ARMAMENTARIUM

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

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 solutionscrub 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 used
o Relatively small
o Around teeth through mucoperiosteum

INSTRUMENTS FOR INCISING TISSUE

2. No.10- similar to No.15
o Large skin incisions
3.No. 11
o Sharp, pointed
o Small stab incisions
o Incising an abscess
4.No.12
o Hooked
o Mucogingival procedures
o 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 elevator
o. 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

1.

2.

3.

Round ended Molt periosteal elevator

Single/double ended
Reflection of soft tissue- 3 methods
Prying motion: pointed end to elevate soft
tissue
Push stroke: broad end slid under the flapseparates mucoperiosteum from bone
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. Howarths Periosteal Elevator
o Double-ended
o One end: flat, broad, spatulate- sharp
edge
o Other end: Rugine end; flat &
rectangular. Small tip sharp projection
perpendicular
o Reflection & retraction : mucoperiosteal
flaps
o Reflection: periosteum

INSTRUMENTS FOR ELEVATING

MUCOPERIOSTEUM
IV. Moons Probe
o Right angled- narrow working edge
o Flat handle & blade; blade perpendicular
to handle
o Narrow working edge; blunt & rounded
tip
o Mucoperiosteal elevation : prior to
extraction
o Objective symptom: anesthesia

INSTRUMENTS
FOR
RETRACTING
SOFT TISSUE

INSTRUMENTS FOR RETRACTING SOFT

TISSUE

o
o

Good vision & access

Cheeks, tongue & mucoperiosteal flaps
Right angle Austin retractor
L-shaped- no handle
Retraction of small intraoral flaps:
removal of impacted teeth

INSTRUMENTS FOR RETRACTING SOFT

TISSUE

Offset broad Minnesota retractor

Both Austins & 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 retractor
o Similar to a periosteal elevator
o Leading edge: dull- shouldnt reflect
periosteum

INSTRUMENTS FOR RETRACTING SOFT

TISSUE
Periosteal elevator- primary instrument for
retraction
-positioned on the bone & held to reflect tissue
Mouth Mirror
o Common Retract tongue
Weider Retractor
o Broad, heart-shaped
o Serrated on one side: firmly engage tongue,
retract it medially & interiorly
o Dont position posteriorlygagging

INSTRUMENTS FOR RETRACTING SOFT

TISSUE
Langenbacks Retractor
o L shaped retractor- long handle
o Retraction of flap edges : improved
visualization of deeper layers &
structures
o Different sizes: handle length & blade
width

INSTRUMENTS FOR RETRACTING SOFT

TISSUE
Tongue Depressor
o L- shaped; no handle
o Broad, flat, rounded blade
o Retraction & depression of tongue
o Improve visibility- posterior pharyngeal
wall & tonsillar region, lingual side of
mandible
o Removal of throat pack
o As cheek retractor

INSTRUMENTS FOR RETRACTING SOFT

TISSUE
Towel clip
o Hold the tongue
o Biopsy: performed on the posterior
aspect; by holding the anterior tongue
o Profound L/A

INSTRUMENTS
FOR
CONTROLLING
HEMORRHAGE

INSTRUMENTS FOR CONTROLLING

HEMORRHAGE
Arteries & veins- bleeding : pressure not
enough
Hemostat
o Variety of shapes
o Small or delicate/ Larger
o Straight/ Curved
o Curved hemostat- common
o 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

INSTRUMENT
S FOR
GRASPING
TISSUE

INSTRUMENTS FOR GRASPING TISSUE

Soft tissue stabilization- pass suture
needle
Adsons Tissue Forceps/ Pickups
o Delicate forceps
o Small teeth
o Gently hold tissue & stabilize
o Dont grasp too tight- crushing
o Non-toothed

INSTRUMENTS FOR GRASPING TISSUE

Tissue Holding Forceps
o Toothed/ Non- toothed
o Toothed:
periosteum,
aponeurosis
o Nontoothed:
fascia,
pathological tissues

muscle,
mucosa,

INSTRUMENTS FOR GRASPING TISSUE

Stillies forceps
o Longer, but similar to Adsons
o 7-9 long
o Easy grasp of tissue in the posterior part, with
enough part protruding beyond the lips: control
College/Cotton forceps
o Angled
o Small fragments of tooth/amalgam/foreign
material
o Placing/removing gauze packs

INSTRUMENTS FOR GRASPING TISSUE

Allis Tissue forceps
o Locking handles
- proper placement
- held by asst. :necessary
tension
o Teeth which will firmly grip the tissue
o Removal of large amounts of fibrous tissue:
Epulis fissuratum
o Never : tissue to be left in mouth- crushing
injury

INSTRUMENTS FOR GRASPING TISSUE

Russian Tissue forceps
o Large, round-ended
o Teeth elevated from sockets
o Round end: positive grip, avoids
slippage; unlike hemostat
o Placement of gauze: isolation

INSTRUMENTS FOR GRASPING TISSUE

Babcocks Tissue Holding Forceps
o Non-toothed blades
o Long beaks- broad working edge
o Smooth, non-serrated edges
o Rings- locking mechanism
o Hold delicate tissues: mucosa, lymph
nodes
o Holding cyst lining during enucleation

INSTRUMENTS
FOR REMOVING
BONE

INSTRUMENTS FOR REMOVING BONE

Rongeur forceps
o Most commonly used
o Sharp blades- squeezed together;
cutting/pinching through bone
o 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

Chisel
o Monobevel chisel: bone is removed
o Bibevel chisel: teeth
o Success: sharpness- sharpen before
sterilisation
o 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 file
o Final smoothing of bone
before suturing of
mucoperiosteal flap: small
o Double-ended: small &
large
o Removes bone: pull stroke
o Avoid push motionburnishing & crushing the
bone

INSTRUMENTS FOR REMOVING BONE

Bur and Handpiece
o Surgical removal of teeth
o High-speed + sharp carbide burs:
cortical bone removal
o No. 557,703 fissure burs; No.8 round bur
o Large bone bur : acrylic bur- large bone
removal (torus)

INSTRUMENTS FOR REMOVING BONE

o

Completely sterilizable in a steam

autoclave: ensure on purchase
Relatively high speed & torque: rapid
bone removal & efficient sectioning
Must not exhaust air into the operative
field
Avoid high-speed turbine drills used in
restorative dentistry:
tissue emphysema

INSTRUMENTS FOR REMOVING

PATHOLOGICAL TISSUE
Periapical Curette
o Angled, double-ended
o Removal of granulomas/small cysts from
periapical lesions
o 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 holder
o Instrument with a locking handle, short,
stout beak
o I/O use: 6 or 15cm recommended
o Beak- shorter & stronger than hemostat
o 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 needle
o Mucosal closure: circle or 3/8 circle
o Curved: pass through a limited space;
twisted wrist
o Large variety of shapes
o Very small very large
o 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
1/3 cutting;
remaining- round
Tapered :
vascular, ocular
Care: cut through
tissues lateral to
the track

INSTRUMENTS FOR SUTURING MUCOSA

Suture material: usually swaged on
Held 2/3rd between the tip & the base:
- enough exposed to pass through the
tissue
- grasp in the strong portion to prevent
bending
o

INSTRUMENTS FOR SUTURING MUCOSA

III. Suture material
Classified based on:
Diameter
o Oral mucosa: 3-0 (000)
- withstand tension intraorally
- easier knot tying
o 6-0 < 5-0 < 4-0 < 3-0< 2-0 < 0
o 6-0: conspicuous planes- face: less
scarring

INSTRUMENTS FOR SUTURING MUCOSA

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

INSTRUMENTS FOR SUTURING MUCOSA

Synthetic: long chains of polymers- braided
- polyglycolic acid
- polylactic acid
Advantages
Easy to handle & tie
Rarely untied
Cut ends: soft & nonirritating
Disadvantages
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 significant
3-0 chromic suture- removal not needed

INSTRUMENTS FOR SUTURING MUCOSA

IV. Scissors
o Short cutting edges
o Long handles
o Thumb & ring fingers
o Held same as needle holder
Dean scissors
o Slightly curved handles
o 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
Dont cut sutures: dull the edges- less
effective & more traumatic
Iris: Very fine skin sutures

INSTRUMEN
TS 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 patients 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/teethinjury
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 angulationend
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 patients skin

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 INSTRUMENTS
Syringe
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 2x2
Hemostat

INSTRUMENTS FOR EXTRACTING TEETH

DENTAL ELEVATORS
I. Luxate teeth from the surrounding bone
Makes extractions easier
II. Expands alveolar bone:
Buccocervical plate of bone- tooth with
limited & obstructed path of removal
III. Remove broken/ surgically sectioned roots
IV. Remove interradicular bone
V. 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 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

Finger grip: delicate applications

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

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 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

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
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

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 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

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.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

No.151, 151A, 151S

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

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

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 Surgery2nd edition: Chitra Chakravarthy
Dental Instruments: A Pocket Guide- 2nd
edition: Linda R. Bartolomucci Boyd

Thank you for the PATIENT LISTENING