ARMAMENTERIUMS IN ORAL AND MAXILLOFACIAL SURGERY

1. ARMAMENTARIUM
S FOR
ORAL SURGERY
Dr. Rahul Tiwari – 2nd Yr. MDS – PG Student.
Department of Oral & Maxillofacial Surgery.
9/19/2016
9:08:14 AM
Armamenteriums for Oral Surgery/3RT/140 1

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
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2

3. CONTENTS
 Instruments for Suturing Mucosa
 Instruments for Holding the Mouth Open
 Instruments for Suctioning
 Instruments for holding towels & drapes in
position
 Instruments for Irrigating
 Instruments for Extracting the Teeth
-Local Anesthetic instruments
-Dental elevators
-Extraction forceps
 Instrument trays
 Conclusion
 References
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4. INTRODUCTION
 Myriad of instruments- oral surgical
procedures
 Variety of purposes:
-hard tissue
-soft tissue
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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
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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
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6

7. INSTRUMENTS
FOR INCISING
TISSUE
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8. INSTRUMENTS FOR INCISING TISSUE
SCALPEL:
 Handle- No. 3, No.7
 Differently shaped
 Disposable, sterile sharp blade:
BLADES:
1. No.15- most commonly used
o Relatively small
o Around teeth through mucoperiosteum
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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 tuberosity9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
9

10. INSTRUMENTS FOR INCISING
TISSUE
Blade loaded
Blade removed
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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
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12. INSTRUMENTS
FOR ELEVATING
MUCOPERIOSTE
UM
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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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
13

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
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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
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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
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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
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18. INSTRUMENTS
FOR
RETRACTING
SOFT TISSUE
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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
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20. INSTRUMENTS FOR
RETRACTING SOFT TISSUE
 Offset broad Minnesota retractor
Both Austin’s & Minnesota : retract cheek &
mucoperiosteal flap simultaneously
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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
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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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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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
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25. INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Towel clip
o Hold the tongue
o Biopsy: performed on the posterior aspect; by
holding the anterior tongue
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26. INSTRUMENTS
FOR
CONTROLLING
HEMORRHAGE
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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
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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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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29. INSTRUMENT
S FOR
GRASPING
TISSUE9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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31. INSTRUMENTS FOR GRASPING
TISSUE
Tissue Holding Forceps
o Toothed/ Non- toothed
o Toothed: periosteum, muscle, aponeurosis
o Non- toothed: fascia, mucosa, pathological
tissues
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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
College/Cotton forceps
o Angled
o Small fragments of tooth/amalgam/foreign
material
o Placing/removing gauze packs
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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
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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
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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
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36. INSTRUMENT
S FOR
REMOVING
BONE9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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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
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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
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40. INSTRUMENTS FOR REMOVING
BONE
Chisel
o Monobevel chisel: bone is removed
o Bibevel chisel: teeth
o Success: sharpness- sharpen before
sterilisation
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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
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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
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43. INSTRUMENTS FOR REMOVING
BONE
Osteotome
 Splitting bone
 Cylindrical handle- serrated for good grip
 Flat end- tapped with mallet
 Flat & rectangular blade
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44. INSTRUMENTS FOR REMOVING
BONE
 Osteotomy cuts: orthognathic surgery/
refracturing malunited fractures
 Osteoplasty/ bone recontouring
 Split impacted tooth for easy removal
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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
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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

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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)
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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
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48

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
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49

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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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51. INSTRUMENTS
FOR
SUTURING
MUCOSA9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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53. INSTRUMENTS FOR SUTURING
MUCOSA
o Held in the proper fashion: control & direct
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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
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54

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
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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
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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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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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
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60. INSTRUMENTS FOR SUTURING
MUCOSA
 Resorbability
o Nonresorbable : silk, nylon, vinyl & stainless
steel, prolene.
o Resorbable
primarily made of gut- serosal surface of sheep
intestines
- plain catgut: resorbs in 3-5 days
- chromic gut: 7-10 days
- vicryl
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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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
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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
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62

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
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63

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: less effective & more
traumatic
 Iris: Very fine skin sutures
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64

65. INSTRUMENTS
FOR HOLDING
THE MOUTH OPEN
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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
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66

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
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67

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
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68

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
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69

70. Remember..
 Histers jaw elevator
 Avoid opening too wide: stress on TMJ
 Stretch injury
 Long procedures: remove periodically; move
the jaw; rest the muscles
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70

71. INSTRUMENTS
FOR
SUCTIONING
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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
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72

73. INSTRUMENTS FOR
SUCTIONING
Fraser suction:
 Hole in the handle
 Hard tissue cut; hole covered to remove the
solution rapidly
 Soft tissue suctioned
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73

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
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74

75. INSTRUMENTS FOR
SUCTIONING
Saliva Ejector
 Low volume suction tip
 Disposable plastic- different designs
 Flexible- bent & adapted under tongue
 Buccal vestibule: partially retracts cheek
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75

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
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76

77.  J Bachaus Towel clip
Schaedel Towel clip
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77

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
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78

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
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79

80. INSTRUMENTS
FOR EXTRACTING
TEETH
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80

81. INSTRUMENTS FOR
EXTRACTING TEETH
LOCAL ANESTHETICINSTRUMENTS
Syringe
Types:
1. Non- disposable syringes
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81

82. LOCAL ANESTHETIC
INSTRUMENTS
2. Disposable
syringes
3. Safety syringes
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82

83. LOCAL ANESTHETIC
INSTRUMENTS
4. Computer Controlled Local Anesthetic
Delivery System
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83

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
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84

85. LOCAL ANESTHETIC
INSTRUMENTS
Needle
 Single piece of tubular metal; plastic/ metal
syringe adaptor + needle hub
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85

86. LOCAL ANESTHETIC
INSTRUMENTS
 Long: 32mm & Short: 20mm needles
 27gauge long (yellow) & 30 gauge short (red):
commonly purchased – dental use
 25 gauge: preferred for high risk of positive
aspiration- blue
 30 gauge: not specific; local infiltration
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86

87. LOCAL ANESTHETIC
INSTRUMENTS
Additional Armamentarium
 Topical antiseptic- Betadine (povidone-iodine)
and Merthiolate (thimerosal).
 Topical anesthetic
 Applicator sticks
 Sterile gauze 2”x2”
 Hemostat
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87

88. INSTRUMENTS FOR
EXTRACTING TEETH
DENTALELEVATORS
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
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88

89. DENTAL ELEVATORS
PARTS
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89

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
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90

91. DENTAL ELEVATORS
Basic grips:
 Palm grip: heavy forces; handle rests against
heel of palm
 Finger grip: delicate applications
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91

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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
92

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
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93

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
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94

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
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95

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
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96

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
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97

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
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98

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 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
99

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
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100

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
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101

102. DENTAL ELEVATORS
Cryers
 ‘Offset’ blade: at an angle to the shank
 Curved & triangular blade
 Heavy pear shaped handle
 Pairs
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102

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
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103

104. DENTAL ELEVATORS
Crossbar elevator
 Offset blade- similar to cryers
 Handle perpendicular to shank
 Maximum mechanical advantage due to
crossbar handle & offset blade
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104

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
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105

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
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106

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
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107

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
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108

109. EXTRACTION FORCEPS
COMPONENTS
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109

110. EXTRACTION FORCEPS
Handles
 Adequate size
-comfortable handling
-sufficient pressure & leverage
 Serrated surface
-positive grip
-prevent slippage
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110

111. EXTRACTION FORCEPS
Holding handles:
-Maxillary: palm underneath;
beaks superior
-Mandibular: palm on top;
beaks point down
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111

112. EXTRACTION FORCEPS
 Straight/ curved
better fit
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112

113. EXTRACTION FORCEPS
Hinge
 Connects the handle – beaks
 Transfers & concentrates : force
Types
 American: horizontal
 English: vertical
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113

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
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114

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
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115

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
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116

117. No.150, 150A, 150S
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117

118. MAXILLARY FORCEPS
 Straight forceps
 No. 1 forceps: easier for upper incisors
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118

119. MAXILLARY FORCEPS
Maxillary molars:
-smooth, concave surface: palatal root
-pointed: bifurcation
-right & left
-offset: posterior & correct position
-No.53
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119

120. No.53
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120

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
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121

122. MAXILLARY FORCEPS
No.210S Forceps
o 2nd & 3rd molars- single conical root
o Smooth beaks: offset
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122

123. MAXILLARY FORCEPS
Root Tip Forceps: No.65
o Offset – very narrow beaks
o Broken molar roots, narrow premolars, lower
incisors
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123

124. MAXILLARY FORCEPS
Root Forceps
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124

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
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125

126. No.151, 151A, 151S
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126

127. MANDIBULAR FORCEPS
English Style Vertical-Hinge Forceps
o Single-rooted
o Great force generated
o Root fracture
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127

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
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128

129. No.17
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129

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
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130

131. No.87
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131

132. MANDIBULAR FORCEPS
Root Forceps
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132

133. BASIC EXTRACTION PACK
 Local anesthesia syringe
 Needle
 Cartridge
 No.9 Periosteal elevator
 Periapical curette
 Straight elevator: small & large
 Curved hemostat
 Towel clip
 Austin/Minnesota retractor
 Suction tip
 2x2 inch/4x4 inch gauze
 Forceps
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133

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
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134

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
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135

136. POSTOPERATIVE TRAY
 Irrigation: syringe, suction tip
 Suture removal: Scissors, College pliers,
Cotton applicator sticks, gauze
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136

137. INSTRUMENT
ARRANGEMENT
TRAY
 Flat, sterilized wrapped with sterilization paper
 Opened preserving sterility
 Requires large autoclave
CASSETTE
 More compact
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137

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
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138

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: Daniel M Laskin
 Dental Instruments: A Pocket Guide- 2nd
edition: Linda R. Bartolomucci Boyd
 Basic guide to dental instruments- Carmen
Scheller 9/19/2016 9:08:14 AMArmamenteriums for Oral Surgery/3RT/140
139

140. THANK YOU
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