Surgical Extraction Tray Setup

Key points

• The simple and surgical trays share one core; the surgical tray adds instruments for a flap, bone removal and sectioning.
• Forceps are chosen by tooth and by pattern number, and English and American numbers don't match, so order by both.
• For the instruments themselves, in order of use, see the tooth extraction instruments guide; this page covers the tray and the procedure.

Step by step

1. 1

   Confirm the tooth and the plan

   Check the radiograph, the tooth number and the consent against the tray. For an impacted molar, note the depth, the angulation and how close the roots are to the inferior alveolar canal.

   Dental Mouth Mirrors

2. 2

   Anaesthetise and seat the mouth prop

   Give buccal and palatal infiltration for an upper molar, or an inferior alveolar block with buccal infiltration for a lower molar. Place the mouth prop on the opposite side to support the jaw.

   Dental Aspirating Syringes (Dental Anaesthetic Syringes)

3. 3

   Free the gingiva or raise a flap

   For a simple extraction, detach the gingival cuff with the periosteal elevator; where an implant is planned, a periotome can cut the ligament first to spare the socket walls. For an impacted molar, make a two- or three-sided incision with a buccal relieving cut and reflect a full-thickness flap.

   Dental Scalpel Handles and BladesPeriosteal Elevators: Molt 9, Freer, Buser and Other PatternsPeriotomes for Atraumatic Extraction

4. 4

   Retract and remove bone

   Hold the flap with a Minnesota or Austin retractor resting on bone. Cut a buccal gutter with a surgical bur under sterile saline irrigation, or use a chisel and mallet where that is the surgeon's preference.

   Dental and Oral Surgery RetractorsBone Chisels and Surgical Mallets in DentistrySurgical Suction Tips for Oral Surgery

5. 5

   Section and elevate

   Divide a multi-rooted impacted tooth at the furcation if it will not lift out whole. Luxate with a straight elevator, fulcrum on bone and never on the adjacent tooth, and use Cryer elevators for the remaining roots.

   Dental Elevators and Luxators

6. 6

   Deliver with forceps

   Seat the forceps as far apically as possible on root surface. Deliver an upper first molar with steady buccal and palatal pressure, and a lower molar with No. 17 or No. 16 cowhorn forceps.

   Dental Extraction Forceps

7. 7

   Debride and smooth the socket

   Remove the follicle and granulation tissue with a surgical curette, without curetting the apex of a lower third molar socket. Trim sharp margins with a rongeur and finish them with a bone file.

   Surgical Curettes (Bone Curettes) for Oral SurgeryDental Rongeurs and Bone Files

8. 8

   Irrigate and close

   Irrigate with sterile saline and check for fragments. Replace the flap, close with sutures using the needle holder and tissue forceps, and cut the tails with suture scissors.

   Dental Needle Holders (Needle Drivers)Dental Tissue Forceps (Toothed and Non-Toothed)Dental Surgical Scissors

9. 9

   Pressure and aftercare

   Have the patient bite on a damp gauze pack for at least five minutes and check haemostasis before they leave. Give written aftercare and book suture removal on its own small tray if non-resorbable sutures were used.

   Dental Cotton Pliers (Dental Tweezers)Suture Removal Tray Setup

Tray checklist: simple upper molar extraction

A routine extraction of an upper right first molar uses the universal surgical tray with one elevator and the forceps for that tooth. For a lower first or second molar the tray is identical except that No. 17 lower molar forceps replace the 88R.

What is added for an impacted lower molar?

Lower third molars are the teeth most often impacted; a StatPearls review by Muhsin and Brizuela puts the share with some degree of impaction at 17% to 69%. The surgical tray adds instruments for the flap, bone removal and sectioning.

Which forceps go on which tray?

Forceps numbers belong to a pattern, not to a tooth. Equate's catalogue shows the trap: an English-pattern Fig. 17 is an upper right molar forceps, while an American-pattern Fig. 17 is a lower molar forceps. State the pattern and the figure when ordering or restocking a tray. The table lists only the forceps these trays use; the full numbered forceps table is in the oral surgery and extraction instruments guide.

How are the trays laid out and reprocessed?

Lay each tray out left to right in the order of the steps above: examination, flap, bone removal, elevators, forceps, debridement, closure. Keep the mallet and chisel together at the far end so the chisel is never struck by mistake when not in use, and keep the burs in a bur block rather than loose on the tray.

Every instrument here enters bone or soft tissue, so the CDC's 2003 guidelines class it as critical: clean, then heat-sterilise, and store it wrapped. The same guidelines call for sterile saline or sterile water as the irrigant for surgical procedures and sterile surgeon's gloves. Open forceps, rongeurs and needle holders for cleaning, brush bone debris out of rongeur jaws and file teeth, lubricate the joints and check the cutting edges before packing. Follow each manufacturer's ISO 17664-1 instructions and, in England, HTM 01-05.

What are the common mistakes in extraction tray setup?

• Picking forceps by figure number alone and getting the wrong pattern.
• Using the adjacent tooth as a fulcrum for the elevator.
• Turning a T-bar elevator hard before the root is free: the torque can fracture the buccal plate or the mandible (see the oral surgery and extraction instruments guide).
• Using a root-tip elevator or pick as a lever against the sinus floor or near the inferior alveolar canal.
• Cutting bone with an air turbine instead of a surgical handpiece, which can force air into the tissues.
• Seating the forceps on crown instead of root, which fractures the crown.
• Removing lingual bone near a lower third molar, which puts the lingual nerve at risk.
• Curetting the apex of a lower third molar socket, close to the inferior alveolar nerve.
• Leaving sharp bone edges that the patient feels through the healing gum.

Build these trays with Equate

Equate covers both trays from its oral surgery range. For the upper molar there are 6 upper right molar forceps, including American-pattern Fig. 88R, 53R and 18R, plus 18 universal forceps, among them Fig. 150 and 151. The 27 lower molar forceps include Fig. 16, 17 and 23 American patterns. There are 24 straight elevators, including 2, 3 and 4 mm blades and a 13 mm Walter pattern, and 12 Cryer elevators, left and right, in 8 and 12 mm.

For bone work there are 9 side-cutting and 6 end-cutting rongeurs, 23 straight bone chisels from 1 to 9 mm and 6 surgical mallets, 4 with replaceable plastic faces, plus bone file rasps and 10 surgical suction tubes from 1.5 to 5 mm. Instruments are designed in Finland. Clinics can request samples and a quote, or compare the ready-made sets on the tooth extraction instruments page.

Equate Surgical Extraction Tray Setup options

Hirschfeld File 3/7 - Anatomical Solid Handle 6 mm

EI-1958

Hirschfeld File 5/11 - Anatomical Solid Handle 6 mm

EI-1959

Hirschfeld File No. 9 - Solid Handle 6mm

EI-1960

Sugarman File 1S/2S - Solid Handle 6 mm

EI-2159

Sugarman File 3S/4S - Solid Handle 6 mm

EI-2160

Schluger File 9/10 - Solid Handle 6 mm

EI-2161

Back File 11/12 - Solid Handle 6 mm

EI-2162

Cryer Elevator Fig.31 - Right, 12 mm

EI-0324

Cryer Elevator Fig.32 - Left, 12 mm

EI-0325

Bone Chisel Double Cut 3 mm

EI-0554

Bone Chisel Double Cut 6 mm

EI-0555

Extraction Forceps - Fig. 17 Upper Right Molars

EI-0641

Buying in your market

• UK & Ireland
• North America
• DACH
• Nordics & Scandinavia
• Baltics
• GCC
• Turkey

Frequently asked questions

References

1. Hupp JR, Tucker MR, Ellis E. Contemporary Oral and Maxillofacial Surgery, 7th edition. Elsevier, 2018 (principles of routine and complicated exodontia; management of impacted teeth)
2. Muhsin H, Brizuela M. Oral Surgery, Extraction of Mandibular Third Molars. StatPearls, StatPearls Publishing, 2023
3. Gadhia A, Pepper T. Oral Surgery, Extraction of Teeth. StatPearls, StatPearls Publishing, 2023
4. Kohn WG, Collins AS, Cleveland JL, Harte JA, Eklund KJ, Malvitz DM. Guidelines for Infection Control in Dental Health-Care Settings, 2003. MMWR Recommendations and Reports 52(RR-17), Centers for Disease Control and Prevention, 2003
5. Department of Health. Health Technical Memorandum 01-05: Decontamination in primary care dental practices, 2013 edition
6. ISO 17664-1:2021 Processing of health care products: information to be provided by the medical device manufacturer for the processing of medical devices, Part 1
7. Boyd LB. Dental Instruments: A Pocket Guide, 7th edition. Saunders/Elsevier, 2020. Chapter 17, Oral Surgery Extraction Instruments (photographs used under licence)
8. Rohe C, Schlam M. Alveolar Osteitis. StatPearls, StatPearls Publishing, updated 29 May 2023
9. Scottish Dental Clinical Effectiveness Programme. Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs, 2nd edition, 2022
10. Canadian Dental Association. Oasis Discussions: which handpiece for surgical extractions? Answer by Dr Suham Alexander and Dr George Sandor, 20 March 2014

Related

• Tooth Extraction Instruments
• Dental Extraction Forceps
• Dental Elevators and Luxators
• Oral Surgery Tray Setup
• Suture Removal Tray Setup
• Dental Rongeurs and Bone Files
• Oral Surgery and Extraction Instruments
• Surgical Curettes (Bone Curettes) for Oral Surgery
• Bone Chisels and Surgical Mallets in Dentistry

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