Extraction of the Maxillary First Premolar

What does the maxillary first premolar look like?

The maxillary first premolar has the longest crown of any of the maxillary posterior teeth and has a prominent mesiolingual developmental groove on its mesial side.

The maxillary first premolar is single rooted for the first 2/3rds of the tooth – only until the apical 1/3rd does a bifurcation exist separating into two roots. In fact, the maxillary first premolar is the only premolar with two roots. With this in mind, these small roots are subject to fracture – more commonly in older patients.

How do you remove the maxillary first premolar?

Because the root tips of the maxillary first premolar can break easily, it’s important that this tooth is elevated as much as possible for extraction. The forceps of choice for the maxillary first premolar are the upper universal (No. 150). Forces should be directed in the buccal and the lingual direction, and rotational forces avoided. If the root tips were to break, the labial (towards the lip) root would be easier to retrieve. With this in mind, buccal pressures should be utilized more as opposed to palatal pressures (this is common with other maxillary teeth, as well).

To summarize:

  • Use the No. 150 universal forceps
  • Buccal pressure more than lingual pressure (and finish buccally)
  • No rotation
  • Be wary of easily breakable roots (especially those in older patients

For more on the Extraction Series:


Hupp, J. R., Ellis, E., & Tucker, M. R. (2019). Contemporary oral and maxillofacial surgery. St. Louis: Elsevier.

(n.d.) Permanent Maxillary First Premolars. Dr. Charles Arcoria. A.T. Still Missouri School of Dentistry and Oral Health.

Canida, B., Moore, B., Cheatham, K., & Cheatham, M. (2016). B&B Dental: Modernized Ndbe Part 1 Board Prep (2.8 ed.). B&B Dental.

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