Armamentarium For Basic Oral Surgery

ARMAMENTARIU
M FOR
BASIC ORAL
SURGERY
Dr. Saabir
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
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
 Long, angulated beaks: serrated
 Beaks: dipped in antiseptic solution
 Lift up sterile instruments from autoclave/
drum
TRANSFER FORCEPS
 Heavy, right-angled – heavy jaws
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
INSTRUMENTS
FOR INCISING
TISSUE
INSTRUMENTS FOR INCISING
TISSUE
SCALPEL:
 Handle- No. 3, No.7
 Differently shaped
 Disposable, sterile sharp blade:
1. No.15- most commonly used

o Relatively small
o Around teeth through u

mucoperioste m
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

TISSUE
Blade loaded
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
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
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
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
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
INSTRUMENTS
FOR
RETRACTING
SOFT
TISSUE
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
INSTRUMENTS FOR
 Offset broad Minnesota retractor
Both Austin’s & Minnesota : retract cheek

& mucoperiosteal flap simultaneously
INSTRUMENTS FOR
 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
INSTRUMENTS FOR
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
INSTRUMENTS FOR
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
INSTRUMENTS FOR
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
INSTRUMENTS FOR
Towel clip
o Hold the tongue
o Biopsy: performed on the posterior aspect;
by holding the anterior tongue

o Profound L/A
INSTRUMENTS
FOR
CONTROLLING
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
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

INSTRUMENT
S FOR
GRASPING
TISSUE
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
TISSUE
Tissue Holding Forceps
o Toothed/ Non- toothed
o Toothed: periosteum, muscle, aponeurosis
o Non- toothed: fascia, mucosa,

pathological tissues
TISSUE
Stillies forceps
o Longer, but similar to Adson’s
o 7”-9” long
o Easy grasp of tissue in the posterior part, with
enough part protruding beyond the lips: control

College/Cotton forceps
o Angled
o Small fragments of tooth/amalgam/foreign
material
o Placing/removing gauze packs
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: Epulis
fissuratum
o Never : tissue to be left in mouth- crushing injury
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
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
INSTRUMENTS
FOR
REMOVING
BONE
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
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
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
BONE
Chisel
o Monobevel chisel: bone is removed
o Bibevel chisel: teeth
o Success: sharpness- sharpen
before sterilisation
o Carbide tips- use more than once,
before sharpening
BONE
 Cylindrical handle- serrated with flat
end: struck with mallet
 Flat & rectangular: cutting edge in
different sizes
 Single bevel- cutting edge
BONE
 Transalveolar extraction/ removal of
impacted tooth
 Shape/ contour irregular bony surfaces
 Bevel faces- bone to be cut
 Cutting edge- perpendicular to bone
BONE
Osteotome
 Splitting bone
 Cylindrical handle- serrated for good grip
 Flat end- tapped with mallet
 Flat & rectangular blade
 Bibivelled cutting edge- converge to a
sharp edge
BONE
 Osteotomy cuts: orthognathic
surgery/ refracturing malunited
fractures
 Osteoplasty/ bone recontouring
 Split impacted tooth for easy removal
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
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
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)

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
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

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
INSTRUMENTS
FOR
SUTURING
MUCOSA
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

MUCOSA
o Held in the proper fashion: control & direct
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
COMPARISO
N
 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
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

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
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
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
MUCOSA
 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
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-
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
MUCOSA
IV. Scissors
o Short cutting edges
o Long handles
o Thumb & ring fingers
oHeld same as needle holder

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
INSTRUMEN
TS 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
THE MOUTH OPEN
 Various sizes: various sized patients & varying
degrees of opening
 Wider opening- position more posteriorly
 Pediatric-sized block: adequate over molars
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
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

Remember..
 Avoid opening too wide: stress on TMJ
 Stretch injury
 Long procedures: remove periodically;

move the jaw; rest the muscles
INSTRUMENTS
FOR
SUCTIONING
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
INSTRUMENTS FOR
SUCTIONING
Fraser suction:
 Hole in the handle
 Hard tissue cut; hole covered to remove
the solution rapidly

 Soft tissue suctioned: hole uncovered
to prevent injury
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

INSTRUMENTS FOR
SUCTIONING
Saliva Ejector
 Low volume suction tip
 Disposable plastic- different designs
 Flexible- bent & adapted under tongue
 Buccal vestibule: partially retracts
cheek
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
 J Bachaus Towel clip
Schaedel Towel clip

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
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
INSTRUMENTS
FOR
EXTRACTING
TEETH
INSTRUMENTS FOR
EXTRACTING TEETH
LOCAL ANESTHETIC
INSTRUMENTS
Syringe
T 1
y
p
e
s
:
.
LOCAL ANESTHETIC
INSTRUMENTS
2. Disposable 3. Safety syringes

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

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

LOCAL ANESTHETIC
INSTRUMENTS
 Long: 32mm & Short: 20mm needles
 27gauge long & 30 gauge short:
commonly purchased – dental use
 25 gauge: preferred for high risk of
positive aspiration
 30 gauge: not specific; local infiltration
LOCAL ANESTHETIC
INSTRUMENTS
Additional
Armamentarium
 Topical antiseptic
 Topical anesthetic
 Applicator sticks
 Sterile gauze 2”x2”
 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
PART
S
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
DENTAL ELEVATORS
Basic grips:
 Palm grip: heavy forces; handle rests
against heel of palm
 Finger grip: delicate

applications
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
 Transmit the force to the tooth, bone or

DENTAL ELEVATORS
TYPES
I. Based on the shape & size:
1. Straight
2. Triangle/ Pennant-shape
3. Pick
II. Based on their form:

4. Straight
5. Angular
6. Crossbar
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
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
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
 Blade: concave/ convex surface & an
inclined plane
 Concave groove on one side
 Sharp & straight tip

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
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
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
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
DENTAL ELEVATORS
Cryers
 ‘Offset’ blade: at an angle to the shank
 Curved & triangular blade
 Heavy pear shaped handle
 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
 Handle perpendicular to shank
 Maximum mechanical advantage due
to crossbar handle & offset blade

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
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

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

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
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
-Mandibular: palm on
top; beaks point down
EXTRACTION FORCEPS
 Straight/ curved
better fit
EXTRACTION FORCEPS
Hinge
 Connects the handle – beaks
 Transfers & concentrates : force
Types
 American: horizontal
 English: vertical
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

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
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

No.150, 150A, 150S
MAXILLARY FORCEPS
 Straight forceps
 No. 1 forceps: easier for upper
incisors
MAXILLARY FORCEPS
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
o Severely carious crowns
o Deeper into trifurcation: sound dentin
o Caution: crush alveolar bone; # large
amounts of buccal bone – intact teeth

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

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

No.151, 151A, 151S
MANDIBULAR FORCEPS
English Style Vertical-Hinge Forceps
o Single-rooted
o Great force generated
o Root fracture
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
No.17
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
No.87
MANDIBULAR FORCEPS
Root Forceps
BASIC EXTRACTION PACK
 Local anesthesia syringe

 Needle
 Cartridge
 No.9 Periosteal elevator
 Periapical curette
 Straight elevator: small & large
 College pliers
 Curved hemostat
 Towel clip
 Austin/Minnesota retractor
 Suction tip
 2x2 inch/4x4 inch gauze
 Forceps
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

BIOPSY TRAY
 Basic tray without elevators
 Blade handle & blade
 Needle holder &
suture, suture scissors
 Metzenbaum scissors
 Allis tissue forceps
 Adson tissue forceps
 Curved hemostat
POSTOPERATIVE TRAY
 Irrigation: syringe, suction tip
 Suture removal: Scissors, College
pliers, Cotton applicator sticks, gauze
INSTRUMENT ARRANGEMENT
TRAY
 Flat, sterilized wrapped with sterilization
paper
 Opened preserving sterility
 Requires large autoclave
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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Armamentarium For Basic Oral Surgery

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Armamentarium For Basic Oral Surgery

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ARMAMENTARIU

 Long, angulated beaks: serrated

 Beaks: dipped in antiseptic solution

 Lift up sterile instruments from autoclave/

 Long handles, straight beaks- fenestrated

 Disposable, sterile sharp blade:

1. No.15- most commonly used

o Around teeth through u

o Small stab incisions

o Posterior aspect of teeth/ maxillary

 Reflection of soft tissue- 3 methods

II. Woodson periosteal elevator

 Loosen the soft tissues via gingival

o One end: flat, broad, spatulate- sharp edge

o Other end: Rugine end; flat & rectangular.

Small tip – sharp projection perpendicular

o Flat handle & blade; blade perpendicular

o Mucoperiosteal elevation : prior to

 Right angle Austin retractor

Both Austin’s & Minnesota : retract cheek

the bone & used to retract the flap

o Leading edge: dull- shouldn’t

o Serrated on one side: firmly engage tongue,

retract it medially & interiorly

o Retraction of flap edges : improved

visualization of deeper layers &

o Broad, flat, rounded blade

o Retraction & depression of tongue

o Improve visibility- posterior pharyngeal wall

& tonsillar region, lingual side of mandible

o Biopsy: performed on the posterior aspect;

by holding the anterior tongue

o Small or delicate/ Larger

o Curved hemostat- common

o Long, delicate beak to grasp tissue & a

 Picks up root tips, pieces of calculus,

fragments of amalgam restorations, any

 Eg: Crile, Spencer Wells, Halstead

mosquito artery forceps

o Gently hold tissue & stabilize

o Don’t grasp too tight- crushing

o Toothed: periosteum, muscle, aponeurosis

o Non- toothed: fascia, mucosa,

o Easy grasp of tissue in the posterior part, with

enough part protruding beyond the lips: control

o Small fragments of tooth/amalgam/foreign

o Removal of large amounts of fibrous tissue: Epulis

o Teeth elevated from sockets

o Round end: positive grip, avoids

slippage; unlike hemostat

o Long beaks- broad working edge

o Smooth, non-serrated edges

o Rings- locking mechanism

o Hold delicate tissues: mucosa, lymph

o Sharp blades- squeezed

instrument opens when hand pressure is

 Side-cutting & end-cutting/

o Bibevel chisel: teeth

o Success: sharpness- sharpen

 Cylindrical handle- serrated for good grip

 Flat end- tapped with mallet

 Flat & rectangular blade

 Bibivelled cutting edge- converge to a