Armamentarium for basic oral surgery


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Armamentarium for basic oral surgery

  2. 2. 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
  3. 3. 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
  4. 4. INTRODUCTION  Myriad of instruments- oral surgical procedures  Variety of purposes: -hard tissue -soft tissue
  5. 5. 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
  6. 6. 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
  8. 8. 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
  9. 9. 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
  10. 10. INSTRUMENTS FOR INCISING TISSUE Blade loaded Blade removed
  11. 11. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. 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
  19. 19. 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
  20. 20. INSTRUMENTS FOR RETRACTING SOFT TISSUE  Offset broad Minnesota retractor Both Austin’s & Minnesota : retract cheek & mucoperiosteal flap simultaneously
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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
  27. 27. 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
  28. 28. 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
  30. 30. 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
  31. 31. INSTRUMENTS FOR GRASPING TISSUE Tissue Holding Forceps o Toothed/ Non- toothed o Toothed: periosteum, muscle, aponeurosis o Non- toothed: fascia, mucosa, pathological tissues
  32. 32. 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
  33. 33. 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
  34. 34. 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
  35. 35. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. INSTRUMENTS FOR REMOVING BONE  Cylindrical handle- serrated with flat end: struck with mallet  Flat & rectangular: cutting edge in different sizes  Single bevel- cutting edge
  42. 42. 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
  43. 43. 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
  44. 44. INSTRUMENTS FOR REMOVING BONE  Osteotomy cuts: orthognathic surgery/ refracturing malunited fractures  Osteoplasty/ bone recontouring  Split impacted tooth for easy removal
  45. 45. 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
  46. 46. 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
  47. 47. 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)
  48. 48. 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
  49. 49. 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
  50. 50. 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
  52. 52. 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
  53. 53. INSTRUMENTS FOR SUTURING MUCOSA o Held in the proper fashion: control & direct
  54. 54. 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
  55. 55. 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
  56. 56. 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
  57. 57. 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
  58. 58. 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
  59. 59. 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
  60. 60. 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
  61. 61. 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
  62. 62. 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
  63. 63. 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
  64. 64. 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
  66. 66. 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
  67. 67. 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
  68. 68. 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
  69. 69. 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
  70. 70. Remember..  Avoid opening too wide: stress on TMJ  Stretch injury  Long procedures: remove periodically; move the jaw; rest the muscles
  72. 72. 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
  73. 73. 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
  74. 74. 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
  75. 75. INSTRUMENTS FOR SUCTIONING Saliva Ejector  Low volume suction tip  Disposable plastic- different designs  Flexible- bent & adapted under tongue  Buccal vestibule: partially retracts cheek
  76. 76. 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
  77. 77.  J Bachaus Towel clip Schaedel Towel clip
  78. 78. 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
  79. 79. 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
  82. 82. LOCAL ANESTHETIC INSTRUMENTS 2. Disposable syringes 3. Safety syringes
  83. 83. LOCAL ANESTHETIC INSTRUMENTS 4. Computer Controlled Local Anesthetic Delivery System
  84. 84. 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
  85. 85. LOCAL ANESTHETIC INSTRUMENTS Needle  Single piece of tubular metal; plastic/ metal syringe adaptor + needle hub
  86. 86. 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
  87. 87. LOCAL ANESTHETIC INSTRUMENTS Additional Armamentarium  Topical antiseptic  Topical anesthetic  Applicator sticks  Sterile gauze 2”x2”  Hemostat
  88. 88. 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
  90. 90. 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
  91. 91. DENTAL ELEVATORS Basic grips:  Palm grip: heavy forces; handle rests against heel of palm  Finger grip: delicate applications
  92. 92. 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
  93. 93. 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
  94. 94. 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
  95. 95. 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
  96. 96. 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
  97. 97. 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
  98. 98. 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
  99. 99. 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
  100. 100. 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
  101. 101. 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
  102. 102. DENTAL ELEVATORS Cryers  ‘Offset’ blade: at an angle to the shank  Curved & triangular blade  Heavy pear shaped handle  Pairs
  103. 103. 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
  104. 104. DENTAL ELEVATORS Crossbar elevator  Offset blade- similar to cryers  Handle perpendicular to shank  Maximum mechanical advantage due to crossbar handle & offset blade
  105. 105. 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
  106. 106. 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
  107. 107. 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
  108. 108. 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
  110. 110. EXTRACTION FORCEPS Handles  Adequate size -comfortable handling -sufficient pressure & leverage  Serrated surface -positive grip -prevent slippage
  111. 111. EXTRACTION FORCEPS Holding handles: -Maxillary: palm underneath; beaks superior -Mandibular: palm on top; beaks point down
  112. 112. EXTRACTION FORCEPS  Straight/ curved better fit
  113. 113. EXTRACTION FORCEPS Hinge  Connects the handle – beaks  Transfers & concentrates : force Types  American: horizontal  English: vertical
  114. 114. 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
  115. 115. 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
  116. 116. 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
  117. 117. No.150, 150A, 150S
  118. 118. MAXILLARY FORCEPS  Straight forceps  No. 1 forceps: easier for upper incisors
  119. 119. MAXILLARY FORCEPS Maxillary molars: -smooth, concave surface: palatal root -pointed: bifurcation -right & left -offset: posterior & correct position -No.53
  120. 120. No.53
  121. 121. 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
  122. 122. MAXILLARY FORCEPS No.210S Forceps o 2nd & 3rd molars- single conical root o Smooth beaks: offset
  123. 123. MAXILLARY FORCEPS Root Tip Forceps: No.65 o Offset – very narrow beaks o Broken molar roots, narrow premolars, lower incisors
  124. 124. MAXILLARY FORCEPS Root Forceps
  125. 125. 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
  126. 126. No.151, 151A, 151S
  127. 127. MANDIBULAR FORCEPS English Style Vertical-Hinge Forceps o Single-rooted o Great force generated o Root fracture
  128. 128. 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
  129. 129. No.17
  130. 130. 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
  131. 131. No.87
  132. 132. MANDIBULAR FORCEPS Root Forceps
  133. 133. 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
  134. 134. 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
  135. 135. BIOPSY TRAY  Basic tray without elevators  Blade handle & blade  Needle holder & suture, suture scissors  Metzenbaum scissors  Allis tissue forceps  Adson tissue forceps  Curved hemostat
  136. 136. POSTOPERATIVE TRAY  Irrigation: syringe, suction tip  Suture removal: Scissors, College pliers, Cotton applicator sticks, gauze
  137. 137. INSTRUMENT ARRANGEMENT TRAY  Flat, sterilized wrapped with sterilization paper  Opened preserving sterility  Requires large autoclave CASSETTE  More compact
  138. 138.  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
  139. 139. 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
  140. 140. Thank you for the PATIENT LISTENING