Instrumentation for Basic Oral Surgery Dr.Ali Mohammed AbuTrab

2. • This lecture will introduce the basic and the main instruments that perform the
procedures of oral surgery……..
• Instruments for Incising Tissue
• Instruments for Elevating Mucoperiosteum
• Instruments for Retraction of Soft Tissue
• Instruments for Grasping Tissue
• Instruments for Removing Bone
• Instruments for Removing Pathologic Tissue
• Instruments for Suturing Mucosa
• Instruments for Extracting the Teeth (Dental elevators -Extraction
forceps)

3. Instruments for Incising Tissue
• Many surgical procedures begin with an incision. The primary instrument for
making incisions is the scalpel, which is composed of a handle and a sterile, very
sharp blade. blade handle
the pen grasp
for maximal
control
There are many types of blades and each type
has its own uses.

4. • The most common blades that use in our field
Shape Description Uses
No.10
- A blade with a curved belly
- The belly being the sharp edge
Making skin incisions
No.11
-A blade with straight and an angled
edge with a pointed end
Making stab incisions to insert
drains
No.12
-A blade with crescent shape and
the inner side is sharp
Useful for mucogingival procedures
in which incisions are made on the
posterior aspects of teeth or in the
maxillary tuberosity area
No.15
-The most frequently used scalpel
blade for intraoral surgery
- The blade is similar in shape to the
larger No. 10 blade
Used to make incisions around teeth
and through soft tissue

5. Instruments for Elevating Mucoperiosteum
• When an incision is made through the periosteum, ideally the periosteum should be reflected from the underlying
cortical bone.
No. 9 Molt periosteal elevator
1-This instrument has a sharp, pointed end and a broader,
rounded end.
2-The pointed end is used to begin the periosteal reflection
and to reflect dental papillae from between teeth (dissection).
3- The broad, rounded end is used to continue the elevation
of the periosteum from bone.

6. Instruments for Retraction of Soft Tissue
• Good access and vision are critical to performing excellent surgery.
• Use to Retract the cheek, tongue, and mucoperiosteal flaps to provide access and
visibility during surgery
Shape Description Uses
Austin retractor
-right-angle retractor -These retractors can also be used to
retract the cheek and a mucoperiosteal
flap simultaneously.
-Retractors are also used to help protect
soft tissue from sharp cutting
instruments
Minnesota retractor
-broad offset retractor
Before the flap is created, the retractor is held loosely in the cheek.
Once the flap is reflected, the retractor edge is placed on bone and is then used to retract the flap

7. Shape Description Uses
Seldin retractor
-Retractor may look similar to a
periosteal elevator, the leading edge is
not sharp but, instead, smooth; these
instruments are not typically used to
elevate the mucoperiosteum
Used to retract oral soft tissue
The Weider retractor
-A broad, heart-shaped retractor that is
serrated on one side
It can more firmly engage the tongue and
retract it medially and anteriorly .
When this retractor is used, care must be
taken not to position it so far posteriorly
as to cause gagging or to push the
tongue into the oropharynx
A towel clip
-When a biopsy procedure is to be performed on the posterior aspect of the
tongue, the most positive way to control the tongue is by holding the anterior
tongue with a towel clip.

8. Instruments for Grasping Tissue
• Various oral surgical procedures require the surgeon to grasp soft tissue to incise it, to stop bleeding, or to pass a
suture needle.
• Adson forceps
These are delicate forceps, with or without small teeth at the tips, that can be used to hold tissue gently while
stabilizing it. When this instrument is used, care should be taken not to grasp the tissue too tightly to avoid crushing
it.
• Stillies forceps
These forceps are usually 7 to 9 inches long and can easily grasp
tissue in the posterior part of the mouth, still leaving enough of
the instrument protruding beyond the lips for the surgeon to hold
and control it
With tooth Without tooth

9. • Allis tissue forceps
-Use when removing larger amounts of tissue or
doing biopsies.
-forceps with locking handles and teeth that will
firmly grip the tissue are necessary.
-The Allis forceps should never be used on tissue
that is to be left in the mouth because they cause
a relatively large amount of tissue crushing.
Comparison of Adson beaks (right)
with Allis beaks (left) shows the
differences in their designs and uses.

10. Instruments for Removing Bone
Rongeurs Forceps
• The instrument most commonly used for removing bone in
dentoalveolar surgery (Alveoloplasty).
• This instrument has sharp blades that are squeezed together
by the handles, cutting or pinching through bone.
• Rongeur forceps have a rebound mechanism incorporated so
that when hand pressure is released, the instrument reopens
(like spring).
• Two major designs for rongeur forceps are :
1-a side-cutting forceps and 2-the side- and end-cutting forceps
• Rongeurs can be used to remove large amounts of bone
efficiently and quickly. Because a rongeur is a delicate
instrument, the surgeon should not use it to remove large
amounts of bone in single bites. Rather, smaller amounts of
bone should be removed in multiple bites. The end-cutting forceps can be inserted into
sockets for the removal of interradicular bone
and can also be used to remove sharp edges
of bone.
Side-cutting rongeurs used for trimming and
recontouring alveolar bone and gross tissue
removal.

11. • Burr and Handpiece
• Moderate-speed, high-torque handpieces with
sharp carbide round burs remove cortical bone
efficiently.
• The handpiece must not exhaust air into the
operative field, which would make it improper to
use the typical high-speed air-turbine drills
employed in routine restorative dentistry. The
reason is that the air exhausted into the wound may
be forced into deeper tissue planes and produce
tissue emphysema, a dangerous occurrence.
• Bone File
• The bone file is usually a double-ended instrument
with small and larger ends. The bone file cannot be
used efficiently for removal of large amounts of
bone; therefore it is used only for final smoothing.

12. Instruments for Removing Pathologic Tissue
• The curette commonly used for oral surgery is an angled, double-ended
instrument used to remove soft tissue from bony defects.
• Its principal use is to remove granulomas or small cysts from periapical lesions,
but the curette may also be used to remove small amounts of granulation tissue
debris from a tooth socket.
• Larger currettes are available for removing soft tissue from larger bony cavities
such as cysts.

13. Instruments for Suturing Mucosa
• Needle Holder
an instrument with a locking handle and a short, blunt
beak. For intraoral placement of sutures, a 7-inch (15-
cm) needle holder is usually recommended.
Hemostat: longer and
thinner beak
Needle holder: shorter
and thicker
The face of the hemostat has
parallel grooves that do not
allow a firm grip on the needle
The face of the shorter beak of the
needle holder is cross-hatched to
ensure a positive grip on the
needle

14. Suture Needle
Shape Description Uses
Triangular tip with the apex forming a
cutting surface
Used for tough tissue, such as skin (use of
a tapered needle with skin causes excess
trauma because of difficulty in
penetration)
Similar to a conventional cutting needle
except the cutting edge faces down
instead of up
This may decrease the likelihood of
sutures pulling through soft tissue (most
used in oral surgery)
Gradually taper to the point and cross-
section reveals a round, smooth shaft
Used for tissue that is easy to penetrate,
such as bowel or blood vessels
• Most sutures with the suture material swaged onto the base of the needle.
• Shapes vary from a quarter circle to five-eighths of a circle, depending on how confined the operating field is.
• Choice of needle should not alter the tissue to be sutured as little as possible and this depend on :
-The tissue being sutured -Ease of access to the tissue

15. Suture Material
They are classified according :
• 1-Size :The size of suture relates to its diameter and is designated by a series of zeros. The
diameter most commonly used in the suturing of oral mucosa is 3-0 (000). A larger-sized
suture is 2-0, or 0. Smaller sizes are designated with more zeros, for example 4-0, 5-0, and 7-
0. Sutures of very fine size, such as 7-0, are usually used in conspicuous places on the skin—
for example, the face—because properly placed smaller sutures usually cause less scarring.
• 2-Resorbability: Sutures may be resorbable or nonresorbable. Nonresorbable suture
materials include such types as silk, nylon, vinyl, and stainless steel. The most commonly used
nonresorbable suture in the oral cavity is silk. Nylon, vinyl, and stainless steel are rarely used
in the mouth. Resorbable sutures are primarily made of gut. Although the term catgut is
often used to designate this type of suture, gut actually is derived from the serosal surface of
sheep intestines. Plain catgut resorbs quickly in the oral cavity, rarely lasting longer than 3
to 5 days. chromic gut lasts longer than plain gut by up to 7 to 10 days. polyglycolic acid
and polylactic acid materials are slowly resorbed, taking up to 4 weeks to do so. Such long-
lasting resorbable sutures are rarely indicated for basic oral surgery.

16. • 3-Monofilament or polyfilament: Monofilament sutures are sutures such as
plain and chromic gut, nylon, and stainless steel. Polyfilament sutures are
braided sutures such as silk, polyglycolic acid, and polylactic acid. Sutures that
are made of braided material are easier to handle and tie than monofilament
sutures and rarely come untied.
• One of the most commonly used sutures for the oral cavity is 3-0 black silk.
The size 3-0 has the appropriate amount of strength; the polyfilament nature
of the silk makes it straightforward to tie and well tolerated by the patient’s
soft tissues. The color makes the suture easy to see when the patient returns
for suture removal. Sutures that are holding mucosa together usually stay no
longer than 5 to 7 days, so the wicking action is of little clinical importance.
Many surgeons prefer 3-0 chromic suture to avoid the need to later remove it.

17. Scissors
• Suture scissors usually have short cutting edges because their sole purpose is to cut sutures. They usually have
long handles and thumb and finger rings. Scissors are held in the same manner as needle holders.
Scissor shape Description
The most commonly used suture scissors for oral surgery are Dean scissors.
These have slightly curved handles and serrated blades that make cutting
sutures easier.
Iris scissors are small, sharp-
pointed, delicate tools used for
fine work.
-These scissors are designed for
cutting soft tissue.
-They can have either sharp or blunt
(rounded) tips.

18. Instruments for Extracting the Teeth
A- Elevators
• The three major components of the elevator are
the handle, shank, and blade.
• Types of Elevators: (1) the straight type, (2) the
triangle or pennant-shaped type, and (3) the pick
type.

19. Straight Elevators
• The straight elevator is the most commonly used elevator to luxate teeth. The
blade of the straight elevator has a concave surface on one side that is placed
toward the tooth to be elevated.
The small straight elevator is
frequently used for beginning the
luxation of an erupted tooth
before application of the forceps.
Larger straight elevators are
used to displace roots from their
sockets and to luxate teeth that
are more widely spaced, or they
are used once a smaller-sized
straight elevator becomes less
effective.

20. • The shape of the blade of the straight elevator can be angled from the shank,
allowing this instrument to be used in the more posterior aspects of the mouth.
Two examples of the angled-shank elevator with a blade similar to that of the
straight elevator are the Miller elevator and the Potts elevator.

21. Coupland chisel
It has similar shape of the luxator, but the tip is sharper and has straight-cut.
Depending on the width of the working end, there are different sizes including: Size
1, 2 and 3. Coupland chisel can be used to elevate teeth (by leverage action) and
separate teeth. It can also remove bone to create point of application.

22. The Triangle or Pennant-Shaped( Cryer Elevator )
• These elevators are provided in pairs: a left and a right. The triangular elevator is most useful
when a broken root remains in the tooth socket and the adjacent socket is empty.
• The tip of the triangular elevator is placed into the socket with the shank of the elevator
resting on the buccal plate of bone. The elevator is then turned in a wheel-and-axle rotation,
with the sharp tip of the elevator engaging the cementum of the remaining distal root; the
elevator is then turned and the root is delivered.

23. The Pick Type Elevators
• A- Crane pick: This instrument is used as a lever to elevate a broken
root from the tooth socket. Usually it is necessary to drill a hole with a
burr (purchase point) approximately 3 mm deep into the root just at
the bony crest. The tip of the pick is then inserted into the hole, and,
with the buccal plate of bone as a fulcrum, the root is elevated from
the tooth socket. Occasionally the sharp point can be used without
preparing a purchase point by engaging the cementum or the
furcation of the tooth.
• B- Apexo elevator: The root-tip pick is a delicate instrument that is
used to tease small root tips from their sockets. It must be
emphasized that this is a thin instrument and should not be used as a
wheel and- axle or lever type of elevator such as the Cryer elevator
or the Crane pick. The root-tip pick is used to tease the very small
root end of a tooth by inserting the tip into the periodontal ligament
space between the root tip and the socket wall. This instrument
works best on roots left after a tooth has been well elevated.

24. B-Periotomes
• Are instruments used to extract teeth while preserving the anatomy of the tooth’s socket.
The general principle behind their use is to sever some of the periodontal ligaments of the
tooth to facilitate its removal. There are varying types of periotomes with different blade
shapes.
• The tip of the periotome blade is inserted into the periodontal ligament space and advanced
using pressure in the apical direction along the long axis of the tooth. It is advanced about 2
to 3 mm and then removed and reinserted into an adjacent accessible site. The process is
continued around the tooth, gradually advancing the depth of the periotome tip while
progressing apically. Once sufficient severance of periodontal ligaments has been
accomplished, the tooth is removed by using a dental elevator, extraction forceps, or both,
taking care to avoid excessive expansion or fracture of bone.

25. Extraction Forceps
-Forceps are used to lift elevator-luxated teeth from their sockets rather than to pull teeth from
their sockets.
- The handles have a serrated surface to allow a positive grip and to prevent slippage.
British
forceps type
American
forceps type
The usual American type of forceps has a
hinge in a horizontal direction.
The British preference is for a vertical hinge and a
corresponding vertically positioned handle.
The beaks of the extraction forceps are the source of the greatest variation among forceps.
The beaks are designed to adapt to the tooth root near the junction of the crown and root. It
must be remembered that the beaks of the forceps are designed to be adapted to the root
structure of the tooth and not to the crown of the tooth.

26. Maxillary Forceps
Single rooted teeth (incisors- canine and second premolar)
American type British type
Beaks that are found on the same level as the handles characterize these forceps, and the beaks are concave
and not pointed .

27. Maxillary Forceps
Upper premolars
The forceps used for
premolars have a slightly
curved shape and look like
an “S.” Holding the forceps in
the hand, the concave part of
the curved part of the handle
faces the palm, while the
concave part of the beaks is
turned upwards. The ends of
the beaks of the forceps are
concave and are not pointed.
These forceps ma also be
used for extraction of the six
anterior teeth of the upper
jaw.
British
type
American type No. 150 Forceps

28. Maxillary Forceps
Upper Molars (6-7)
• Maxillary Molar Forceps, for
the First and Second Molar.
There are two of these forceps:
one for the left and one for the
right side. Just like the
previously mentioned forceps,
they have a slightly curved
shape that looks like an “S” .The
buccal beak of each forceps has
a pointed design, which fits into
the buccal bifurcation of the
two buccal roots, while the
palatal beak is concave and fits
into the convex surface of the
palatal root.
Upper Molar
(Left)
Upper Molar
(Light)

29. Maxillary Forceps
Upper Molars(8)
• Maxillary Third Molar Forceps.
These forceps have a slightly curved
shape, just like the aforementioned
forceps, and are the longest forceps,
due to the posterior position of the
third molar. Because this tooth
varies in shape and size, the beaks
of the forceps are concave and
smooth (without pointed ends), so
that these forceps may be used for
extraction of both the left and right
third molar of the upper jaw.

30. Maxillary Forceps
Cowhorns Forceps
• Maxillary Cowhorn Molar Forceps. The
upper cowhorn forceps are a variation
of the maxillary molar forceps. The
beaks of this type of forceps have
sharply pointed ends, which fit into the
trifurcation of the roots of the molars.
They are primarily used for extraction of
teeth with severely decayed crowns,
because when they are used to extract
intact teeth, they may fracture the
buccal alveolar bone due to the large
amount of force they generate.

31. Maxillary Root Tip Forceps
Maxillary Root Tip Forceps
• Maxillary Root Tip Forceps.
The handles of the root tip
forceps are straight, while
the beaks are narrow and
angle-shaped. The ends of
the beaks are concave and
without a pointed design.

32. Mandibular Forceps
Anterior And Premolars Teeth Forceps
• Mandibular Universal Forceps or
No. 151 Forceps. Unlike the maxillary
forceps, the beaks and handles of
these forceps face the same direction,
creating an arch. When the forceps
are held in the hand, the concave part
of the arch of the handles faces the
palm, while the beaks obviously face
downward. The ends of the beaks are
concave, without pointed-ends. The
no. 151 forceps are used for extraction
of the six anterior teeth and the four
premolars of the lower jaw.
Mandibular
Universal Forceps
or No. 151 Forceps British
pattern

33. Mandibular Forceps
Molars Forceps
• These forceps are used for both
sides of the jaw and have straight
handles while the beaks are curved
at approximately a right angle
compared to the handles. Both
beaks of the forceps have pointed
ends, which fit into the bifurcation of
the roots buccally and lingually
.These forceps are used for the
removal of both the first and second
molar of the right and left side of the
lower jaw.
American
pattern British
pattern

34. Mandibular Forceps
Third Molar Forceps
• . These forceps also have straight
handles, while the beaks, just like
those of the first and second molar
forceps, are curved at a right angle
compared to the handles. The
beaks are a little longer compared
to the previous forceps, due to the
posterior position of the third molar
in the dental arch. Because this
tooth varies in size and shape and
because there is usually no root
bifurcation, the ends of the beaks
of the forceps are concave without
a pointed design

35. Mandibular Forceps
Cowhorn Molar Forceps
• The lower cowhorn forceps or no. 23 forceps are a
variation of the mandibular molar forceps. In comparison
to the standard forceps, the beaks have a semicircular
shape with sharply pointed ends so that they can fit into
the bifurcation of the roots and firmly grasp the tooth.
wing to the function of these forceps, tooth extraction may
be achieved quite easily as long as the roots are not
curved. With the beaks of the forceps grasping the crown
of the molar and the sharp ends fitting into the root
bifurcation, the surgeon squeezes the handles and, using
small buccolingual movements, slides the tooth out of the
socket. Also, the cowhorn forceps are very useful for
sectioning roots of posterior teeth in the lower jaw, when
their crowns are severely decayed. After grasping the
roots, the teeth are easily sectioned after applying
pressure at the bifurcation point.

36. Mandibular Forceps
Root Tip Forceps
• The handles of the root tip
forceps are straight , while
the beaks are curved at a
right angle. Their ends are
very narrow and meet at
the tip when the forceps
are closed.

37. References:
• James R. Hupp , Edward Ellis , Myron R. Tucker ;”CONTEMPORARY
ORAL AND MAXILLOFACIAL SURGERY, SEVENTH EDITION “; PART II-
Principles of Exodontia, chapter7,Instrumentation for Basic Oral
Surgery.
• Fragiskos D. Fragiskos; “Oral Surgery”;chapter 4 Equipment,
Instruments,and Materials.
• Seth Delpachitra,Anton Sklavos,Ricky Kumar; ”Principles of
Dentoalveolar Extractions”

38. Any
Question????

39. Thank you