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Instruments in Oral Surgery II

Instruments in Oral Surgery II. Jan 25, 2008. RCT=Brittle. Remember-older RCT-easier to break Flap it, trough it, remove it. Forceps. Adapt to the anatomic crown Older patients bone is more dense, not elastic We want to dilate the bone to remove the tooth

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Instruments in Oral Surgery II

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  1. Instruments in Oral Surgery II Jan 25, 2008

  2. RCT=Brittle • Remember-older RCT-easier to break • Flap it, trough it, remove it

  3. Forceps • Adapt to the anatomic crown • Older patients bone is more dense, not elastic • We want to dilate the bone to remove the tooth • Best time to remove thirds, 16-20 years old • The bone can expand better

  4. Forceps • Remember to look at the roots • Path of the roots=draw • Hypercementosis-won’t come out easily • Know the difference between surgical and routine (look at handout)

  5. 88R & 88L • Use only if furcation involvement • Younger patients won’t have furcation • Can fracture the buccal plate, palatal plate and crush mucosa

  6. 88R and 88L

  7. #23 Cowhorn • Furcation of mand. Molar • Can fracture lingual plate, break roots, etc • Make sure to compress! • Buccal and lingual movements • Seat the beaks and “pump” them closed • Rock them mesiodistally as well, then figure of 8

  8. #23 Cowhorn Forceps

  9. Elevators • Used as wedges or shoehorns (displacement) down into the PDL and tear the fibers • Used as a lever- (most common way to use them) • Used in socket (wheel and axle)

  10. Elevators • Easier to remove root fragments and tips post-elevator use, rather than attempting to remove tooth with forceps alone • Otherwise, will need to reflect a flap and remove surgically

  11. Crane Pick • Wheel and axle • Fulcrum on buccal bone • Bury tip into cementum • Usually needs purchase point • Roll the root out • Not for Max 3rds

  12. Apex Elevator • Remove roots where the PDL has already been torn • Can perforate into the sinus

  13. Oral-Antral Perforation & IA canal • If potential for damage to the sinus or mandibular canal; • May leave the root tip, UNLESS potential for infection, then must remove them • Third molars, let them be, they are most likely not infected

  14. Oral-Antral Perforation • National Board Question: • NEVER enlarge the apical area to remove a root tip that has been shoved into the sinus • This will create an oral-antral fistula

  15. Oral-Antral Perforation • 1st- Get X-ray • To make sure if it is in the sinus • To know whether the sinus will heal or not depends on: • 1) Size of the perforation • 2) Infection or not

  16. Caldwell-Luc Procedure • This is the procedure used to retreive a root tip from the sinus • Make an envelope over the cuspid and bicuspid • Make a window into the lateral wall of the sinus • Remove the tip and close the flap • Get primary closure of the margins • Place the patient on antibiotics • Place the patient on decongestants • Give patient strict instructions regarding disturbing pressures

  17. Allison Clamp • Has rat teeth to remove tuberosity reduction, (this is not a tuberosity reduction surgery, if you wondered) but those are Allison clamps

  18. Hemostats/clamps • Clamping vessels • Remove pieces of roots and bone • NOT used to drive a needle

  19. Curved Hemostat/Mosquito Hemostat

  20. Adson Forceps • “Pickups” control tissue

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