In the case of extraction of Maxillary and Mandibular teeth in a full mouth rehabilitation case we need to follow a sequence or step by step procedure to extract all the teeth. Extraction of teeth can be due to many reasons, such as Full mouth rehabilitation where the remaining teeth are not worth saving or cannot be used to replace the missing teeth. With the recent advances, the replacement of all the Maxillary and Mandibular teeth can be done with fixed dentures which take the help of Implants – Implant-supported complete dentures which are fixed. So it is important to make sure that bone is preserved around the tooth which is extracted by making the extractions as atraumatic as possible.
It is also called as “Full Mouth Extraction” as all the remaining teeth are extracted at a time or in a gap of a few days to make way for new teeth – Dentures.
Maxillary teeth are extracted first which is a rule we always follow and also the rule that posterior teeth are extracted before extracting anterior teeth.
Why are Maxillary Teeth Extracted before Mandibular teeth?
- Maxillary teeth get anesthetized before the Mandibular teeth
- It prevents any fall of enamel or restorative debris from falling into the extraction sockets of the lower arch.
- This rule is not required in the removal of Impacted third molars
Both of these rules are followed even in full mouth extraction in both maxillary and mandibular teeth.
The sequence of teeth to be extracted in full mouth extraction:
- Maxillary posterior teeth (1st and 2nd Premolars, 2nd and 3rd molars) except 1st molars
- Maxillary anterior teeth(central and laterals) except canine
- Maxillary 1st Molar
- Maxillary Canine
- Mandibular posterior teeth (1st and 2nd Premolars, 2nd and 3rd molars) except 1st molars
- Mandibular anterior teeth(central and laterals) except canine
- Mandibular 1st Molar
- Mandibular Canine
The 1st molar and canine are extracted last in each quadrant because they help in maintaining the stability and integrity of the alveolar mucosa of the quadrant anteriorly by canine and posteriorly by 1st molar.
We have to first suture the Alveolar mucosa posterior to the 1st molar and alveolar mucosa anterior to the Canine in the quadrant.
hello sir
great thing you’re doing
my question is why remove maxillary teeth 1st?
my Q is basically referring to wisdoms. if we have to remove upper and lower wisdoms on one side; wouldnt blood from extracted upper blur your vision?
plz reply on dr.shak83@gmail.com
thank you
There is no definitive answer for that, but I feel that in case mandibular teeth are extracted first and later the Maxillary teeth, the debris or calculus etc from the maxillary teeth might fall into the open mandibular sockets which can lead to infection. Might be because of this reason the maxillary teeth are extracted first and the manidular teeth second.
Do let us know if you find any definitive answer for this, so that we can share it with others.
hi q if we have simple extraction and a difficult extraction , which one we begin to extract first ?
hi q if we have simple extraction and a difficult extraction , which one do we begin to extract first ?
You can do it either way, there will not be problem with that until you follow the sequence of Extraction.
Practically speaking it would be better to complete the easier one first and then going to the harder one.
Thanx bro..your information really beneficial..order of extraction of maxillary arch is 87546213 or 87542163..I am looking for mandibular arch..
Hi ! When considering extraction in patients with chronic periodontitis ,with peri apical abscesses ,what do you think should be extracted first ,mobile teeth or mobile teeth With TOP?
Which tooth is the most difficult to extract in the max arch and why
Also in the mandible
There is nothing as difficult or easy, every tooth is the same if you know what you are doing.
But if we see, third molars are the most difficult ones in both Maxilla and Mandible as they have varied anatomy and can sometimes require a surgical approach to extract them.
sir y maxillary teeth is extracted pror to mand teeth has become biggest question mark for me??? ur earlier reply is not up to mark for me sir. better explaination ?? p
First application/ direction of forcep force in extraction of mandibular 1 St premolar is apical direction or lingual direction??? Why??Reply
It is because Apical Force will separate the Periodontal Ligament and loosens the tooth, Lingual force is given in mandibular pre molar as the lingual plate is thin as compared to buccal bone, so luxation is easier lingually, care should be taken not to exert excess force which might break the lingual plate.
How long before my mouth heals to eat. I had all upper teeth removed
Mandibular tooth extraction sequence is also same as maxillary ( 87542163 )
We can pack site before in lower then proceed for upper,it is more easy as blood oozes if upper attempted 1st
Yes, that can be an option.
Sir… I am BDS(Intern)student
Your Answer is true but sir I cant understand those concept..
Why we need to extract posterior teeth first then only anterior teeth ? If extract anterior teeth first it is more easy for instrumentation on posterior teeth right?
Maxillary bone is spongy/cancellous whereas mandibular bone is compact. Therefore anaesthesia spreads earlier in maxilla than that of mandible. And hence maxillary teeth should be removed first.
That is also a very valid point. Will add it to the post.
When extracting Impacted Mandibular or Maxillary third molar, even if you stick to general guidelines for extracting the Maxillary tooth first, nothing wrong, usually Maxillary tooth extraction is easier, patient cooperation for extracting the Mandibular tooth will be better after that .but still decision will be case specific, personal skill, exprience .
What if the visibility is blocked in the mandibular teeth by the blood after extracting the maxillary teeth first?
If such profuse bleeding is happening you better first concentrate on stopping the bleeding before going for extraction of lower teeth.
You can always clean the extraction site using cotton, gauze, suction, Gel foam etc.
Can’t we go for achieving haemostasis after extracting both maxillary and mandibular teeth at the same time as well?
In case of seprate root stumps of maxillary first molars is there any oder to remove the roots?? Like which root should be removed first
I dont think anything is mentioned about the sequence in which the root stumps need to be removed. It all varies with where the purchase point can be achieved.