Armamentarium for basic oral surgery

1. ARMAMENTARIUM FOR BASIC ORAL SURGERY DEEPTHI P.R. INTERN DEPT. OF ORAL SURGERY

2. CONTENTS Introduction Instruments for Transferring Sterile Instruments Instruments for Incising Tissue Instruments for Elevating Mucoperiosteum Instruments for Retracting Soft Tissue Instruments for Controlling Hemorrhage Instruments for Grasping Tissue Instruments for Removing Bone Instruments for Removing Pathologic Tissue

3. 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

4. INTRODUCTION Myriad of instruments- oral surgical procedures Variety of purposes: -hard tissue -soft tissue

5. 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

6. 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 solution- scrub the surgical field

7. INSTRUMENTS FOR INCISING TISSUE

8. INSTRUMENTS FOR INCISING TISSUE SCALPEL : Handle- No. 3, No.7 Differently shaped Disposable, sterile sharp blade: 1. No.15 - most commonly used Relatively small Around teeth through mucoperiosteum

9. INSTRUMENTS FOR INCISING TISSUE 2. No.10 - similar to No.15 Large skin incisions 3. No. 11 Sharp, pointed Small stab incisions Incising an abscess 4. No.12 Hooked Mucogingival procedures Posterior aspect of teeth/ maxillary tuberosity

10. INSTRUMENTS FOR INCISING TISSUE Blade loaded Blade removed

11. Remember.. Pen Grasp: Allow maximal control Hold mobile tissue firmly Press down firmly Single- patient use: dulled easily Several incisions : single operation- 2 nd blade Dull blades: no clean sharp incisions

12. INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM

13. INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM Mucosa & Periosteum reflected in single layer: Periosteal Elevator No.9 Molt periosteal elevator sharp, pointed end: reflect papillae from between teeth, loosen soft tissues via gingival sulcus Broader, flat end: elevating the tissue from bone Thin, sharp cutting edge- clean separation of periosteum from bone

14. INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM 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 flap- separates mucoperiosteum from bone Pull/ Scrape: tends to shred periosteum ,if not careful

15. 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

16. INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM III. Howarth’s Periosteal Elevator Double-ended One end: flat, broad, spatulate - sharp edge Other end: Rugine end; flat & rectangular. Small tip – sharp projection perpendicular Reflection & retraction : mucoperiosteal flaps Reflection: periosteum

17. INSTRUMENTS FOR ELEVATING MUCOPERIOSTEUM IV. Moon’s Probe Right angled- narrow working edge Flat handle & blade; blade perpendicular to handle Narrow working edge; blunt & rounded tip Mucoperiosteal elevation : prior to extraction Objective symptom: anesthesia

18. INSTRUMENTS FOR RETRACTING SOFT TISSUE

19. INSTRUMENTS FOR RETRACTING SOFT TISSUE Good vision & access Cheeks, tongue & mucoperiosteal flaps Right angle Austin retractor ‘L’-shaped- no handle Retraction of small intraoral flaps: removal of impacted teeth

20. INSTRUMENTS FOR RETRACTING SOFT TISSUE Offset broad Minnesota retractor Both Austin’s & Minnesota : retract cheek & mucoperiosteal flap simultaneously

21. 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 Similar to a periosteal elevator Leading edge: dull- shouldn’t reflect periosteum

22. INSTRUMENTS FOR RETRACTING SOFT TISSUE Periosteal elevator - primary instrument for retraction - positioned on the bone & held to reflect tissue Mouth Mirror Common –Retract tongue Weider Retractor Broad, heart-shaped Serrated on one side: firmly engage tongue, retract it medially & interiorly Don’t position posteriorly- gagging

23. INSTRUMENTS FOR RETRACTING SOFT TISSUE Langenback’s Retractor ‘L’ shaped retractor- long handle Retraction of flap edges : improved visualization of deeper layers & structures Different sizes: handle length & blade width

24. INSTRUMENTS FOR RETRACTING SOFT TISSUE Tongue Depressor ‘L’- shaped; no handle Broad, flat, rounded blade Retraction & depression of tongue Improve visibility- posterior pharyngeal wall & tonsillar region, lingual side of mandible Removal of throat pack As cheek retractor

25. INSTRUMENTS FOR RETRACTING SOFT TISSUE Towel clip Hold the tongue Biopsy: performed on the posterior aspect; by holding the anterior tongue Profound L/A

26. INSTRUMENTS FOR CONTROLLING HEMORRHAGE

27. INSTRUMENTS FOR CONTROLLING HEMORRHAGE Arteries & veins- bleeding : pressure not enough Hemostat Variety of shapes Small or delicate/ Larger Straight/ Curved Curved hemostat- common Long, delicate beak to grasp tissue & a locking handle

28. 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

29. INSTRUMENTS FOR GRASPING TISSUE

30. INSTRUMENTS FOR GRASPING TISSUE Soft tissue stabilization- pass suture needle Adson’s Tissue Forceps/ Pickups Delicate forceps Small teeth Gently hold tissue & stabilize Don’t grasp too tight- crushing Non-toothed

31. INSTRUMENTS FOR GRASPING TISSUE Tissue Holding Forceps Toothed/ Non- toothed Toothed: periosteum , muscle, aponeurosis Non- toothed: fascia, mucosa, pathological tissues

32. INSTRUMENTS FOR GRASPING TISSUE Stillies forceps Longer, but similar to Adson’s 7”-9” long Easy grasp of tissue in the posterior part, with enough part protruding beyond the lips: control College/Cotton forceps Angled Small fragments of tooth/amalgam/foreign material Placing/removing gauze packs

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

34. INSTRUMENTS FOR GRASPING TISSUE Russian Tissue forceps Large, round-ended Teeth elevated from sockets Round end: positive grip, avoids slippage; unlike hemostat Placement of gauze: isolation

35. INSTRUMENTS FOR GRASPING TISSUE Babcock’s Tissue Holding Forceps Non-toothed blades Long beaks- broad working edge Smooth, non-serrated edges Rings- locking mechanism Hold delicate tissues: mucosa, lymph nodes Holding cyst lining during enucleation

36. INSTRUMENTS FOR REMOVING BONE

37. INSTRUMENTS FOR REMOVING BONE Rongeur forceps Most commonly used Sharp blades- squeezed together; cutting/pinching through bone Leaf spring between the handle : instrument opens when hand pressure is released Repeated cuts without manually reopening

38. 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

39. 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

40. INSTRUMENTS FOR REMOVING BONE Chisel Monobevel chisel: bone is removed Bibevel chisel: teeth Success: sharpness- sharpen before sterilisation Carbide tips- use more than once, before sharpening

41. INSTRUMENTS FOR REMOVING BONE Cylindrical handle- serrated with flat end: struck with mallet Flat & rectangular: cutting edge in different sizes Single bevel - cutting edge

42. 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

43. 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

44. INSTRUMENTS FOR REMOVING BONE Osteotomy cuts: orthognathic surgery/ refracturing malunited fractures Osteoplasty / bone recontouring Split impacted tooth for easy removal

45. 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

46. INSTRUMENTS FOR REMOVING BONE Bone file Final smoothing of bone before suturing of mucoperiosteal flap: small Double-ended: small & large Removes bone: pull stroke Avoid push motion- burnishing & crushing the bone

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

48. INSTRUMENTS FOR REMOVING BONE 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

49. INSTRUMENTS FOR REMOVING PATHOLOGICAL TISSUE Periapical Curette Angled, double-ended Removal of granulomas/small cysts from periapical lesions Small amounts of granulation tissue debris from tooth sockets

50. 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

51. INSTRUMENTS FOR SUTURING MUCOSA

52. INSTRUMENTS FOR SUTURING MUCOSA Flap returned to its original position & held by sutures I. Needle holder Instrument with a locking handle, short, stout beak I/O use: 6” or 15cm recommended Beak- shorter & stronger than hemostat Face of the beak crosshatched : positive grasp; unlike hemostat

53. INSTRUMENTS FOR SUTURING MUCOSA Held in the proper fashion: control & direct

54. 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

55. 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

56. INSTRUMENTS FOR SUTURING MUCOSA II. Suture needle Mucosal closure: ½ circle or 3/8 circle Curved: pass through a limited space; twisted wrist Large variety of shapes Very small – very large Tips: ( i ) tapered- sewing needle (ii) triangular – cutting needle

57. INSTRUMENTS FOR SUTURING MUCOSA 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

58. INSTRUMENTS FOR SUTURING MUCOSA Suture material: usually swaged on Held 2/3 rd – between the tip & the base: - enough exposed to pass through the tissue - grasp in the strong portion to prevent bending

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

60. 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

61. 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

62. 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

63. INSTRUMENTS FOR SUTURING MUCOSA IV. Scissors Short cutting edges Long handles Thumb & ring fingers Held same as needle holder Dean scissors Slightly curved handles Serrated blades

64. Tissue scissors Iris scissors & Metzenbaum scissors Straight or curved blades Iris: small, sharp pointed, delicate Metzenbaum: undermining soft tissue & cutting; sharp or rounded tips Don’t cut sutures: dull the edges- less effective & more traumatic Iris: Very fine skin sutures

65. INSTRUMENTS FOR HOLDING THE MOUTH OPEN

66. 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 patient’s TMJ, while mandibular teeth

67. 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

68. 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/teeth- injury Deeply sedated Mild trismus

69. 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

70. Remember.. Avoid opening too wide: stress on TMJ Stretch injury Long procedures: remove periodically; move the jaw; rest the muscles

71. INSTRUMENTS FOR SUCTIONING

72. 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

73. 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

74. INSTRUMENTS FOR SUCTIONING High Volume Suction Tip Large bore tubes with slight angulation - end Autoclavable stainless steel/ plastic Disposable plastic tubes Suck out large volumes of irrigation fluids, blood clots & debris

75. INSTRUMENTS FOR SUCTIONING Saliva Ejector Low volume suction tip Disposable plastic- different designs Flexible- bent & adapted under tongue Buccal vestibule: partially retracts cheek

76. 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 patient’s skin

77. J Bachaus Towel clip Schaedel Towel clip

78. 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

79. 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

80. INSTRUMENTS FOR EXTRACTING TEETH

81. INSTRUMENTS FOR EXTRACTING TEETH LOCAL ANESTHETIC INSTRUMENTS Syringe Types: 1. Non- disposable syringes

82. LOCAL ANESTHETIC INSTRUMENTS 2. Disposable syringes 3. Safety syringes

83. LOCAL ANESTHETIC INSTRUMENTS 4. Computer Controlled Local Anesthetic Delivery System

84. 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

85. LOCAL ANESTHETIC INSTRUMENTS Needle Single piece of tubular metal; plastic/ metal syringe adaptor + needle hub

86. 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

87. LOCAL ANESTHETIC INSTRUMENTS Additional Armamentarium Topical antiseptic Topical anesthetic Applicator sticks Sterile gauze 2”x2” Hemostat

88. 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

89. DENTAL ELEVATORS PARTS

90. 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 direction- adequate support to the adjacent tooth Finger guard: support adjacent tissues

91. DENTAL ELEVATORS Basic grips: Palm grip: heavy forces; handle rests against heel of palm Finger grip: delicate applications

92. 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

93. DENTAL ELEVATORS TYPES I. Based on the shape & size: Straight Triangle/ Pennant-shape Pick II. Based on their form: Straight Angular Crossbar

94. DENTAL ELEVATORS III. Based on their use: Remove entire tooth Remove roots broken at the gingival line Remove roots broken half way to the apex Remove the apical third of the root Reflect mucoperiosteum

95. 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

96. 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

97. DENTAL ELEVATORS Straight Elevator: Coupland’s Large, pear-shaped handle Straight shank Blade: concave/ convex surface & an inclined plane Concave groove on one side Sharp & straight tip

98. DENTAL ELEVATORS Impacted/ malaligned teeth Wedge & 1 st order lever principle 45 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

99. DENTAL ELEVATORS Straight elevator: Hospital Blade, handle & shank: same plane Handle: flat & triangular- deep criss -cross grooves Blade: flat with vertical serrations; other side- convex with pointed tip Serrated flat side: faces the tooth to be extracted 45 to the long axis/ wedged into the PDL space: vertically along the long axis Wedge & 1 st order lever

100. 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

101. 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

102. DENTAL ELEVATORS Cryers ‘Offset’ blade: at an angle to the shank Curved & triangular blade Heavy pear shaped handle Pairs

103. 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

104. DENTAL ELEVATORS Crossbar elevator Offset blade- similar to cryers Handle perpendicular to shank Maximum mechanical advantage due to crossbar handle & offset blade

105. 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

106. 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

107. DENTAL ELEVATORS 2. Root tip pick/apex Delicate Tease small root tips Don’t use: wheel- and- axle/lever Very small root end : insert the tip into the PDL space- root tip & socket wall

108. 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

109. EXTRACTION FORCEPS COMPONENTS

110. EXTRACTION FORCEPS Handles Adequate size -comfortable handling -sufficient pressure & leverage Serrated surface -positive grip -prevent slippage

111. EXTRACTION FORCEPS Holding handles: -Maxillary: palm underneath; beaks superior -Mandibular: palm on top; beaks point down

112. EXTRACTION FORCEPS Straight/ curved better fit

113. EXTRACTION FORCEPS Hinge Connects the handle – beaks Transfers & concentrates : force Types American: horizontal English: vertical

114. 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

115. 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 fashion- posterior aspect with beaks parallel Mandibular forceps: Perpendicular to the handles

116. MAXILLARY FORCEPS Single-rooted: incisors, canines, premolars 3-rooted: molars Maxillary Universal Forceps: No.150 Slightly S-shaped: from side- incisors & premolars Straight: from above Beaks curved: meet only at the tip Modification: No.150A- premolars No.150S : Primary teeth

117. No.150, 150A, 150S

118. MAXILLARY FORCEPS Straight forceps No. 1 forceps: easier for upper incisors

119. MAXILLARY FORCEPS Maxillary molars : -smooth, concave surface: palatal root -pointed: bifurcation -right & left -offset: posterior & correct position -No.53

120. No.53

121. MAXILLARY FORCEPS Upper Cowhorn forceps: No.88 longer, accentuated, pointed beaks Severely carious crowns Deeper into trifurcation: sound dentin Caution: crush alveolar bone; # large amounts of buccal bone – intact teeth

122. MAXILLARY FORCEPS No.210S Forceps 2 nd & 3 rd molars- single conical root Smooth beaks: offset

123. MAXILLARY FORCEPS Root Tip Forceps: No.65 Offset – very narrow beaks Broken molar roots, narrow premolars, lower incisors

124. MAXILLARY FORCEPS Root Forceps

125. MANDIBULAR FORCEPS Single-rooted: Incisors, canines, premolars Two-rooted: molars Lower Universal Forceps: No.151 Handles- No.150 Beaks: pointed inferiorly Smooth & narrow: meet only at the tip Fit near the cervical line- grasp root No. 151A: Premolar No.151S: Primary mandibular teeth

126. No.151, 151A, 151S

127. MANDIBULAR FORCEPS English Style Vertical-Hinge Forceps Single-rooted Great force generated Root fracture

128. MANDIBULAR FORCEPS Lower Molar Forceps: No.17 Single forceps: both sides Straight-handled Beaks: obliquely downward Pointed tips – centre: bifurcation Remainder: sides of the furcation Not for fused, conical roots: 151

129. No.17

130. MANDIBULAR FORCEPS Lower Cowhorn Forceps: No.87 Two pointed, heavy beaks: bifurcation Forceps positioned: handles pumped up & down- tooth elevated Beaks squeezed into furcation: buccal & lingual cortical plates- fulcrums Alveolar bone #, damage to maxillary teeth

131. No.87

132. MANDIBULAR FORCEPS Root Forceps

133. 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 Forceps

134. 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

135. BIOPSY TRAY Basic tray without elevators Blade handle & blade Needle holder & suture, suture scissors Metzenbaum scissors Allis tissue forceps Adson tissue forceps Curved hemostat

136. POSTOPERATIVE TRAY Irrigation : syringe, suction tip Suture removal: Scissors, College pliers, Cotton applicator sticks, gauze

137. INSTRUMENT ARRANGEMENT TRAY Flat, sterilized wrapped with sterilization paper Opened preserving sterility Requires large autoclave CASSETTE More compact

138. 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

139. REFERENCES Contemporary Oral & Maxillofacial Surgery- 5 th edition : Hupp , Ellis, Tucker Handbook of Local Anesthesia- 5 th edition: Stanley F. Malamed Textbook of Oral & Maxillofacial Surgery- 2 nd edition: Chitra Chakravarthy Dental Instruments: A Pocket Guide- 2 nd edition: Linda R. Bartolomucci Boyd

140. Thank you for the PATIENT LISTENING