Instrumentation for Basic Oral Surgery

Part II

Dr. Rahaf Al-Habbab BDS. MsD. DABOMSDiplomat of the American Boards of OMFS

Consultant of Oral and Maxillofacial SurgeryHead of Orthognathic Unit

Saudi Boards Residents DirectorHospital Education and Residency Director

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.

Dental Elevators

The three major component of the elevator are:

1. Handle2. Shank, and3. 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---------|

Types of Elevators

The three basic types of elevators:1. Straight type2. Triangle or pennant-shape type3. 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

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

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

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

Held differently according to the extracted tooth:

Maxillary teeth: Palm underneath theforceps, with the beaksdirected in a superiordirection

Mandibular teeth: Palm on top of theforceps, with the beaksDirected downward towardsthe teeth.

Extraction Forceps

Hinge: • Connect the beaks to the handle• Transfers and concentrate the force applied on the handle to

the beakBeaks:• 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

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)

Maxillary Forceps

Anterior TeethPremolars

• 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

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. 1 Forceps

No. 150A

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

Maxillary Forceps

• A design variation is No. 88 Right and Left forceps (upper cowhorn)

• Longer more accenuated, pointed beak formation

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.

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

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

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

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

Mandibular Forceps

English Style Forceps

• Used for single rooted teeth in the mandible

• Can generate great force

• High incident of root fracture

No. 74

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

Mandibular Forceps Cowhorn 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.

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

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

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

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

Post-operative Tray

• Irrigation instruments (Suture removal

instruments)

• Scissors• College pliers • Irrigation syringe• Cotton applicator sticks• Gauze• Suction tip

Thank You

Reference: Contemporary Oral and Maxillofacial Surgery, 5th Edition

James R. Hupp, Edward Ellis III, Myron R. TuckerChapter 6, Instrumentations for Basic Oral Surgery