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Oral Surgery- Basic Instruments for Exodontia

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Oral Surgery- Basic Instruments for Exodontia

  1. 1. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 1 Oral Surgery Propedeutics Instruments Amit Dattani 2012
  2. 2. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 2 Contents Extraction Forceps ..................................................................................................................................4 General Notes .....................................................................................................................................4 Maxillary Extraction Forceps...............................................................................................................4 Incisors & Canines...........................................................................................................................4 Premolars........................................................................................................................................5 Molars .............................................................................................................................................6 3rd Molar/Wisdom...........................................................................................................................7 Upper Roots ........................................................................................................................................8 Incisors & Canines...........................................................................................................................8 Premolars and Molars.....................................................................................................................8 Mandibular Extraction Forceps.............................................................................................................10 Incisors, Canines, Premolars .............................................................................................................10 Molars ...........................................................................................................................................11 Lower Root Forceps ......................................................................................................................12 Instruments for Incision........................................................................................................................13 Instruments for Elevating Mucoperiosteum.........................................................................................14 Instruments for Retracting Soft Tissues................................................................................................16 Instruments for Retraction of the Tongue............................................................................................17 Instruments for Controlling Bleeding....................................................................................................18 Hemostats.........................................................................................................................................18 Instruments for Grasping Tissues .........................................................................................................19 Forceps..............................................................................................................................................19 Instruments for Removing Bone...........................................................................................................21 Instruments for Removing Soft Tissues from Bone Defects.................................................................23 Instruments for Suturing Mucosa.........................................................................................................24 Needle Holders .................................................................................................................................24 Surgical Needles................................................................................................................................24 Suture Materials ...............................................................................................................................24 Resorbable ....................................................................................................................................24 Non-resorbable.............................................................................................................................24 Monofilament ...............................................................................................................................24 Polyfilament..................................................................................................................................24
  3. 3. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 3 Scissors..............................................................................................................................................25 Instruments for Holding the Mouth Open............................................................................................26 Instruments of Irrigation.......................................................................................................................26 Dental Elevators....................................................................................................................................27 Straight Elevators..............................................................................................................................27 Triangular Elevators ..........................................................................................................................28 How to identify between left and right Barry Elevator?...............................................................29 Cryer Elevator................................................................................................................................29 Pick Type Elevators ...............................................................................................................................30 Towel Clamps........................................................................................................................................31 Sponge and Dressing Clamps................................................................................................................31 Probes ...................................................................................................................................................32 Sinus Probe .......................................................................................................................................32 Other Instruments ................................................................................................................................32 -------------------------------------------------------------------------------- The content of this material has been obtained from the lectures at the University of Debrecen, internet sources and practical lessons taught at the University of Debrecen. I take no legal obligation in the copyright or reproduction of this material. It is solely for viewing and learning purposes. Wishing you all the best, -- Amit Dattani
  4. 4. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 4 Extraction Forceps General Notes  Crown Forceps (above)- beaks don’t touch  Root forceps (see later) – beaks touch  Three parts to any extraction forcep: Beak, Hinge, Handle (obvious!)  Maxillary forceps – straight beaks  Mandibular forceps – 90 degree bend in beak Maxillary Extraction Forceps Incisors & Canines (Crown forceps) Dental extraction forceps for maxillary Incisors and canines are straight when viewed from the side.  Straight beak  Same forcep used for maxillary incisors and canines  (English forcep shown above- that’s what you need to know)
  5. 5. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 5 Premolars (Crown forceps) Forceps for maxillary premolars are similar, to the incisor and canine forceps, but slightly curved when viewed from the side.  Used only for upper premolars  Slight angulation (when viewed from the side)  Follows curvature of premolars  Used for both upper premolars Remember: The upper 1st premolar has two roots! (Just a reminder)
  6. 6. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 6 Molars (Crown forceps) Forceps for upper molars (three rooted teeth) are different for left and right molars. The Palatal beak has a SMOOTH concave surface and the buccal beak is POINTED. (this point buccal beak in placed in the buccal bifurcation when extracting- clever huh?!)  To distinguish between left and right forcep (patients left or right!): o Try placing the buccal pointed beak into the buccal bifurcation of the 1st or 2nd upper molars o If the handle is anterior (to the patient) then you are correct, if its pointing to the posterior side of the patient then it’s the opposite side! (you will understand this if you try it once or twice in practice) o E.g. the big right picture above is for the RIGHT SIDE 1st and 2nd molar (of the patient!)  We use the same forceps for the 1st and 2nd molars (on the same side).
  7. 7. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 7 3rd Molar/Wisdom (Crown forceps)  Forceps have broad and smooth beaks  The forceps are bent in a certain way (Bayonet) to reach the most posterior teeth (wisdom teeth)  This provides easier access to them  One forcep can be used for both sides (upper left and right)  Only for 3rd molars!  (Also called Bayonet forcep- due its shape)
  8. 8. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 8 Upper Roots Incisors & Canines (Root Forceps)  These forceps can be used canine- canine. (incisors and canines)  The beaks touch each other  Used for upper roots only  Both beaks are rounded Tip: When extracting, try and reach apically as possible on the root surface Premolars and Molars
  9. 9. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 9 (Root Forceps)  Also known as “Bayonett Root forceps”  Also known as a “Wisdom Bayonett”  Used for upper premolars and all molar roots (including 3rd molar roots)  Shaped in the way it is (Bayonett) for easier access to the posterior teeth  Beaks touch- used only for extracting roots!
  10. 10. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 10 Mandibular Extraction Forceps Incisors, Canines, Premolars (Crown forceps) Forceps for single rooted teeth have smooth, relatively narrow beaks  Used for lower premolar-premolar (all lower incisors, canines, premolars)  Beaks don’t touch because they are crown forceps  Beaks are rounded, not pointed to fit around crown curvature  90 degree angle between beak and handle (at hinge) o 90 degree angle - ease of positioning when patient is in an upright position (patient is in a seated position and dentist is standing) Practical tip: lower dental chair (vertically) till the lower jaw is at elbow height to the (standing) dentist.
  11. 11. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 11 Molars (Crown Forceps) Have a bi-lateral pointed beak to adapt to the bifurcation and vertical hinge  Two pointed beaks  Beaks do not touch – crown forceps  Both beaks are pointed so they can be used for the left and right side of the patient  All molars can be extracted with this, 1st - 3rd . (In case of trismus see further  Forceps for molars with fused, conically shaped roots have shorter beaks without pointed tips and a hinge in a horizontal direction  Also called trismus forceps
  12. 12. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 12 Lower Root Forceps  Maxillary and mandibular forceps for removal of broken roots have a similar shape as those for removal of teeth with a crown, but their beaks are relatively narrow and meet at the tip.  Can be used on all lower root extractions
  13. 13. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 13 Instruments for Incision Scalpel consists of:  Sterilizable handle  Sterile, disposable blade No 15 – used for intraoral incision No 12 – pointed (used for stab like incisions) No 11 – hooked blades (for mucogingival procedures on posterior aspect of teeth) Scalpel Handle Scalpel Blades
  14. 14. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 14 Fixed Blade Scalpel / Conventional Scalpel Instruments for Elevating Mucoperiosteum  Raspatories of different size  Periosteal elevators (Single or Double ended) Their cutting edge is sharp and thin and can make a clean separation of mucoperiosteum from the bone with the undermining method. (Konig) Mucoperiosteal elevator
  15. 15. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 15 Molt Raspatorium  They all come in different shapes and sizes  Use the appropriate shape and size
  16. 16. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 16 Instruments for Retracting Soft Tissues  Austin, Minnesota retractors can retract the cheeks and the mucoperiosteal flap  Middledorpf retractor for cheek retraction  Langebeck for mucoperiosteal flap retraction Periosteal elevators, raspatories may often be used for retracting mucoperiosteal flaps Austin Retractor Minessota Retractor Langenback Retractor/ Fork Retractor (with teeth) Middledorpf Retractor
  17. 17. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 17 Instruments for Retraction of the Tongue  Mouth mirror  Tongue retractor  Tongue spatules  Tongue forceps (only in deep sedation) Mouth Mirror Tongue Retractor Tongue Spatula Tongue Forceps
  18. 18. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 18 Instruments for Controlling Bleeding Hemostats  Have a relatively long, delicate beaks with parallel grooves on their inner surface to grasp tissue  Handles with a locking mechanism, the clamps remain clamped onto the tissues  Are provided in different size and shapes (straight or curved)  May be used for picking up small particles from the wound area Mosquito Hartmann Hemostat Halsted Hemostat Peak Hemostat Kelly Hemostat
  19. 19. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 19 Instruments for Grasping Tissues  Non-traumatic dissecting forceps and angled college forceps are not useful for handling tissues; these are used for placing and removing gauze packs and foreign materials.  Delicate tissue forceps with small teeth are used for stabilizing the soft tissues during suturing.  Allis tissue clamps have locking handles and beaks with more teeth and permit a stronger and more convenient grasping of the tissue during dissection. Forceps Dissecting Forceps/ Anatomical Forceps (no teeth) Adson Forceps Tissue Forceps/ Surgical Forceps (with teeth) Allis Tissue Clamp
  20. 20. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 20 Note: You should know what the following is and its use: Angled College Forceps / Dental Forceps
  21. 21. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 21 Instruments for Removing Bone  Ronguer forceps: smaller amount of bone can be cut in a single bit with the sharp blades.  Chisels (monobevel for cutting bone) and a Mallet with nylon facing are not commonly used in oral surgery.  Bone files are used for final smoothing of bone before wound closure; work only on a pull stroke.  Different sizes are available for all types of instruments  Most commonly a handpiece and bur are used to remove alveolar bone o The (micromotor) handpiece should have high speed and torque to allow relatively rapid bone removal and efficient sectioning of teeth o High speed turbine drills must NOT be used for oral surgery because of the danger of tissue emphysema o Round and fissue bus of different sizes are most commonly used Luer Rongeur Forceps Bluementhal Rongeurs Mallet (also known as bone hammer) and Chisel Bone file (different shapes and sizes available)
  22. 22. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 22 Surgical motor with integrated cooling system Handpiece for burs
  23. 23. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 23 Instruments for Removing Soft Tissues from Bone Defects  Bone curettes – round or oval o Working part is concave on one side with sharp edges o They are used in a scraping motion to remove small cysts and granulomas from bony crypts.  Some Types: o Volkmann o Uffenorde o Kerpel Volkmann Curette (most commonly used) Uffenorde Curette Kerpel Bone Curette When to use Curettes? Immediately after extraction of a tooth suspected to have a cyst or granuloma formation
  24. 24. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 24 Instruments for Suturing Mucosa Needle Holders  Have a locking handles  Short stout beaks and a crosshatched surface for grasping the needle and the sutures Surgical Needles  Most commonly are curved needles  Common sizes 1/4 or 3/8 circle  Cutting needles have a triangular crossection at the tip (most commonly used in oral surgery) Suture Materials Sutures can be threaded through the eye of the needles or can be purchased already swaged on by the manufacturer Resorbable o Catgut, synthetic sutures Non-resorbable o Wire, nylon, silk Monofilament o Do not cause a wicking action (inter-twine) o Difficult to use o Difficult to tie (stiffer) Polyfilament o Wicking action (inter-twined) o Soft o Easy to tie Mayo-Hegar Needle Holder Mathieu Needle Holder
  25. 25. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 25 Surgical Needles Scissors  Scissors for removing sutures have short beaks  Dissecting scissors: flat points for dissecting tissues  Iris scissors are small, sharp-pointed and are delicate for fine work Scissors for Sutures (one pointed and one blunt end) Dissecting Scissors (two pointed ends)
  26. 26. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 26 Instruments for Holding the Mouth Open  Rubber bite block in basic oral surgery  Mouth Props in patients who are deeply sedated Hesiter Mouth Gag (keeps mouth open) Doyen – Jansen Mouth Gag (keeps mouth open) Instruments of Irrigation Irrigation with sterile saline  Made with a large plastic syringe and a blunt angled needle  Prevents bone damage by heat buildup during bone removal with a handpiece  Washes away the bone chips and increases efficiency of the bur  Provides lubrication for tissues  Before wound closure the surgical site must be irrigated Frasier Suction Tip
  27. 27. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 27 Dental Elevators  Dental elevators have three major components: 1. Handle 2. Shank 3. Blade  The biggest variation in the type of elevator is the shape and size of the blade.  There are three basic types of elevators: 1. Straight elevator 2. Triangular elevator 3. Pick-type elevator Straight Elevators  Used to luxate the tooth before the tooth forceps is used  Their blade has a concave surface on one side, it can be used in the same fashion as a shoehorn  The blade can be angled from the shank (working in the more posterior aspects of the mouth) Bein Elevator White Elevator Seldin Elevator Note: You only need to know the Bein Elevator
  28. 28. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 28 Triangular Elevators  Provided in pairs (left and right)  Are used for lower roots  Are most useful when a broken root remains in the socket and the adjacent socket is empty  The blade is inserted into the socket, the shank rest on the buccal plate of the bone, then the elevator is turned with the sharp tip engaging the root cementum
  29. 29. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 29 How to identify between left and right Barry Elevator?  Hold the Barry elevator in your left or right hand in the normal grip position (shown in practices)  Position the long axis of the handle parallel to your body  Position the shank of the elevator perpendicular to the front of your body  Then see if the blade is curving towards or away from you o Left – pointing towards you o Right – pointing away from you Cryer Elevator
  30. 30. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 30 Pick Type Elevators  Are you used to elevated broken root tips  Are fine, pointed elevators with extremely long working ends  Angled forms for the lower root tips  Straight forms for the upper root tips E.g. Crane Pick Elevator:
  31. 31. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 31 Towel Clamps Backhaus Towel Clamp Jones Towel Clamp Sponge and Dressing Clamps Sponge and Dressing Forceps/ Clamp
  32. 32. 3rd Year 2nd Semester Oral Surgery Propedeutics Instruments AMIT DATTANI 2012 University of Debrecen, Medical and Health Science Center – Faculty of Dentistry 32 Probes Sinus Probe  Used after extraction of a posterior maxillary tooth  To check perforation of maxillary sinus insert probe in socket lightly and probe to check for no opening! LIGHTLY-OTHERWISE YOU WILL MAKE AN OPENING!  You can also use the nose-blow test and if you hear a hissing sound sinus has been perforated Other Instruments These you should be aware of: K-wire Bender: Used for bending and cutting splint wires

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