oral surgery- basic instruments for exodontia

3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012

University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 1

Oral Surgery Propedeutics

Instruments

Amit Dattani

2012



Contents

Extraction Forceps .................................................................................................................................. 4

General Notes ..................................................................................................................................... 4

Maxillary Extraction Forceps ............................................................................................................... 4

Incisors & Canines ........................................................................................................................... 4

Premolars ........................................................................................................................................ 5

Molars ............................................................................................................................................. 6

3rd Molar/Wisdom ........................................................................................................................... 7

Upper Roots ........................................................................................................................................ 8

Incisors & Canines ........................................................................................................................... 8

Premolars and Molars ..................................................................................................................... 8

Mandibular Extraction Forceps ............................................................................................................. 10

Incisors, Canines, Premolars ............................................................................................................. 10

Molars ........................................................................................................................................... 11

Lower Root Forceps ...................................................................................................................... 12

Instruments for Incision ........................................................................................................................ 13

Instruments for Elevating Mucoperiosteum ......................................................................................... 14

Instruments for Retracting Soft Tissues ................................................................................................ 16

Instruments for Retraction of the Tongue ............................................................................................ 17

Instruments for Controlling Bleeding.................................................................................................... 18

Hemostats ......................................................................................................................................... 18

Instruments for Grasping Tissues ......................................................................................................... 19

Forceps .............................................................................................................................................. 19

Instruments for Removing Bone ........................................................................................................... 21

Instruments for Removing Soft Tissues from Bone Defects ................................................................. 23

Instruments for Suturing Mucosa ......................................................................................................... 24

Needle Holders ................................................................................................................................. 24

Surgical Needles ................................................................................................................................ 24

Suture Materials ............................................................................................................................... 24

Resorbable .................................................................................................................................... 24

Non-resorbable ............................................................................................................................. 24

Monofilament ............................................................................................................................... 24

Polyfilament .................................................................................................................................. 24



Scissors .............................................................................................................................................. 25

Instruments for Holding the Mouth Open ............................................................................................ 26

Instruments of Irrigation ....................................................................................................................... 26

Dental Elevators .................................................................................................................................... 27

Straight Elevators .............................................................................................................................. 27

Triangular Elevators .......................................................................................................................... 28

How to identify between left and right Barry Elevator? ............................................................... 29

Cryer Elevator................................................................................................................................ 29

Pick Type Elevators ............................................................................................................................... 30

Towel Clamps ........................................................................................................................................ 31

Sponge and Dressing Clamps ................................................................................................................ 31

Probes ................................................................................................................................................... 32

Sinus Probe ....................................................................................................................................... 32

Other Instruments ................................................................................................................................ 32

--------------------------------------------------------------------------------

The content of this material has been obtained from the lectures at the University of

Debrecen, internet sources and practical lessons taught at the University of Debrecen. I

take no legal obligation in the copyright or reproduction of this material. It is solely for

viewing and learning purposes.

Wishing you all the best,

--

Amit Dattani



Extraction Forceps

General Notes

Crown Forceps (above)- beaks don’t touch

Root forceps (see later) – beaks touch

Three parts to any extraction forcep: Beak, Hinge, Handle (obvious!)

Maxillary forceps – straight beaks

Mandibular forceps – 90 degree bend in beak

Maxillary Extraction Forceps

Incisors & Canines

(Crown forceps)

Dental extraction forceps for maxillary Incisors and canines are straight when viewed from

the side.

Straight beak

Same forcep used for maxillary incisors and canines

(English forcep shown above- that’s what you need to know)



Premolars

(Crown forceps)

Forceps for maxillary premolars are similar, to the incisor and canine forceps, but slightly

curved when viewed from the side.

Used only for upper premolars

Slight angulation (when viewed from the side)

Follows curvature of premolars

Used for both upper premolars

Remember: The upper 1st premolar has two roots! (Just a reminder)



Molars

(Crown forceps)

Forceps for upper molars (three rooted teeth) are different for left and right molars. The

Palatal beak has a SMOOTH concave surface and the buccal beak is POINTED. (this point

buccal beak in placed in the buccal bifurcation when extracting- clever huh?!)

To distinguish between left and right forcep (patients left or right!):

o Try placing the buccal pointed beak into the buccal bifurcation of the 1st

or 2nd upper molars

o If the handle is anterior (to the patient) then you are correct, if its

pointing to the posterior side of the patient then it’s the opposite side!

(you will understand this if you try it once or twice in practice)

o E.g. the big right picture above is for the RIGHT SIDE 1st and 2nd molar (of

the patient!)

We use the same forceps for the 1st and 2nd molars (on the same side).



3rd Molar/Wisdom

(Crown forceps)

Forceps have broad and smooth beaks

The forceps are bent in a certain way (Bayonet) to reach the most posterior teeth

(wisdom teeth)

This provides easier access to them

One forcep can be used for both sides (upper left and right)

Only for 3rd molars!

(Also called Bayonet forcep- due its shape)



Upper Roots

Incisors & Canines

(Root Forceps)

These forceps can be used canine- canine. (incisors and canines)

The beaks touch each other

Used for upper roots only

Both beaks are rounded

Tip: When extracting, try and reach apically as possible on the root surface

Premolars and Molars



(Root Forceps)

Also known as “Bayonett Root forceps”

Also known as a “Wisdom Bayonett”

Used for upper premolars and all molar roots (including 3rd molar roots)

Shaped in the way it is (Bayonett) for easier access to the posterior teeth

Beaks touch- used only for extracting roots!



Mandibular Extraction Forceps

Incisors, Canines, Premolars

(Crown forceps)

Forceps for single rooted teeth have smooth, relatively narrow beaks

Used for lower premolar-premolar (all lower incisors, canines, premolars)

Beaks don’t touch because they are crown forceps

Beaks are rounded, not pointed to fit around crown curvature

90 degree angle between beak and handle (at hinge)

o 90 degree angle - ease of positioning when patient is in an upright

position (patient is in a seated position and dentist is standing)

Practical tip: lower dental chair (vertically) till the lower jaw is at elbow height to the

(standing) dentist.



Molars

(Crown Forceps)

Have a bi-lateral pointed beak to adapt to the bifurcation and vertical hinge

Two pointed beaks

Beaks do not touch – crown forceps

Both beaks are pointed so they can be used for the left and right side of the

patient

All molars can be extracted with this, 1st - 3rd. (In case of trismus see further

Forceps for molars with fused, conically shaped roots have shorter beaks

without pointed tips and a hinge in a horizontal direction

Also called trismus forceps



Lower Root Forceps

Maxillary and mandibular forceps for removal of broken roots have a similar

shape as those for removal of teeth with a crown, but their beaks are relatively

narrow and meet at the tip.

Can be used on all lower root extractions



Instruments for Incision

Scalpel consists of:

Sterilizable handle

Sterile, disposable blade

No 15 – used for intraoral incision

No 12 – pointed (used for stab like incisions)

No 11 – hooked blades (for mucogingival procedures on posterior aspect of teeth)

Scalpel Handle

Scalpel Blades



Fixed Blade Scalpel / Conventional Scalpel

Instruments for Elevating Mucoperiosteum

Raspatories of different size

Periosteal elevators (Single or Double ended)

Their cutting edge is sharp and thin and can make a clean separation of mucoperiosteum from the

bone with the undermining method.

(Konig) Mucoperiosteal elevator



Molt Raspatorium

They all come in different shapes and sizes

Use the appropriate shape and size



Instruments for Retracting Soft Tissues

Austin, Minnesota retractors can retract the cheeks and the mucoperiosteal flap

Middledorpf retractor for cheek retraction

Langebeck for mucoperiosteal flap retraction

Periosteal elevators, raspatories may often be used for retracting mucoperiosteal flaps

Austin Retractor

Minessota Retractor

Langenback Retractor/ Fork Retractor (with teeth)

Middledorpf Retractor



Instruments for Retraction of the Tongue

Mouth mirror

Tongue retractor

Tongue spatules

Tongue forceps (only in deep sedation)

Mouth Mirror

Tongue Retractor

Tongue Spatula

Tongue Forceps



Instruments for Controlling Bleeding

Hemostats

Have a relatively long, delicate beaks with parallel grooves on their inner surface to grasp

tissue

Handles with a locking mechanism, the clamps remain clamped onto the tissues

Are provided in different size and shapes (straight or curved)

May be used for picking up small particles from the wound area

Mosquito Hartmann Hemostat

Halsted Hemostat

Peak Hemostat

Kelly Hemostat



Instruments for Grasping Tissues

Non-traumatic dissecting forceps and angled college forceps are not useful for handling

tissues; these are used for placing and removing gauze packs and foreign materials.

Delicate tissue forceps with small teeth are used for stabilizing the soft tissues during

suturing.

Allis tissue clamps have locking handles and beaks with more teeth and permit a stronger

and more convenient grasping of the tissue during dissection.

Forceps

Dissecting Forceps/ Anatomical Forceps (no teeth)

Adson Forceps

Tissue Forceps/ Surgical Forceps (with teeth)

Allis Tissue Clamp



Note: You should know what the following is and its use:

Angled College Forceps / Dental Forceps



Instruments for Removing Bone

Ronguer forceps: smaller amount of bone can be cut in a single bit with the sharp blades.

Chisels (monobevel for cutting bone) and a Mallet with nylon facing are not commonly used

in oral surgery.

Bone files are used for final smoothing of bone before wound closure; work only on a pull

stroke.

Different sizes are available for all types of instruments

Most commonly a handpiece and bur are used to remove alveolar bone

o The (micromotor) handpiece should have high speed and torque to allow relatively

rapid bone removal and efficient sectioning of teeth

o High speed turbine drills must NOT be used for oral surgery because of the danger

of tissue emphysema

o Round and fissue bus of different sizes are most commonly used

Luer Rongeur Forceps

Bluementhal Rongeurs

Mallet (also known as bone hammer) and Chisel

Bone file (different shapes and sizes available)



Surgical motor with integrated cooling system

Handpiece for burs



Instruments for Removing Soft Tissues from Bone Defects

Bone curettes – round or oval

o Working part is concave on one side with sharp edges

o They are used in a scraping motion to remove small cysts and granulomas from bony

crypts.

Some Types:

o Volkmann

o Uffenorde

o Kerpel

Volkmann Curette (most commonly used)

Uffenorde Curette

Kerpel Bone Curette

When to use Curettes?

Immediately after extraction of a tooth suspected to have a cyst or granuloma formation



Instruments for Suturing Mucosa

Needle Holders Have a locking handles

Short stout beaks and a crosshatched surface for grasping the needle and the sutures

Surgical Needles Most commonly are curved needles

Common sizes 1/4 or 3/8 circle

Cutting needles have a triangular crossection at the tip (most commonly used in oral

surgery)

Suture Materials Sutures can be threaded through the eye of the needles or can be purchased already swaged on by

the manufacturer

Resorbable

o Catgut, synthetic sutures

Non-resorbable

o Wire, nylon, silk

Monofilament

o Do not cause a wicking action (inter-twine)

o Difficult to use

o Difficult to tie (stiffer)

Polyfilament

o Wicking action (inter-twined)

o Soft

o Easy to tie

Mayo-Hegar Needle Holder

Mathieu Needle Holder



Surgical Needles

Scissors

Scissors for removing sutures have short beaks

Dissecting scissors: flat points for dissecting tissues

Iris scissors are small, sharp-pointed and are delicate for fine work

Scissors for Sutures (one pointed and one blunt end)

Dissecting Scissors (two pointed ends)



Instruments for Holding the Mouth Open

Rubber bite block in basic oral surgery

Mouth Props in patients who are deeply sedated

Hesiter Mouth Gag (keeps mouth open)

Doyen – Jansen Mouth Gag (keeps mouth open)

Instruments of Irrigation Irrigation with sterile saline

Made with a large plastic syringe and a blunt angled needle

Prevents bone damage by heat buildup during bone removal with a handpiece

Washes away the bone chips and increases efficiency of the bur

Provides lubrication for tissues

Before wound closure the surgical site must be irrigated

Frasier Suction Tip



Dental Elevators

Dental elevators have three major components:

1. Handle

2. Shank

3. Blade

The biggest variation in the type of elevator is the shape and size of the blade.

There are three basic types of elevators:

1. Straight elevator

2. Triangular elevator

3. Pick-type elevator

Straight Elevators

Used to luxate the tooth before the tooth forceps is used

Their blade has a concave surface on one side, it can be used in the same fashion as a

shoehorn

The blade can be angled from the shank (working in the more posterior aspects of the

mouth)

Bein Elevator

White Elevator

Seldin Elevator

Note: You only need to know the Bein Elevator



Triangular Elevators

Provided in pairs (left and right)

Are used for lower roots

Are most useful when a broken root remains in the socket and the adjacent socket is empty

The blade is inserted into the socket, the shank rest on the buccal plate of the bone, then

the elevator is turned with the sharp tip engaging the root cementum



How to identify between left and right Barry Elevator?

Hold the Barry elevator in your left or right hand in the normal grip position (shown in

practices)

Position the long axis of the handle parallel to your body

Position the shank of the elevator perpendicular to the front of your body

Then see if the blade is curving towards or away from you

o Left – pointing towards you

o Right – pointing away from you

Cryer Elevator



Pick Type Elevators

Are you used to elevated broken root tips

Are fine, pointed elevators with extremely long working ends

Angled forms for the lower root tips

Straight forms for the upper root tips

E.g. Crane Pick Elevator:



Towel Clamps

Backhaus Towel Clamp

Jones Towel Clamp

Sponge and Dressing Clamps

Sponge and Dressing Forceps/ Clamp



Probes

Sinus Probe

Used after extraction of a posterior maxillary tooth

To check perforation of maxillary sinus insert probe in socket lightly and probe to check for

no opening! LIGHTLY-OTHERWISE YOU WILL MAKE AN OPENING!

You can also use the nose-blow test and if you hear a hissing sound sinus has been

perforated

Other Instruments

These you should be aware of:

K-wire Bender: Used for bending and cutting splint wires

oral surgery- basic instruments for exodontia

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