exodontia,minor surgery,sterilisation

1. Instrumentation & Sterilisation
By
Dr.Sudeep Upadhyay,
Oral & Maxillofacial Surgeon

2. Contents
• Introduction
• History
• Designing of instruments
• Principles of elevators
• Instruments for
- Gaining surgical asepsis.
- Gaining surgical access.
- Retraction of tissues.
- Maintaining a clean surgical field.
- Holding
- Removal of bone

3. Introduction
• Armamentarium have evolved:-
- For the ease of surgeon.
- Shortening on table-time.
- Widening the Surgical Field.
- Increasing the Visibility.
- Minimizing trauma to the Surgical Site.

4. Saint Apollonia

5. History
Pelican bird
Fauchard’s Dental pelican.
Dental pelican.

6. Early dental key
Folding dental key,
Straight shanked key with single claw The nadir of dental keys

7. 1.Hind’s foot elevator with ebony handle; 2. Spade-shaped elevator c1800-1810, made
by French instrument maker Blanu; 3. Punch elevator with ebony handle c1795; 4.
Goat’s foot elevator with ebony handle.

8. Design of Instruments
•Joint types.
•Handle types.
•Retaining Systems.

9. Joint types
Box lock
Lap Joint
Double Action Joint

10. Handle types
Ring Handle
Ring Handle with one
extra large handle
Grooved Handle
Grooved Handle with horn
Hollow Handle

11. Ratchet lock
Single spring
Double spring
Spring with roller Double spring with ball and socket joint
Retaining Systems

12. Bar ratchet
Double leaf spring
Cam ratchet
Bar and wingnut
Sliding ring

13. Principles of Elevators

14. First order Lever Principle

15. Wedge principle

16. Wheel and Axle Principle

17. Tooth Extraction Forceps

18. Maxillary Forceps
No.1 Forceps
No.150A Forceps
No.53 Forceps

19. .
No.286 Forceps.
No.210 Forceps
NO.88 Forceps

20. Mandibular Forceps
No.151 Forceps
No.151A Forceps
No.17 Forceps

21. No.222 Forceps
No.23 Forceps

22. Physics Forceps
• First class lever mechanism.
• One handle is connected to the
bumper that functions as the
fulcrum during extraction.
• Advantage – causes atraumatic
extraction.

23. Dental Elevators
Straight elevator
Coupland elevator

24. Warwick james elevator

25. Cryer elevator

26. Apexo elevator
Winter cryer elevator

27. Instruments for Gaining Surgical
Asepsis

28. Cheatle’s Forceps
• Long handles and long
angulated, beaks which are
serrated for better grip.
• To remove instruments and
drapes from the autoclave.

29. Swab Holding Forceps
• long handles but straight beaks
are fenestrated and serrated in
the ends.
• Used to hold the swab and paint
the surgical area with an
antiseptic preoperatively

30. Towel Clip
Backhaus towel clip
Schaedel towel clip

31. Instruments for Gaining Surgical
Access

32. Bard-Parker Handle

33. Ultrasonic Harmonic Scalpel
• Uses ultrasound technology to
simultaneously cut and coagulate.
Advantages:-
• Reduction in operating time
• Reduction in intraoperative blood loss
• Reduced drainage
• Decreased postoperative pain
• Fewer postoperative complications.

34. Suture Cutting Scissors
Deans scissor Heath stitch scissor Goldman Fox scissor Iris Scissor

35. Dissecting Scissor
Metzanbaum Scissor Mayo Scissor

36. Instruments for reflection of
mucoperiosteal flap

37. Molt’s No.9 Periosteal
Elevator
Howarth’s Periosteal
Elevator
Seldin Periosteal
Elevator
Freer Elevator

38. Instruments for retraction of the
Tissues

39. Cheek Retractor

40. Modified cheek retractor- Takafumi Chin, MD,a Tokyo, Japan
NIPPON MEDICAL SCHOOL HOSPITAL
Modified Cheek Retractor

41. Kilner C-shaped Retractor
Minnesota Retractor
Tongue Depressor

42. • Forked
Austin’s Retractor
Regular Curved
Forked Retractor with Suction Tip
Forked

43. Weider’s Retractor
Self retaining Retractor (Weitlaner):-
Chin Retractor

44. Langenbeck’s Retractor Obwegessor’s Ramus RetractorCrile Retractor

45. Cat’s Paw Retractor Senn Retractor Skin hooks

46. Instrument for maintaining a clean
surgical field

47. Frazier Suction tip Yankauer Suction tip

48. Suction ApparatusSuction tube

49. Instruments for Holding

50. Mayo- Hegar Needle Holder
• Has a locking handle and
a short, stout beak.
• It has a vertical slot
• Beak is shorter and
stronger than the
hemostat.
• Used in intraoral
placement of sutures

51. Crile Artery Forceps Halsted Mosquito
Forceps
Kelly Forceps Kocher Clamp

52. Adson Forceps Stillies Forceps
DeBakey
Forceps
Gillies
Forceps
College
Forceps

53. Allis Tissue Holding
Forceps
Russian Tissue
Forceps
Babcock’s Tissue
Forceps

54. Instruments for Removal of Bone

55. Luer- Friedmann Rongeur Forceps
•Two major designs are a side cutting
forceps and side-cutting/end-cutting
forceps.
•Side-cutting/end-cutting forceps are
more practical for dentoalveolar surgical
procedures.
•Used to remove bone and sharp bone
spicules during intraoral surgery.

56. Chisel MalletOsteotome

57. Miller Bone File
Bone Holding Forceps

58. Hand Piece No.557 No.703 No.8 burs

59. Ultrasonic Osteotomy
• Barium titanate transducers
• Low frequencies (20-36
kHz) used to cut the bone.
• Placing excessive pressure
on an ultrasonic tip can
prevent its proper vibration,
and in overheating.

60. Instruments for Wound
Debridement

61. Lucas Periapical Curette Volkmann’s Bone Scoop Lister’s Sinus Forceps

62. Penrose Drains Corrugated Rubber Drain
Closed Wound Suction System

63. Miscellaneous

64. Alexis retractorMouth prop

65. .
Dingman mouth gag
Fergusson Auckland and
Doyen’s mouth gag.
Heister’s Mouth opener

66. Sterilization

67. Sterilization

68. Sterilization
 It is the act or process, physical or
chemical, that destroys or eliminates all
forms of life, especially microorganisms
either in vegetative or spore state.
 Destruction or removal of all microbial
life including endospores.

69. Disinfectant
•A disinfectant is an agent that frees from infection,
usually a chemical agent but sometimes a physical
one, such as x-rays or ultraviolet light, that
destroys disease or other harmful microorganisms
but may not kill bacterial spores.
•It refers to substances applied to inanimate
objects.

70. Asepsis
 It is a substance that prevents or arrests the
growth or action of microorganisms, either by
inhibiting their activity or destroying them. It is
used to prevent contamination of wounds and
other sites (living tissue).

71. Presterilization cleaning
Ultrasonic washing Mechanical washingManual washing

72. Methods of sterilization
Physical agents
1. Dry heat
a. Flaming
b. Incineration
c. Hot air
2.Moist air
a. Pasteurisation
b. Boiling
c. Steam under pressure
3.Filteration
4.Radiations
Chemical agents
1. Alcohols
2. Aldehydes
3. Dyes
4.Halogens
5.Phenols
6.Gases
7.surface active
agents
8. metallic salts

73. Method Mechanism
of action
Comment Preferred use
Autoclaving Protein
denaturation
Very effective
method of
sterilization; at about
15 psi of pressure
(1210 C), all
vegetative cells and
their endospores are
killed in about 15
min.
Microbiological
media, solutions,
linens, utensils,
dressings,
equipment, and
other items that
can withstand
temperature and
pressure
Hot air
sterilization
Oxidation Very effective
method of
sterilization, but
requires
temperature of 1210
C for about 2 hr.
Empty glassware,
instruments,
needles and glass
syringes

74. Items
Autoclave Setting
1210c/15psi 1320c/27psi
Dressing-Wrapped in
equipment
30mins 15mins
Glass ware 15mins 3mins
Instruments(Metal) 15mins 3mins
Suture material,tubing 20mins 10mins
Linen packs 30mins 10mins
Treatment tray 30mins 15mins