This document introduces common surgical instruments used in oral and maxillofacial surgery. It describes scalpel blades, periosteal elevators, retractors, forceps for grasping tissue and controlling hemorrhage, bone cutting instruments like rongeurs and chisels, instruments for removing soft tissue from bone, suturing tools like needle holders and suture materials, dental extraction instruments like elevators and forceps, and various trays used in oral surgery procedures. The purpose is to familiarize residents with the basic instrumentation required to perform routine dental extractions and other oral surgical operations.

1. SURGICAL INSTRUMENTS
Dr. Hadi Munib
Oral and Maxillofacial Surgery Resident

2. INTRODUCTION
• The purpose is to introduce the instrumentation commonly
required to perform routine dental extractions and other basic
oral surgical operations.
• These instruments are used for a wide variety of purposes,
including soft and hard tissue procedures.

3. INCISING TISSUES
The most commonly used handle for oral
surgery is the No. 3 handle. The tip of a
scalpel handle is prepared to receive a
variety of differently shaped scalpel blades
to be inserted onto the slotted portion of
the handle
Scalpel Blades: Left to right: #10 , #11, #12 and #15

4. LOADING SCALPEL BLADE

5. ELEVATING THE MUCOPERIOSTEUM
• When an incision is made ideally the periosteum should be reflected from the
underlying cortical bone in a single layer with a periosteal elevator.
• No. 9 Molt Periosteal Elevator
• Two ends: Pointed and broad
• Three methods: 1. Twisting, 2. Push stroke and 3. Pull stroke

6. RETRACTING SOFT TISSUE
• Good access and vision are essential to performing excellent surgery.
• Retractors can also help protect soft tissue from sharp cutting instruments.
Right Angle Austin Retractor
Minnesota Retractor

7. WEIDER RETRACTOR – HEART SHAPED
Henahan (top) and Seldin (bottom)
Retractors

8. MALLEABLE RETRACTOR

9. GRASPING SOFT TISSUE
• Most commonly used Tissue Forceps is the Adson’s or the pick-up
• If in posterior parts of the mouth then the Adson’s will be too short,
Stillies forceps are longer and useful in this situation.
• College or cotton forceps useful for broken restorations or fragments of
teeth.

10. ALLIS FORCEPS – TISSUES TO
BE EXCISED

11. CONTROLLING HEMORRHAGE - HEMOSTAT
• Mosquito or artery forceps are other names.
• Has long and delicate beaks used to grasp tissue and a locking handle.
• Transverse serrations.

12. CUTTING BONE
• Rongeur forceps  most commonly used
• Handpiece and bur [ALWAYS WITH WATER] WHY?
• Mallet and Chisel
• Bone File

13. MALLET AND CHISEL AND BONE FILE

14. REMOVING SOFT TISSUES FROM BONY CAVITIES

15. SUTURING SOFT TISSUE
• Needle Holder

16. NEEDLE HOLDER VS. HEMOSTAT

17. SUTURE
NEEDLE
• Three-Eights circle or half-circle needle
• Cutting vs. Non-cutting
• Triangular vs. Round cross section.

18. HOLDING NEEDLE HOLDER AND NEEDLE

19. SUTURE MATERIALS
• Classified by diameter, resorbability, and whether they are monofilament or poly-
filament.
• Size of suture relates to its diameter and the diameter most commonly used in
the suturing of oral mucosa is 3-0 (000). The greater the number the smaller the
size.
• Resorbable vs. Non-Resorbable
• Non-Resorbable suture materials include such types as silk, nylon, vinyl, and
stainless. The most commonly used non-resorbable suture in the oral cavity is
silk.
• Resorbable sutures are primarily made of gut. Plain catgut resorbs quickly in the
oral cavity, rarely lasting longer than 3 to 5 days
• Chromic Gut lasts up to 7-10 days, Polyglycolic/Polyacitic acid sutures last up to 4
weeks

20. SCISSORS

21. HOW TO KEEP THE MOUTH OPEN?
• Bite Block
• Side-Action or Molt Mouth prop
• Sutures?

22. SURGICAL SUCTION

23. TOWEL CLIP – HOLDING DRAPES IN POSITION

24. IRRIGATION

25. EXTRACTION OF TEETH
• Elevators
• Function?
• Straight or Copeland
• Triangular or Cryers
• Pick-up elevators

26. STRAIGHT ELEVATOR

27. TRIANGULAR ELEVATOR

28. APEXO ELEVATORS

29. PICK-TYPE ELEVATORS

30. WARWICK JAMES

31. PERIOTOMES

32. EXTRACTION FORCEPS
• American vs. British
• Tooth vs Remaining Root Forceps
• Upper vs. Lower

33. AMERICAN VS. BRITISH

34. UPPER VS. LOWER AMERICAN

35. UPPER ANTERIOR FORCEPS

36. UPPER PREMOLAR FORCEPS

37. UPPER MOLAR FORCEPS

38. UPPER REMAINING ROOT FORCEPS

39. LOWER ANTERIOR FORCEPS

40. LOWER PREMOLAR FORCEPS

41. LOWER MOLAR FORCEPS

42. LOWER COWHORN FORCEPS

43. LOWER ROOT FORCEPS

44. BASIC EXTRACTION TRAY

45. SURGICAL EXTRACTION TRAY

46. POST-OPERATIVE TRAY

47. BIOPSY TRAY

48. REFERENCES
• Chapter 6:
Instrumentation

49. THANK YOU