June 2009, Volume 5, Issue 6
Published by AEGIS Communications
New Furcation Forceps From Karl Schumacher
Furcation-pattern forceps (often referred to as “cowhorns”) have long been favored in oral surgery for the extraction of lower molars with ordinary root-anatomy. The advantage of the design is its ability to deliver the tooth occlusally in an area of the mandible where socket-expansion through bucco-lingual luxation can be greatly hindered by dense cortical plate and limited access.
Conventional “Cowhorn” Forceps
Conventional furcation or “cowhorn” forceps for lower molars have pointed beaks that are designed to be worked below the bone crest, into the furcation of the molar and, through a wedging action, initiate superior (occlusal) movement of the tooth. The technique is constant apical pressure combined with a pumping motion of the handles to make ever-deeper penetration into the furcation. One drawback of this otherwise very effective design is that while the forceps does the work of making progress into the furcation, the crown of the tooth is left unaddressed or, worse, initiates the breakdown of the tooth by the very design of the forceps beaks. Frequently the crown is broken down, brittle, or riddled with restorations, leaving it weak and susceptible to fracture.
Additionally, the design of most conventional furcation forceps is such that the upper portion of the beaks actually contributes to the crushing of the crown (Figure 1A).
Schumacher Modified Cowhorns 23CR and 79AS
The Schumacher #23CR cowhorn is shown in comparison to a standard design (Figure 1B). A diagram of a distal view of a lower molar is superimposed onto each forceps for comparison. The wider aperature of the upper beaks accommodates the height of contour of the crown while the thinner furcation beaks provide better access to the furcation and easier penetration of the often-dense surrounding fossa. The finer shape of the cowhorn prong limits any defect to the surrounding bone. This is an ideal combination to address these particularly ensconced teeth.
The Schumacher 79AS forceps combines the superior movement achieved through the beaks wedging into the furcation, with a modified, crown-grasping upper area of the beaks (Figure 2). This crown-gripping feature allows the operator control of the object tooth from initial superior movement through completion of any luxation that may be required to expand the socket to give the roots a path of egress. The additional contact with the coronal portion of the tooth is particularly suited to brittle and broken-down teeth and helps to prevent fracture. The 79AS is also available in a pedodontic version.
Each of these new forceps patterns combines a slim profile and long handles to access posterior teeth especially in cases of limited mouth opening or temporomandibular joint disorders (Figure 3). Older patients often present with very dense bone and/or exotoses that can make penetration into the furcation very difficult.
Standard radiographic assessment of the tooth will dictate whether a furcation forceps is advisable. Molars with widely divergent, convergent, or otherwise anomalous root shape will not escape the bony crypt intact. Likewise, molars with root divergence greater than the space occupied by the clinical crown, display ankylosis, or exhibit dilacerated roots should all be sectioned and surgically removed as single-rooted teeth.
The use of furcation forceps can provide a great mechanical advantage in the extraction of some of the most difficult teeth to remove. These instruments can be used particularly in conjunction with proximators and periotomes, which eliminate the other retentive factor: that of the fibrous attachment in an occlusal path of egress with minimal trauma to the surrounding bone.
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The preceding material was provided by the manufacturer. The statements and opinions contained therein are solely those of the manufacturer and not of the editors, publisher, or the Editorial Board of Inside Dentistry. The preceding is not a warranty, endorsement, or approval for the aforementioned products or services or their effectiveness, quality, or safety on the part of Inside Dentistry or AEGIS Communications. The publisher disclaims responsibility for any injury to persons or property resulting from any ideas or products referred to in the preceding material.Figure 2 The Schumacher #79AS combines features of both a cowhorn, which engages the furcation, and standard forceps which engage the crown of the molar. Figure 3 Karl Schumacher's Modified Cowhorns, #79AS and #23CR.