This document provides an overview of periodontal surgical instruments, magnification loupes, and microsurgical instruments. It discusses the identification, usage, and classification of common periodontal knives, curettes, elevators, chisels and other instruments. It describes the optical principles and types of magnification loupes, including simple, compound and prism loupes. Finally, it outlines the characteristics of microsurgical instruments and why they enable improved precision, ergonomics and wound healing compared to conventional tools.

1. Surgical
periodontal
instrument and
magnification
loupes
Done by; Mohammed Abo-AlNaga
may, 2020

2. At the end of this presentation should be able to;
1. Identify each periodontal surgical instruments
2. Differentiate each periodontal surgical instrument and it’s usage
3. Understand the optical Principle of magnifying loupes
4. Differentiate between the types of magnifying loupes
5. Mention the advantages and disadvantages of each type of loupes
6. Have a general idea about microsurgical instruments
ILOS

3. Content of the presentation
topic
1
HEADING
periodontal
surgical
instruments
topic
2
HEADING
Magnification
Loupes
topic
3
HEADING
Microsurgical
Instruments

4. SURGICAL
INSTRUMENTS
01

5. 1. Excisional and incisional instruments
2. Surgical curettes and sickles
3. Periosteal elevators
4. Surgical chisels
5. Surgical files
6. Scissors
7. Hemostats and tissue forceps
Classification of surgical instruments

6. A. Periodontal Knives (Gingivectomy Knives)
The Kirkland knife is representative of knives typically used for gingivectomy.
These knives can be obtained as either double-ended or single-ended instruments.
The entire periphery of these kidney-shaped knives is the cutting edge
Excisional and incisional instruments

7. B. Interdental Knives
The Orban and the Merrifield knife #1, 2, 3, and 4 are examples of knives used for
interdental areas. These spear-shaped knives have cutting edges on both sides of the
blade and are designed with either double-ended or single-ended blades.

8. C. Surgical Blades
Scalpel blades of different shapes and sizes are used in periodontal surgery.
The most common blades are 12D, 15, and 15C The 12D blade is a beak shaped blade with cutting
edges on both sides, allowing the operator to engage narrow, restricted areas with both pushing and
pulling cutting motions. The 15 blade is used for thinning flaps and general purposes. The 15C blade,
a narrower version of the 15 blade, is useful for making the initial, scalloping type incision. The slim
design of this blade allows for incising into the narrow interdental portion of the flap. All these blades
are discarded after one use.

9. 1.Bard barker handle
Which is used typical in oral surgical procedures and it used also for cutting gingival tissues and
making surgical incisions.
2. No. 5 Scalpel handle
Finely balanced, pen like scalpel handle with fingertip control that easily rotates and maneuvers in
difficult to reach areas.
3. No. 5E & No. 5EM European Style Scalpel handle
Finely balanced, European style pen like scalpel handle with fingertip control that easily rotates and
maneuvers in difficult to reach areas.
SCALPEL HANDLE

10. 2. Surgical Curettes and Sickles
Larger and heavier curettes and sickles are often needed during surgery for the removal of
granulation tissue, fibrous interdental tissues, and tenacious subgingival deposits. The Prichard
curette and the Kirkland surgical instruments are heavy curettes, whereas the Ball scaler B2-B3 is a
popular heavy sickle. The wider, heavier blades of these instruments make them suitable for surgical
procedures.

11. 3. Periosteal Elevators
The periosteal elevators are needed to reflect and move the flap after the incision has been made for
flap surgery. The Woodson and Prichard elevators are well designed periosteal instruments.

12. 4. Surgical Chisels
There are two types of surgical chisels straight chicsels which is is used with a push motion such as ;
Wiedelstadt, Ochsenbein 1-2, The Ochsenbein chisel is a useful chisel with a semicircular
indentation on both sides of the shank that allows the instrument to engage around the tooth and into
the interdental area . and there are back action chisels which they used with a pull motion eg; The
Rhodes .

13. 5. Tissue Forceps
The tissue forceps is used to hold the flap during suturing. It is also used to position and displace the
flap after the flap has been reflected. The DeBakey forcep is an extremely efficient instrument
6. Scissors and Nippers
Scissors and nippers are used in periodontal surgery to remove tabs of tissue during gingivectomy,
trim the margins of flaps, enlarge incisions in periodontal abscesses, and remove muscle
attachments in mucogingival surgery. Many types are available, and individual preference
determines the choice.
Eg; The Goldman–Fox 16 scissor , Goldman-Fox Tissue Nippers
7. Needle holders
Needle holders are used to suture the flap at the desired position after the surgical procedure has
been completed. In addition to the regular types of needle holder the Castroviejo needle holder is
used for delicate, precise techniques that require quick and easy release and grasp of the suture.

14. MAGNIFICATION
LOUPES
02

15. Generally there are two basic types of magnification systems are commonly used;
1. Loupes
2. Surgical microscope
The Loupes are the most common magnification system used in periodontics. These are
fundamentally two monocular microscopes, with side by-side lenses, angled to focus an object. The
magnified image that
is formed has stereoscopic properties that are created by the use of convergent lens systems which
is called Keplerian optical system.
Loupes are further classified as:
1. Single-lens magnifiers (Simple , clip-on, flip-up, jeweller's glasses)
2. Multi-lens telescopic loupes ;
A. compound
B. prism loupes
The Optical principles of loupes
SIMPLE compound prism

16. 1. Single-lens magnifiers ( simple loupes )
They cosist of simple pair of single meniscus lenses which they produce the described diopter
magnification that simply adjust the working distance to a set length. As diopters increase, the
working distances decrease. A set working distance creates difficulty in maintaining focus and,
therefore, may cause neck and back strain from poor posture. Their magnification can only increase
by increasing lens diameter and thickness which is limited by the loupe’s size and it’s weight to 1.5X.
Another disadvantage of simple loupes is that they are greatly affected by spherical and chromatic
aberration. This distorts the image shape and color of objects being viewed.
2. compound loupes
compound loupes use multiple lenses with intervening air spaces which allow an adjustment of
magnification, working distance, and depth of the field without excessive increase in size or weight
because it allow higher magnification simply by lengthening the distance between lenses. Als it offers
improved optical performance, compound lenses can be achromatic. Achromatic lenses consist of
two glass lenses, joined together with clear resin. The specific density of each lens counteracts the
chromatic aberration of its paired lens to produce a color correct image. But it’s disadvantage that the
multi-element compound loupes become optically inefficient at magnifications above 3x.

17. 3. Prism loupes
Prism loupes are the most optically advanced type of loupe magnification, offering improved
ergonomic posture as well as significant advancements in optical performance.They contain Pechan
or Schmidt prisms that lengthen the light path through a series of mirror reflections within the loupes
confined to a range determined by the loupe's characteristics. The proper depth of field allows the
practitioner to avoid too much leaning and any overextension while practicing. The increased weight
of prism telescopic loupes with magnification above 4X makes headband mounting more comfortable
and stable than eyeglass frame mounting. Recent innovations in prism telescopic loupes include
coaxial fiberoptic lighting incorporated in the lens elements to improve illumination.

18. Microsurgical
Instruments
03

19. - Microsurgical triad
Operating microscope renders three unambiguous benefits of illumination, magnification, and
increased precision in delivery of surgical skills, collectively known as microsurgical triad.
- Microsurgical instruments
with the principle of microsurgical triad Smaller instruments can be used with more precision due to
improved visual acuity. To aid in proper handling and for a high-precision movement
Which they require to be ;
1. slightly top heavy,
2. circular in cross-section
3. approximately 18 cm in length, Shorter instruments with a rectangular cross-sectional design do
not allow precise manipulation and are not ideal for microsurgery.
4. Microsurgical instruments usually have a color-coated surface to avoid an unfavorable metallic
flare due to the light of the microscope.
5. Weight of microsurgical instruments should not be more than 15–20 g to avoid fatigue of hand and
arm muscles. Needle holders should have an appropriate working lock which does not surpass a
locking force of 50 g (0.5 N) as low locking forces diminish the precision and high locking forces
engender tremors.
6. Different manufacturers provide sets of periodontal microsurgical instruments made of steel or
titanium( the last is stronger, lighter, and nonmagnetized in comparison to stainless steel
instruments).

20. - their ability to create clean incisions that prepare wounds for healing by primary
intention.
- Micro-surgical incisions are established at a 90-degree angle to the surface using
ophthalmic microsurgical scalpels
- permits easy identification of ragged wound edges for trimming and freshening.
- For primary wound closure, microsutures in the range of 6-0 to 9-0 are needed to
approximate the wound edges accurately
- Microsurgical wound apposition minimizes gaps or voids at the wound edges.
- This encourages rapid healing with less postoperative inflammation and with less
pain.
- (BETTER ERGONOMICS ) ;
- Studies show that motor coordination is greatly improved when surgeons use
microsurgical instruments specifically designed to employ a precision grip of the
hand.
- These methods also greatly reduce surgical fatigue as well as the spinal and
occupational pathology common in periodontics
WHY MICROSURGICAL INSTRUMENT ?

21. Micro knives
microsurgical and
conventional needle
holder
microsuture

22. ● https://www.hu-friedy.com/sites/default/files/Surgical-Catalog_HF-
711_2014_MC.pdf
● https://www.dentalevolution.com/pdf/Hartzell-catalogo.pdf
● Carranza's clinical periodontology
● Magnification Tools: Surgical Operating Microscope And
Magnifying Loupe In Dental Practice Dr. Ranjana Mohan,
Professor and Head, Dept of Periodontology, Dr. Mohan Gundappa,
Principal, Professor and Head, Dept of Endodontics
● https://www.researchgate.net/publication/49703900
● https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855270/?report=clas
sic
References

23. x
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