Instrumentation for Basic Oral Surgery

1. Instrumentation for Basic Oral Surgery Part II Dr. Rahaf Al-Habbab BDS. MsD. DABOMS Diplomat of the American Boards of OMFS Consultant of Oral and Maxillofacial Surgery Head of Orthognathic Unit Saudi Boards Residents Director Hospital Education and Residency Director

2. Extracting Teeth Dental Elevators: • Used to luxate teeth from bone before applying the dental Forceps • Can minimize the incidence of broken roots • Facilitate the removal of broken root should it occur • Expand alveolar bone, overcoming the obstructed path • Used to remove broken or surgically sectioned roots from their sockets.

3. Dental Elevators The three major component of the elevator are: • Handle • Shank, and • Blade Handle • Large size to allow comfortable grip • T-bar or cross bar handle can also be used but with great caution. |Blade |---shank-----|-----------handle---------|

4. Types of Elevators The three basic types of elevators: • Straight type • Triangle or pennant-shape type • Pick type Straight Elevators: • Most common • The blade has a concave surface on one side placed toward the tooth • Small elevators are used to start the luxation • Large size used to displace roots from sockets, and luxate widely spaced teeth • The blades can be angled to allow access to postrior aspect of the mouth

5. Triangular Elevators: • Provided in pairs (right and left) • Most useful with broken root and empty adjacent socket • Used in a wheel- and- axle rotation • The sharp tip engage the cementum of the root, and shank resting on buccal plate • The cryer is the most common one

6. Pick-type Elevators: • Used as a lever to remove roots. • Crane pick is the heavy version. • Might Require drilling a hole with a bur 3mm deep at the bony crest (purchase point) • Root tip pick, delicate instrument, used to tease very small root tips • Should not be used as wheel-and-axle, or lever

7. Extraction Forceps Each forceps is composed of a handle, hinge, and beaks Handle: • Adequate size to handle comfortably and deliver sufficient pressure and leverage • Have a serrated surface to allow positive grip and prevent slippage |---B---|-H-|--------------handle----------------| Straight handles are usually preferred but curved handles are preferred by some surgeons

8. Held differently according to the extracted tooth: Maxillary teeth: Palm underneath the forceps, with the beaks directed in a superior direction Mandibular teeth: Palm on top of the forceps, with the beaks Directed downward towards the teeth.

9. Extraction Forceps Hinge: • Connect the beaks to the handle • Transfers and concentrate the force applied on the handle to the beak Beaks: • Source of the greatest variation • Designed to adapt to the tooth root near the junction between the crown and root • Design and width varies with different teeth • Beaks are angled to be parallel to the long axis of the tooth

10. Maxillary Forceps • Requires single rooted, and three rooted instruments. • The first premolar has a bifurcated root, but only occurring at the apical third. • The single-rooted maxillary teeth are usually extracted using Maxillary Universal Forceps (No.150)

11. Maxillary Forceps Anterior Teeth Premolars • No. 150 forceps are slightly S-shaped when viewed from the side, and straight from above • The beaks curve to meet only at the tip • No.150S, for primary teeth

12. Maxillary Forceps • The modified No.150, is called No.150A, useful for premolars • Should NOT be used for incisors, because of poor root adaptation. • The No.1 forceps, straight forceps, easier to use with maxillary incisors, and canines. No. 150A No. 1 Forceps

13. Maxillary Forceps Posterior Teeth • Three rooted, with a single palatal root and buccal bifurcation • Have a smooth, concave surface for the palatal root • Have a pointed beak to fit the buccal bifurcation No. 53 • Offset to reach posterior teeth • Comes in pairs: Right and Left

14. Maxillary Forceps • A design variation is No. 88 Right and Left forceps (upper cowhorn) • Longer more accenuated, pointed beak formation

15. Maxillary Forceps Advantages • Useful with severely carious teeth. • Sharply pointed beaks may reach deeper into the trifurcation dentin. Disadvantages • Crush crestal alveolar bone. • Can fracture of large amount of buccal bone if not used cautiously.

16. Maxillary Forceps • Occasionally, second molars, and erupted third molars have a single conical root • Broad, smooth beaks, offset from the handle can be useful (No. 210S) No. 210S

17. Maxillary Forceps Root tip forceps (No. 65) • Very narrow beaks. • Used primarily for broken maxillary molar roots • Can also be used to remove, narrow premolars, and lower incisors No. 65

18. Mandibular Forceps • Requires single rooted, and two-rooted teeth forceps • Lower universal forceps, are most commonly used (No. 151) • Beaks are pointed inferiorly, smooth and narrow, and meet only at the tip, to meet at the cervical line. No. 151

19. Mandibular Forceps • The modified No. 151A, were made for mandibular premolars. • Should NOT be used for any other teeth, because its form prevents root adaptation No. 151A

20. Mandibular Forceps English Style Forceps • Used for single rooted teeth in the mandible • Can generate great force • High incident of root fracture No. 74

21. Mandibular Forceps • Buccal and lingual bifurcation, allows the use of only a single molar forceps. • No. 17 forceps are straight-handled, and beaks are set obliquely downward • The beaks have pointed tip • Can’t be used for fused, conical rooted molars

22. Mandibular ForcepsCowhorn Forceps • No. 87, Is a major lower molar forceps variation. • Designed with Two pointed, heavy beak, entering the bifurcation of lower molar • The beaks uses the buccal and lingual cortical plate as fulcrum • Improper use can result in fracture of alveolar bone or damage to maxillary teeth of force is uncontrolled by the surgeon.

23. Mandibular Forceps • The No. 151, is also adapted for primary teeth • No. 151 S is the same general design, but scaled down to adapt to primary teeth

24. Instrument Tray System Standard sets of instrument are packaged together, sterilized, and used at surgery Basic Extraction Pack: • Local anesthesia syringe, needle, cartridge. • No.9 periosteal elevator. • periapical curette • Small and large straight elevator • Pair of college pliers • Curved hemostat • Towel clip • Austin or Minnesota retractor • Suction tip • 2X2-inch or 4X4-inch gauze The required forceps will be added to the tray

25. Surgical Extraction Tray • Basic extraction tray, plus • Needle holder • Suture • Pair of scissors • Blade and scalpel • Adson forceps • Bone file • Tongue retractor • Pair of cryer elevators • Rongeur • Handpiece and bur

26. Biopsy Tray • Basic extraction tray Minus • The Elevators Plus, • Needle holder, and suture • Suture scissors • Metzenbaum scissors • Allis tissue forceps • Adson tissue forceps • Curved hemostat

27. Post-operative Tray • Irrigation instruments (Suture removal instruments) • Scissors • College pliers • Irrigation syringe • Cotton applicator sticks • Gauze • Suction tip

28. Thank You Reference: Contemporary Oral and Maxillofacial Surgery, 5th Edition James R. Hupp, Edward Ellis III, Myron R. Tucker Chapter 6, Instrumentations for Basic Oral Surgery