PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

buccal expansion. Labially displaced lower canines are removed in a manner similar
to that described for buccally placed upper anteriors. Mesial and distal application of
forceps or straight elevators are used. Straight elevators are used on lower incisors
that are labially placed. The position of lingually placed lower anteriors normally
precludes the use of forceps and straight elevators applied mesially and distally should
be employed.


LOWER PRIMARY MOLARS
These teeth are removed by buccolingual expansion of the socket. They can be
extracted using either lower primary molar or lower primary root forceps. Lower
primary molar forceps are similar in design to the permanent molar forceps. They
have two pointed beaks which engage the bifurcation. Lower primary root forceps are
used by applying the beaks to the mesial root of the primary molar. Lower first
primary molars are usually more easily removed with lower primary root forceps.
After application of the forceps a small lingual movement is followed by a continuous
buccal force, which delivers the tooth.


LOWER PREMOLARS
When these teeth are fully erupted in the arch of the young patient they are usually
simply removed by a rotatory movement around the long axis of the root using lower
premolar forceps. Malpositioned lower second premolars are normally lingually
positioned and can be difficult to remove with lower forceps. When lingually placed,
lower premolars may be extracted using straight elevators applied mesially, lingually,
and distally. Alternatively, it is often possible to apply the beaks of upper fine root
forceps mesially and distally to the crown of the lingually placed tooth when the
forceps are directed from the opposite side of the jaw. Gentle rotation of the tooth
with the forceps may then effect removal.


LOWER PERMANENT MOLARS
Two designs of forceps are used to extract lower molar teeth. The lower molar forceps
have two pointed beaks that are applied in the region of the bifurcation buccally and
lingually. Once applied the forceps are used to move the tooth in a buccal direction to
expand the buccal cortical plate. When buccal expansion is not sufficient to deliver
the tooth then the forceps should be moved in a figure-of-eight fashion to expand the
socket lingually as well as buccally, and this is generally successful.


A different technique is used with forceps of the cowhorn design. These forceps have
two beaks that taper to a point. The points are applied to the bifurcation of the lower
molar in a manner identical to that described above. The next movement is to squeeze
the forceps handles together, which results in the beaks approaching one another at
the base of the bifurcation. The only way the beaks can approach each other is by
displacing the tooth in an occlusal direction resulting in extraction of the tooth. Both
the methods are successful in removing permanent molar teeth in children and the
choice of technique depends mainly on the preference of the operator.


Management of buried teeth


Buried teeth (including supernumeraries) are treated in children for several reasons:


(1) symptomatic (e.g. pain);

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