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Within
the oral and maxillofacial surgery setting, mandibular forceps are an ideal
collection of instruments utilized for the extraction of lower-jaw teeth that
is efficient, anatomy-focused, and secure. Through their wonderful precision,
they make extraction of mandibular teeth possible by crown grasping through
forceful, firm grasp with force being applied as a focus on mobilization and
extraction from alveolar bone. In exodontia and in intricate surgery,
mandibular forceps are an asset of dental surgeons that provides leverage as
well as control.
In
order to approximate mandibular forceps design and use, one should be well
familiar with the anatomical features of the mandible:
•Mandibular
Arch: Supports lower
teeth—central incisors, lateral incisors, canines, premolars, and molars.
•Alveolar
Process: The bony
ridge over the teeth sockets.
•Bone
Density: Denser than
maxillary bone, more force and leverage needed to remove.
•Mandibular
Canal: Holds the
inferior alveolar nerve, which must be avoided when extracting.
•Angle
and Ramus:
Structural features that affect direction and access in extractions.
Dental
forceps are categorized according to:
Maxillary
Forceps
Mandibular
Forceps
Incisor
Forceps
Canine
Forceps
Premolar
Forceps
Molar
Forceps
Root
Tip Forceps
English pattern (vertical handle)
American pattern (horizontal handle)
Mandibular
forceps are specifically designed to fit on the lower jaw. They have:
•Handles: Angled for placement of hand
leverage and traction.".
•
Beaks: Serrated or
sharp tips for acceptance of mandibular tooth structure.
• Shank Design: Curved and longer for accessing posterior areas.
• Fulcrum Mechanism: Mechanical advantage for elevation and luxation.
Forceps
are also categorized by tooth shape and location. Some of the most widely used
types are:
Universal
mandibular forceps.
For
lower incisors, canines, and premolars.
Also
known as "Ash forceps" or "Bird beak forceps.
For
lower anterior teeth.
Specifically for mandibular molars.
Has
pointed beaks that engage the bifurcation.
For
lower molars with bifurcated roots.
Has
pump handle motion to raise.
Reserved
for deeply placed or decayed molars.
Narrow
beaks for tip engagement of root.
Reserved for deciduous mandibular teeth.
Each
forceps is designed specifically to be employed for a special surgical
function:
Beaks
should contact lingual and buccal sides to be secure.
Curvature
is same with dental arch.
To
reduce fatigue and improve control.
Perpendicular
to handle in mandibular forceps to direct vertical position of lower teeth.
Successful
mandibular extraction has the following steps:
Radiograph examination.
Evaluation of tooth mobility, root morphology, and adjacent anatomy.
Inferior
alveolar nerve block.
Patient's
head slightly back.
Operator
in front or side depending upon tooth.
Beaks
approximating cervical line of the tooth.
Buccal-lingual
rocking for anterior teeth.
Rotational
force for single-rooted teeth.
Pump-handle
action for molars with forceps No. 23.
•
Forceps No. 101 or 151S are used.
•
Fine usage and small-hand constructed.
•
Short beaks and handles for receiving smaller teeth.
Most
frequently occurring complications are:
•
Root Fracture:
Prevented by proper beak design.
•
Alveolar Fracture:
Prevented by anatomically selected forceps.
• Soft Tissue Injury: Prevented by rounded surfaces and controlled sliding.
• Displacement of tooth into soft tissue: Improper or inadequate grip and/or improper selection of forceps heightens the risk.
The
mandibular forceps will have to be
•
Autoclaved between patients.
•
Inspected for rust, loose articulations or wear.
•
Lubricated in the hinges so that they move freely.
•
Stored in padded, dry trays to avoid damage.
Emerging
technology advancements are:
•
Enhanced Serrated Grip for enhanced tactile sensitivity.
•
Titanium Coated Instruments to resist corrosion.
•
Laser Etched Calibration Sets to assist identification.
• Color-Coded Sets of forceps to distinguish.
• 3D Printed Prototype Models for individualized patient use.
Students
are instructed by dental schools in:
•
Recognition of varieties of forces.
•
Application techniques on models and patients.
•
Regulation of forces to prevent overuse or injury.
•
Examination after the operation of socket integrity.
•
Periosteal Elevators:
To reflect gingiva.
•
Luxators: To loosen
periodontal ligament.
• Bone Files or Rongeurs: In case of alveoloplasty.
• Suction Tips: To maintain the field dry.
•
Mandibular Beaks:
Parallel to handle.
•
Handle Length: More
length for deep access.
•
Force Application:
Requires more torque.
•
Operator Positioning:
More vertical access for the lower arch.
Uses
No. 222 or surgical forceps.
Combined
with bone guttering.
No.
74 forceps with careful beak adaptation.
•
Forcing Beaks:
Fractures enamel or root.
•
Inappropriate Choice of Forceps: Makes
the procedure more challenging.
•
Two-Point Contact Failure:
Causes slippage.
•
Failure to Obtain Preoperative X-rays:
Places at risk anatomical injury.
Mandibular
forceps are not a mechanical device—beware, they are the intersection of
surgical science and anatomical delicacy. Used in the dental tissues with
correct technique, they can provide successful, atraumatic removals of teeth.
From ancient No. 151 to Cowhorn No. 23 for a special indication, they all
belong to the dentist-surgeon's arsenal. The ability to manipulate these
forceps is not so much a reflection of surgical skill as evidence of the
dedication of the dentist to the well-being of patients.