Instruments for Oral Surgery
-
Upload
graz-fernandez -
Category
Education
-
view
484 -
download
5
description
Transcript of Instruments for Oral Surgery
ARMAMENTARIUM FOR BASIC ORAL SURGERY
Graz Fernandez
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 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 usedo Relatively smallo Around teeth through mucoperiosteum
INSTRUMENTS FOR INCISING TISSUE
2. No.10- similar to No.15o Large skin incisions3.No. 11o Sharp, pointed o Small stab incisionso Incising an abscess4.No.12o Hookedo Mucogingival procedureso Posterior aspect of teeth/ maxillary
tuberosity
INSTRUMENTS FOR INCISING 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 elevatoro 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
Reflection of soft tissue- 3 methods1. Prying motion: pointed end to elevate soft
tissue2. Push stroke: broad end slid under the flap-
separates mucoperiosteum from bone3. Pull/ Scrape: tends to shred periosteum ,if
not careful
INSTRUMENTS FOR ELEVATING 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
INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM
III. Howarth’s Periosteal Elevatoro Double-endedo One end: flat, broad, spatulate- sharp
edgeo Other end: Rugine end; flat &
rectangular. Small tip – sharp projection perpendicular
o Reflection & retraction : mucoperiosteal flaps
o Reflection: periosteum
INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM
IV. Moon’s Probeo Right angled- narrow working edgeo Flat handle & blade; blade perpendicular
to handleo Narrow working edge; blunt & rounded
tipo Mucoperiosteal elevation : prior to
extractiono Objective symptom: anesthesia
INSTRUMENTS FOR
RETRACTING SOFT TISSUE
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Good vision & access Cheeks, tongue & mucoperiosteal flaps
Right angle Austin retractoro ‘L’-shaped- no handleo Retraction of small intraoral flaps:
removal of impacted teeth
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Offset broad Minnesota retractor
Both Austin’s & Minnesota : retract cheek & mucoperiosteal flap simultaneously
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Before flap- retractor held loosely in the cheek
After flap reflection- retractor placed on the bone & used to retract the flap
Seldin retractoro Similar to a periosteal elevatoro Leading edge: dull- shouldn’t reflect
periosteum
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Periosteal elevator- primary instrument for retraction
-positioned on the bone & held to reflect tissueMouth Mirroro Common –Retract tongueWeider Retractoro Broad, heart-shapedo Serrated on one side: firmly engage tongue,
retract it medially & interiorlyo Don’t position posteriorly- gagging
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Langenback’s Retractoro ‘L’ shaped retractor- long handleo Retraction of flap edges : improved
visualization of deeper layers & structures
o Different sizes: handle length & blade width
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Tongue Depressoro ‘L’- shaped; no handleo Broad, flat, rounded bladeo Retraction & depression of tongueo Improve visibility- posterior pharyngeal
wall & tonsillar region, lingual side of mandible
o Removal of throat packo As cheek retractor
INSTRUMENTS FOR RETRACTING SOFT TISSUE
Towel clipo Hold the tongueo Biopsy: performed on the posterior
aspect; by holding the anterior tongueo Profound L/A
INSTRUMENTS FOR
CONTROLLING HEMORRHAGE
INSTRUMENTS FOR CONTROLLING HEMORRHAGE
Arteries & veins- bleeding : pressure not enough
Hemostato Variety of shapeso Small or delicate/ Largero Straight/ Curvedo Curved hemostat- commono 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
INSTRUMENTS FOR
GRASPING TISSUE
INSTRUMENTS FOR GRASPING TISSUE
Soft tissue stabilization- pass suture needle
Adson’s Tissue Forceps/ Pickupso Delicate forceps o Small teetho Gently hold tissue & stabilizeo Don’t grasp too tight- crushingo Non-toothed
INSTRUMENTS FOR GRASPING TISSUE
Tissue Holding Forcepso Toothed/ Non- toothedo Toothed: periosteum, muscle,
aponeurosiso Non- toothed: fascia, mucosa,
pathological tissues
INSTRUMENTS FOR GRASPING TISSUE
Stillies forcepso Longer, but similar to Adson’so 7”-9” longo Easy grasp of tissue in the posterior part, with
enough part protruding beyond the lips: controlCollege/Cotton forcepso Angledo Small fragments of tooth/amalgam/foreign
materialo Placing/removing gauze packs
INSTRUMENTS FOR GRASPING TISSUE
Allis Tissue forcepso Locking handles - proper placement - held by asst. :necessary tensiono Teeth which will firmly grip the tissueo Removal of large amounts of fibrous tissue:
Epulis fissuratumo Never : tissue to be left in mouth- crushing
injury
INSTRUMENTS FOR GRASPING TISSUE
Russian Tissue forcepso Large, round-endedo Teeth elevated from socketso Round end: positive grip, avoids
slippage; unlike hemostato Placement of gauze: isolation
INSTRUMENTS FOR GRASPING TISSUE
Babcock’s Tissue Holding Forcepso Non-toothed bladeso Long beaks- broad working edgeo Smooth, non-serrated edgeso Rings- locking mechanismo Hold delicate tissues: mucosa, lymph
nodeso Holding cyst lining during enucleation
INSTRUMENTS FOR REMOVING
BONE
INSTRUMENTS FOR REMOVING BONE
Rongeur forcepso Most commonly usedo Sharp blades- squeezed together;
cutting/pinching through boneo Leaf spring between the handle :
instrument opens when hand pressure is released
o Repeated cuts without manually reopening
INSTRUMENTS FOR REMOVING 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
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
Chiselo Monobevel chisel: bone is removedo Bibevel chisel: teetho Success: sharpness- sharpen before
sterilisationo 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 Cylindrical handle- serrated for good grip Flat end- tapped with mallet Flat & rectangular blade Bibivelled cutting edge- converge to a
sharp 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 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
INSTRUMENTS FOR REMOVING BONE
Bone fileo Final smoothing of bone
before suturing of mucoperiosteal flap: small
o Double-ended: small & large
o Removes bone: pull strokeo Avoid push motion-
burnishing & crushing the bone
INSTRUMENTS FOR REMOVING BONE
Bur and Handpieceo Surgical removal of teetho High-speed + sharp carbide burs:
cortical bone removalo No. 557,703 fissure burs; No.8 round buro Large bone bur : acrylic bur- large bone
removal (torus)
INSTRUMENTS FOR REMOVING 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
INSTRUMENTS FOR REMOVING PATHOLOGICAL TISSUE
Periapical Curetteo Angled, double-endedo Removal of granulomas/small cysts from
periapical lesionso Small amounts of granulation tissue
debris from tooth sockets
INSTRUMENTS FOR REMOVING 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 holdero Instrument with a locking handle, short,
stout beak o I/O use: 6” or 15cm recommendedo Beak- shorter & stronger than hemostato Face of the beak crosshatched : positive grasp; unlike hemostat
INSTRUMENTS FOR SUTURING MUCOSA
o Held in the proper fashion: control & direct
INSTRUMENTS FOR SUTURING 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
COMPARISON
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
INSTRUMENTS FOR SUTURING MUCOSA
II. Suture needleo Mucosal closure: ½ circle or 3/8 circleo Curved: pass through a limited space;
twisted wristo Large variety of shapeso Very small – very largeo Tips: (i) tapered- sewing needle (ii) triangular – cutting needle
INSTRUMENTS FOR SUTURING 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
INSTRUMENTS FOR SUTURING MUCOSA
o Suture material: usually swaged ono Held 2/3rd – between the tip & the base: - enough exposed to pass through the
tissue - grasp in the strong portion to prevent
bending
INSTRUMENTS FOR SUTURING MUCOSA
III. Suture materialClassified based on: Diametero Oral mucosa: 3-0 (000) - withstand tension intraorally - easier knot tyingo 6-0 < 5-0 < 4-0 < 3-0< 2-0 < 0o 6-0: conspicuous planes- face: less
scarring
INSTRUMENTS FOR SUTURING MUCOSA
Resorbability o Nonresorbable : silk, nylon, vinyl &
stainless steelo 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 acidAdvantages Easy to handle & tie Rarely untied Cut ends: soft & nonirritatingDisadvantages ‘Wick’ oral fluids- underlying tissues Bacteria + saliva
INSTRUMENTS FOR SUTURING MUCOSA
3-0 Black silk Appropriate strength Easy to tie Well tolerated by tissues Easily recognizable – removal Wicking- not significant3-0 chromic suture- removal not needed
INSTRUMENTS FOR SUTURING MUCOSA
IV. Scissorso Short cutting edgeso Long handleso Thumb & ring fingerso Held same as needle holderDean scissorso Slightly curved handleso 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 Ratchet-type action: opening wider as
handle 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 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
INSTRUMENTS FOR HOLDING 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 Caution: not to pinch patient’s skin
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 INSTRUMENTSSyringe
Types:1. Non- disposable syringes
LOCAL ANESTHETIC INSTRUMENTS
2. Disposable syringes
3. Safety 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 ELEVATORSI. Luxate teeth from the surrounding bone Makes extractions easierII. Expands alveolar bone: Buccocervical plate of bone- tooth with
limited & obstructed path of removalIII. Remove broken/ surgically sectioned roots IV. Remove interradicular boneV. Split teeth once a bur groove has been
placed
DENTAL ELEVATORS
PARTS
DENTAL ELEVATORS
Handle: 2 designs Heavy pear-shaped Crossbar: right angles to the shankGeneral 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: cautionShank: Connects handle to the working end Substantial size; strong enough to transmit
forceBlade: Working tip Transmit the force to the tooth, bone or both
DENTAL ELEVATORS
TYPESI. Based on the shape & size:1. Straight2. Triangle/ Pennant-shape3. Pick
II. Based on their form:4. Straight5. Angular6. Crossbar
DENTAL ELEVATORS
III. Based on their use:1. Remove entire tooth2. Remove roots broken at the gingival
line3. Remove roots broken half way to the
apex4. Remove the apical third of the root5. 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
PickRemove roots1. 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 molarsBeaks 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: molarsMaxillary Universal Forceps: No.150o Slightly S-shaped: from side- incisors &
premolarso Straight: from aboveo Beaks curved: meet only at the tipo Modification: No.150A- premolarso 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.88o longer, accentuated, pointed beakso Severely carious crownso Deeper into trifurcation: sound dentino Caution: crush alveolar bone; # large
amounts of buccal bone – intact teeth
MAXILLARY FORCEPS
No.210S Forcepso 2nd & 3rd molars- single conical rooto Smooth beaks: offset
MAXILLARY FORCEPS
Root Tip Forceps: No.65o Offset – very narrow beakso Broken molar roots, narrow premolars,
lower incisors
MAXILLARY FORCEPS
Root Forceps
MANDIBULAR FORCEPS
Single-rooted: Incisors, canines, premolars Two-rooted: molarsLower Universal Forceps: No.151o Handles- No.150o Beaks: pointed inferiorlyo Smooth & narrow: meet only at the tipo Fit near the cervical line- grasp rooto No. 151A: Premolar o No.151S: Primary mandibular teeth
No.151, 151A, 151S
MANDIBULAR FORCEPS
English Style Vertical-Hinge Forcepso Single-rootedo Great force generatedo Root fracture
MANDIBULAR FORCEPS
Lower Molar Forceps: No.17o Single forceps: both sideso Straight-handledo Beaks: obliquely downwardo Pointed tips – centre: bifurcationo Remainder: sides of the furcationo Not for fused, conical roots: 151
No.17
MANDIBULAR FORCEPS
Lower Cowhorn Forceps: No.87o Two pointed, heavy beaks: bifurcationo Forceps positioned: handles pumped up
& down- tooth elevatedo Beaks squeezed into furcation: buccal &
lingual cortical plates- fulcrumso 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 LISTENING