Instrumentation

for Basic Oral Surgery

1
Objectives
To know the instruments that are used to perform oral surgeries.
To know the uses and the characteristics of each instrument.

2
INSTRUMENTS FOR INCISING TISSUE
SCALPEL

3
 Scalpel
Two types are available:
1. Scalpel with a reusable handle and a disposable, sterile sharp blade.
2. single-use scalpel with a plastic handle and fixed blade.
The most commonly used handle: No. 3 handle
Blades:
Blade Characteristics Uses
No. 15 1. most commonly used Used to make incisions around teeth and through soft tissue.
2. small
No. 11 sharp-pointed Used to make small stab incisions such as for incising into an abscess.
No. 12 hooked Used in mucogingival procedures in which incisions are made on the posterior aspects
of teeth or in the maxillary tuberosity area.

4
 12 15
10 11

Scalpels are composed of handle and sharp, disposable Scalpel blades used in oral surgery include
blade. Scalpel No. 3 handle with No. 15 blade is most No. 10, No. 11, No. 12, and No. 15, going
commonly used. from left to right.

5
How to prepare it?
When loading Surgeon then
scalpel blade, the slides the blade
surgeon holds the into the handle
blade in the needle until it clicks into
holder and handle, place.
with the male
portion of the
fitting pointing
upward.
To remove the The surgeon
blade, the surgeon then gently
uses the needle slides the blade
holder to grasp the off the handle.
end of the blade
next to the handle
and lifts it to
disengage it from
the fitting.

6
How to use it?
The scalpel is held in the pen grasp to allow maximal
control.
Mobile tissue should be held firmly in place under
some tension so that as the incision is made, the blade
will incise and not just push away the mucosa.
When incising depressible soft tissue, an instrument
such as a retractor should be used to hold the tissue
taut while incising.
pen grasp
When a mucoperiosteal incision is made, the blade
should be pressed down firmly so that the incision
penetrates the mucosa and periosteum with the same
stroke.

7
INSTRUMENTS FOR ELEVATING
MUCOPERIOSTEUM
NO. 9 MOLT PERIOSTEAL ELEVATOR

8
No. 9 Molt periosteal elevator
Characteristics: it has a sharp, pointed end and a broader, rounded end.
The pointed end is used to begin the periosteal reflection and to reflect dental papillae from
between teeth.
The broad, rounded end is used to continue the elevation of the periosteum from bone.

9
How to use it?
1. The first method: the pointed end is used in a twisting, prying motion to elevate soft tissue,
most commonly when elevating a dental papilla from between teeth or the attached gingiva
around a tooth to be extracted.

2. The second method: is the push stroke, in which the pointed or the broad end of the
instrument is slid underneath the periosteum, separating it from the underlying bone, this
being the most efficient stroke that results in the cleanest reflection of periosteum.

3. The third method: is a pull stroke, which is occasionally useful but tends to shred or tear the
periosteum unless done carefully.

10
INSTRUMENTS FOR RETRACTING SOFT
TISSUE
CHEEK RETRACTORS, ORAL SOFT TISSUE RETRACTOR, TONGUE
RETRACTORS

11
Why do we use it?
They are used to retract cheek, tongue, and mucoperiosteal flap to provide access and visibility
during surgery.
Retractors can also help protect soft tissue from sharp cutting instruments.

The Austin retractor is a right-angle retractor that can be The Minnesota retractor is an offset retractor used for
used to retract the cheek, tongue, or flaps. retraction of cheeks and flaps.

12
Types
Type Example Characteristics
Cheek (1) the right-angle Austin retractor - They can be used to retract the cheek and a
retractors (2) the broad offset Minnesota retractor mucoperiosteal flap simultaneously.
Oral soft tissue Seldin retractor - It look similar to a periosteal elevator.
retractor - the leading edge is not sharp but, instead, is smooth.
- it should not be used to elevate the
mucoperiosteum.
Tongue the mouth mirror - It can also be used as a tongue or cheek retractor.
retractors The Weider tongue retractor - a broad, heart-shaped retractor that is serrated on one
side so that it can more firmly engage the tongue and
retract it medially and anteriorly.
towel clip Used when a biopsy procedure is to
be performed on the posterior aspect of the tongue.

13
 A

The Henahan (top) and Seldin (bottom) retractors are broader

B
A, Weider retractor is a large retractor designed to retract the tongue. The serrated surface helps
engage the tongue so that it can be held securely. B, The Weider retractor is used to hold the
tongue away from the surgical field. The Austin retractor is used to retract the cheek.

14
INSTRUMENTS FOR GRASPING SOFT
TISSUE
TISSUE FORCEPS

15
Tissue forceps
Adson forceps: These are delicate forceps, with or without small teeth at the tips, which can be
used to hold tissue gently and thereby stabilize it.
Stillies forceps: These forceps are usually 7 to 9 inches long and can easily grasp tissue in the
posterior part of the mouth while still leaving enough of the instrument protruding beyond the
lips for the surgeon to hold and easily control it.
Angled forceps: Such a forceps is the college, or cotton, forceps. They are used for picking up
loose fragments of tooth, amalgam, or other foreign material, and for placing or removing gauze
packs.
Allis tissue forceps: forceps with locking handles and teeth that will grip the tissue firmly, used
especially when removing larger amounts of tissue or doing biopsies

16
 A A

B B
A, The small, delicate Adson tissue forceps are used to gently
stabilize soft tissue for suturing or dissection. B, The Stillies pickup
(top) is longer than the Adson pickup and is used to handle tissue
in the more posterior aspect of the mouth. The college pliers
(bottom) are angled forceps that are used for picking up small
objects in the mouth or from the tray stand. The college pliers
shown here are the locking version.
C
A, The Allis tissue forceps are useful for grasping and holding tissue that will be
excised. B, The Allis forceps are held in the same fashion as the needle holder. C,
Comparison of Adson beaks (right) with Allis beaks (left) shows the differences in
their designs and uses.

17
INSTRUMENTS FOR CONTROLLING
HEMORRHAGE
HEMOSTAT

18
Hemostat
Hemostats come in a variety of shapes: small and
delicate or larger, and are straight or curved.
The hemostat most commonly used in surgery is the
curved hemostat.
A hemostat has long, delicate beaks used to grasp tissue
and a locking handle. Superior view of the hemostat used for
oral surgery.
The hemostat is especially useful in oral surgery to
remove granulation tissue from tooth sockets and to pick
up small root tips, pieces of calculus, amalgam,
fragments, and any other small particles that have
dropped into the wound or adjacent areas.
Oblique view of the curved hemostat.
Straight hemostats are alsoavailable.

19
INSTRUMENTS FOR REMOVING BONE
RONGEURS, BUR AND HANDPIECE, MALLET AND CHISEL, BONE FILE

20
 Rongeurs
This instrument has sharp blades that are squeezed together by
the handles, cutting or pinching through bone.

Two major designs for rongeur forceps are: (1) a side-cutting

Uses:
1. they can be inserted into sockets for removal of inter-radicular bone.
2. they can be used to remove sharp edges of bone.
3. can be used to remove large amounts of bone efficiently and quickly.
4. should never be used to remove teeth.

21
Bur and Handpiece
Most used when removing bone for the surgical removal
of teeth.
High-speed, high-torque handpieces with sharp
carbide burs remove cortical bone efficiently. (Burs such
as No. 557 or No. 703 fissure bur and No. 8 round bur
are used.)
When large amounts of bone must be removed, such as Typical moderate-speed, high-torque,
in torus reduction, a large bone bur that resembles an sterilizable handpiece with No. 703 bur.
acrylic bur is used.
The handpiece that is used must be completely
sterilizable.

22
Mallet and Chisel Bone File

The mallet and chisel are often used when Final smoothing of bone before completing
removing lingual tori. surgery is usually performed with a small bone
file.
The edge of the chisel must be kept sharp to
function properly. The bone file is usually a double-ended
instrument with a small and larger end.

23
INSTRUMENTS FOR REMOVING SOFT
TISSUE FROM BONY CAVITIES
CURET TES

24
Curettes
Example: periapical curette and periodontal curette.
Used to remove soft tissue from bony defects.
The principal use is to remove granulomas or small cysts from periapical lesions.
May also be used to remove small amounts of granulation tissue debris from a tooth socket.

25
INSTRUMENTS FOR SUTURING SOFT
TISSUE
NEEDLE HOLDER, SUTURE NEEDLE, SUTURE MATERIAL, SCISSORS

26
Needle Holder
Is the instrument used to place the sutures.
The needle holder is an instrument with a locking
handle and a short, blunt beak.
For intraoral placement of sutures, a 6-inch (15-
cm) needle holder is usually recommended.
The needle holder is held by using the thumb and
the ring finger in rings and the first and second
fingers to control the instrument.

27
Suture Needle
It is used in closing oral mucosal incisions.
It is usually a small half-circle or three eighthscircle
suture needle. The needle is curved to allow it to pass
through a limited space where a straight needle cannot
reach, and passage can be done with a twist of the
wrist.
The tips of suture needles either are tapered like
sewing needles, or they have triangular tips.
A cutting needle will pass through the
mucoperiosteum more easily.
Tapered needles are used for more delicate tissues, The needle holder grasps the curved
such as in ocular or vascular surgery. needle two thirds of the distance from
the tip of the needle.

28
Suture Material
The materials are classified by diameter, resorbability, and whether they are monofilament or
polyfilament.
The diameter most commonly used in the suturing of oral mucosa is 3-0 (000).
One of the most commonly used sutures for the oral cavity is 3-0 black silk.
The size 3-0 has the appropriate amount of strength.
the polyfilament nature of the silk makes it easy to tie and well tolerated by the patients soft
tissues.
The color makes the suture easy to see when the patient returns for suture removal.
Sutures that are holding mucosa together usually stay no longer than 5 to 7 days.
Many surgeons prefer 3-0 chromic suture to avoid the need to later remove it.

29
Scissors
Suture scissors are necessary for placing sutures.
The suture scissors usually have short cutting edges because their
sole purpose is to cut sutures.
The most commonly used suture scissors for oral surgery are Dean
scissors. These scissors have slightly curved handles and serrated
blades that make cutting sutures easier.
Scissors that are designed for cutting soft tissue: iris scissors and
Metzenbaum scissors.
Iris scissors are small, sharp-pointed, delicate tools used for fine
work.
Iris scissors (top), Metzenbaum
Metzenbaum scissors are used for undermining soft tissue and for
cutting. scissors (bottom).

Tissue scissors such as iris or Metzenbaum scissors should not be

30
Questions ~
1. What is the most commonly used blade for incising tissues?
A. No. 12 B. No. 11 C. No. 15

2. Which instrument is used in controlling hemorrhage?

3. What is most commonly used sutures for the oral cavity?

31
Thanks for listening .

32