INSTRUMENTS USED IN ORAL SURGERY

1. INSTRUMENTS USED IN ORAL SURGERY

2. GENERAL SURGICAL INSTRUMENT • Chittle Forceps • Instruments used for lifting out sterile instruments from autoclave or instrument tray. • It has long handles and long, angulated and serrated beaks for better grip. • When not in use beaks are placed dipped in antiseptic solution.

3. Swab Holding Forceps • This is also an instrument with long handles but straight beaks which are fenestrated in the ends. • It is used for holding the swab dipped in an antiseptic solution for preparing the surgical field. • Towel Clips • Instruments used to hold the patient’s drapes in place Also used to clip on the suction tubes, drills on to the drapes to hold them in place. • It can also be used to hold tongue and retract it forward in an unconscious patient.

4. Hemostat (artery forceps) • These are the instruments used to clamp bleeding vessels (arteries and veins). • Also used to hold the vessels for ligation. • They have narrow tapering beaks with transverse serrations. • The handle has a latch called rachet. • They can be of different types straight, curved and come in different sizes. • A small artery forceps is also known as mosquito forceps.

6. Scissors • Dissecting scissors can be used for incising soft tissue flaps, excising pathological soft tissue and can be used for blunt dissection into the deeper layers. • Dean’s suture cutting scissors are used for cutting suture materials. • Dissecting scissors usually have narrower blades than a suture cutting scissors and may be straight or curved, sharp ended or blunt ended scissors. • Dean’s suture cutting scissors has broader blades and may be straight or curve. Needle Holder • It is used to hold the suturing needle.

7. It has short blades which have crisscross serrations and groove in the centre. • It has rachet to hold the needle firmly. • The handle of the instrument are held between the ring finger while the index finger support the instrument. • Scalpel • This is an instrument used for incising tissues. There are different types of blades which can be fit onto a Bard Parker handle. • A number 11 blade used for stab incision for drainage of an abscess. • A number 12 blade used for placing crevicular incision for periodontal procedures. • A number 10 blade used for skin incisions.

8. TISSUE HOLDING INSTRUMENTS Allis Tissue Holding Forceps • This is tissue holding forceps in which beaks are narrow but it broadens out at tip which has toothed edge. • This forceps has a rachet and is used to hold on the soft tissue margins such as skin, periosteum, muscles etc., to retract it away from the surgical field to improve visibility into deeper layers. • Can also be used to hold soft tissue under tension, e.g., while removing a tumor by curettage, after removing it, the pathological tissue may be held with an Allis and pulled away from the attached part so that the remaining attachments may be curetted out easily.

9. Babcock’s Tissue Holding Forceps • This is also tissue holding forceps but its blades are non-toothed. • It may be used to hold delicate soft tissues such as lymph nodes, fascia etc., which may be torn if held with a toothed tissue holding forceps. Tissue Holding Forceps • This instrument is used to hold soft tissues while suturing. • While suturing flap edged, the margins of the flap are held with this instrument so that it is stabilized and the needle can be pass through it easily. • They may be toothed or non-toothed.

10. Delicate tissue such as fascia, mucosa, pathological tissues may be held with a non toothed forceps; whereas periosteum, muscles, aponeurosis, etc., may be held with a toothed tissue holding forceps. • Adson’s tissue holding forceps is a delicate toothed tissue holding forceps used for cosmetic suturing on the face. BONE CUTTING INSTRUMENTS • Osteotome • This is an instrument used for splitting bone. • It has bi-bevelled edge and comes in various sizes depending on the width of cutting edges and the length of the instruments. • Used to perform osteotomy cuts and in certain cases may also be used to split impacted teeth to facilitate removal.

12. Chise • Instruments used for cutting bone. • Used for transalveolar extraction and for the removal of impacted teeth. • It has single bevellel on its working edge. • While cutting bone, the bevellel is made to face towards bone which is to be cut. • In mandible, the grain pattern is important while using a chisel, It may be necessary to place stops cuts to prevent unnecessary bone removal.

13. Ronguer • This is also called bone nibbler. • Used for removal of sharp edges of the bone on the alveolar ridge as in case of alveoloplasty. • It can be used to remove sharp margins of the bone around a surgical wound after extraction or removal of cyst or tumor. • It may be of end cutting or side cutting variety. • The bone is held firmly and crushed for removal.

14. Bone File • This is an instrument which has sharp serrations on its working edge. • It is used for the smoothening of sharp edges of bone. • After cutting bone with a burr or a rongeur, the ends may need to smoothened or rounded off prior to closure. This is done with a bone file. Mallet • An osteotome and chisel are used with mallet. • It is usually made of steel and is used with a light “pull-back” action with force coming from the wrist.

15. Burrs and Handpiece • This is a rotary cutting instrument which is attached to a micromotor. • The burrs may be round, straight fissured or tapered depending on the need. • Used for cutting bone for transalveolar extraction, removal of impacted teeth. • Also used for removal of bone enclosing a cyst or tumor. • Used for making osteotomy. • The bone is cut under copious saline irrigation to prevent heating of the bone and bone necrosis.

16. INSTRUMENTS USED FOR MAXILLOFACIAL TRAUMA Rowe’s Maxillary Disimpaction Forceps • This is paired instrument which is used in maxillofacial trauma. • It is used for disimpaction of Le-Fort fractures of the maxilla. • By standing at the head-end of the patient the curved blade is inserted onto the palate while the padded blade with lesser curvature is inserted along the floor of the nose. • The maxilla is thus grasped between the blades of the instrument and mobilized. • This can be used similarly to mobilized the Le-Fort osteotomy segment.

17. Walsham’s Forceps • This is also paired instrument used for the reduction of nasal bone fractures. • One curved blade is placed is placed externally along the bone while the other blade goes in to the nose to support the nasal bone. • The fractured nasal bone thus be grasped and maintained in the position. Asche’s Septal Forceps • Also known as nasal septel forceps as it is used for reduction of a fractured nasal septum. This is used along with Walshman’s forceps in nasal fractures. • It is an unpaired intrument whose blades are placed into the nose to grasp and realign the nasal septum and vomer.

18. Erich’s Arch Bar • This is an thin, flat stainless steel bar which can be easily bent and adapted along upper and lower arches. • The bar consist of hooks and cleats which help in engaging the wire for maxillomandibular fixation. • This is adapted to the arch with the cleats facing the vestibule and fixed in the position to the dentoalveolar aspect with the help of dentoalveolar wiring. • Upper and lower arch bars may be placed and wired together keeping for teeth in occlusion for MMF. • Arch bars can also be used for the fixation of dentoalveolar fractures. Wire Twister • This instrument is used for holding wire, passing it interdentally or through bone for dentoalveolar wiring or transosseous wiring. • Usually 26 gauge wires are used for maxillofacial trauma.

19. This instrument is similar to needle holder except that the blades are shorter and stouter. There are no vertical groove. It has rachet. • A heavy wire cutter is used for cutting the ends of the twisted or stretched wire.

20. Bone Plating System • Consist of bone plates, monocortical screw, screw holder, plate bending forceps and screw driver. • Used for open reduction and fixation of fractures. • The bone plates come in different sizes depending upon the thickness and size of the hole for the screw. They can be 1.5 mm, 2mm. 2.5 mm can be used for fixation of mandibular fractures. • They come in variety of shapes such as “L”, “X”, “Y” and straight etc. • The screw are of different length and diameter depending upon thickness of the cortical bone into which they are fixed.

21. RETRACTORS Langenback’s Retractor • “L” shaped retractor with long handle. • Used for retraction of the edges of a flap for improved visualization of the deeper layers and structures. • It comes in different sizes depending upon length of the handle and width of the blade. Tongue Depressor • Also a “L” shaped retractor without handle. • It has broad, flat rounded blade. • Used for the retraction and depression of the tongue to improve visibility of the posterior pharyngeal wall and the tonsillar region. • Also used for the rotation of the tongue for the removal of throat pack, visualizing the lingual side of the mandible for the procedures.

22. It can also be used for cheek retractors. Austin’s Retractor • Also an “L” shaped retractor without handle. • Used basically for the retraction of small intraoral flaps as in case of removal of an impacted tooth. MISCELLANEOUS Sinus Forceps • This is used in the drainage of pus from an abcess. • After an incision, the sinus forceps is inserted by blunt dissection into the abcess cavity and opened up. The pus drains along the blades of the forceps. • The blades are narrower and longer than a hemostat. It has sterration only at the tip. Periosteal Elevators • These can be of different designs: Howart’s Dial’s periosteal elevators, Moon’s probe etc. • After a mucoperiosteal incision, the sharp end of the periosteal elevator is used to reflect a mucoperiosteal flap.

23. Dial’s periosteal elevator : This has one rounded edge and one pointed end. The pointed edge is used todetect the papilla while the rounded edge to reflect the mucoperiosteal flap and small flaps. • Moon’s Probe : It is right angled instrument with a narrow working edge. Used basically for mucoperiosteal elevation around the tooth before extraction. Curette • This is a spoon-like instrument used for enucleation or curettage. • It is used to remove soft tissue lesion within the bone cavity such as cyst or tumor. • Can also be used to remove sinus tracts, necrotic tissue from extraction socket etc. • It is used by scraping against the bony walls to separate the pathological soft tissue from the healthy bone.

24. Mouth Gag • This is an instrument used to forcefully open the mouth in case of trismus. • It has broad serrated blades which are made to rest on the occlusal aspect of the molars while the instrument is opened with slow, gradual force. • It can also be used to keep the mouth open for intraoral procedures under anaesthesia.

25. INSTRUMENTS USED FOR EXTRACTION OF TEETH AND ROOT REMNANTS • Elevators • The dental elevators are used to luxate the teeth from socket prior to application of the forceps. It addition elevators also expands the bony socket facilitating tooth extraction. • They are also used to remove root remnants from the extraction socket.

26. The elevator has three components : • The handle, • The Shank and • The blade. • Depending on the size and shape of the blades the elevators can be classified as : • Straight or gouge type • Triangular type • Pick type. • Commonly Used Elevators • Straight Elevators (Coupland, London Pattern) • Straight elevators are most commonly used for luxation of teeth. The blades have concave surface on one side, that faces the tooth to be elevated. Sometimes blade can be at the angle of shank, allowing the instrument to reach the posterior areas of the oral cavity. Common examples of these elevators are, the Miller and the Potts elevator.

27. Cryer’s Elevator • Cryer’s elevator is a straight elevators with a triangular blade. • The working tip is angulated, with one covex and another flat surface. • The flat surface is the working side. It is based on lever and the wedge principle.

28. Uses • For extraction of root stumps of mandibular molars when one root is removed and the other left behind. 2. For extraction of mandibular molar root stumps when both the roots are present but one fractured at a lower levelthan the other or when the furcation is intact. • Two separate elevators are available for the mesial and distal angles to the handle. • Winter’s Elevator • It is a crossbar elevator. The shank is at right angles to the handle. The working tip ia at an angle to the shank. The blade has flat and convex surface. The flat surface is the working surface and is placed facing to be elevated. It work on the wheel and axel principle. • Uses : To luxate the mandibular molar teeth.

29. Winter Cyrer’s Elevator • The elevator is cross bar elevator with triangular blade. It works on wheel, axel and wedge principle. • Apexo Elevators • Apexo Elevators are straight one and have a biangulated and sharp, straight working tip. They are paired elevator for mesial and distal roots. They can be used to remove maxillary root stumps. • Hockey Stick or London Hospital Elevator • It has working blade at an angulation to the shank, but the blade at an angulation to the shank, but the blade is straight, rather than triangular, and has convex and a flat surface. • The flat surface is working surface and the transverse serration on it for better contact with the root stump. • When viewed the instrument look like a hockey stick. • Extraction Forceps • Extraction forceps are designed to deliver teeth from the socket. • Each forcep has an handle, a joint and a beak.

30. All the forceps have cross hatching on the handle to allow a firm grip and have serrations on the inner side of the beaks to allow better grip on the tooth. • The forceps beaks are applied along the long axis of the tooth, below Cemento-enamel junction of the tooth. • A firm grip is established prior to giving any forcep movement. • Maxillary Extraction forceps • The handle and the beaks are at 180 deg. To each other, i.e. in a straight line. • Maxillary Anterior Forceps • They have identical beaks that are closed, straight, flat and broad. • They are used to extract the maxillary incisors and canines. • Maxillary Premolar Forceps • They have identical beaks that are concave on the side of facing the oprator. • The beaks are broad and open. • They are used for extraction of premolars. • The curvature of the blade is to access the premolars placed posteriorly in the arch. • Maxillary Molars (Right and Left) • The beaks of these forceps are not identical. One beak is rounded and other one is

32. Pointed. • The pointed beak engages the groove between the buccal roots and the rounded one engages the palatal surface below cemento-enamel junction. • The beaks also have curvature to the side facing operator. • When viewed, if the pointed beaks to the left of the operator it is right sided forcep and vice versa. • Maxillary Cowhorn Forceps • These forceps have unidentical beaks, one of which has pointed tip and other one has bifid pointed tip. • The single pointed tip engages the furcation between the two buccal roots and the other bifid pointed tip engages the palatal root. • It is paired forceps. The beaks are curves towards operator. While viewing the concave surface of the beaks, the bifid beaks will be on the right for the maxillary right side forceps abs vice versa. • They are used for maxillary teeth, where there is extensive destruction of the crown, but roots are not seprate. • Maxillary anterior root forceps • They have identical, straight, slender and closed beaks.

33. They are used primarily for extraction of stumps of the maxillary anterior teeth. • Maxillary posterior root forceps • They are similar to the anterior root forceps, but like the premolar forceps, they have curvature towards the operator for access posteriorly. • They are used for removing of single molar root pieces and premolar root stumps. • Bayonet Forceps • They have identical, pointed, angulated and closed beaks. The length of the beaks vary from long to short. • According to the thickness of the beak they can be classified into thick beaks and thin beak bayonet forceps. The thick beak forceps is used to remove maxillary posterior root stumps that are not separate, while the thin beak forceps are used to remove single roots. • Mandibular Forceps • Mandibular Anterior Forceps • The mandibular anterior forceps have identical broad, short, closed beaks. The joints is a rivet joint unlike most forceps have box joint. • They are used for extraction of mandibular anterior teeth. • Mandibular Premolar Forceps

35. The mandibular premolar forceps have identical broad open beaks that are longer than the beaks of the anterior forceps. • They are used for extraction of mandibular premolar teeth. • Mandibular Molar Forceps • They have identical, broad, open beaks that are longer than the beaks of anterior forceps. • They are used for extracting mandibular molar teeth. • Mandibular Cowhorn Forceps • It has identical, open, beaks that resemble the horn of the cow. The beaks are round and taper to the point. • The forceps grips the tooth at the furcation between the mesial and distal roots. • When pressure is applied and the beaks are closed, the tooth is luxated or literally squeezed out of the socket, using buccal and lingual plates as the fulcrum. • They are used to remove grossly carious mandibular molars with extensive destruction of the crown. • Mandibular root forceps • These forceps have identical, slender beaks that are closed. The beaks are longer than that of the premolar forceps to enable the forceps to take a deep grip on the root

36. stumps of all the mandibular teeth. • Suture Needles • They have three basic components: • The eye, • The body and • The point. • The Eye • The can be closed or swaged. The close eye is similar to a house needle. The shape of eye may be round, oblong or square. • The Body • The various Body Shapes are : • Straight, • Half Curve, • One-fourth circle, • Three-eight circle, • Half circle,

37. Five-eight circle • Compound curve • The Point • The points id the extreme tip of the needle to the maximum cross section of the body. • The tip can be cutting, round or blunt. • Cutting needles have at least two opposite cutting edge.

38. The Syringe • Syringe Type available in dentistry : • Nondisposable syringe : • Breech-loading, metallic, cartridge-type, aspirating • Breech-loading, plastic, cartridge-type, aspirating • Breech-loading, metallic, cartridge-type, self-aspirating • Pressure syringe for periodontal ligament injection • Jet injection (“needleless” syringe) • Disposable syringe • “Safety” syringe • Computer controlled local anesthesia delivery systems

39. The Needle • Components of local anesthetic needle : • Bevel, • Shaft, • Hub, • Syringe adaptor and • Cartridge penetration end • The Cartridge • The prefilled 1.8-ml dental cartridge consist of four parts : • Cylindrical glass tube • Stopper (plunger, blung) • Aluminum cap • Diaphargm

41. Reference • Textbook Of Oral Surgery - Chitra Chakravarthy • Textbook Of Oral & Maxillofacial Surgery – B. Shrinivasan