Oral Surgery Instruments

Oral Surgery Instruments Date: 2012/2/10 Presenter: R1 鄭瑋之 Instructor: 陳靜容 醫師

1. For incising tissue • Scalpel = handle + disposable, sterile blade

To load and remove blade…

To make an incision…

• Pen grasp • Mobile tissue: held firmly to stabilize it • Mucoperiosteum: pressed down firmly so that the incision penetrates the mucosa and periosteum with the same stroke • Got dulled very easily when in contact with hard tissue  do not make clean, sharp incisions

2. For elevating mucoperiosteum • No.9 Molt periosteal elevator

• Pry stroke: Using tooth as a fulcrum, the sharp pointed end to reflect soft tissue. • Push stroke: Using the broad end, slid unterneath the flap to separate the periosteum from the underlying bone. • Pull or scrape stroke: can shred or tear the periosteum • Retractor

2. For elevating mucoperiosteum • No. 1 Woodson periosteal elevator – to loosen soft tissue from teeth before extraction

3. For retracting soft tissue • Austin retractor • Minnesota retractor – to retract the cheek and a mucoperiosteal flap

• Seldin retractor – to reflect soft tissue flaps

– look similar to a periosteal elevator, but with dull leading edge

3. For retracting soft tissue • Mouth Mirror • Weider tongue retractor – To retract tongue – Positioned too posteriorly  gagging

• Towel clip – Biopsy of posterior tongue with local anesthesia on the anterior area

4. For controlling hemorrhage • Hemostat: – to clamp and restrict bleeders or tissue, to control the flow of blood – remove granulation tissue from tooth sockets and to pick up small root tips, pieces of calculus, and any other small particles

5. For grasping tissue • Adson forceps – Delicate forceps with serrated tips – To gently hold tissue to stabilize it – Not to grasp the tissue too tightly, thereby crushing it

5. For grasping tissue • Stillies forceps – Longer (7 to 9 inches), posterior part of the mouth

• College/cotton forceps – Angled forceps – Excellent for picking up small fragments and placing or removing gauze packs

5. For grasping tissue • Allis tissue forceps – Removing larger amounts of fibrous tissue (ex. epulis fissuratum) – locking handles and serrated tips to grip the tissue firmly to provide the tension for proper dissection. – Do not use on tissue that is to be left in the mouth

5. For grasping tissue • Russian tissue forceps – To pick up teeth that have been elevated from their sockets. – The round end allows a positive grip on a tooth so that it won't slip out, as commonly occurs with the hemostat. – To place gauze in the mouth when the surgeon is isolating a particular area for surgery.

6. For removing bone • Rongeur Forceps – Sharp blades squeezed together by the handles, cutting or pinching through the bone. – The side-cutting and end-cutting forceps are more practical for most dentoalveolar surgeries. Can be inserted into sockets for removal of interradicular bone or sharp edges

6. For removing bone • Rongeur Forceps: Clinical Tips 1. Smaller amount of bone should be removed in each of multiple bites but never large amount of bone in a single bite. 2. A constant cleansing of the blades is necessary. 3. Rongeurs are delicate and relatively expensive therefore, NEVER remove teeth with rongeurs.

6. For removing bone • Osteotomes – To shape and sculpt bone, or section a tooth

• Chisels – To cut a window in the bone cortex for access or to gain pure soft bone – Monobevel: remove bone – Bibevel: section teeth.

• Gouges – To scoop away strips of soft bone, especially in bone grafting

6. For removing bone • Mallet – with a nylon facing imparts less shock to the patient, is less noisy, and is therefore recommended.

• Bur and Handpiece – High-speed, high-torque with sharp carbide burs – Autoclavable – If exhaust air into the wound  into deeper tissue planes  tissue emphysema

6. For removing bone • Bone File – Final smoothing of the bone before suturing a mucoperiosteal flap back into position

6. For removing bone

• Bone File: Clinical Tips 1. Pull stroke  remove bone 2. Pushing  burnish and crush the bone (X) 3. Cleanse the instrument by wiping the grooved ends with a sponge. By failure to do this, dust or chips may easily remain in the wound.

7. For removing soft tissue from bony defects • Periapical curette – Angled, double-ended, spoon shape – to remove granulomas or small cysts from periapical lesions – to remove small amounts of granulation tissue debris from the socket

8. For suturing mucosa • Needle Holder – a locking handle and a short, stout beak. – For intraoral placement of sutures, a 6-inch needle holder is usually recommended.

Difference between needle holder & hemostat Hemostat Needle holder

Needle holder

Hemostat

How to hold a needle holder…

8. For suturing mucosa

• Needle – Small half-circle or 3/8 circle suture needles – A cutting needle will pass through mucoperiosteum more easily than the tapered needle – The curved needle is held approximately 2/3 of the distance between the tip and the base of the needle.

8. For suturing mucosa • Suture Material – Diameter, resorbability, mono/polyfilament – The diameter most commonly used in the suturing of oral mucosa is 3-0. Nonresorbable Silk Polyfilament Nylon Vinyl Stainless steel

Resorbable Chromic gut: 10-12 days Catgut: 3-5 days Polyglycolic acid & poly lactic acid: 4 weeks

8. For suturing mucosa • Scissors – Long handles, short cutting edge – Suture scissors (most common: Dean scissors) – Tissue scissors – Should not be used to cut sutures 1) Iris scissors: small, sharp-pointed delicate tools used for fine work 2) Metzenbaum scissors: blunt-nosed scissors used for undermining soft tissue

8. For suturing mucosa

Iris: small sharp-pointed scissors

Metzenbaum: longer, delicate, blunt-nosed scissors

9. For holding mouth open • Bite blocks – To prevent stress on the TMJ when performing extractions of mandibular teeth.

• Side-action/Molt mouth prop (ratchet-type action) – Avoid opening the mouth too widely  stretch injury to the joint

10. For providing suction • To provide adequate visualization • Designed with several orifices so that the soft tissue will not become aspirated into the suction hole and cause tissue damage • Fraser suction – has a hole in the handle portion – hard tissue: hole is covered so that the solution is removed rapidly – soft tissue: the hole is uncovered to prevent tissue injury

11. For holding towels and drapes in position

• Towel clip – Not to pinch the patient's underlying skin.

12. For irrigation • Steady stream of sterile saline to cool the bur and prevent bone-damaging heat buildup • Increase the cutting efficiency by washing away bone clips • Before the mucoperiosteal flap is sutured back, the surgical field should be irrigated thoroughly with saline. • A large plastic syringe with a blunt 18-gauge needle is commonly used for irrigation.

13. Dental elevators • Elevators – – – –

To loosen teeth from the surrounding bone To prevent broken roots and teeth To expand alveolar bone To remove broken or surgically sectioned roots Handle

shank

blade

A. Straight/gouge type • Luxation of an erupted tooth, displace root from the socket. • Angled, used in the more posterior aspects. Ex: Miller elevator & Potts elevator

concave on its working side

B. Triangle/pennant-shape type • Provided in pairs: left, right • Most useful when a broke root remains in the tooth socket and the adjacent socket is empty. Ex: Cryer

C. Pick type • Crane pick – Drill a hole with a bur about 3 mm deep into the root just at the bony crest.  buccal plate as a fulcrum  crane pick as a lever to elevate a broken root from the socket.

• Root tip pick – To tease the very small root end

14. Extraction forceps

How to hold forceps…

14. Extraction forceps • Maxillary forceps – Single root: maxillary incisors, canines, premolars

Universal forceps No. 150 – incisors, canines

14. Extraction forceps • Maxillary forceps – Bifurcated root: premolars

No.150

No.150A

No. 150 A – premolars

14. Extraction forceps • Maxillary forceps – Single-rooted: maxillary incisors, canines

No. 1 – incisors , canines

14. Extraction forceps • Maxillary forceps

Concave for P root Beak fits into B bifurcation

– Trifurcated root: maxillary molars

No. 53 right and left

14. Extraction forceps • Maxillary forceps – Trifurcated root: maxillary molars

Maxillary molars whose crowns are severely decayed

N0. 88 right and left (upper cowhorn forceps)

14. Extraction forceps • Maxillary forceps

Maxillary 2nd molars and erupted 3rd molars have a single conically shaped root

N0. 210 S

14. Extraction forceps

Broken upper molar root, narrow premolars, lower incisors

N0. 286 – root tip forceps

14. Extraction forceps Universal primary maxillary teeth forceps

N0. 150S

14. Extraction forceps • Mandibular forceps

No. 151 – lower universal forceps

14. Extraction forceps • Mandibular forceps No. 151 A – mandibular premolars

14. Extraction forceps English style of vertical-hinge forceps

Single-rooted teeth in the mandible Great force  root fracture

14. Extraction forceps Mandibular molars: bifurcated, two-rooted

No. 17 N0. 151－Fused, concial roots

Bifurcation is on both B & L, only single molar forceps are necessary for the left and right

14. Extraction forceps 2 pointed heavy beaks into the bifurcation of the lower molar

N0. 23 (Cowhorn forceps)

14. Extraction forceps Universal primary mandibular teeth forceps

No. 151 S

Thank you for your attention!