Sir, I read with some amusement and interest the article by Jeavons on 'familiar forceps'.1 Doubtlessly, down through time, both dentists and patients alike have sought and prayed for that 'painless and easy' extraction. In order to make in particular those molar and premolar extractions easy (easier), I have found empirically that rotation movements greatly assist. Standard forceps are placed on a multirooted tooth, after application of straight elevator to the buccal and lingual – be it a molar or premolar – care being taken to grasp as far apically with the forceps as possible. Then, firm steady clockwise rotational force is applied until strong resistance is felt. Pause against the resistance and relax the grip. Then redo this manipulation two to three times in the same clockwise fashion. Release the forceps and re-apply and perform this manipulation several times anticlockwise. Again release and proceed clockwise in such a fashion. By this stage the tooth will be found to be relatively loose in its socket. Standard elevation can now be attempted to deliver the offending structure! This procedure fractures periodontal ligament fibres and aids socket dilation of the most reluctant of teeth. I personally find it much less of an effort than standard figure of eight and socket dilation via compression and tensional forces. The patient too doubtlessly appreciates the simpler approach with the only caveat being that for lower teeth good jaw support with the opposing hand is required – but this is not entirely different from a standard protocol extraction.

Quinn2 has demonstrated that rotational movements are indeed workable for a multirooted tooth contrary to the general dogma of not using rotational forces in teeth with more than one root. Rotation can be demonstrated to be effective with a low incidence of alveolar and root fractures. Quinn uses the rotational approach with cow horn forceps into the bifurcation area. One caveat is that the roots must be relatively straight. Although this author does not advise this approach with finer multirooted maxillary teeth I personally find that the rotational method works well with upper as well as lower multirooted teeth.

From a theoretical viewpoint, the periodontal ligament can be modelled as an anisotropic, viscoelastic material.3 In other words, shows directional dependence in terms of stress and strain and has elements of elastic recovery and flow deformation. I would add that the periodontal ligament fibres can be perhaps also likened to a series of springs and thus could be mimicked by Hooke's spring laws. For those seeking the more technical engineering application, finite element analysis has been adequately outlined in regards translational orthodontic tooth movements.4 Ultimately, engineering modelling for dental extraction also has the potential to greatly support the clinician involved in this procedure daily.

Whatever the model or theory applied, perhaps the periodontal ligament and socket can be simply viewed as weaker under rotational shear and torsional forces than compression or tension. From first principles it can be appreciated that chewing forces would place less torsional load on teeth compared to compression or tension. Nonetheless, for my clinical colleagues I would without hesitation recommend the use of the described controlled rotational movements for the removal of any multirooted tooth with reasonably straight roots. This straightforward technique ought to be added to the general dentist's armamentarium. No extra equipment is required and you and your patients may well be thankful for any such method that makes exodontia easy (easier)!