Understanding Forceps Design
Extraction forceps are designed with specific beak shapes, handle angles, and sizes to match different teeth and positions in the arch. Selecting the correct forceps is critical for an atraumatic extraction that preserves the alveolar bone and surrounding tissue.
Upper Arch Forceps
Anterior Teeth (Incisors & Canines)
- No. 1 (Universal Upper Anterior): Straight-handled with narrow beaks for incisors and canines
- The beaks should be positioned parallel to the long axis of the tooth
- Use a slow, controlled rotational motion for single-rooted teeth
Premolars
- No. 150 (Universal Upper): The most commonly used upper forceps; suitable for premolars and roots
- Slightly angled handle provides better access to the premolar region
- Apply buccal-palatal rocking motion rather than rotation
Molars
- No. 53R / 53L (Upper Molar): Right and left versions with a pointed beak to engage the buccal bifurcation
- No. 210S (Upper Third Molar): Bayonet-shaped for posterior access
- Always identify the number of roots and any divergence on the radiograph before selecting forceps
Lower Arch Forceps
Anterior Teeth
- No. 151 (Universal Lower): Angled handle with narrow beaks for lower incisors, canines, and premolars
- Beaks should adapt to the cervical area below the CEJ
Molars
- No. 17 (Lower Molar): Pointed beaks engage the furcation on both buccal and lingual sides
- No. 222 / 23 (Cowhorn): Designed to engage the furcation directly — particularly effective for teeth with significant decay
- Apply figure-of-eight motion for lower molars: buccal, lingual, then delivery
Grip Technique
Proper grip is essential for control and to minimize fatigue:
- Use the palm grip for maximum control — wrap the hand around the handle with the thumb on the outer surface
- Position your wrist in a neutral alignment to generate force from the forearm, not the fingers
- The opposite hand should always support the alveolar bone and retract soft tissue
- Apply slow, steady, progressive force — never jerk or use sudden movements
Elevation Before Extraction
Proper elevation with a periosteal elevator or straight elevator before applying forceps makes the extraction significantly easier:
- Reflect the gingival attachment around the tooth
- Use a #9 Molt periosteal elevator to separate the soft tissue
- Apply a straight elevator (No. 301 or 34S) into the PDL space to begin luxation
- Only transition to forceps once the tooth demonstrates initial mobility