Hello friends this is ur Dr.Lx brought you with best of oral surgery instruments at one place. Dear readers I would like to inform that the techniques for use of forceps and elevators were mentioned in my previously uploaded ppt. EXODONTIA so watch it to gain maximum knowledge .Hope you learn and enjoy this ppt.

1. Armamentarium for oral
surgery
Dr. Laxmi Pandey

2. content
 Introduction
 Classification of instruments.
 Instrument for Transferring Sterile Instrument.
 Instrument for Incising Tissue.
 Instrument for Elevating Mucoperiosteum.
 Instrument for Retracting Soft Tissue.
 Instrument for Controlling Hemorrhage.
 Instrument for Grasping Tissue.
 Instrument for Removing Bone.
 Instrument for Removing Pathology Tissue.

3. Cont..
 Instruments for Suturing Mucosa.
 Instrument for Opening Mouth.
 Instrument for Suctioning.
 Instrument for Irrigation.
 Instruments for Holding Towels And Drapes In Position
 Instrument for Extraction Of Teeth
-Local Anesthesia
-Dental Elevators
-Extraction Forceps
 Instrument Trays
 Conclusion
 References

4.  Myriad of
instruments-oral
surgical procedures.
 Variety of purposes:
- hard tissue
- soft tissue

5. Instrument for Transferring Sterile
Instrument.

6. CHEATLE FORCEPS
 Long handles
 Long angulated beaks 
serrated
 Beaks  dipped in antiseptic
solution lift up sterile
instruments from
autoclave/drum
TRANSFER FORCEP:
 HEAVY , RIGHT angled-heavy
jaws

7. SWAB HOLDING FORCEP:
 Long handles ,straight beaks 
fenestrated ends
 Rings  end of handles
 Working end :inner aspect  serrated
USES:
 Pick up sterile gauze transfer to tray.
 Hold gauze dipped in antiseptic
solution-scrub the surgical field

8. Instrument for Incising Tissue.

9. SCALPEL:
 Handle  No.3,No.7
 Differently shaped
 Disposable ,sterile sharp blade.
No.15  most commonly used
 For Mucoperiosteum
No.10  similar to No.15
 For large incisions
No.11  sharp pointed, small stab
incision for abcess
No.12  Hooked, Mucogingival
surgery. posterior aspect of
teeth, tuberosity

10.  Pen grasp(allows maximum control)
 Hold mobile tissue firmly
 Press down firmly
 Single pt. use
 Always use no blade because it gets dulled
easily and thus gives dull incision
Blade loaded
Pen grasp
Blade removed

11. Instrument for Elevating
Mucoperiosteum.

12.  Mucosa and periosteum reflected in single
layer:
 Periosteal elevator
NO.9 MOLT PERIOSTEAL ELEVATOR:-
 Sharp pointed end  reflects papillae from
between teeth, loosen soft tissues via
gingival sulcus.
 Broader end  elevating the tissues from
bone
 Thin, sharp cutting edge  clean separation
of periosteum from bone.
ROUNDED ENDED MOLT PERIOSTEAL
ELEVATOR:-
 Single/double ended
REFLECTION OF SOFT TISSUE-3 METHODS
 Prying motion 
 Push motion 
 Pull/scrape motion 
PRYING

13. WOODSON PERIOSTEAL ELEVATOR:-
 Small and delicate
 Loosen soft tissues via gingival sulcus
HOWARTH’S PERIOSTEAL ELEVATOR:-
 Double ended
 One ended  flat, broad ,spatulate -sharp edge
 Other end  rugine end: flat and rectangular
small tip-sharp perpendicular
 Reflection and retraction  mucoperiosteal flaps
 Reflection  periosteum
MOON’S PROBE:-
 Right angled narrow working edge
 Flat handle and blade  blade perpendicular to
handle.
 Narrow working edge  blunt and rounded tip
 Mucoperiosteal elevation  prior to extraction

14. Instrument for Retracting Soft
Tissue

15.  It is done for good vision and access
 Cheeks, tongue and mucoperiosteal
flaps .
MOUTH MIRROR:-
 Commonly used
WEIDER RETRACTOR:-
 Broad ,heart shaped
 Serrated on one side  firmly engage
tongue , retract it medially and
inferiorly.
 Don’t position posteriorly  causes
gagging.
AUSTIN RETRACTOR:-
 It is right an right angle L-shaped 
no handle
 Retraction of small intraoral flaps ,
removal of impacted teeth.

16. MINNESOTA RETRACTOR:-
 Both austin and minnesota  retract
cheek and mucoperiosteal flap
simultaneously.
 Before flap  retractor held loosely in
the cheek.
 After flap reflection  retractor
placed on the bone and used to
retract the flap.
SELDIN RETRACTOR:-
 Similar to a periosteal elevator.
 Leading edge  dull, shouldn’t
reflect periosteum.
PERIOSTEAL ELEVATOR:-
 Primary instrument for retraction.
 Positioned on the bone and held to
reflect tissue

17. LANGENBACK’S RETRACTOR:-
 ‘L’ Shaped retractor  long handle
 Retraction of flap edges  improved
visualization of deeper layers and
structures.
 Different sizes  handle length and
blade width
TONGUE DEPRESSOR:-
 ‘L’ shaped  no handle
 Broad flat ,flat ,rounded blade.
 Retraction and depression of tongue
 Improve visibility  posterior
pharyngeal wall and tonsillar region ,
lingual side of mandible.
 Removal of throat pack.
 As cheek retractor

18. TOWEL CLIP:-
 Hold the tongue.
 BIOPSY  performed on
the posterior aspect; by
holding the anterior
tongue.
 Profound L/A

19. Instrument for Controlling Hemorrhage.

20. Arteries and veins  bleeding  pressure
not enough.
HAEMOSTAT
 Variety of shapes
 Small or delicate/large.
 straight/curved
Curved hemostat :-
 Long ,delicate beak to grasp tissue and looking
handle.
 Locking handle  clamps onto a vessel; then
let go and 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.

21. Instrument for Grasping Tissue.

22.  Soft tissue stabilization  pass suture
needle.
ADSON’S TISSUE FORCEP/PICKUPS:-
 Delicate forceps.
 Small teeth.
 Gently hold tissue and stabilize.
 Don’t grasp too tightly crushing
 Non toothed.
TISSUE HOLDING FORCEPS:-
 Toothed  periosteum, muscle,
aponeurosis.
 Non toothed fascia, mucosa, pathological
tissues.
STILLIES FORCEPS:-
 Longer but similar Adson’s
 7”-9” long
 Easy grasp of tissue in the posterior part,
with enough part protruding beyond the lips

23. COTTON FORCEPS:-
 Angled
 Small fragments of
tooth/amalgam/foreign material.
 Placing/removing gauze packs
ALLIS TISSUE FORCEPS:-
 Locking handles 
- Proper placement
-Held by asst. necessary tension
 Teeth which will firmly grip the tissue
 Removal of large amounts of fibrous
tissue  epulis fissuratum
 Never let tissue to be left in mouth 
crushing injury

24. RUSSIAN TISSUE FORCEPS:-
 Large rounded end
 Teeth elevated from sockets
 Round end positive grip, avoids
spillage; unlike hemostat
 Placement of gauze isolation
BABCOCK’S TISSUE HOLDING FORCEP:-
 Non toothed blades
 Long beaks-broad working edge
 Smooth, non serrated edges
 Rings-locking mechanism
 Hold delicate tissues lymph nodes,
mucosa
 Holding cyst lining during enucleation

25. Instrument for Removing Bone

26. RONGEUR FORCEPS:-
 Most commonly used
 Sharp blades squeezed together,
cutting/pinching through bone.
 Leaf spring between the handle 
instrument opens when hand pressure is
released.
 Repeated cuts without manually reopening
2 major designs:
 Side-cutting
 Side-cutting and end cutting/
BLUMENTHAL RONGEURS
-most dentoalveolar surgical procedures
- inserted into sockets: interradicular bone
-sharp edges of bone
 Large amounts of bone, quickly and
efficiently
 Do not  remove large amount of bone in
single bites

27. CHISEL:-
 Monobevel chiesel  bone is
removed
 Bibevel chisel  teeth
 Success  sharpness before
sterilization
 Carbide tips  use more than once,
before sharpening.
 Cylindrical handle  serrated with
flat end  struck with mallet
 Flat and rectangular  cutting edge
in different sizes
 Single bevel  cutting edge
 Transalveolar extraction/removal of
impacted tooth
 Bevel faces  bone to be cut
 Cutting edge  perpendicular to
bone.

28. OSTEOTOME:-
 Splitting bone
 Cylindrical handle serrated for good
grip
 Flat end tapped with mallet
 Flat and rectangular blade
 Bibevel cutting edge  converge to a
sharp edge
BONE FILE :-
 Final smoothing of bone before
suturing of mucoperiosteal flap
 Double-ended  small and large
 Removes bone  pull stroke
 Avoids push motion  burnishing and
crushing the bone

29. SURGICAL MALLET:-
 Cutting bone with osteotome/ chisel
 Stainless steal  strong cylindrical handle
 Tapped  ‘pull-back’ action  force from
wrist
 Tapped with controlled force ; made to spring
back from chisel/osteotome
 For jaw surgery  inadvertent force.
BUR AND HANDPIECE:-
 Surgical removal of teeth.
 High speed + sharp carbide burs = cortical
bone removal
 No.557 ,703 fissure burs ;No.8 round bur
 Large bone bur : acrylic bur – large bone
removal (torus)
 Relatively high speed and torque :rapid bone
removal and efficient sectioning
 Avoid high speed turbine drills used inn
restorative dentistry causes tissue
emphysema

30. Instrument for Removing
Pathology Tissue.

31. PERIAPICAL CURETTE:-
 Angled, double ended
 Removal of granulation /small cysts
from periapical lesions
 Small amounts of granulation tissue
debris from tooth sockets.
HILTONS SINUS FORCEPS:-
 Handles with rings at the end .
 No lock/ratchet
 Narrow , long , slender beaks
 Inner surface  traverse striations
:close to the tip
 Draining pus from an abcess
 Inserted by blunt dissection and
opened up.
 No lock  blind insertion and close 
injure structures

32. Instruments for Suturing Mucosa.

33.  Flap returned to its original position and
held by suture
NEEDLE HOLDER:-
 Instrument with a locking handle, short,
stout, beak
 I/O use: 6” or 15 cm recommended
 Beak  shorter and stronger than hemostat
 Face of the beak cross hatched, positive
grasp ,unlike hemostat.
 Thumb and ring finger through the rings
 Index finger along the length of the holder
 Second finger  aids in controlling the
locking mechanism
COMPARISON:
 HAEMOSTAT :Beaks smaller than sinus
forceps, longer than needle holder; traverse
striation; ratchet
 NEEDLE HOLDER: Criss - cross striations
;ratchet
 SINUS FORCEP: Striations only near the tip;
no ratchet

34. SUTURE NEEDLE:-
 Mucosal closure :1/2 circle or 3/8 circle.
 Curved  pass through limited space
;twisted wrist
 Large variety of shapes
 Very small to very large
 Cutting needle  pass through
mucoperiosteum more easily than a tapered
needle
 1/3  cutting remaining  round
 Tapered  vascular, ocular
 Should always be cut through tissues lateral
to the track
 Suture material :usually swaged on
 Held 2/3rd -> between the tip and the base.
-enough exposed to pass through the tissue
- grasp in the strong portion to prevent
bending

35. SCISSORS:-
 Short cutting edges
 Long handles
 Thumb and ring fingers
 Held same as needle holder
DEAN SCISSORS:-
 Slightly curved handles
 Serrated blades
IRIS SCISSORS and METZENBAUM
SCISSORS:-
 Straight or curved blades
 IRIS SCISSORS : very fine skin sutures, small,
sharp pointed delicate
 METZENBAUM SCISSORS :undermining soft
tissue and cutting ;sharp or rounded tips.
 Don’t cut sutures causes dulling of the
edges –less effective and more traumatic

36. Instrument for Opening Mouth.

37.  Soft, rubber like block where pt.
rests his teeth
 Pt. opens to comfortably wide
position –block inserted: holds in the
position
 Protects pt, TMJ ,while mandibular
teeth
 Various sizes – for various pt. and
varying degrees of opening
Fergusson ackland
mouth gag

38. Mouth gag
Bite block

39. Doyen’s mouth prop
Molt mouth prop

40. Heister’s jaw stretcher
Therabite

41. Mouth prop with mouth gaurd
Mouth prop with suction tip

42. Instrument for Suctioning

43.  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 and injured
SALIVA EJECTORHIGH VOLUME SUCTION TIPS
FRASER SUCTION

44. Instrument for Irrigation

45. Bone removal with steady stream of
irrigation sterile saline or water
 Cools the bur
 Prevents bone damaging heat build
up
 Increase efficiency of bur
-Washes away bone chips
-Lubrication
 Completion of procedure : before
suturing
 LARGE PLASTIC SYRINGE + BLUNT 18-
GAUGE NEEDLE

46. Instruments for Holding Towels And
Drapes In Position

47. Backhaus towel clip
Towel clips
Schaedel towel clip

48. Instrument for Extraction Of Teeth

49. LOCAL ANESTHETIC
INSTRUMENTS:-
LENGTH:32mm and 20mm needles
27/30 gauge : commonly used
25 gauge: preferred for high risk of
positive aspiration
30 gauge: not specific; local
infiltration
PARTS OF NEEDLE

51. COMPUTER CONTROLED L/A
DELIVERY SYSTEM
SAFETY SYRINGES
DISPOSABLE SYRINGES NON DIPOSABLE SYRINGES

52. Needle holder

53. ADDITIONAL ARMAMENTARIUM:-
 Topical antiseptic
 Topical anesthetic
 Applicator sticks
 Sterile gauze 2*2”
 Hemostat

54. DENTAL ELEVATORS
GRIPS:-
 Palm grip:-heavy forces; handle rests
against heel of palm
 Finger grip:-delicate applications
TYPES:-
1. BASED ON THEIR SHAPE AND SIZE:-
 Straight
 Triangle/pennant-shape
 pick
2. BASED ON THEIR FORM
 Straight
 Angular
 Crossbar

55. 3. BASED ON THEIR USE:-
Remove roots broken at the
gingival line
Remove entire tooth
Remove mucoperiosteum
Remove roots broken half
way to the apex
Remove the apical third of the root

56. Forceps for maxillary tooth

57. MAXILLARY ANTERIOR MAXILLARY PREMOLAR

58. MAXILLARY MOLARS MAXILLARY THIRD MOLAR

59. MAXILLARY COWHORN FORCEP

60. MAXILLARY COWHORN FORCEP

61. MAXILLARY ROOT FORCEP

62. Forceps for Mandibular tooth

63. ANTERIOR FORCEP PREMOLAR FORCEP MOLAR FORCEP

64. MOLAR FORCEP
THIRD MOLAR FORCEP

65. COWHORN FORCEP
ROOT FORCEP

66. ELEVATORS
CRANEPICK ELEVATOR
STRAIGHT ELEVATOR APEXO ELEVATOR
ROOT TIP PICK ELEVATOR

67. COUPLAND ELEVATOR
CRYERS FORCEPCROSSBAR ELEVATOR
COUPLAND ELEVATOR

68. Instrument Trays

69. INSTRUMENT ARRANGEMENT
 TRAY :-
1. Flat, Sterilized wrapped
with sterilization paper
2. Opened preserving
sterility
3. Requires large autoclave
 CASSETTE :-
-More compact

70. BASIC EXTRACTION PACK
1. Local anesthesia
2. Needle
3. Cartridge
4. No. 9 periosteal elevator
5. Periapical curette
6. Straight elevator: small and large
7. College pliers
8. Curved hemostat
9. Towel clip
10. Austin/Minnesota retractor
11. Suction tip
12. 2*2”/4*4” gauze
13. Forceps

71. Surgical extraction tray
ADDITIONAL ITEMS:-
1. Needle holder and suture
2. Suture scissors
3. Blade handle and blade
4. Adison tissue forceps
5. Bone file
6. Tongue retractor
7. Cryers elevators
8. Rongeur
9. Handpiece and bur

72. BIOPSY TRAY
1. Basic tray without elevators
2. Blade handle and blade
3. Needle holder and suture, suture
scissors.
4. Metzenbaum scissors
5. Allis forceps
6. Adson tissue forceps
7. Curved hemostat

73. POSTOPERATIVE TRAY
 IRRIGATION :
1. Syringe
2. Suction tip
 SUTURE REMOVAL :
1. Scissors
2. College pliers
3. Cotton applicator sticks
4. Gauze