Instrumentation Flashcards
What are extraction forceps?
Remove teeth from alveolar bone
What are the components of extraction forceps?
- Handle
- Hinge
- Beaks
What does the handle of the extraction forcep do?
- Allow instrument to be grasped
- Deliver leverage and pressure to beak
What are the two types of extraction forcept handles?
horizontal grasped
vertical grasped
What are horizontal grasped handles of extraction forceps?
- American style forceps
- Handles are horizontal to floor
— Palm down for mandibular extraction
— Palm up for maxillary extraction
for right handed operator at 7-9 o’clock position
What are vertical grasped handles of an extraction forcep?
- European style forceps
- Handles in vertical plane
- For removal of mandibular teeth
What does the hinge of the extraction forcep do?
Transfer and amplify force from handle to beaks
When selecting types of forceps, consider the following:
- Danger to soft tissue
- Some hinge design may crush soft tissue or lip
- Cleaning
- Concealed hinge cleaning problem
- Ultrasonic cleaner is a must
- Lubrication
- Silicon lubricant
What do the beaks of the extraction forcep do?
Beaks adapt tooth at level near or below cervical line of the tooth
What are the different styles of beaks for extraction forceps?
- Conical
- Bifurcated
- Trifurcated
If you have too large of a beak on the extraction forceps what happens?
unable to migrate forceps apically
If you use the wrong size beaks on the extraction forceps what happens?
poor adaptation
What is the degree of the beaks on maxillary extraction forceps?
Parallel or offset at 45⁰
What is the degree of the beaks on mandibular extraction forceps?
Right angle (perpendicular)
What forceps do you use on maxillary anterior teeth?
Conical to triangular shaped roots
- # 1 & #99-C
- # 150 (good alternative)
Extraction of __________ usually involves surgical removal of buccal bone
canine
What forceps do you use on maxillary premolars?
150
#150-A
What is the #150 extraction forceps good for?
- “Universal” forceps generally good for oval shaped / conical shaped roots
- Beaks migrate toward apex of anterior teeth when proper forces are applied
What is the #150-A extraction forceps good for?
- Conform to premolar crowns.
- Poorer adaptation to maxillary anterior teeth
- Less beak migration toward apex
How are the roots different on maxillary first versus second premolars?
Maxillary First Premolars
- Usually bifurcated root
- Overall conical root shape
Maxillary Second Premolars
- Single conical roots
What forceps do you use on maxillary molars?
Forceps are location specific
* Need a pair, one for right and one for left
- # 89 & #90
- # 88R & #88L
- # 53R & #53L
How are the roots different on maxillary first versus second molar?
1st molars
- Trifurcated with 2 buccal + 1 palatal root 2nd molars
- Smaller, trifurcated but can be conical roots
Why do you need to be careful when using a #88R and #88L
Reckless use of this instrument -> alveolar fracture, crushing gingival tissue, damage adjacent teeth
What is the function of the #88R and #88L forceps?
- “Upper cowhorn”
- 2 palatal prongs slide to either side of palatal root
- Buccal prong enters the furcation
What is the function of the #89 and #90 forceps?
Palatal beak adapts to palatal root but NOT entering furcation
What is the function of the #53R and #53L?
- For trifurcated 1st & 2nd molars
- Not used when coronal structures
are compromised
— Extensive coronal caries
— Endodontically treated tooth
What forceps are used for erupted maxillary 3rd molar?
210-S
- Short beak due to usually short crown on 3rd molars
What forceps are used for maxillary root fragments?
286
- Long & slender beak
What forceps are used for maxillary primary teeth?
150-S
- Smaller version of #150
- Good for all primary maxillary teeth
150 can be used anywhere
What are the roots like on mandibular anteriors and premolars?
- Flatten in mesial-distal root
- Mandibular canine has longest roots of the lower arch
What forceps are used for mandibular anterior and premolars?
- # 74, #74-N, #74-extra-N. (Ash)
- # 151, #151A, and #203
What are the functions of the #74, #74-N, #74-extra-N. (Ash) forceps?
- Vertical English or European style
- Continually seating beaks during extraction
— Prevent crown fracture
What are the functions of the #151, #151A, and #203 forceps?
- # 151, Lower Universal (shown in pic)
- # 151A, Grasp premolar but not adapt well to other mandibular teeth
- # 203, thinner beak better adaptation
What are the roots like on mandibular 1st and 2nd molars?
1st molars
* Bifurcated mesial-distally
2nd Molars
* Less extent bifurcated, often conical roots
What forceps are used for mandibular molars?
- # 23 (cownhorn)
- # 17
What are the functions of the #23 (cownhorn) forceps?
- Most popular mandibular forceps since 1884
- Properly adapted to tooth, Tooth is “squeezed” out of the socket
What are the functions of the #17 forceps?
- For bifurcated 1st, 2nd molars
- Not adapt to conical-rooted molars
What forceps are used on mandibular third molars?
222 (Can be used for conical-rooted second molars)
What forceps are used on primary mandibular teeth?
151-S (Scaled down version of #151)
What are elevators?
- Valuable aid to extraction of teeth
- Used to luxate teeth
No attempt should be made to extract a tooth with only _______
elevator
* Unless root has clear unobstructed path of exit
* The force used to bypass obstruction of bone will either fracture the bone or tooth
What are the components of an elevator?
- handle
- shank
- blade/tip
What is the handle of an elevator for?
Large handle so it can be firmly grasped and held in control
What is the shanke of an elevator for?
- Strong to withstand the forces of action
- Index finger rest
What is the blade/tip of an elevator for?
Portion of the elevator in contact with teeth or alveolar bone
How do you use an elevator?
Displacement
- insert into PDL space to dislodge root tip
Lever Action
- prying tooth root tip from its socket
Wheel and Axle
- engage a purchase point, use bone as fulcrum to rotate the tip out
When should you not insert the elevator into the PDL space to dislodge the root tip?
cannot use this technique for maxillary root especially when its in close proximity to maxillary sinus
May displace root into maxillary sinus thus create an oro-antral communication
What is the function of the #30 and #31 (cryer) elevator?
Wheel & axle
* Use with or without purchase point
* Remove root with adjacent empty socket
* Example: mandibular molar
What is the function of the #41 (crane pick) elevator?
- Wheel & axle
- Most dangerous elevator
— Fulcrum on buccal bone and sharp point buried into cementum of root to “drag” root out - Use with “purchase point” created
with bur
When making a purchase point, it needs to be __mm apical to CEJ and ___mm deep
3 mm
3mm
What is the most dangerous elevator?
41 (Crane Pick)
What is the function of the #73 and #74 elevators (miller or potts)?
- Used as a cork screw
- Potts has T handle which deliver more force
- Usually used for impacted Maxillary 3rd molars
What is the most commonly used elevator that will be used on most cases?
301 (small elevator)
What is the function of the #301, #302, #303 elevators?
- Smaller version of large elevator (#34-S, #46)
- Most Commonly used elevator!!
What are the 2nd most commonly used elevators?
34-S and #46 (Large shoehorn, Straight elevators)
What is the function of the #34-S and #46 (Large shoehorn, Straight elevators) elevators?
- 2nd most commonly used elevators
- Place into PDL space parallel to tooth
- Grasp properly and not to slip
What elevators should you start with?
Start with #301 then #34-S/#46
What is the function of the Apex elevators (Root picks) elevators?
- Straight shank or angled
- Essential in small detached root tips
- Sharp end of the instrument is placed in the PDL space
- If root tip is still attached by its PDL, one should use #301 and NOT root picks (you can break the elevator)
What elevator/action would you use for…
Removal of Sectioned roots following sectioning
30 & #31 (Cryer)
Wheel & Axle
* Use with or without purchase point
What elevator/action would you use for…
Removal of tooth or portion of tooth
41 (Crane pick)
Wheel & Axle
* Use with purchase point
What elevator/action would you use for…
Removal of maxillary 3rd molars, both erupted and impacted
73 & #74 (Miller) Potts
Wheel & Axle
What elevator/action would you use for…
Removal of larger single roots when forceps aren’t preferred
34-S & #46
Displacement
What elevator/action would you use for…
Luxating teeth prior to forceps application
34-S & #46, #301 sometimes
Lever action: fulcrum placed on interseptal bone
What elevator/action would you use for…
Removal of medium size roots or medium size root tips when #34-S or #46 elevators are too large
301, #302 & #303
Displacement
What elevator/action would you use for…
Removal of small root tips when tips have
unobstructed pathway and are loose
Apex Elevators ( Root picks)
Displacement
What is the function of the #5 rongeurs?
- Large-bladed, side-cutting
- Known as “bone forceps”
- Cuts rather than “pinches” bone
- **may pinch/cut lip or cheek **
- Alveoplasty with good access
What is the function of the #4A rongeurs and blumenthal rongeurs?
- Side & end-cutting
- Most popular by dentist
- They cut bone by “pinching”
- Minor alveoplasty with limited access
What is the function of the mallet-surgical?
- Nylon head to soften the blow
What is the function of the chesels?
- Section teeth or remove bone
- Bibevel #2 chisel
— Split teeth - Monobevel #52 chisel
— Remove bone
— Should be so sharp that hand pressure alone can remove bone
What is the function of the curette?
- Curettage granuloma
- Enucleation of small cysts
- Debride sockets
- Need assorted sizes and shapes
What is the function of the bone file #12?
- Smoothing bone
- Not for gross bone reduction
— Bone reduction- use rongeur or drill - Pull stroke only
What is the function of the periosteal elevator (#9 Molt, Hopkins)?
- Reflect full thickness mucoperiosteum
— If not used carefully, end up with reflecting supraperiosteal flap - Present splitting or tearing of flap
- Push/pry motion
— Sever attachment of gingiva - Pull
— Reflect loosely attached gingiva
What is the function of the kelly and dean scissors?
Kelly
* Universal-type scissors
* Trimming of wound margins
* Cutting sutures
* Left-handed model available
Dean
* Long curved handle
What is the function of the needle holder?
- Thumb and ring finger through the hold
- Index finger along the shaft
What are the different blades for the bard-parker knife handle (#3)?
- # 15 blade is the standard blade
- # 11 pointed - for I&D (incision and drainage)
- # 12 “hooked” - Reach inaccessible region
- # 12b - Incise on both side
- # 10 - Not used for intraoral surgery
What are tissue forceps (adson)?
- Tissue forceps with “teeth”
- Support flap, enable suture needle to penetrate the flap at 90-degree angle
- Avoid crushing tissue when
performing biopsy
What is the function of a retractor?
Minnesota and Austin Retractor
* Hold mucoperiosteal (Flaps, cheeks, lips, tongue)
* Improve visibility and protect tissues
What is the different types of suction tips?
Yankeur
* General suction
Frazier
* Precision surgical suction
Coupland Suction
* 2 pieces design with various tip sizes
What type of carbide burs are used in oral surgery?
Tapered fissure burs
* #701, #702, #703
* Remove bone, section teeth, place purchase point
Round burs
* Various sizes: #4, #6, #8…
* Placement of purchase point
Acrylic “football”, “pear-shaped” burs
* Removal of exostosis, torus, or alveoplasty
What is the most common bur used in oral surgery?
703
What are the features of an electric drill in oral surgery?
- No need for additional air compressor
- Downside is Very expensive
- Proper maintenance is an absolute must
What are the features of a high speed air rotor in oral surgery?
- Impact-Air
- Exhaust air to the rear
— Regular dental handpieces exhaust air into surgical wound and may cause air embolism to surgical site.
