babylon oral surgery instruments

UPLOAD BY : AHMED ALI ABBAS

BABYLON UNIVERSITY COLLEGE OF DENTISTRY

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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


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


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


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


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


Offset broad Minnesota retractor

Both Austin’s & Minnesota : retract cheek &

mucoperiosteal flap simultaneously

INSTRUMENTS FOR


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


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


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


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


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


TISSUE

Tissue Holding Forceps

o Toothed/ Non- toothed

o Toothed: periosteum, muscle, aponeurosis

o Non- toothed: fascia, mucosa, pathological

tissues


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


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


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


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


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


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


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


BONE

Cylindrical handle- serrated with flat end:

struck with mallet

Flat & rectangular: cutting edge in different

sizes

Single bevel- cutting edge


BONE

Transalveolar extraction/ removal of impacted

tooth

Shape/ contour irregular bony surfaces

Bevel faces- bone to be cut

Cutting edge- perpendicular to bone


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


BONE

Osteotomy cuts: orthognathic surgery/

refracturing malunited fractures

Osteoplasty/ bone recontouring

Split impacted tooth for easy removal


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


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


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)


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


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


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


MUCOSA

o Held in the proper fashion: control & direct


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


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


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


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


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


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


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


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


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


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


THE MOUTH OPEN

Various sizes: various sized patients & varying

degrees of opening

Wider opening- position more posteriorly

Pediatric-sized block: adequate over molars


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


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


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

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

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

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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babylon oral surgery instruments

Education

incising tissue instruments

bone instruments

mucoperiosteum instruments

careful instruments

flat end

pointed end

broad end

reflection of soft tissue