: For No. 23, use pumping motion to elevate tooth coronally.
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▪️ Adequate luxation before applying traction.
▪️ Stabilizing the alveolus with counter-pressure.
▪️ Avoiding excessive rotational forces in multi-rooted teeth.
▪️ Ensuring correct fulcrum position to avoid cortical plate fracture.
📊 Comparative Table: Differences Between Adult and Pediatric Forceps
| Aspect | Advantages | Limitations |
|---|---|---|
| Size & Dimensions | Pediatric forceps are smaller and designed to fit limited oral openings; reduce soft-tissue interference. | Smaller size provides less mechanical advantage and may limit grip on large or multi-rooted teeth. |
| Beak Design & Adaptation | Pediatric beaks are shaped to match primary tooth crowns and slender roots, minimizing accidental damage to developing permanent teeth. | Adult beaks offer broader purchase on permanent tooth anatomy; pediatric beaks may not engage adequately on malformed or erupted permanent teeth. |
| Handle Length & Leverage | Shorter handles improve control in small mouths and reduce operator hand fatigue during pediatric procedures. | Reduced leverage can make difficult extractions more challenging and may necessitate adjunctive techniques (e.g., elevators). |
| Trauma Risk & Clinical Use | Pediatric forceps tend to be less traumatic to alveolar bone and adjacent tissues when used correctly; suited for atraumatic extractions in children. | Adult forceps provide greater force and may cause collateral damage in small jaws; pediatric instruments may be unavailable in some settings. |
Current literature emphasizes that extraction success depends not only on clinician skill but also on matching forceps geometry to tooth anatomy. Forceps with anatomical beaks distribute forces more efficiently, reducing risk of alveolar bone damage. However, universal forceps remain valuable in pediatric and general practice settings due to their adaptability.
Newer ergonomic designs and improved steel alloys have increased precision and tactile feedback, but biomechanical principles remain unchanged: controlled force, correct fulcrum, and proper luxation are essential.
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Correct forceps selection according to tooth type enhances procedural predictability, minimizes trauma, and improves postoperative healing. Universal forceps are practical, but anatomy-specific instruments provide superior biomechanical efficiency in complex extractions. Mastery of both instrument selection and atraumatic technique remains essential for safe and successful practice.
🔎 Recommendations
▪️ Use universal forceps for routine anterior extractions but switch to anatomy-specific instruments for molars.
▪️ Apply controlled luxation before traction to minimize fractures.
▪️ Incorporate clinical radiographic evaluation to anticipate root divergence, curvature, or anomalies.
▪️ Consider specialized forceps (#23 cowhorn) for mandibular molars with advanced interradicular bone loss.
📚 References
✔ Bouloux, G. F., Steed, M. B., & Perciaccante, V. J. (2007). Complications of third molar surgery. Oral and Maxillofacial Surgery Clinics of North America, 19(1), 117–128. https://doi.org/10.1016/j.coms.2006.11.009
✔ Hupp, J. R., Ellis, E., & Tucker, M. R. (2018). Contemporary Oral and Maxillofacial Surgery (7th ed.). Elsevier.
✔ Peterson, L. J., Ellis, E., Hupp, J. R., & Tucker, M. R. (2012). Peterson’s Principles of Oral and Maxillofacial Surgery (3rd ed.). PMPH-USA.
✔ Tsichlaki, A., & Jones, K. (2019). Mechanical considerations in dental extractions. British Dental Journal, 226, 403–410. https://doi.org/10.1038/s41415-019-0077-8
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