Armamentarium For Basic Oral Surgery

Instruments to incise tissue

Composed of handle and disposable sterile sharp blade

Scalpel

Scalpel blade Scalpel handle

no.3 handle: Most common used handle Occasionally, the longer the handle, the more slender like no. 7

no. 15, 12, 11 : most commonly used scalpel blade for intraoral surgery No. 15: relatively small and can be used to make incisions around teeth and through mucoperiostuem

Scalpel handle

No. 11: sharp-pointed blade used primarily for making small stab incisions such as incising an abscess. no. 10 :for large skin incisions

No. 12:used for mucogingival procedures in which incisions must be made on posterior aspect of teeth in maxillary tuberosity area

Scalpel handle

are only for single-patient use

Dulled very easily when come in contact to bone and teeth.

Dull blades do not make clean, sharp incisions in soft tissue

Scalpel blades

INSTRUMENTS FOR ELEVATING

MUCOPERIOSTEUM

can be single or double-ended. It can be used to reflect soft tissue.Three methods of using:

1. Prying motion2. Push Stroke

3. Pull or scrape stroke

Periosteal Elevator

Periosteal Elevator

most commonly used when teeth are to be extracted and the soft tissue attachment around the tooth must be released.

This instrument is relatively small and delicate and can be used to loosen the soft tissue via gingival sulcus.

No.1 Woodson Periosteal Elevator

is thin and sharp resulting in a clean separation of the periosteum from the bone

N0. 9 or Molt Periosteal Elevator

INSTRUMENTS FOR

CONTROLLING EMORRHAGE

has long, delicate beak, used to grasp tissue, and a locking handle

Used also to remove granulation tissue from the sockets

To pick up small root tips, pieces of calculus, fragments of amalgam restorations and any other small particles that have dropped into the mouth or wound area

Hemostat

INSTRUMENTS TO GRASP TISSUE

delicate forceps with small teeth which can be used to gently hold tissue and thereby stabilize it.

Adson Forceps

Adson Forcep

Allison Forcep

longer forceps usually 7 to 9 inches and easily grasp tissue in the posterior part of the mouth

Stillies Forceps

excellent for picking up small fragments of tooth, amalgam or other foreign material, for placing or removing gauze packs.

This is used in tray systems

Angled Forceps

for removing larger amounts of fibrous tissue like epulis fissuratum

Not to be used on tissue that is to be left in the mouth

Allis Tissue forceps

are large, round-ended tissue forceps more useful to pick up teeth that have been elevated from their sockets

Useful for placing gauze in the mouth

Russian tissue forceps

INSTRUMENTS FOR REMOVING BONE

used for removing bone

Has leaf spring between the handle, so that when hand pressure is released, the instrument will open to make repeated cuts of bone without reopening the instrument

Rongeur Forceps

To cut and contour bone—removes sharp edges of alveolar crest after extractions

for better contour of alveolar ridge; removes exostoses

Side-cutting Rongeur

more practical for most dentoalveolar surgical procedures that require bone removal

Remove large amounts of bone efficiently and quickly

Usually quite expensive

Blumenthal Rongeurs

Side-Cutting Rongeurs

End-Cutting Rongeurs

Most obvious bone removal

Monobevel chisel: bone removal

Bibevel chisel: removed sectioned teeth

Chisel and Mallet

Monobevel Chisel

Bibevel Chisel

Mallet

usually double-ended instrument with a small and large end

Cannot be used efficiently for removal of large amounts of bone

used only for final smoothing

Pull stroke

Bone File

final method of removing bone

Relatively high-speed handpieces with sharp carbide burs remove cortical bone efficiently. Burs such as no. 557 or no. 703 fissure bur or no. 8 round bur

Bur and Handpiece

INSTRUMENTS TO REMOVE SOFT TISSUE FROM BONY

DEFECTS

angled, double-ended instrument used to remove soft tissue from bony defects

Principal use: remove granulomas or small cysts from periapical lesionsUsed to removed small amounts of granulation tissue debris from the tooth socket

Periapical Curette

Surgical Curette(Double –ended and Angular)

Molt Surgical Curette

INSTRUMENTS FOR

SUTURING MUCOSA

instrument with a locking handle and a short, stout beak. For intraoral placement of sutures, a 6-inch (15cm) needle holder is recommended

Hemostat not used in suturing

Needle Holder

used in closing mucosal incisions and usually a small half-circle or three eights-circle suture needle

It is curved to allow the needle to pass through a limited space

Needle

To close incision site“Stitches” hold tissues in place during healing

classified in size, resorbability and whether monofilament or polyfilament

Suture material

designated by series of zeros. 2-0 or 0 larger suture

Smaller sizes would be 4-0, 5-0 and 6-0 sutures

3-0 most commonly used size

Suture size

include silk, nylon, and stainless steel

Silk is the most commonly used in oral cavity

Nylon and Stainless are rarely used in mouth

Nonresorbable suture materials

primarily made of gut (Derived from serosal surfaces of sheep’s intestines. Quickly resorbs in the oral cavity. Rarely lasting longer than 5 days)

Chromic gut: gut treated with tanning solutions (chromic acid) last 10 to 12 days longer

Polyglycolic acid and polylactic acid: are long chains of polymer which slowly resorbed and takes 4 weeks before they resorbed and it is rarely indicated to oral cavity

Resorbable suture materials

are both plain and chromic gut, nylon and stainless steel

Monofilament sutures

are silk, polyglycolic acid and polylactic acid

Polyfilament

has relatively long handles and thumb and finger rings. They are held in same way as needle holder

Has short cutting edges

Most commonly used suture scissors are Dean Scissors which have slightly curved handles and serrated blades

Suture Scissor

Dean Scissor

Iris Scissor

INSTRUMENTS FOR

RETRACTING SOFT TISSUE

Right angle Austin retractor and Off-set

broad Minnesota retractor are most popular cheek retractors. It can retract

cheek and mucoperiosteal flap simultaneously

Austin Retractor

Senn Retractor

Seldin Retractor

Minnesota Retractor

Shuman Retractor

most commonly used to retract the tongue

Mouth mirror

broad, heart-shaped retractor that is serrated on one side

Care must be taken not to position it so far posteriorly because it will cause gagging

Weider tongue retractor

can be used to hold the tongue when a biopsy procedure is to be done

Towel Clip

INSTRUMENTS TO HOLD

MOUTH OPEN

a rubber block on which the patient can rest the teeth or the patient opens her mouth comfortably wide position

Bite block

Also called as Side-action mouth prop

used by the operator to open the mouth widely

Used in patients who are deeply sedated

Molt mouth prop

INSTRUMENTS FOR PROVIDING SUCTION

Surgical suction has smaller orifice

Fraser suction has hole in the handle portion that be covered

Type of Suction

Byrd Self-Cleaning Aspirating Tip

Cogswell Aspirating Tip

Frazier Aspirating Tip

Yankeur Tonsil Aspirator

INSTRUMENTS TO TRANSFER

INSTRUMENTS

forceps are heavy forceps used to move instruments from one sterile are to another

Usually right- angled forceps with heavy jaws

Stored in a container that is usually filled with bactericidal solution such as glutaraldehyde.

Transfer forceps

INSTRUMENTS TO HOLD TOWELS AND DRAPES IN POSITION

To secure surgical drapes and to secure plastic and rubber tubing to drapes

Towel clip/clamp

INSTRUMENTS FOR IRRIGATION

Sterile Saline

Large plastic syringe with a blunt 18-gauge needle. Syringe is disposable, it can be sterilized multiple times before it must be discarded

DENTAL ELEVATORS

one of the most important instruments in extraction procedure

Used to luxate teeth from surrounding bone

Purposes:1. Minimize the incidence of broken roots and teeth2. Facilitates removal of broken root 3. Expand alveolar bone

Handle: held comfortably in hand to apply substantial but controlled force Shank: strong enough to transmit the force from the handle to the blade

Blade: working tip of the elevator and is used to transmit the force to the tooth, bone or both

Dental elevators

Straight/ Gouge Type

Triangle/ Pennant Shape

Pick Type

3 Basic Types

most commonly used elevator to luxate teeth

no. 301: frequently used for beginning of luxation of an erupted tooth

Larger straight elevator: used to displace roots, from their sockets and to tooth that is widely spaced

Straight/ Gouge type

301 Elevator

34 Elevator

second most commonly used elevator which are provided in pairs, a left and right

Useful when a broken root remains in the tooth socket and the adjacent socket is empty. i.e. Cryer elevator

Triangle/ Pennant Shape

Cryer Elevator

Potts Elevator

used to removed roots like Crane pick (heavier in version)

Used as a lever to elevate a broken root form the tooth socket

Root Tip Pick or Apex Elevator: delicate instrument which is used to tease small root tips from their sockets.

Pick Type

Crane Elevator

Root Tip Picks (Angled)

Root Tip Picks (Straight)

EXTRACTION FORCEPS

Instruments that come to mind when thinking of the removal of a tooth Used for removing the tooth from the alveolar bone

Are designed in many styles and configurations, to adapt to the variety of teeth for which they are used

Extraction forceps

COMPONENTS EXTRACTION FORCEPS

usually adequate size to be handled comfortably and deliver sufficient pressure and leverage to remove the required toothHave serrated surface to allow positive grip and prevent slippage

Held differently depending on the position of tooth to be removed. i.e Maxillary forceps and Mandibular forceps

Usually straight but may be curved to provide operator “better fit”

Handle

like the shank of the elevator For connecting the handle to the beak

Transfers and concentrates the force applied to the beak

Hinge

are the source of the greatest variation among forceps

designed to adapt to the tooth root at the junction of the crown and root

designed to be adapted to the root structure of the tooth and not to the crown of the tooth, in a sense then, different beaks are designed for single- rooted teeth, two-rooted teeth, and three-rooted teeth

Beaks

adapt closely to the various root formations, decreasing the chance for root fracture

The more closely the beak of the forceps adapts to the tooth roots, the more efficient will be the extraction and the less chance for untoward complications

Beaks

Some forceps are narrow, because their primary use is to remove narrow teeth, such as incisor teeth. Other forceps are somewhat broader, because the teeth they are designed to remove are substantially wider, such as lower molar teeth. Forceps designed to remove a lower incisor can be used to remove a lower molar

Width of the beak

The beaks of the forceps are angled so that they can be placed parallel to the long axis of the tooth, with the handle in a comfortable position

Width of the beak

MAXILLARY FORCEPS

single-rooted maxillary teeth are usually removed with maxillary universal forceps are slightly curved when viewed from the side and are essentially straight when viewed from above

The beaks of the forceps curve to meet only at the tip

The slight curve of the no. 150 allows the operator to reach not only the incisors, but also the bicuspids in a comfortable fashion

No. 150 Forcep

#150 Maxillary Anteriors And Premolars

The maxillary molar teeth are three-rooted teeth with a single palatal root and a buccal bifurcation. Therefore forceps that are adapted to fit the maxillary molars must have a smooth, concave surface for the palatal root and a beak with a pointed design that will fit into the buccal bifurcation on the buccal beak. This requires that the molar forceps come in pairs: a left and a right

#18R Maxillary Right First And Second Molars

#18L Maxillary Right First And Second Molars

 is useful for the maxillary premolar teeth and should not be used for the incisors, because their adaptation to the roots of the incisors is poor

NO. 150A

 smaller version of the no. 150 is useful for removing primary teeth. These adapt well to all maxillary primary teeth and can be used as universal primary tooth forceps

NO. 150S

 can be used for maxillary incisors and canines, are slightly easier to use than the no. 150 for incisors

NO. 1

The most commonly used molar forceps

These forceps are designed to fit anatomically around the palatal beak, and the pointed buccal beak fits into the buccal bifurcation. The beak is offset to allow for good positioning

No. 53 right and left

#53R Molars Forcep

 A design variation is shown in the no. 88 right and left forceps, which have a longer, more accentuated, pointed beak formation are particularly useful for maxillary molars whose crowns are severely decayed

The sharply pointed beaks may reach deeper into the trifurcation to sound dentin. The major disadvantage is that they crush alveolar bone, and when used on intact teeth without due caution, fracture of large amounts of buccal alveolar bone may occur

Upper cowhorn forceps

#88R Maxillary Left First And Second Molars

#88L Maxillary Left First And Second Molars

with broad, smooth beaks that are off- set from the handle for maxillary second molars and erupted third molars have a single conically shaped root

Universal (both beaks same design-fit equally well on facial and lingual) for right and left quadrants

No. 210S forceps

#210 Maxillary Third Molars

#88L Maxillary Left First And Second Molars

To remove teeth, tooth fragments, and root tips from bony socket

#65 and #69 Maxillary Overlapping Anteriors And Root

Tips

#65

#65 Maxillary Overlapping Anteriors And Root Tips

#69

#69 Maxillary Overlapping Anteriors And Root Tips

MANDIBULAR FORCEPS

Extraction of mandibular teeth

requires forceps that can be used

for single-rooted teeth for the

incisors, canines, and premolars,

as well as for two-rooted teeth

for the molars

The forceps most commonly used for the single-rooted teeth are the lower universal forceps have handles similar in shape to the no. 150, but the beaks are pointed inferiorly for the lower teethThe beaks are smooth and relatively narrow and meet only at the tip. This allows the beaks to fit at the cervical line of the tooth and grasp the root

No. 151

#151/Lower Universal Forcep

forceps have been modified slightly for mandibular premolar teeth  They should not be used for other lower teeth, because their form prevents adaptation to the roots of the teeth 

English style of vertical-hinge forceps is used occasionally for the single-rooted teeth in the mandible

NO. 151A

same general design as the no. 151 but is scaled down to adapt to the primary teeth. A single pair of forceps is adequate for removal of all primary mandibular teeth

No. 151S

most useful lower molar forceps are usually straight-handled, and the beaks are set obliquely downward

The beaks have bilateral pointed tips in the center to adapt into the bifurcation of the molar teeth. cannot be used for molar teeth, which have fused, conically shaped roots

No. 17

#17 Mandibular First And Second Molars

similar in design to the no. 17, but the beaks are shorter and do not have pointed tips useful in the erupted mandibular third molar.

No. 222 forceps

#222 Mandibular Third Molars

major design variation in lower molar forceps designed with two pointed heavy beaks that enter into the bifurcation of the lower molar. After the forceps are seated into the correct position, the tooth is elevated by squeezing the handles of the forceps together tightly 

No. 23 or Cowhorn forceps

#23 or Cowhorn forceps

To remove tooth fragments and root tips from bony socket

Universal (both beaks same design-fit equally well on facial and lingual) for rightand left quadrants

#74 Mandibular Root Tips

#74 Mandibular Root TipsVertical Hinge ForcepEnglish Style

#101 All Deciduous Teeth And Mandibular Anteriors

PURPOSE: To provide instrumentation for surgical removal of tooth/teeth. 1. Sterile gauze2. Local anesthesia syringe, needles, and cartridges3. Surgical aspirating tip4. Cotton pliers5. Mouth mirror6. Periosteal elevator7. Straight elevators8. Surgical curette9. Hemostat10. Extraction forceps (selected for specific tooth/teeth)

BASIC EXTRACTION SET-UP

POSTOPERATIVE TRAYnecessary instruments to irrigate the surgical site and remove suturesscissorscollege pliersirrigation syringeapplicator sticksgauzesuction

 necessary instruments to irrigate the surgical site and remove sutures 1. Scissors

2. pliers3. irrigation 4. Syringe 5. applicator sticks6. Gauze7. suction

Postoperative Tray

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