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Oral Surgery Instruments

Date: 2012/2/10 Presenter: R1 Instructor:

1. For incising tissue

Scalpel = handle + disposable, sterile blade

To load and remove blade

To make an incision

Pen grasp Mobile tissue: held firmly to stabilize it Mucoperiosteum: pressed down firmly so that the incision penetrates the mucosa and periosteum with the same stroke Got dulled very easily when in contact with hard tissue do not make clean, sharp incisions

2. For elevating mucoperiosteum

No.9 Molt periosteal elevator

Pry stroke: Using tooth as a fulcrum, the sharp pointed end to reflect soft tissue. Push stroke: Using the broad end, slid unterneath the flap to separate the periosteum from the underlying bone. Pull or scrape stroke: can shred or tear the periosteum Retractor

2. For elevating mucoperiosteum

No. 1 Woodson periosteal elevator
to loosen soft tissue from teeth before extraction

3. For retracting soft tissue

Austin retractor Minnesota retractor
to retract the cheek and a mucoperiosteal flap

Seldin retractor
to reflect soft tissue flaps

look similar to a periosteal elevator, but with dull leading edge

3. For retracting soft tissue

Mouth Mirror Weider tongue retractor
To retract tongue Positioned too posteriorly gagging

Towel clip
Biopsy of posterior tongue with local anesthesia on the anterior area

4. For controlling hemorrhage

to clamp and restrict bleeders or tissue, to control the flow of blood remove granulation tissue from tooth sockets and to pick up small root tips, pieces of calculus, and any other small particles

5. For grasping tissue

Adson forceps
Delicate forceps with serrated tips To gently hold tissue to stabilize it Not to grasp the tissue too tightly, thereby crushing it

5. For grasping tissue

Stillies forceps
Longer (7 to 9 inches), posterior part of the mouth

College/cotton forceps
Angled forceps Excellent for picking up small fragments and placing or removing gauze packs

5. For grasping tissue

Allis tissue forceps
Removing larger amounts of fibrous tissue (ex. epulis fissuratum) locking handles and serrated tips to grip the tissue firmly to provide the tension for proper dissection. Do not use on tissue that is to be left in the mouth

5. For grasping tissue

Russian tissue forceps
To pick up teeth that have been elevated from their sockets. The round end allows a positive grip on a tooth so that it won't slip out, as commonly occurs with the hemostat. To place gauze in the mouth when the surgeon is isolating a particular area for surgery.

6. For removing bone

Rongeur Forceps
Sharp blades squeezed together by the handles, cutting or pinching through the bone. The side-cutting and end-cutting forceps are more practical for most dentoalveolar surgeries. Can be inserted into sockets for removal of interradicular bone or sharp edges

6. For removing bone

Rongeur Forceps: Clinical Tips
1. Smaller amount of bone should be removed in each of multiple bites but never large amount of bone in a single bite. 2. A constant cleansing of the blades is necessary. 3. Rongeurs are delicate and relatively expensive therefore, NEVER remove teeth with rongeurs.

6. For removing bone

To shape and sculpt bone, or section a tooth

To cut a window in the bone cortex for access or to gain pure soft bone Monobevel: remove bone Bibevel: section teeth.

To scoop away strips of soft bone, especially in bone grafting

6. For removing bone

with a nylon facing imparts less shock to the patient, is less noisy, and is therefore recommended.

Bur and Handpiece

High-speed, high-torque with sharp carbide burs Autoclavable If exhaust air into the wound into deeper tissue planes tissue emphysema

6. For removing bone

Bone File
Final smoothing of the bone before suturing a mucoperiosteal flap back into position

6. For removing bone

Bone File: Clinical Tips

1. Pull stroke remove bone 2. Pushing burnish and crush the bone (X) 3. Cleanse the instrument by wiping the grooved ends with a sponge. By failure to do this, dust or chips may easily remain in the wound.

7. For removing soft tissue from bony defects

Periapical curette
Angled, double-ended, spoon shape to remove granulomas or small cysts from periapical lesions to remove small amounts of granulation tissue debris from the socket

8. For suturing mucosa

Needle Holder
a locking handle and a short, stout beak. For intraoral placement of sutures, a 6-inch needle holder is usually recommended.

Difference between needle holder & hemostat

Needle holder

Needle holder


How to hold a needle holder

8. For suturing mucosa

Small half-circle or 3/8 circle suture needles A cutting needle will pass through mucoperiosteum more easily than the tapered needle The curved needle is held approximately 2/3 of the distance between the tip and the base of the needle.

8. For suturing mucosa

Suture Material
Diameter, resorbability, mono/polyfilament The diameter most commonly used in the suturing of oral mucosa is 3-0.
Nonresorbable Silk Polyfilament Nylon Vinyl Stainless steel Resorbable Chromic gut: 10-12 days Catgut: 3-5 days Polyglycolic acid & poly lactic acid: 4 weeks

8. For suturing mucosa

Long handles, short cutting edge Suture scissors (most common: Dean scissors) Tissue scissors Should not be used to cut sutures 1) Iris scissors: small, sharp-pointed delicate tools used for fine work 2) Metzenbaum scissors: blunt-nosed scissors used for undermining soft tissue

8. For suturing mucosa

Iris: small sharp-pointed scissors

Metzenbaum: longer, delicate, blunt-nosed scissors

9. For holding mouth open

Bite blocks
To prevent stress on the TMJ when performing extractions of mandibular teeth.

Side-action/Molt mouth prop (ratchet-type action)

Avoid opening the mouth too widely stretch injury to the joint

10. For providing suction

To provide adequate visualization Designed with several orifices so that the soft tissue will not become aspirated into the suction hole and cause tissue damage Fraser suction
has a hole in the handle portion hard tissue: hole is covered so that the solution is removed rapidly soft tissue: the hole is uncovered to prevent tissue injury

11. For holding towels and drapes in position

Towel clip
Not to pinch the patient's underlying skin.

12. For irrigation

Steady stream of sterile saline to cool the bur and prevent bone-damaging heat buildup Increase the cutting efficiency by washing away bone clips Before the mucoperiosteal flap is sutured back, the surgical field should be irrigated thoroughly with saline. A large plastic syringe with a blunt 18-gauge needle is commonly used for irrigation.

13. Dental elevators

To loosen teeth from the surrounding bone To prevent broken roots and teeth To expand alveolar bone To remove broken or surgically sectioned roots
Handle shank blade

A. Straight/gouge type
Luxation of an erupted tooth, displace root from the socket. Angled, used in the more posterior aspects. Ex: Miller elevator & Potts elevator

concave on its working side

B. Triangle/pennant-shape type
Provided in pairs: left, right Most useful when a broke root remains in the tooth socket and the adjacent socket is empty. Ex: Cryer

C. Pick type
Crane pick
Drill a hole with a bur about 3 mm deep into the root just at the bony crest. buccal plate as a fulcrum crane pick as a lever to elevate a broken root from the socket.

Root tip pick

To tease the very small root end

14. Extraction forceps

How to hold forceps

14. Extraction forceps

Maxillary forceps
Single root: maxillary incisors, canines, premolars

Universal forceps No. 150 incisors, canines

14. Extraction forceps

Maxillary forceps
Bifurcated root: premolars



No. 150 A premolars

14. Extraction forceps

Maxillary forceps
Single-rooted: maxillary incisors, canines

No. 1 incisors , canines

14. Extraction forceps

Maxillary forceps
Concave for P root Beak fits into B bifurcation

Trifurcated root: maxillary molars

No. 53 right and left

14. Extraction forceps

Maxillary forceps
Trifurcated root: maxillary molars
Maxillary molars whose crowns are severely decayed

N0. 88 right and left (upper cowhorn forceps)

14. Extraction forceps

Maxillary forceps
Maxillary 2nd molars and erupted 3rd molars have a single conically shaped root

N0. 210 S

14. Extraction forceps

Broken upper molar root, narrow premolars, lower incisors

N0. 286 root tip forceps

14. Extraction forceps

Universal primary maxillary teeth forceps

N0. 150S

14. Extraction forceps

Mandibular forceps

No. 151 lower universal forceps

14. Extraction forceps

Mandibular forceps
No. 151 A mandibular premolars

14. Extraction forceps

English style of vertical-hinge forceps

Single-rooted teeth in the mandible Great force root fracture

14. Extraction forceps

Mandibular molars: bifurcated, two-rooted
Bifurcation is on both B & L, only single molar forceps are necessary for the left and right

No. 17 N0. 151Fused, concial roots

14. Extraction forceps

2 pointed heavy beaks into the bifurcation of the lower molar

N0. 23 (Cowhorn forceps)

14. Extraction forceps

Universal primary mandibular teeth forceps

No. 151 S

Thank you for your attention!