Card Set Information
Most common use
: #3 handle (more slender, longer #7 is used sometimes) with #15 blade (for incision
around teeth and through mucoperiosteum)
Blade inserted with needle holder no laceration
Pen grasp onto the scalpel maximal control!
Dull edge → no clean sharp incision but tears the tissue!!!
2. Instruments for elevating mucoperiosteum:
Reflect mucosa and periosteum in a single layer!
: #9 Molt periosteal elevator!
(i) Sharp, pointed end
: reflect dental papillae from teeth
(ii) Broad end
: elevating tissue from bone
3 methods of reflecting soft tissue
(i) Pointed end used to pry elevate soft tissue → for dental papilla from inbetween teeth
(ii) Push stroke with broad end from underneath the periosteum → MOST efficient stroke/cleanest reflection
(iii) Pull/scrape stroke → shred or tear the periosteum unless done carefully
Instruments for retracting soft tissue
a. Cheek retractor:
: 1 & 2 retract both cheek and mucoperiosteal flap
1) Right-angle Austin retractor
2) Offset broader Minnesota retractor
3) Seldin retractor
: only soft tissue flap but not mucoperiosteum (bc not sharp)
b. Tongue retractor
1) Most common
: Mouth mirror
2) Weider tongue retractor
: more firmly engage tongue and retract more anteriorly and medially
Careful not to push tongue too far back and cause gagging reflex!
3) Towel clip (especially for biopsy of posterior aspect of tongue!) → must be anesthesized!!!
Instruments for controlling hemorrhage
→ for simple pressure control
: curved hemostat!
Locking mechanism allows to clamp to vessel
Also used for
: removing granulation tissue from tooth sucket, picking up small root tips, calculus, amalgam
Instruments for grasping tissue:
a. Adson forceps to stabilize soft tissue flaps to pass a suture needle!
b. Stillies forceps
: for posterior part of the mouth!
c. Sometimes cotton forceps if needs to be angled!
d. Allis tissue forceps
: when need locking handles and with teeth grips
NEVER to be used for tissue that will stay in the mouth since this will destroy the tissue by crushing it!
e. Russian forceps
: for grasping teeth that are loose in the mouth!
6. Instruments for removing bone
a. Roungeur Forceps
Most commonly used to remove bone!
With spring-loaded handle repeated cuts of bone without manually opening the instrument
: side cutting or end cutting or Blumenthal roungeur (side and end cutting)
smaller amounts of bone in multiple times
do not remove teeth with Roungeur forceps
b. Chisel and Mallet
Bone with monobevel and teeth with bibevel chisels
Mallet with nylon facing impart to ↓ noise
c. Bone File
Final smoothing of bone before suturing the mucoperiosteal flap back into position
File only on pull stroke!
d. Bur and Handpiece
MOST used by surgeons to remove bone or teeth!
Must not exhaust air into operative field as do dental drills!!! → bc air may be forced into deeper tissue
planes and produce tissue emphysema (potentially dangerous occurance!)
Instruments for removing soft tissue from bony defects:
To remove granuloma or small cysts from periapical lesions or tooth sucket!
Instruments for suturing mucosa
a. Needle holder (locking handle and a short, stout beak)
Beak is shorter and stronger than that of hemostat
Face of beak is crosshatched positive grasp of the suture needle and suture!
Intraoral placement of suture → 6 in needle holder!
Held by using thumb and ring finger in rings and first and 2nd fingers to control instrument!
For mucosal suture
: ½ or 3/8 circle suture needle! → allow the needle to pass through a limited space
Tapered tip or triangular tips (cutting tips easily pass mucoperiosteum!)
Suture can be either threaded or already swaged by manufacturer
Curved need held about 2/3 distance between tip and end of needle!
c. Suture Material (dpend on size, resorbability and monofilament vs polyfilament)
: commonly 3-0 (or 000)
(i) Larger size suture would be 2-0 or 0
(ii) Smaller size
: 4-0, 5-0, 6-0 → maybe in face bc smaller suture cause less scarring
(i) large enough to prevent tearing through mucosa
(ii) strong enough to withstand tension intraorally
(iii) strong enough for easy knot tying with needle holder
Resorbable vs. non-resorbable
: silk, nylon, stainless steel
(ii) Resorbable 1° made of gut!
: catgut but mainly sheep intestine → lasts about 5 days
b) chromic gut lasts 10-12 days bc treated with tanning solution (chromic acid)
: some are synthetically made resorbable!!! : long chains of polymers braided into suture material
→ lasts about 4 weeks! not indicated in oral cavity!
: polyglycolic acid and polylactic acid!
Monofilament vs polyfilament
: plain, chromic gut, nylon and stainless steel
a) No wicking action
b) More difficult to tie, tend to become untied
c) Stiffer more irritating to soft tissue
: skilk, polyglycolic acid, polylactic acid
a) Easier to handle and tie and rarely come untied
b) Cut ends are soft and nonirritating to tongue
c) “wick” oral fluids along the suture to tissues which may carry bacteria along with saliva!!!
: MOST COMMON USED IN ORAL CAVITY IS 3-0 black silk!!!
Easily tie and tolerated by pt
Black makes it easy to see for suture removal
Since suture no longer than 5-7 days, wicking action is of little clinical importance!
: to cut sutures!
: Dean scissors!: slightly curved handles and serrated blades
: Iris and Metzenbaum scissors
Instruments for holding mouth open:
especially for mandibular extractions, must prevent stress on TMJ
a. Bite block
: rubber block that pt rests their teeth
If must open wider, bite block positioned more posteriorly
b. Side-action mouth prop or Molt mouth prop→ used by operator to open mouth wider if necessary!
Caution since ↑ pressure on teeth and TMJ
Only for pts that are deeply sedated
: always caution not to open too widely bc stress on TMJ and if it’s a long surgery, periodically remove and allow TMJ
Instruments for providing suction: for adequate visualization
a. Surgical suction
: smaller orifice than operative suction for tooth socket!
b. Fraser suction
: holde in the handle portion that can be covered as required
1) Hard tissue suction
: hole is covered under copious irrigation
2) Soft tissue
: uncovered to prevent tissue injury
Instruments for transferring sterile instruments:
Can move large and small items without dropping them
Stored in container filled with bactericidal solution (glutaraldehyde)
Must be emptied and replaced at least every other day and autoclaved at least once per week
Instruments for holding towels and drapes in position:
Locking handle & finger and thumb rings
: sharp, curbed points penetrate towel and drapes
Caution not to pinch the pt’s underlying skin
Instruments for irrigation:
large plastic syringe with blunt 18-gouge needle (blunted and smoothed and angled!!)
: when handpiece and bur is used to remove bone, need steady stream of irrigating solution: usually sterile saline
to cool bur and prevent bone-damaging heat buildup!
↑efficiency of bur by washing away bone chips from flutes of bur and for lubrication
to luxate teeth (loose them) from surrounding bone
minimize incidence of broken roots and teeth
facilitate removal of broken root later if it happens
expand alveolar bone
also used to remove broken or surgically sectioned roots from sockets (especially roots!!!)
Large substantial but controlled force
May use with crossbar or T-bar → careful bc ↑↑amount of force is generated!
: connects handle to blade
: working tip that is used to transmit for to tooth, bone or both
b. Types (biggest variateion
: shape and size of blade)
1) Straight or gouge type
: luxate teeth (MOST COMMONLY USED)
Concave on one side used like shosehorn
: can be angled from shank allow use in posterior region of mouth (ex: Miller and Potts elevator)
2) Triangle or pennant-shape type
: when broken root remains in tooth and adjacent socket is empty
Provided in pairs (left and right) for specific roots
3) Pick type
: to remove roots
: heavy instrument for removing root after drilling a hole with a bur (3mm into root)
Root tip pick/ apex elevator
: small root tip fragments from their socket (VERY THIN instrument must
tease not lever!)
Extraction Forceps: remove tooth from alveolar bone
: adequate size enough pressure and leverage to remove required tooth + serrated surface no slippage
Held differently depending on position of tooth to be removed
: palm underneath forceps
: palm on top of forceps beak down
: connects handle to beak
Transfers and concentrates force applied to handles to beak
(i) American type
: hinge in horizontal direction
: vertical hinge vertically positioned handle
: greatest variations
Adapts to tooth ROOT STRUCTURE at the CEJ different beaks for 1,2, 3 rooted teeth chance of
Closer beak adapts to tooth roots, more efficient extraction and less chance for complications
Width of beak depending on type of teeth removing
Beaks are angles parallel to long axis of tooth
(i) Maxillary beak
: usually parallel to the handle (offset a little for comfort)
(ii) Mandibular beak
: usually perpendicular to handles
b. Maxillary forceps
4) Considered single rooted teeth
: Maxillary incisors, canine, premolar (even though 1PM bifurcates since only care
about root near CEJ)
Remove with maxillary universal forceps (usually #150 for anterior and #150A for premolars)
: #150S (smaller version) for all primary maxillary teeth!!!
Straight forceps #1 is easier for maxillary incisors
2) Considered 3 roots for maxillary molars (1 palatal root and buccal bifurcation)
Molar forceps in pairs
: Right and Left
: Design to fit around palatal beak, pointed buccal beak into buccal bifurcation and offset for good
(ii) #88 (a.k.a.; upper cowhorn forceps)
: longer, more accentuated, pointed beak formation
: ESPECIALLY USUFUL FOR MAXILLARY MOLARS WITH DECAYED CROWNS, BUT MAY
CRUSH ALVEOLAR BONE
(iii) when have single conical root for some reason
: #210: broad, smooth beak with offset
(iv) Removing broken roots/ narrow premolars/lower incisor
: #286 (a.k.a.: root tip forceps)
c. Mandibular forceps
1) Considered single rooted teeth
: Anteriors and premolars
Lower universal forceps
: #151 (similar to 150 but beak pointed inferiorly) for anteriors and #151A for PM
English-style vertical hinge forceps sometimes for mandibular single rooted teeth force generation
2) 2-rooted teeth for molars
: B and L bifurcation
ONLY single molar forceps (no R and L)
: straight handled and oblique beaks and bilateral pointed tips for bifurcations
#222 for conically shaped roots of mandibular molars (no bifurcation 3rd molar) since no pointed tips
: cowhorn forceps): two pointed heavy beaks that uses B/L cortical plates as fulcrum risk of
fracture of alveolar bone
#151S for all mandibular primary teeth
Typical extraction pack with (required forceps lateral added)
1. Local anesthesia syringe
3. Local anesthesia cartridge
4. Woodson elevator
5. Periapical curette
6. S/L straight elevator
7. Cotton pliers
8. Curved hemostat
9. Towel clip
10. Austin retractor
Surgical Extraction tray
: for incision, reflection of soft tissue, removal of bone, section of teeth, retrieval of roots, debridement and suturing
2. needle holder
5. periosteal elevator
6. blade handle
8. Adson tissue forceps
9. bone file
10. tongue retractor
11. root tip pick
12. Russian tissue forceps
13. Cryer elevator
15. handpiece and bur
Biopsy tray: for incision and dissection and closure of wound
2. Blade handle and blade
3. Needle holder and suture, suture scissors
4. Metzenbaum scissors
5. Allis tissue forceps
6. Adson tissue forceps
7. Curved hemostat
Postoperative tray: to irrigate surgical site and remove sutures
2. College pliers
3. Irrigation syringe
4. Applicator sticks
: primary incisors
: 3 root molars
: cowhorn, molars
: molars single conical root
: both max/mand broken roots, narrow premolars
: single rooted
: dobuble rooted
: cowhorn, molars