Professional Documents
Culture Documents
FOR
BASIC ORAL
SURGERY
DEEPTHI P.R.
INTERN
DEPT. OF ORAL SURGERY
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
CONTENTS
Instruments for Suturing Mucosa
Instruments for Holding the Mouth Open
Instruments for Suctioning
Instruments for Irrigating
Instruments for Extracting the Teeth
-Local Anesthetic instruments
-Dental elevators
-Extraction forceps
Instrument trays
Conclusion
References
INTRODUCTION
Myriad of instruments- oral surgical
procedures
Variety of purposes:
-hard tissue
-soft tissue
INSTRUMENTS FOR TRANFERRING
STERILE INSTRUMENTS
CHEATLE FORCEPS
Long handles
TRANSFER FORCEPS
Heavy, right-angled – heavy jaws
SWAB HOLDING FORCEPS
SCALPEL:
Handle- No. 3, No.7
Differently shaped
3.No. 11
o Sharp, pointed
o Incising an abscess
4.No.12
o Hooked
o Mucogingival procedures
Blade removed
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
INSTRUMENTS
FOR ELEVATING
MUCOPERIOSTE
UM
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
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
Round ended Molt periosteal elevator
o Single/double ended
o Reflection: periosteum
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
IV. Moon’s Probe
o Right angled- narrow working edge
handle
o Narrow working edge; blunt & rounded tip
Weider Retractor
o Broad, heart-shaped
gagging
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Langenback’s Retractor
o ‘L’ shaped retractor- long handle
o As cheek retractor
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
Towel clip
o Hold the tongue
o Straight/ Curved
handle
INSTRUMENTS FOR
CONTROLLING HEMORRHAGE
Locking handle: clamps onto a vessel; then let
go & remains clamped onto tissue
Removes granulation tissue
o Small teeth
o Non-toothed
INSTRUMENTS FOR GRASPING
TISSUE
Tissue Holding Forceps
o Toothed/ Non- toothed
tissues
INSTRUMENTS FOR GRASPING
TISSUE
Stillies forceps
o Longer, but similar to Adson’s
o 7”-9” long
- proper placement
- held by asst. :necessary
tension
o Teeth which will firmly grip the tissue
unlike hemostat
o Placement of gauze: isolation
INSTRUMENTS FOR GRASPING
TISSUE
Babcock’s Tissue Holding Forceps
o Non-toothed blades
Blumenthal rongeurs
- most dentoalveolar surgical procedures
- inserted into sockets: interradicular bone
- sharp edges of bone
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
INSTRUMENTS FOR REMOVING
BONE
Chisel
o Monobevel chisel: bone is removed
sterilisation
o Carbide tips- use more than once, before
sharpening
INSTRUMENTS FOR REMOVING
BONE
Cylindrical handle- serrated with flat end:
struck with mallet
Flat & rectangular: cutting edge in different
sizes
Single bevel- cutting edge
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
INSTRUMENTS FOR REMOVING
BONE
Osteotome
Splitting bone
edge
INSTRUMENTS FOR REMOVING
BONE
Osteotomy cuts: orthognathic surgery/
refracturing malunited fractures
Osteoplasty/ bone recontouring
Split impacted tooth for easy removal
INSTRUMENTS FOR REMOVING
BONE
Surgical Mallet
Cutting bone with osteotome/ chisel
removal
o No. 557,703 fissure burs; No.8 round bur
periapical lesions
o Small amounts of granulation tissue debris
No lock/ ratchet
beak
o I/O use: 6” or 15cm recommended
wrist
o Large variety of shapes
Resorbability
o Nonresorbable : silk, nylon, vinyl & stainless
steel
o Resorbable
primarily made of gut- serosal surface of
sheep intestines
- plain catgut: resorbs in 3-5 days
- chromic gut: 7-10 days
INSTRUMENTS FOR SUTURING
MUCOSA
Synthetic: long chains of polymers- braided
- polyglycolic acid
- polylactic acid
Advantages
Easy to handle & tie
Rarely untied
Disadvantages
‘Wick’ oral fluids- underlying tissues
Bacteria + saliva
INSTRUMENTS FOR SUTURING
MUCOSA
Easy to tie
o Long handles
Dean scissors
o Slightly curved handles
o Serrated blades
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: dull the edges- less effective
& more traumatic
Iris: Very fine skin sutures
INSTRUMENTS
FOR HOLDING
THE MOUTH
OPEN
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
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
INSTRUMENTS FOR HOLDING
TE MOUTH OPEN
Side-action Mouth prop/ Molt Mouth prop
Used for wider mouth opening
is closed
Caution : great pressure to joint/teeth- injury
Deeply sedated
Mild trismus
INSTRUMENTS FOR HOLDING
THE MOUTH OPEN
Mouth Gag
Forcefully open mouth: trismus
Stretch injury
solution rapidly
Soft tissue suctioned: hole uncovered to
prevent injury
INSTRUMENTS FOR
SUCTIONING
High Volume Suction Tip
Large bore tubes with slight angulation- end
1.8ml/1.7ml/2.2ml
Rubber
Diaphragm Silicon rubber
plunger
Topical anesthetic
Applicator sticks
Hemostat
INSTRUMENTS FOR
EXTRACTING TEETH
DENTAL ELEVATORS
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
DENTAL ELEVATORS
PARTS
DENTAL ELEVATORS
Handle: 2 designs
Heavy pear-shaped
General rules:
Adjacent tooth- not the fulcrum; unless to be
extracted
Crest of the alveolar bone: fulcrum
heel of palm
Shank:
Connects handle to the working end
5. Reflect mucoperiosteum
DENTAL ELEVATORS
Straight
Most commonly used
to be elevated
Small- No.301:beginning the luxation of an
erupted tooth
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
DENTAL ELEVATORS
Straight Elevator: Coupland’s
Large, pear-shaped handle
Straight shank
plane
Concave groove on one side
Wedge principle
DENTAL ELEVATORS
Triangular
Second most commonly used
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
DENTAL ELEVATORS
Cryers
‘Offset’ blade: at an angle to the shank
Pairs
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
DENTAL ELEVATORS
Crossbar elevator
Offset blade- similar to cryers
using bur
Tip of the pick inserted- buccal plate of the
bone as fulcrum
DENTAL ELEVATORS
Very small root end : insert the tip into the PDL
Extraction forceps
Removing the tooth from the alveolar bone
Many styles and configuration: variety of teeth
Each basic design: multiple variation
EXTRACTION FORCEPS
COMPONENTS
EXTRACTION FORCEPS
Handles
Adequate size
-comfortable handling
-sufficient pressure & leverage
Serrated surface
-positive grip
-prevent slippage
EXTRACTION FORCEPS
Holding handles:
-Maxillary: palm underneath;
beaks superior
better fit
EXTRACTION FORCEPS
Hinge
Connects the handle – beaks
Types
American: horizontal
English: vertical
EXTRACTION FORCEPS
Beaks
Greatest variation
chance of fracture
EXTRACTION FORCEPS
Width of the beaks
Narrow: incisors
premolars
o Straight: from above
Maxillary molars:
-smooth, concave surface: palatal root
-pointed: bifurcation
-right & left
-offset: posterior & correct position
-No.53
No.53
MAXILLARY FORCEPS
Upper Cowhorn forceps: No.88
o longer, accentuated, pointed beaks
incisors
MAXILLARY FORCEPS
Root Forceps
MANDIBULAR FORCEPS
Single-rooted: Incisors, canines, premolars
Two-rooted: molars
o Root fracture
MANDIBULAR FORCEPS
Lower Molar Forceps: No.17
o Single forceps: both sides
o Straight-handled
Additional items
Needle holder & suture
Suture scissors
Bone file
Tongue retractor
Cryer elevators
Rongeur
TRAY
Flat, sterilized wrapped with sterilization paper
CASSETTE
More compact
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
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: Chitra Chakravarthy
Dental Instruments: A Pocket Guide- 2nd
edition: Linda R. Bartolomucci Boyd
Thank you for the PATIENT
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