1. Instrumentation for Basic Oral Surgery Part I
Dr. Rahaf Y. Al-Habbab BDS. MsD. DABOMS Diplomat of the American Boards of Oral and Maxillofacial Surgery

2. Introduction
The purpose of this lecture is to introduce the instrumentation commonly required to perform routine dental extraction
Different instruments are used for variety of reasons, including both soft and hard tissue procedures

3. Incising Soft Tissue Scalpel: Reusable handle (No. 3)
Disposable, sterile, sharp blade
Single use scalpel:
Plastic handle
Fixed blade

4. Incising Soft Tissue Scalpel Blades:
Most commonly used for intraoral use is No. 15
Used to make incisions around teeth and through soft tissue
Blade No. 10: Is similar in shape but larger in size, used for skin
Blade No. 11: Sharp and pointed, stab incision
#10

5. Incising Soft Tissue
Scalpel Blades: Blade No. 12: Hooked blade, useful for incisions on the posterior aspect of teeth (retro- molar, tuberosity)

6. Scalpel Loading
Blades are loaded to handles carefully using a needle holder
Blade is held on the unsharpened edge
The handle is held with the slotted portion upward
Blade is slowly slid onto the handle along the groove

7. To allow maximum control when making the incision
Scalpel handling
When using the scalpel the
surgeon typically hold it in the
pen grasp, why?
To allow maximum control when making the incision
Blades are dulled easily when in contact with bone or teeth
Dull blades do not make clean, sharp incisions

8. Elevators
After making an incision, periosteum should be reflected of the underlying cortical bone in a single layer, using a periosteal Elevator
No. 9 Molt periosteal Elevator is most commonly used
Has a sharp pointed end and broad rounded end

9. Periosteal Elevator
Can be used to reflect tissue in three different methods:
The pointed end is used in a twisting, prying motion to elevate soft tissue (dental papilla).
Push stroke, where the pointed or the broad end is slid underneath the periosteum (reflection).
Pull stroke, useful, but tend to shred or tear the periosteum, unless done carefully (reflection)

10. Soft Tissue Retractors
Needed for good access and
vision of surgical field
Different retractors are used for
cheek, tongue, and
mucoperiosteal flap
Most common cheek retractors:
Right-Angle Austin retractor
Minnesota retractor
Can be used after to retract the flap

11. Soft Tissue Retractors
Seldin Retractor:
Looks like the periosteal elevator, but with smooth leading edge
Should not be used to elevate mucoperioteum
Mirror:
Most commonly used tongue retractor
Also used for cheek
Weider:
Broad, heart shape retractor
Used for tongue retraction

12. Grasping Soft Tissue Grasping soft tissue is necessary for: Incision
Stop bleeding
Pass a suture needle
Adson Forceps:
Short, Delicate, with or without teeth at tip
Should not hold tissue tightly not to crush it
Toothed are more delicate
Not suitable for the posterior part of the mouth (Stillies)
College or cotton forceps (Angle)

13. Grasping Soft Tissue Allis Tissue Forceps:
Removal of large amount of tissue, or biopsies.
Locking handle, and grasping teeth.
Cause large amount of tissue destruction and for that it should NOT be used on tissues remaining in the mouth
Can be used to grasp the tongue as in towel clip.

14. Hemorrhage Control Pressure is often enough to control bleeding.
If not Hemostat is used
Hemostat:
Comes in variety of sizes and shapes.
Has a long delicate beaks to grasp tissue and a locking handle.
Useful in removing granulation tissue from tooth sockets, root tips, calculus, amalgam, and fragments.

15. Bone Removal Rongeurs:
Most commonly used for bone removal in dentoalveolar surgery
Has sharp blades, squeezed together by the handle
Used for cutting or pinching of the bone
Reopens automatically
Two major designs:
Side cutting forceps.
Side and end-cutting forceps.

16. Bone Removal Bur and Handpiece:
Mostly used by surgeons when performing surgical extraction
High-speed, high-torque handpiece
Sharp carbide burs, remove bone effectively
Most be sterilizable
Most not exhaust air into the field, to prevent tissue emphysema

17. Bone Removal Mallet and Chisel: Occasionally used, as in lingual tori.
The chisel edge must be kept sharp to function properly.
Bone File:
Used for final bone smoothening before suturing the flap.
Double ended with a small and large end
Move bone in only one pull stroke
Pushing against bone will result in burnishing and crushing the bone

18. Removing Soft Tissue from Bony Cavities
Curette:
Angled, double-ended instrument
Used to remove soft tissue from bony defects (granulomas, small cysts from PA lesions)

19. Soft Tissue Suturing
Needle Holder:
An instrument with a locking handle, and a short, blunt beak.
6-inch needle holder is recommended.
The beak surface is crosshatched to permit positive grasp of the suture needle.
Must be held by using thumb and ring finger in rings, with first and second finger to control instrument.

20. Suture Needle
Half-circle or Three-eighths circle suture needle is commonly used.
Curvature allows passing through limited spaces.
Passage can be done with a twist of the wrist.
Comes in large variety of shapes
Tips are either tapered, or triangular (non-cutting vs. cutting)

22. Suture Needle
The cutting portion extends about one third of the needle length, should be used carefully
Tapered needles are used for more delicate tissues (occular, vascular)
Suture material is already swaged on by the manufacture.
The needle is held approximately two thirds of the distance between tip and base. Why?

23. Suture Material Classified by: Diameter Restorability
Monofilament or polyfilament
a) Diameter:
Suture size is related to its diameter
Designated by a serious of zeros
Suture most commonly used is 3-0 (000) to withstand the tension placed on them intraorally, and strong enough for easier knot
Larger sizes are 2-0, or 0

24. Suture Material b) Restorability: Non-resorbable:
Silk, nylon, vinyl, and stainless steel
Resorbable:
Mainly made of gut (sheep intestine serosal surface)
Last 3-5 days
Gut treated by tanning solution (chromic Gut) last 7-10 days
Synthetic resorbable:
polyglycolic acid and poly lactic acid
Long chains of braided polymers
Slowly resorbed (4 wks)
Rarely indicated for intraoral use

25. Suture Material c) Monofilament vs. polyfilament: Polyfilament:
Silk, polyglycolic acid, and polylactic acid
Easy to handle and tie
Rarely untied
Soft and non-irritating ends
Tend to “wick” oral fluids to the underlying tissues, that might carry
bacteria along
Monofilament
Nylon, plain and chromic gut, stainless steel
No wicking action
More difficult to tie
Easily untied
Stiffer, more irritating ends

26. Scissors Short cutting edges Long handles with thumb and finger rings
Different than tissue scissors (Iris and Metzenbaum)

27. Care should be taken with both
Mouth Props
Bite Block:
Pediatric and adult size
Soft rubberlike block
Decrease TMJ stress
Molt Mouth Prop (side action prop):
Ratchet type action
Opens the mouth wider as it close
Useful in sedated patients
Care should be taken with both

28. Suctioning To allow better visualization
Surgical suction has a smaller orifice than the general dentistry one
Many designed with several orifices to prevent suctioning and damaging soft tissue
Fraser Suction:
Has a hole in the handle
Used to control suction force (hard vs. soft tissue)

29. Instruments Towel clip: Hold drapes in place Irrigation:
Steady stream of irrigating solution is required to prevent bone damage during procedure
Irrigating the wound before closure
Large plastic syringe with a blunt 18-gauge needle
Should be angled for efficiency.

30. Thank You Reference: Contemporary Oral and Maxillofacial Surgery,
5th Edition
James R. Hupp, Edward Ellis III, Myron R. Tuker
Chapter 6, Instrumentation for Basic Oral Surgery