BY: Amanj kaify

Hawler Medical University

College of Dentistry

ARMAMENTARIUM FOR

BASIC ORAL SURGERY

BASIC EXTRACTION SET-UP PURPOSE: To provide instrumentation

for surgical removal of tooth/teeth.Oral

Surgery

1. Local anesthesia syringe, needles,

and cartridges

2. Sterile gauze

3. Surgical aspirating tip

4. Cotton pliers

5. Mouth mirror

6. Periosteal elevator

7. Straight elevators

8. Surgical curette

9. Hemostat

10. Extraction forceps (selected for

specific tooth/teeth)

MULTIPLE

EXTRACTION/ALVEOPLASTY/GINGIVOPLASTY

SET-UP PURPOSE: To provide instrumentation for surgically removing multiple

teeth, reshaping boneand gingiva, and placing sutures.Oral Surgery

1. Local anesthesia set-up 2. Tissue retractor

3. Scalpel(s) 4. Mouth prop

5. Sterile gauze 6. Surgical aspirating tip

7. Cotton pliers 8. Mouth mirror

9. Periosteal elevator 10. Straight elevators

11. Tissue retractor 12. Surgical curette

13. Bone file 14. Extraction forceps (selected for

specific tooth/teeth)

15. Rongeur 16. Tissue scissor

17. Needle holder 18. Hemostat

19. Suture

Exam and Basic

Hand Instruments

Dental hand instruments are made of metal alloy or plastic resin. They are named according to their use or shape or named for the designer of the instrument.

Hand instruments may be single- or double-ended.

Advantages of double-ended:

two sizes of the same design in one instrument,

two different working ends in one instrument, or two directions of use in one

instrument (right/left).

There are three parts of a hand instrument:

1.Working end. The design determines the function and may be a beveled cutting edge (chisel),

a point(explorer), a nib (amalgam condenser), a blade (composite instrument) or beaks (pliers).

2.Shank. Portion of the instrument that connects the handle and the working end. The shank may be

straight or angled to provide better access to different areas of the mouth.

3.Handle or shaft. Rounded or hexagonal in different diameters and materials for better fit and grip.

MIRROR, MOUTH FUNCTION: To view tissues of the oral cavity and

reflect light for better visibility

FEATURES: Front surface or plane reflective

surface. Front surface mirrors reflect from the

Magnifying and double-sided also available

CLINICAL APPLICATION: Also used to retract and

protect tongue and cheek

EXPLORER FUNCTION: To examine tooth surfaces for caries, calculus, or defects

using sense of touch (tactile)

FEATURES: Thin, sharp working end comes in different designs

May be single- or double-ended (different design on each side)

CLINICAL APPLICATION: Also used to:

Check fit of margins of restorations

Evaluate root surfaces and

furcation area in periodontal

exam (11/12)

Remove excess material from restoration or preparation

Remove excess cement

COTTON PLIERS COTTON PLIERS

FUNCTION: To place and remove small objects from the oral cavity (i.e., cotton pellets, root canal instruments, wedges)

FEATURES: Serrated or nonserrated beaks, locking or nonlocking handles

Also known as College pliers or dressing pliers

CLINICAL APPLICATION: Also used to retrieve materials from drawers and containers to avoid

cross-contamination

SALIVA EJECTOR TIP

FUNCTION: To remove saliva and maintain dry

field using low-volume evacuation

FEATURES: Disposable plastic

Some designed with attached tongue deflector

-Local Anesthetic instruments

ANESTHETIC SYRINGE

FUNCTION: To deliver local anesthesia to

intraoral site

FEATURES: Aspirating and Non-aspirating

CLINICAL APPLICATION: An aspirating syringe has a harpoon on the end of the piston, the nonaspirating syringe does not.

With pressure, the harpoon imbeds in the rubber stopper of the anesthetic cartridge.

As the dentist begins the injection, he/she draws back on the thumb ring, pulling the harpoon and the rubber stopper back and creating a

vacuum. This will draw in (aspirate) fluid from the farthest end of the needle. If

blood comes back into the cartridge, the dentist will reposition the needle to

prevent injecting anesthetic agent into a blood vessel.

Self-Aspirating Syringes

Disposable

CCLAD (Computer Controlled Local

Anesthetic Delivery

LOCAL ANESTHESIA

ACCESSORIES

1. Anesthetic needles:

Two lengths—1 (short) and 1 5/8 (long)

Three gauges (diameter)—25 gauge, 27 gauge,

and 30 gauge

Some manufacturers identify gauge by color-

coding caps

Available with plastic or metal hubs

Advantage of larger needles

1)Less deflection

2)Greater accuracy in injection

3)Less chance for breakage

4)More reliable aspiration

5)No perceptual difference in patient discomfort

Large diameter

Medium diameter

Small diameter

2. Anesthetic cartridges:

Glass vial containing anesthetic solution such as lidocaine(Xylocaine), mepivacaine (Carbocaine),

prilocaine (Citanest), and bupivacaine (Marcaine).

Aluminum cap with rubber diaphragm that needle penetrates at one end of cartridge.

Rubber stopper at the other end.

Cartridges are sterile and sealed in “blister packs.”

Color coded and labeled with type of anesthetic solution and amount of vasoconstrictor.

Contents of cartridge

1-local anesthetic drug

2-vasoconstrictor

3-anti oxidant

4-Sodium choride

5-distilled water

Topical anesthetic: Used prior to local anesthetic

injection to decrease discomfort

One of the most important instruments used in the extraction

procedure is the dental elevator

Elevators come in different designs, shapes and sizes

The three major components of the elevator are the handle, shank,

and blade

Dental Elevators.

The handle of the elevator is pear shaped

In some situations, crossbar or T-bar handles are used.

The shank of the elevator simply connects the handle to the working end, or blade,

of the elevator.

The blade of the elevator is the working tip of the

The blade has two surfaces: a convex and a concave one.

Types of elevators Straight elevator it is used to luxate the teeth

The blade of the straight elevator has a concave surface on one side

Come in different sizes

Cryer’s elevator –

they come in pairs

The triangle shaped elevator is most useful when a broken root

remains in the tooth socket and the adjacent socket is empty

( Commonly used in the mandibular arch)

In experts hands they can be used in the maxilla to luxate maxillary teeth or roots

Winter’s cross-bar elevator

Coupland Chisel

Used to elevate and loosen the tooth from the periodontal

ligament.

Elevation is done to create space and prevent trauma to

adjacent teeth and tissues.

Available in sizes 1, 2 and 3 – working end gets larger with

increase in size number.

Warwick-James elevator – this is a delicate elevator

Available as straight and curved (paired)

It is used to luxate the teeth in the maxilla

Since the handle is flat , the amount of the force aginat the bone will decrease ( reduce the incidence of the fracture)

Crane pick elevator Crane pick elevator is a heavy instrument used to elevate the whole

roots or even teeth

This elevator possess a sharp and thick , curved working that can be

used for removing root

Root tip pick, or apexo elevator– this is a delicate

instrument

The instrument is wedged between the root and the bone

It is not used to push the roots

Apexo elevator

Double-angled elevators (also refered as Apexo elevator)

They are mainly used to remove root tips in both jaws

Their handle is similar to that of the straight elevator.

The shank has a double angle

The blade has a sharp point which can easily remove small broken root tips

Dental Forceps

Function

Removal of tooth from alveolar bone

Designed in various styles and configurations to adapt to variety of teeth for

which they are used

Components

Components of a dental extraction forceps consists of:

- handle

- Hinge

- beaks

1. Handle

They are made of adequate size

They are serrated

For the maxillary teeth, the forceps are held with palm under the

forceps

For the mandibular teeth, the palm is kept on top of the forceps

Handles can be straight or curved

This provides the operator with a sense of "better fit"

2. Hinge

Like the shank of an elevator

The hinge transfers and concentrates the forces applied

to the beaks.

The American type of forceps has a hinge that is directed in a

horizontal direction with the handles of the forcep

While The English type of forceps has a hinge that is directed

vertically to the handles of the forecep

3. Beaks

The beaks of the forcep are concave on their inner aspect and shaped to fit around the root of the tooth

The beak is designed to adapt to the tooth root at the junction of the crown and root

Individual ForcepsUpper anterior forceps

Used for extracting upper incisors & canines

Beaks are symmetrical & are placed in the same line as the handles

beaks are concave and not pointed

Beaks are shorter than the handles, so that load arm is shorter than

the working arm

Maxillary premolar forceps Used for removing premolars teeth

Beaks are symmetrical , concave, not pointed

The forceps have a slightly curved shape and look like an “S.”

Holding the forceps in the hand, the concave part of the curved handle faces the palm,while the concave part of the beaks is turned upwards

Maxillary molar forceps

There are two maxillary molar forceps: one for the left and one for the right side

Forceps have a slightly curved shape

The have asymmetrical beaks : sharply pointed buccal beak and rounded palatal beak

Beaks are broader than anterior forceps

Maxillary Third Molar Forceps.

It is the longest forceps, due to the posterior position of the third molar

The beaks are offset from the handle in a bayonet fashion

The beaks of forceps are concave and smooth (without pointed ends)

The forceps can be used for extraction of both the left and right maxillry third molar and maxillary second molar (conical roots)

Maxillary cowhorn forceps.

They are particularly useful for maxillary molars whose crowns are severely decayed.

The sharply pointed beaks may reach deeper into the trifurcation

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.

Maxillary cow horn forceps has a bayonet design, and are commonly used to extract the maxillary third molar , as well as , it can be used to extraxt the maxillary first and secnd molar

Maxillary cow horn forceps have unidentical beaks, one has pointed tip and the other has bifid pointed beaks

With experinced hands, the surgeon can extract the maxillary third molar by engaging the furcation area between the buccal roots by one pointed tip of the bifid beak so that other tips engane the trifurcation area from the distal area and from the palatal sides

Or , as it recommened by the manufacture, the dentist can usually extract the third molar by engaging the single pointed beak on the furcation area between the buccal roots and the other bifid pointed tip engages the palatal root

If Maxillary cow horn forceps is used to extract the maxillary first and second molar, the dentist should engage the single pointed beak on the furcation area between the buccal roots and the other bifid pointed beak should engages the palatal root ( strong apical force is important to engage the cervical portion of the root , not the crown (other wise it will crush the crown)

Upper root forceps

Designed for removing maxillary roots

The handles of the root tip forceps are straight, while the beaks are narrow and offset from the handle in a bayonet fashion

Beaks closely approximate each other and they meat at the ends

Beaks are narrow to fit to the circumference of the root & provide firm grip

Lower anterior forceps

Lower anterior forceps have identical , short closed beaks

Beaks are narrower than lower molar forceps, similar to upper root forceps

Beaks are at right angles to the handles

They can also be used as lower root forceps

Mandibular premolar forcep

The mandibular premolar forcep have identical long and broad open beaks

The mandibular premolar forcep and can be use to extract the mandibular

canine

Lower molar forceps

Beaks are at right angles to the handles

Beaks are symmetrically pointed & the sharp pointed tips engage the

bifurcation at the buccal & lingual surfaces

Beaks are more broader & stout

Mandibular Third Molar Forceps.

These have straight handles, while the beaks, are curved at a

right angle compared to the handles.

The beaks are a little longer compared to the previous forceps

Because this tooth varies in the shape and size and because there is usually no root

bifurcation, the ends of the beaks of the forceps are concave without a pointed

design.( most useful for the third molar with have fused conical roots)

Other types of the lower third forcep, have bilateral pointed tips in the center to adapt

into the bifuraction area if it is present between the roots

Lower cowhorns forceps

They have two heavy beaks with a very sharp tips that can fit into the root bifurcation

These forceps are often used when the crown of the tooth is badly broken down.

They often cause the tooth to split in two the roots can be removed separately with elevators

Mandibular Root Tip Forceps.

The handles of the root tip forceps are straight,while the beaks are curved at a right angle.

Their ends are very narrow and meet at the tip when the forceps are closed

HEMOSTATS

FUNCTION: To securely hold small items, clamp blood vessels, and remove

small pieces of tooth

or bone

NEEDLE HOLDERS

FUNCTION: To hold suture needle

FEATURES: Similar to hemostat but with a

concave area on inside of each beak to allow for

curve of suture needle

To avoid needle breakage, place the needle

holder on the needle just beyond the suture

attachment point and at right angles to the curve

of the needle

SUTURE

FUNCTION: To close incision site

“Stitches” hold tissues in place during healing

FEATURES: Suture material attached to sterile stainless steel needle

Different sizes and designs of needles

Suture may be absorbable—plain or chromic gut, polyglycolic acid (PGA,

Vicryl)

or nonabsorbable—silk, polyester, nylon, polypropylene

Sized by diameter of suture material: 3–0 (000), 4–0 (0000), 5–0 (00000) most

common sizes used in dentistry (smaller number larger diameter)

CLINICAL APPLICATION: Nonabsorbable sutures usually removed at 7–10 days

postsurgical visit

Placed with needle holder or hemostat

SCALPEL

FUNCTION: To cut soft tissue—a surgical knife

CLINICAL APPLICATION: For safety, blades are placed and removed from the

metal handle with a hemostat

or a specially designed scalpel blade remover

Used blades should be disposed of in a sharps container

SCALPEL BLADE REMOVER

To safely remove blade from scalpel

handle

RONGEURS—SIDE-CUTTING and END-

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

extractions

for better contour of alveolar ridge; removes exostoses

BONE CHISEL AND MALLET

FUNCTION: To remove bone for better contour of alveolar ridge; remove

exostoses, i.e., tori

BONE FILE

FUNCTION: To smooth bone for better contour of alveolar ridge, often following

use of

rongeurs

FEATURES: Straight or curved working ends

Crosscut or straight cutting ridges

Double ended

TISSUE SCISSORS

FUNCTION: To cut and remove excess or diseased soft tissue

Also used to cut sutures after knots are tied during suture placement