FOR
BASIC ORAL
SURGERY
DEEPTHI P.R.
INTERN
DEPT. OF ORAL SURGERY
CONTENTS
Introduction
Instruments for
Instruments
Instruments for
Instruments for
Instruments for
Instruments for
Instruments for
Instruments for
Instruments for
Transferring Sterile
Incising Tissue
Elevating Mucoperiosteum
Retracting Soft Tissue
Controlling Hemorrhage
Grasping Tissue
Removing Bone
Removing Pathologic Tissue
CONTENTS
INTRODUCTION
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 mucoperiosteum
Blade removed
Remember..
INSTRUMENTS
FOR ELEVATING
MUCOPERIOSTE
UM
1.
2.
3.
INSTRUMENTS
FOR
RETRACTING
SOFT TISSUE
o
o
INSTRUMENTS
FOR
CONTROLLING
HEMORRHAGE
INSTRUMENT
S FOR
GRASPING
TISSUE
muscle,
mucosa,
INSTRUMENTS
FOR REMOVING
BONE
INSTRUMENTS
FOR SUTURING
MUCOSA
COMPARISON
Cutting needle:
pass through
mucoperiosteum
more easily than
a tapered needle
1/3 cutting;
remaining- round
Tapered :
vascular, ocular
Care: cut through
tissues lateral to
the track
Resorbability
Nonresorbable : silk, nylon, vinyl &
stainless steel
Resorbable
primarily made of gut- serosal surface of
sheep intestines
- plain catgut: resorbs in 3-5 days
- chromic gut: 7-10 days
Tissue scissors
INSTRUMEN
TS FOR
HOLDING
THE MOUTH
OPEN
Remember..
Stretch injury
INSTRUMENTS
FOR
SUCTIONING
INSTRUMENTS
FOR
EXTRACTING
TEETH
2. Disposable
syringes
3. Safety syringes
Cartridge
Glass cylinder with L/A & other ingredients
1.8ml/1.7ml/2.2ml
Rubber
Diaphragm
Silicon
rubber plunger
Al cap
Neck
Needle
Single piece of tubular metal; plastic/
metal syringe adaptor + needle hub
Additional Armamentarium
Topical antiseptic
Topical anesthetic
Applicator sticks
Sterile gauze 2x2
Hemostat
DENTAL ELEVATORS
PARTS
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 directionadequate support to the adjacent tooth
Finger guard: support adjacent tissues
DENTAL ELEVATORS
Basic grips:
Palm grip: heavy forces; handle rests
against heel of palm
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 both
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: Couplands
Large, pear-shaped handle
Straight shank
Blade: concave/ convex surface & an
inclined plane
Concave groove on one side
Sharp & straight tip
DENTAL ELEVATORS
DENTAL ELEVATORS
Straight elevator: Hospital
Blade, handle & shank: same plane
Handle: flat & triangular- deep criss-cross
grooves
Blade: flat with vertical serrations; other sideconvex 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
DENTAL ELEVATORS
Crossbar elevator
Offset blade- similar to cryers
Handle perpendicular to shank
Maximum mechanical advantage due to
crossbar handle & offset blade
DENTAL ELEVATORS
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
Dont use: wheel- and- axle/lever
Very small root end : insert the tip into
the PDL space- root tip & socket wall
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
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 fashionposterior 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
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 2nd & 3rd 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
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
BIOPSY TRAY
POSTOPERATIVE TRAY
INSTRUMENT ARRANGEMENT
TRAY
Flat, sterilized wrapped with sterilization
paper
Opened preserving sterility
Requires large autoclave
CASSETTE
More compact
REFERENCES