will be elevated after application to only one of these surfaces. When the curved
Warwick James elevators are used, the right-sided Warwick James is positioned on
the mesiobuccal surface of upper right teeth and the distobuccal surface of upper left
teeth, and then rotated towards the mid-line of the tooth. The left-sided instrument is
used on the opposite root surface in a similar fashion.
Palatally positioned lateral incisors and canines are usually not accessible with
forceps and thus elevators are used as described above, with the exception that they
are applied on the palatomesial and palatodistal surfaces. When the curved elevators
are used the right-sided instrument is applied distally on the right side and mesially on
the left side.
UPPER PRIMARY MOLARS
These teeth display the most widely splayed roots found in either dentition and thus
considerable expansion of the socket is required. Upper primary molar forceps are
used and applied to the roots. The initial movement after application of the forceps is
palatal, to expand the socket in this direction. The tooth is then subjected to a
continuous bucally directed force, which results in delivery. Occasionally, buccal
movement is not adequately obtained due to gross caries on the palatal aspect causing
slippage of the forceps beak on the palatal side during buccal expansion. This may be
overcome by completing the extraction by continued palatal expansion, the elastic
bone of younger patients allowing this to be performed.
UPPER PREMOLARS
The two-rooted, upper first premolar is best removed by buccal expansion using upper
premolar forceps. The upper second premolar is often single rooted and, although
buccal expansion with premolar forceps should be attempted in the first instance, this
tooth can also be subjected to a rotation about its long axis to effect delivery. Palatally
displaced upper premolars are difficult to remove with forceps. The use of elevators in
a manner similar to that described for palatally placed canines is preferred.
UPPER PERMANENT MOLARS
These teeth are removed using left and right upper molar forceps. Following
application of the forceps to the roots of the tooth (the pointed beak being driven
towards the buccal root bifurcation) the tooth is delivered by expanding the socket in
a buccal direction. The use of palatal expansion is not as successful in the removal of
permanent molars, but it may be worth attempting if buccal expansion fails to deliver
the tooth. The problem with palatal expansion when extracting permanent molars is
that it can cause fracture of the palatal root, which is usually the most closely
associated with the maxillary antrum.
LOWER PRIMARY ANTERIORS
These teeth are extracted in the same manner as their upper counterparts, in that,
rotation about the long axis using lower primary anterior or root forceps is employed.
LOWER PERMANENT ANTERIORS
Permanent lower incisors are not readily removed by rotation as their roots are thin
mesiodistally and rotation is likely to cause root fracture. The most effective method
of removal is to apply lower root forceps and expand the socket labially. Permanent
lower canines may be delivered by a rotatory movement about the long axis or by