babylon oral surgery instruments
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UPLOAD BY : AHMED ALI ABBAS
BABYLON UNIVERSITY COLLEGE OF DENTISTRY
DOWNLOAD THIS FILE FROM WEBSITE ON GOOGLE
THEOPTIMALSMILE.WIX.COM/DENTIST
RY
Graz Fernandez
CONTENTS
Introduction
Instruments for Transferring Sterile
Instruments
Instruments for Incising Tissue
Instruments for Elevating Mucoperiosteum
Instruments for Retracting Soft Tissue
Instruments for Controlling Hemorrhage
Instruments for Grasping Tissue
Instruments for Removing Bone
Instruments for Removing Pathologic Tissue
CONTENTS
Instruments for Suturing Mucosa
Instruments for Holding the Mouth Open
Instruments for Suctioning
Instruments for Irrigating
Instruments for Extracting the Teeth
-Local Anesthetic instruments
-Dental elevators
-Extraction forceps
Instrument trays
Conclusion
References
INTRODUCTION
Myriad of instruments- oral surgical
procedures
Variety of purposes:
-hard tissue
-soft tissue
INSTRUMENTS FOR TRANFERRING
STERILE INSTRUMENTS
CHEATLE FORCEPS
Long handles
Long, angulated beaks: serrated
Beaks: dipped in antiseptic solution
Lift up sterile instruments from autoclave/ drum
TRANSFER FORCEPS
Heavy, right-angled – heavy jaws
SWAB HOLDING FORCEPS
Long handles, straight beaks- fenestrated ends
Rings : end of handles
Working end- inner aspect: serrated
Pick up sterile gauze- transfer to tray
Hold gauze dipped in antiseptic solution- scrub
the surgical field
INSTRUMENTS
FOR INCISING
TISSUE
INSTRUMENTS FOR INCISING TISSUE
SCALPEL:
Handle- No. 3, No.7
Differently shaped
Disposable, sterile sharp blade:
1. No.15- most commonly used
o Relatively small
o Around teeth through mucoperiosteum
INSTRUMENTS FOR INCISING TISSUE
2. No.10- similar to No.15
o Large skin incisions
3.No. 11
o Sharp, pointed
o Small stab incisions
o Incising an abscess
4.No.12
o Hooked
o Mucogingival procedures
o Posterior aspect of teeth/ maxillary tuberosity
INSTRUMENTS FOR INCISING
TISSUE
Blade loaded
Blade removed
Remember..
Pen Grasp: Allow maximal control
Hold mobile tissue firmly
Press down firmly
Single- patient use: dulled easily
Several incisions : single operation- 2nd blade
Dull blades: no clean sharp incisions
INSTRUMENTS
FOR ELEVATING
MUCOPERIOSTE
UM
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
Mucosa & Periosteum reflected in single layer:
Periosteal Elevator
I. No.9 Molt periosteal elevator
o sharp, pointed end: reflect papillae from
between teeth, loosen soft tissues via gingival
sulcus
o Broader, flat end: elevating the tissue from
bone
o Thin, sharp cutting edge- clean separation of
periosteum from bone
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
Round ended Molt periosteal elevator
o Single/double ended
Reflection of soft tissue- 3 methods
1. Prying motion: pointed end to elevate soft tissue
2. Push stroke: broad end slid under the flap-separates mucoperiosteum from bone
3. Pull/ Scrape: tends to shred periosteum ,if not careful
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
Also used as retractor
Periosteum elevated
Broad blade pressed against bone: flap
elevated into reflected position
II. Woodson periosteal elevator
Relatively small & delicate
Loosen the soft tissues via gingival sulcus
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
III. Howarth’s Periosteal Elevator
o Double-ended
o One end: flat, broad, spatulate- sharp edge
o Other end: Rugine end; flat & rectangular.
Small tip – sharp projection perpendicular
o Reflection & retraction : mucoperiosteal flaps
o Reflection: periosteum
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
IV. Moon’s Probe
o Right angled- narrow working edge
o Flat handle & blade; blade perpendicular to
handle
o Narrow working edge; blunt & rounded tip
o Mucoperiosteal elevation : prior to extraction
o Objective symptom: anesthesia
INSTRUMENTS
FOR
RETRACTING
SOFT TISSUE
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Good vision & access
Cheeks, tongue & mucoperiosteal flaps
Right angle Austin retractor
o ‘L’-shaped- no handle
o Retraction of small intraoral flaps: removal of
impacted teeth
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Offset broad Minnesota retractor
Both Austin’s & Minnesota : retract cheek &
mucoperiosteal flap simultaneously
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Before flap- retractor held loosely in the cheek
After flap reflection- retractor placed on the
bone & used to retract the flap
Seldin retractor
o Similar to a periosteal elevator
o Leading edge: dull- shouldn’t reflect
periosteum
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Periosteal elevator- primary instrument for retraction
-positioned on the bone & held to reflect tissue
Mouth Mirror
o Common –Retract tongue
Weider Retractor
o Broad, heart-shaped
o Serrated on one side: firmly engage tongue, retract it medially & interiorly
o Don’t position posteriorly-
gagging
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Langenback’s Retractor
o ‘L’ shaped retractor- long handle
o Retraction of flap edges : improved
visualization of deeper layers & structures
o Different sizes: handle length & blade width
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Tongue Depressor
o ‘L’- shaped; no handle
o Broad, flat, rounded blade
o Retraction & depression of tongue
o Improve visibility- posterior pharyngeal wall &
tonsillar region, lingual side of mandible
o Removal of throat pack
o As cheek retractor
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Towel clip
o Hold the tongue
o Biopsy: performed on the posterior aspect; by
holding the anterior tongue
o Profound L/A
INSTRUMENTS
FOR
CONTROLLING
HEMORRHAGE
INSTRUMENTS FOR
CONTROLLING HEMORRHAGE
Arteries & veins- bleeding : pressure not enough
Hemostat
o Variety of shapes
o Small or delicate/ Larger
o Straight/ Curved
o Curved hemostat- common
o Long, delicate beak to grasp tissue & a locking
handle
INSTRUMENTS FOR
CONTROLLING HEMORRHAGE
Locking handle: clamps onto a vessel; then let
go & remains clamped onto tissue
Removes granulation tissue
Picks up root tips, pieces of calculus,
fragments of amalgam restorations, any other
small
particles dropped into the mouth
Small hemostat: Mosquito forceps
Eg: Crile, Spencer Wells, Halstead mosquito
artery forceps
INSTRUMENT
S FOR
GRASPING
TISSUE
INSTRUMENTS FOR GRASPING
TISSUE
Soft tissue stabilization- pass suture needle
Adson’s Tissue Forceps/ Pickups
o Delicate forceps
o Small teeth
o Gently hold tissue & stabilize
o Don’t grasp too tight- crushing
o Non-toothed
INSTRUMENTS FOR GRASPING
TISSUE
Tissue Holding Forceps
o Toothed/ Non- toothed
o Toothed: periosteum, muscle, aponeurosis
o Non- toothed: fascia, mucosa, pathological
tissues
INSTRUMENTS FOR GRASPING
TISSUE
Stillies forceps
o Longer, but similar to Adson’s
o 7”-9” long
o Easy grasp of tissue in the posterior part, with
enough part protruding beyond the lips: control
College/Cotton forceps
o Angled
o Small fragments of tooth/amalgam/foreign
material
o Placing/removing gauze packs
INSTRUMENTS FOR GRASPING
TISSUE
Allis Tissue forceps
o Locking handles
- proper placement
- held by asst. :necessary
tension
o Teeth which will firmly grip the tissue
o Removal of large amounts of fibrous tissue: Epulis fissuratum
o Never : tissue to be left in mouth- crushing injury
INSTRUMENTS FOR GRASPING
TISSUE
Russian Tissue forceps
o Large, round-ended
o Teeth elevated from sockets
o Round end: positive grip, avoids slippage;
unlike hemostat
o Placement of gauze: isolation
INSTRUMENTS FOR GRASPING
TISSUE
Babcock’s Tissue Holding Forceps
o Non-toothed blades
o Long beaks- broad working edge
o Smooth, non-serrated edges
o Rings- locking mechanism
o Hold delicate tissues: mucosa, lymph nodes
o Holding cyst lining during enucleation
INSTRUMENT
S FOR
REMOVING
BONE
INSTRUMENTS FOR REMOVING
BONE
Rongeur forceps
o Most commonly used
o Sharp blades- squeezed together;
cutting/pinching through bone
o Leaf spring between the handle : instrument
opens when hand pressure is released
o Repeated cuts without manually reopening
INSTRUMENTS FOR REMOVING
BONE
2 major designs:
Side-cutting
Side-cutting & end-cutting/
Blumenthal rongeurs
- most dentoalveolar surgical procedures
- inserted into sockets: interradicular bone
- sharp edges of bone
INSTRUMENTS FOR REMOVING
BONE
Large amounts of bone, quickly & efficiently
Do not :
-remove large amounts of bone in single bites
- use to remove teeth
Small amounts- multiple bites
INSTRUMENTS FOR REMOVING
BONE
Chisel
o Monobevel chisel: bone is removed
o Bibevel chisel: teeth
o Success: sharpness- sharpen before
sterilisation
o Carbide tips- use more than once, before
sharpening
INSTRUMENTS FOR REMOVING
BONE
Cylindrical handle- serrated with flat end:
struck with mallet
Flat & rectangular: cutting edge in different
sizes
Single bevel- cutting edge
INSTRUMENTS FOR REMOVING
BONE
Transalveolar extraction/ removal of impacted
tooth
Shape/ contour irregular bony surfaces
Bevel faces- bone to be cut
Cutting edge- perpendicular to bone
INSTRUMENTS FOR REMOVING
BONE
Osteotome
Splitting bone
Cylindrical handle- serrated for good grip
Flat end- tapped with mallet
Flat & rectangular blade
Bibivelled cutting edge- converge to a sharp
edge
INSTRUMENTS FOR REMOVING
BONE
Osteotomy cuts: orthognathic surgery/
refracturing malunited fractures
Osteoplasty/ bone recontouring
Split impacted tooth for easy removal
INSTRUMENTS FOR REMOVING
BONE
Surgical Mallet
Cutting bone with osteotome/ chisel
Stainless steel- strong cylindrical handle
Tapped : ‘pull-back’ action- force from wrist
Tapped with controlled force; made to spring
back from chisel/ osteotome
# jaw: inadvertent force
INSTRUMENTS FOR REMOVING
BONE
Bone file
o Final smoothing of bone
before suturing of
mucoperiosteal flap: small
o Double-ended: small &
large
o Removes bone: pull stroke
o Avoid push motion-
burnishing & crushing the
bone
INSTRUMENTS FOR REMOVING
BONE
Bur and Handpiece
o Surgical removal of teeth
o High-speed + sharp carbide burs: cortical bone
removal
o No. 557,703 fissure burs; No.8 round bur
o Large bone bur : acrylic bur- large bone
removal (torus)
INSTRUMENTS FOR REMOVING
BONE
o Completely sterilizable in a steam autoclave:
ensure on purchase
o Relatively high speed & torque: rapid bone
removal & efficient sectioning
o Must not exhaust air into the operative field
o Avoid high-speed turbine drills used in
restorative dentistry:
tissue emphysema
INSTRUMENTS FOR REMOVING
PATHOLOGICAL TISSUE
Periapical Curette
o Angled, double-ended
o Removal of granulomas/small cysts from
periapical lesions
o Small amounts of granulation tissue debris
from tooth sockets
INSTRUMENTS FOR REMOVING
PATHOLOGICAL TISSUE
Sinus Forceps
Handles with rings at the end
No lock/ ratchet
Narrow, long, slender beaks
Inner surface- transverse striations: close to
the tip
Draining pus from an abscess
Inserted by blunt dissection & opened up
No lock: blind insertion & closure- injure
structures
INSTRUMENTS
FOR
SUTURING
MUCOSA
INSTRUMENTS FOR SUTURING
MUCOSA
Flap returned to its original position & held by
sutures
I. Needle holder
o Instrument with a locking handle, short, stout
beak
o I/O use: 6” or 15cm recommended
o Beak- shorter & stronger than hemostat
o Face of the beak crosshatched :
positive grasp; unlike hemostat
INSTRUMENTS FOR SUTURING
MUCOSA
o Held in the proper fashion: control & direct
INSTRUMENTS FOR SUTURING
MUCOSA
Thumb & ring finger through the rings
Index finger along the length of the holder
Second finger- aids in controlling the locking
mechanism
Index finger through the finger ring: dramatic
decrease in control
COMPARISON
Hemostat: Beaks smaller than sinus forceps,
longer than needle holder; transverse
striations; ratchet
Needle holder: Criss-cross striations; ratchet
Sinus forceps: striations only near the tip; no
ratchet
INSTRUMENTS FOR SUTURING
MUCOSA
II. Suture needle
o Mucosal closure: ½ circle or 3/8 circle
o Curved: pass through a limited space; twisted
wrist
o Large variety of shapes
o Very small – very large
o Tips: (i) tapered- sewing needle
(ii) triangular – cutting needle
INSTRUMENTS FOR SUTURING
MUCOSA
o Cutting needle: pass through mucoperiosteum more easily than a tapered needle
o 1/3 – cutting; remaining- round
o Tapered : vascular, ocular
o Care: cut through tissues lateral to the track
INSTRUMENTS FOR SUTURING
MUCOSA
o Suture material: usually swaged on
o Held 2/3rd – between the tip & the base:
- enough exposed to pass through the tissue
- grasp in the strong portion to prevent
bending
INSTRUMENTS FOR SUTURING
MUCOSA
III. Suture material
Classified based on:
Diameter
o Oral mucosa: 3-0 (000)
- withstand tension intraorally
- easier knot tying
o 6-0 < 5-0 < 4-0 < 3-0< 2-0 < 0
o 6-0: conspicuous planes- face: less scarring
INSTRUMENTS FOR SUTURING
MUCOSA
Resorbability
o Nonresorbable : silk, nylon, vinyl & stainless
steel
o Resorbable
primarily made of gut- serosal surface of
sheep intestines
- plain catgut: resorbs in 3-5 days
- chromic gut: 7-10 days
INSTRUMENTS FOR SUTURING
MUCOSA
Synthetic: long chains of polymers- braided
- polyglycolic acid
- polylactic acid
Advantages
Easy to handle & tie
Rarely untied
Cut ends: soft & nonirritating
Disadvantages
‘Wick’ oral fluids- underlying tissues
Bacteria + saliva
INSTRUMENTS FOR SUTURING
MUCOSA
3-0 Black silk
Appropriate strength
Easy to tie
Well tolerated by tissues
Easily recognizable – removal
Wicking- not significant
3-0 chromic suture- removal not needed
INSTRUMENTS FOR SUTURING
MUCOSA
IV. Scissors
o Short cutting edges
o Long handles
o Thumb & ring fingers
o Held same as needle holder
Dean scissors
o Slightly curved handles
o Serrated blades
Tissue scissors
Iris scissors & Metzenbaum scissors
Straight or curved blades
Iris: small, sharp pointed, delicate
Metzenbaum: undermining soft tissue &
cutting; sharp or rounded tips
Don’t cut sutures: dull the edges- less effective
& more traumatic
Iris: Very fine skin sutures
INSTRUMENTS FOR HOLDING
THE MOUTH OPEN
INSTRUMENTS FOR HOLDING
THE MOUTH OPEN
Soft, rubberlike block- patient rests teeth
Patient opens to comfortably wide position-
block inserted: holds in the position
Protects patient’s TMJ, while mandibular teeth
INSTRUMENTS FOR HOLDING
THE MOUTH OPEN
Various sizes: various sized patients & varying
degrees of opening
Wider opening- position more posteriorly
Pediatric-sized block: adequate over molars
INSTRUMENTS FOR HOLDING
TE MOUTH OPEN
Side-action Mouth prop/ Molt Mouth prop
Used for wider mouth opening
Ratchet-type action: opening wider as handle
is closed
Caution : great pressure to joint/teeth- injury
Deeply sedated
Mild trismus
INSTRUMENTS FOR HOLDING
THE MOUTH OPEN
Mouth Gag
Forcefully open mouth: trismus
Broad, serrated blades: rest on occlusal
surface of molars: instrument opened : slow,
gradual force
Keep mouth open: procedures under G/A
Fergusson Ackland mouth gag
Remember..
Avoid opening too wide: stress on TMJ
Stretch injury
Long procedures: remove periodically; move
the jaw; rest the muscles
INSTRUMENTS
FOR
SUCTIONING
INSTRUMENTS FOR
SUCTIONING
Adequate visualization: blood, saliva, irrigating
solutions suctioned
Surgical suction: smaller orifice than usual-
rapid evacuation of fluids
Several designs of orifice: soft tissue not
aspirated & injured
INSTRUMENTS FOR
SUCTIONING
Fraser suction:
Hole in the handle
Hard tissue cut; hole covered to remove the
solution rapidly
Soft tissue suctioned: hole uncovered to
prevent injury
INSTRUMENTS FOR
SUCTIONING
High Volume Suction Tip
Large bore tubes with slight angulation- end
Autoclavable stainless steel/ plastic
Disposable plastic tubes
Suck out large volumes of irrigation fluids,
blood clots & debris
INSTRUMENTS FOR
SUCTIONING
Saliva Ejector
Low volume suction tip
Disposable plastic- different designs
Flexible- bent & adapted under tongue
Buccal vestibule: partially retracts cheek
INSTRUMENTS FOR HOLDING
TOWELS & DRAPES IN POSITION
Towel clip
Holds together, drapes placed around a
patient
Stabilizes suction tubes, micromotor etc.
Hold & retract tongue: unconscious patient
Locking handle + finger & thumb rings
Sharp/blunt action ends
Curved points- penetrate towels & drapes
Caution: not to pinch patient’s skin
J Bachaus Towel clip
Schaedel Towel clip
INSTRUMENTS FOR
IRRIGATING
Bone removal: Steady stream of irrigation-
sterile saline or water
Cools the bur
Prevents bone-damaging heat buildup
Increases efficiency of bur:
- washes away bone chips
- lubrication
Completion of procedure: before suturing
INSTRUMENTS FOR
IRRIGATING
Large plastic syringe + blunt 18-gauge needle
Sterilized multiple times before disposal
Blunt & smooth needle: not damage soft tissue
Needle angled : efficient direction of the stream
INSTRUMENTS
FOR
EXTRACTING
TEETH
INSTRUMENTS FOR
EXTRACTING TEETH
LOCAL ANESTHETIC INSTRUMENTS
Syringe
Types:
1. Non- disposable syringes
LOCAL ANESTHETIC
INSTRUMENTS
2. Disposable
syringes
3. Safety syringes
LOCAL ANESTHETIC
INSTRUMENTS
4. Computer Controlled Local Anesthetic
Delivery System
LOCAL ANESTHETIC
INSTRUMENTS
Cartridge
Glass cylinder with L/A & other ingredients
1.8ml/1.7ml/2.2ml
Rubber
Diaphragm Silicon rubber
plunger
Al cap Neck Color coded band
LOCAL ANESTHETIC
INSTRUMENTS
Needle
Single piece of tubular metal; plastic/ metal
syringe adaptor + needle hub
LOCAL ANESTHETIC
INSTRUMENTS
Long: 32mm & Short: 20mm needles
27gauge long & 30 gauge short: commonly
purchased – dental use
25 gauge: preferred for high risk of positive
aspiration
30 gauge: not specific; local infiltration
LOCAL ANESTHETIC
INSTRUMENTS
Additional Armamentarium
Topical antiseptic
Topical anesthetic
Applicator sticks
Sterile gauze 2”x2”
Hemostat
INSTRUMENTS FOR
EXTRACTING TEETH
DENTAL ELEVATORS
I. Luxate teeth from the surrounding bone
Makes extractions easier
II. Expands alveolar bone:
Buccocervical plate of bone- tooth with limited
& obstructed path of removal
III. Remove broken/ surgically sectioned roots
IV. Remove interradicular bone
V. Split teeth once a bur groove has been placed
DENTAL ELEVATORS
PARTS
DENTAL ELEVATORS
Handle: 2 designs
Heavy pear-shaped
Crossbar: right angles to the shank
General rules:
Adjacent tooth- not the fulcrum; unless to be extracted
Crest of the alveolar bone: fulcrum
Controlled force- correct direction-
adequate support to the adjacent tooth
Finger guard: support adjacent tissues
DENTAL ELEVATORS
Basic grips:
Palm grip: heavy forces; handle rests against
heel of palm
Finger grip: delicate applications
DENTAL ELEVATORS
Handle:
Generous size: comfortably held
Substantial, controlled force
Cross-bar/ T-bar handles: caution
Shank:
Connects handle to the working end
Substantial size; strong enough to transmit
force
Blade:
Working tip
Transmit the force to the tooth, bone or both
DENTAL ELEVATORS
TYPES
I. Based on the shape & size:
1. Straight
2. Triangle/ Pennant-shape
3. Pick
II. Based on their form:
1. Straight
2. Angular
3. Crossbar
DENTAL ELEVATORS
III. Based on their use:
1. Remove entire tooth
2. Remove roots broken at the gingival line
3. Remove roots broken half way to the apex
4. Remove the apical third of the root
5. Reflect mucoperiosteum
DENTAL ELEVATORS
Straight
Most commonly used
Blade: concave surface on one side-the tooth
to be elevated
Small- No.301:beginning the luxation of an
erupted tooth
DENTAL ELEVATORS
Large:No.34S (common),No.46,No.77R
-displace roots from the sockets
-luxate more widely spaced teeth
-smaller sized elevator: less effective
Angled straight elevator: posterior aspect
Eg : Miller elevator, Potts elevator
DENTAL ELEVATORS
Straight Elevator: Coupland’s
Large, pear-shaped handle
Straight shank
Blade: concave/ convex surface & an inclined
plane
Concave groove on one side
Sharp & straight tip
DENTAL ELEVATORS
Impacted/ malaligned teeth
Wedge & 1st order lever principle
450 to long axis: concavity facing the tooth
Crest of the interseptal bone: fulcrum
Applied to the long axis: wedged into the PDL
space- luxate the tooth
DENTAL ELEVATORS
Straight elevator: Hospital
Blade, handle & shank: same plane
Handle: flat & triangular- deep criss-cross grooves
Blade: flat with vertical serrations; other side-convex with pointed tip
Serrated flat side: faces the tooth to be extracted
450 to the long axis/ wedged into the PDL space: vertically along the long axis
Wedge & 1st order lever
DENTAL ELEVATORS
Apexo elevators
‘Offset’/ angulated elevator
Blade at an angle – shank
Blade ends- sharp pointed tip
Large pear-shaped handle
Pairs- right & left
Remove root fragments
Wedge principle
DENTAL ELEVATORS
Triangular
Second most commonly used
Pairs: left and right
Broken roots in the tooth sockets + adjacent
empty socket
Fractured lower 6:distal root left in the socket-
elevator tip in the socket; shank on the buccal
plate-wheel and axle rotation
Eg : Cryer
DENTAL ELEVATORS
Cryers
‘Offset’ blade: at an angle to the shank
Curved & triangular blade
Heavy pear shaped handle
Pairs
DENTAL ELEVATORS
Impacted molars: buccal furcation & luxated
Fractured root tips: maxillary molars
Erupted maxillary molars
Bur hole- drilled onto the tooth & tip engaged-
purchase point
DENTAL ELEVATORS
Crossbar elevator
Offset blade- similar to cryers
Handle perpendicular to shank
Maximum mechanical advantage due to
crossbar handle & offset blade
DENTAL ELEVATORS
Rotational forces: wheel & axle principle
Impacted mandibular teeth
Caution: impacted mandibular 8- #angle
mandible
Removal of mandibular root fragments
Not used in maxillary arch
DENTAL ELEVATORS
Pick
Remove roots
1. Crane pick: heavy version-lever to elevate the
broken roots
Purchase point: 3mm deep into the root,
using bur
Tip of the pick inserted- buccal plate of the
bone as fulcrum
DENTAL ELEVATORS
2.Root tip pick/apex
Delicate
Tease small root tips
Don’t use: wheel- and- axle/lever
Very small root end : insert the tip into the PDL
space- root tip & socket wall
INSTRUMENTS FOR
EXTRACTING TEETH
Extraction forceps
Removing the tooth from the alveolar bone
Many styles and configuration: variety of teeth
Each basic design: multiple variation
EXTRACTION FORCEPS
COMPONENTS
EXTRACTION FORCEPS
Handles
Adequate size
-comfortable handling
-sufficient pressure & leverage
Serrated surface
-positive grip
-prevent slippage
EXTRACTION FORCEPS
Holding handles:
-Maxillary: palm underneath;
beaks superior
-Mandibular: palm on top;
beaks point down
EXTRACTION FORCEPS
Straight/ curved
better fit
EXTRACTION FORCEPS
Hinge
Connects the handle – beaks
Transfers & concentrates : force
Types
American: horizontal
English: vertical
EXTRACTION FORCEPS
Beaks
Greatest variation
Adapt: tooth root near C/R junction
root & not the crown
Different beaks: single/2/3- rooted teeth
Close adaptation: improved control, decreased
chance of fracture
EXTRACTION FORCEPS
Width of the beaks
Narrow: incisors
Broader: lower molars
Beaks angled: held parallel to the long axis
Maxillary: Parallel to the handles
Maxillary molar: Bayonet fashion- posterior
aspect with beaks parallel
Mandibular forceps: Perpendicular to the
handles
MAXILLARY FORCEPS
Single-rooted: incisors, canines, premolars
3-rooted: molars
Maxillary Universal Forceps: No.150
o Slightly S-shaped: from side- incisors &
premolars
o Straight: from above
o Beaks curved: meet only at the tip
o Modification: No.150A- premolars
o No.150S: Primary teeth
No.150, 150A, 150S
MAXILLARY FORCEPS
Straight forceps
No. 1 forceps: easier for upper incisors
MAXILLARY FORCEPS
Maxillary molars:
-smooth, concave surface: palatal root
-pointed: bifurcation
-right & left
-offset: posterior & correct position
-No.53
No.53
MAXILLARY FORCEPS
Upper Cowhorn forceps: No.88
o longer, accentuated, pointed beaks
o Severely carious crowns
o Deeper into trifurcation: sound dentin
o Caution: crush alveolar bone; # large amounts
of buccal bone – intact teeth
MAXILLARY FORCEPS
No.210S Forceps
o 2nd & 3rd molars- single conical root
o Smooth beaks: offset
MAXILLARY FORCEPS
Root Tip Forceps: No.65
o Offset – very narrow beaks
o Broken molar roots, narrow premolars, lower
incisors
MAXILLARY FORCEPS
Root Forceps
MANDIBULAR FORCEPS
Single-rooted: Incisors, canines, premolars
Two-rooted: molars
Lower Universal Forceps: No.151
o Handles- No.150
o Beaks: pointed inferiorly
o Smooth & narrow: meet only at the tip
o Fit near the cervical line- grasp root
o No. 151A: Premolar
o No.151S: Primary mandibular teeth
No.151, 151A, 151S
MANDIBULAR FORCEPS
English Style Vertical-Hinge Forceps
o Single-rooted
o Great force generated
o Root fracture
MANDIBULAR FORCEPS
Lower Molar Forceps: No.17
o Single forceps: both sides
o Straight-handled
o Beaks: obliquely downward
o Pointed tips – centre: bifurcation
o Remainder: sides of the furcation
o Not for fused, conical roots: 151
No.17
MANDIBULAR FORCEPS
Lower Cowhorn Forceps: No.87
o Two pointed, heavy beaks: bifurcation
o Forceps positioned: handles pumped up &
down- tooth elevated
o Beaks squeezed into furcation: buccal &
lingual cortical plates- fulcrums
o Alveolar bone #, damage to maxillary teeth
No.87
MANDIBULAR FORCEPS
Root Forceps
BASIC EXTRACTION PACK
Local anesthesia syringe
Needle
Cartridge
No.9 Periosteal elevator
Periapical curette
Straight elevator: small & large
College pliers
Curved hemostat
Towel clip
Austin/Minnesota retractor
Suction tip
2x2 inch/4x4 inch gauze
Forceps
SURGICAL EXTRACTION
TRAY
Additional items
Needle holder & suture
Suture scissors
Blade handle & blade
Adson tissue forceps
Bone file
Tongue retractor
Cryer elevators
Rongeur
Handpiece & bur
BIOPSY TRAY
Basic tray without elevators
Blade handle & blade
Needle holder & suture,
suture scissors
Metzenbaum scissors
Allis tissue forceps
Adson tissue forceps
Curved hemostat
POSTOPERATIVE TRAY
Irrigation: syringe, suction tip
Suture removal: Scissors, College pliers,
Cotton applicator sticks, gauze
INSTRUMENT
ARRANGEMENT
TRAY
Flat, sterilized wrapped with sterilization paper
Opened preserving sterility
Requires large autoclave
CASSETTE
More compact
Surgeon must be well versed with the
identification, indications for use as well as the
techniques of using the different basic
instruments
The quality of the instruments- as crucial as
the knowledge & skill of the surgeon
Use of good quality instruments is inevitable in
ensuring the expected standard of care:
expensive
The surgeon & the assistants must handle,
store & use the instruments with utmost care
REFERENCES
Contemporary Oral & Maxillofacial Surgery- 5th
edition : Hupp, Ellis, Tucker
Handbook of Local Anesthesia- 5th edition:
Stanley F. Malamed
Textbook of Oral & Maxillofacial Surgery- 2nd
edition: Chitra Chakravarthy
Dental Instruments: A Pocket Guide- 2nd
edition: Linda R. Bartolomucci Boyd
Thank you for the PATIENT
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