INSTRUMENTATION FOR BASIC ORAL SURGERY Flashcards by Love Dog

T/f

Different surgical procedures require different
sets of instruments

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T/f

SYRINGE

Breech-loading, metallic, cartridge-type aspirating syringe. There are 2 types of harpoon:
1) Spiral
2) Arrow

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T/f

Spiral syringe

Just make sure for the spiral type, look at the directionality of the spiral because that’s where it will rotate
 If rotated the other way, it will never engage

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T/f

MINNESOTA RETRACTOR

It loos like an S, curved.

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 It is used to retract the soft tissue the reflected
soft tissue away from the working area

 If there is a reflected soft tissue, it is used to
keep away from the working area

MINNESOTA RETRACTOR

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Tbf

MINNESOTA RETRACTOR

should not be resting on bone

(should always be resting on bone)

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Never impinge the soft tissue underneath
 It is quite sharp
 If enough force is applied, it can even carry
on the soft tissue

MINNESOTA RETRACTOR

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Referred to as Miller Elevator

MOLT 9 MUCOPERIOSTEAL ELEVATOR

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Commonly known as Tuser

MOLT 9 MUCOPERIOSTEAL ELEVATOR

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This instrument 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.

MOLT 9 MUCOPERIOSTEAL ELEVATOR

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Prying

Pushing

Pulling

MOLT 9 MUCOPERIOSTEAL ELEVATOR

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There are 3 motions as to how to use the Molt 9 Elevator
1) Prying
The ____ 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

pointed end

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

The least used among the 3 techniques because it causes gingival tearing

Prying

Pushing

Pulling

Pushing

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

Thepointedorthebroadendofthe instrument is slid underneath the periosteum, separating it from the underlying bone, this being the most ef􏰀cient stroke that results in the cleanest reflection of periosteum

Prying

Pushing

Pulling

Pushing

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

Occasionallyusefulbuttendstoshred or tear the periosteum unless done carefully

Prying

Pushing

Pulling

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T/f

The Molt 9 Elevator has a concave and convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

side is the sharp end

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

 Pushing towards the bone
 Peel off the periosteum

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

 Make sure to reflect tissue on flap with the mucoperiosteal flap

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

is the rounded end

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

To make a full thickness mucoperiosteal flap, contact the bone then push with the concave pushing towards the bone

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

The soft tissue will just glide through on top of it so there will be no trauma

A. concave
B. convex side

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MOLT 9 MUCOPERIOSTEAL ELEVATOR

If doing other way around, there is a seesaw
and the forces will be directed towards the gingiva tearing it leaving it not cleanly peeled

A. concave
B. convex side

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An angled, double-ended instrument used to
remove soft tissue from bony defects

CURETTE

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Used to remove any pathologic lesion in the apical area of the tooth  The principal use is to remove granulomas or small cysts from periapical lesions, but the ____ may also be used to remove small amounts of granulation tissue debris from a tooth socket

CURETTE

It looks like a ladle  Concave side: sharp  Convex side: rounded

CURETTE

T/f  The old way is every time there is an extraction (EXO), they curette the socket after this.  It is recommended that after EXO, do not forget about the socket it must be curetted  The periodontal fibers that’s holding the tooth are irritated when there is still a periapical lesion in that area  Leaving the periodontal fibers in that area will lead to faster healing (no infection)

Access to working area

GATE HANDLE BARD PARKER 7

The most commonly used scalpel blade for intraoral surgery A. Blade No. 15 B. Blade No. 11 C. Blade No. 11 D. Blade No. 10

Used for almost all the intraoral incisions in the mouth like sulcular incision, almost everything A. Blade No. 15 B. Blade No. 11 C. Blade No. 11 D. Blade No. 10

For cut or incision for drainage of an abscess A. Blade No. 15 B. Blade No. 11 C. Blade No. 11 D. Blade No. 10

Good for sulcular incision A. Blade No. 15 B. Blade No. 11 C. Blade No. 12 D. Blade No. 10

Used for large skin incisions in other parts of the body A. Blade No. 15 B. Blade No. 11 C. Blade No. 12 D. Blade No. 10

T/f Other commonly used blades for intraoral surgery include the No. 11 and No. 12 blades

T/f There is a slot in the blade that is used to attach the blade into the blade holder. It is held at the front of the blade on top of slot.

F (There is a slot in the blade that is used to attach the blade into the blade holder. It is held at the BACK of the blade on top of slot.)

T/f To remove or change the blade, use the needle holder at the bottom part of the slot  Hold securely the blade push it out

BLADE HOLDER Held in a ____ manner because this gives the holder control  Follow the normal flexion of the hands

pen grasp

Final smoothing of bone before completing surgery is usually performed with a small ____

Bone file

T/f The bone file is usually a double-ended instrument with a small and larger end. The bone file cannot be used efficiently for removal of large amounts of bone; therefore, it is used only for fnal smoothing

T/f The teeth of many bone 􏰀les are arranged in such a fashion that they remove bone only on a push stroke

F (The teeth of many bone 􏰀les are arranged in such a fashion that they remove bone only on a PULL stroke)

T/f These are the two different types of bone files  Flat-ended bone file  Bone grasp

BONE FILE Smoothen the bone A. Flat-ended bone file B. Bone grasp

BONE FILE Not pushing or pulling motion (can burnish and crush the bone) A. Flat-ended bone file B. Bone grasp

BONE FILE Criss cross A. Flat-ended bone file B. Bone grasp

BONE FILE  Sharp in any direction  Can be used in pushing and pulling motion A. Flat-ended bone file B. Bone grasp

The instrument most commonly used for removing bone in dentoalveolar surgery  An instrument that can be used to remove gross irregularities in bone

RONGEUR

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

RONGEUR

T/f Rongeur forceps have a rebound mechanism incorporated so that when hand pressure is released, the instrument reopens. This allows the surgeon to make repeated bone trimming actions without manually reopening the instrument

T/f Aside from the rongeur, a bur can be used in removing bone which is faster

T/f If alveoloplasty, smoothen the alveolar ridge after extraction of multiple teeth using the rongeur not the bur

T/f The rongeur is not a cutting instrument

F (The rongeur is a cutting instrument)

Known as blumenthal rongeurs 1) Side cutting 2) Side-and-end cutting

2) Side-and-end cutting

Theyarepreferredfororal surgery procedures 1) Side cutting 2) Side-and-end cutting

2) Side-and-end cutting

 Very easy to cut the interseptal bone  Bone between the two teeth  Clip it and it can remove the interseptal bone 1) Side cutting 2) Side-and-end cutting

2) Side-and-end cutting

T/f RONGEUR Since it is a cutting instrument, do not clip it on teeth to be used as a forcep to remove the tooth  It dulls easily when used on the tooth

T/f A needle holder has a locking handle and a short, stout beak.

T/f The needle holder is an instrument with a locking handle and a short, blunt beak.

T/f NEEDLE HOLDER  For intraoral placement of sutures, a 6-inch (15-cm) needle holder is usually recommended  Longer ones are recommended than short because it is harder to manipulate

T/f The beaks of a needle holder are shorter and weaker than the beaks of a hemostat

F (The beaks of a needle holder are shorter and STRONGER than the beaks of a hemostat)

T/f The face of a beak of the needle holder is cross-hatched to permit a negative grasp of the suture needle.  It looks like a bone file  To help with rotating the needle

F (The face of a beak of the needle holder is cross-hatched to permit a POSITIVE grasp of the suture needle.  It looks like a bone file  To help with rotating the needle)

Which is bigger and smaller? Mosquito Hemostat Kelly Hemostat

Mosquito Hemostat (smaller) Kelly Hemostat (bigger)

T/f When going into the socket and remove retained small fragment as well as calcular deposits, it is preferable to use the smaller hemostat or the mosquito hemostat.

T/f Curved hemostat is not easier to insert into the socket and anywhere in the oral cavity

F (Curved hemostat is EASIER to insert into the socket and anywhere in the oral cavity)

T/f Curved hemostat, used for clogging the blood vessels in cases there accidental cuts or cutting into tumor

F (Straight hemostat, used for clogging the blood vessels in cases there accidental cuts or cutting into tumor)

A ____ is used to control the bleeding

hemostat

T/f  When incisions are made through tissue, small arteries and veins are incised, causing bleeding.  For most dentoalveolar surgery, pressure on the wound is usually suf􏰀cient to control bleeding.  Occasionally, pressure does not stop the bleeding from a larger artery or vein.

It loos like a cotton plier but at the tip it is broad and rounded

RUSSIAN FORCEP

It is better in picking up root fragments and calcular deposits because it has a bigger surface and it can easily pick on small root fragments as compared to college pliers which are very good in holding gauze put in the mouth

RUSSIAN FORCEP

T/f The straight elevator is the most commonly used elevator to luxate teeth

STRAIGHT ELEVATOR Which is the smallest and largest? 301 34s

301 – smallest 34s – largest

STRAIGHT ELEVATOr The most commonly used large straight elevator 301 34s

34s

T/f Larger straight elevators are used to displace roots from their sockets and are also used to luxate teeth that are more widely spaced or once a smaller-sized straight elevator becomes less effective

T/f STRAIGHT ELEVATOR  When luxating the tooth, start with 301 (the smallest).  When the tooth becomes loose, increase in size with 304 until 34s

Parts of an elevator  Working area where inserting between the tooth and the bone  Convex and concave surfaces A. Blade B. Shank C. Handle

T/f Luxating elevators have thinner finner tips than regular straight elevators. Regular straight elevators is not as finner at the tip

An elevator Usually used for maxillary posterior teeth, Very easy to use for impacted maxillary third molars

E92 ELEVATOR

Type of elavator, Used to loosen the tooth from the periodontal ligament and ease extraction

E92 ELEVATOR

 Triangular elevator  It looks like a flag

CRYER

An elevator is most useful when a broken root remains in the tooth socket and the adjacent socket is empty. Used for mesial or distal roots

CRYER

T/f A typical example would be when a mandibular first molar is fractured, leaving the distal root in the socket but the mesial root removed with the crown.  The tip of the triangular elevator is placed into the socket, with the shank of the elevator resting on the buccal plate of bone.

T-bar handle

CROSS-BAR

T/f  Functions the same as the Cryer but Cryer is more preferred than the cross-bar  Cross-bar generates more force that it could cause fracture  A cross-bar handle is used on certain elevators.

T/f CROSS-BAR, Used with great caution

 This doesn’t have a pointed tip just like the Cryer that can really engage  Can be used in wheel and axle technique

MILLER ELEVATOR

ADSON’S TISSUE FORCEPS Upon clipping, it will engage to the gingiva and easily manipulate without applying too much force  Allow tissue to be held with a more delicate grip A. With tooth B. Non-tooth

ADSON’S TISSUE FORCEPS Does not clip properly and end up crushing more to manipulate the tissue A. With tooth B. Non-tooth

 These are delicate forceps, with or without small teeth at the tips, which can be used to hold tissue gently and thereby stabilize it.  When this instrument is used, care should be taken not to grasp the tissue too tightly, crushing the tissue.

ADSON’S TISSUE FORCEPS

Better known as Semkin Tissue Forceps

STILLIES FORCEPS

Longer version of Adson’s Tissue Forceps. Manage more posterior parts of the mouth. Looks like cotton pliers

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

STILLIES FORCEPS

Used as a lever to elevate a broken root from the tooth socket.  Usually, it is necessary to drill a hole with a bur (purchase point) approximately 3 mm deep into the root just at the bony crest  The tip of the pick is then inserted into the hole, and with the buccal plate of bone as a fulcrum, the root is elevated from the tooth socket.

CRANE PICK ELEVATOR

Very useful for removing root fragment and to create a hole in the apex  But not possible if attachment is not yet broken  Wedge technique

CRANE PICK ELEVATOR

T/f Every time in attempting to adapt the forceps to the neck of the tooth, the lingual ridge should be adapted first before the labial. The reason for this is the ease of placement as well as for visibility. In this way, it will not be able to impinge the gingiva because the goal is to place or adapt it as far as apically as possible.

T/f Maxillary Forceps is Convex, Has finer and longer tip

T/f The maxillary first premolar frequently has a bifurcated root, but because this occurs in the apical one third, it has no influence on the design of the forceps.

T/f Mandibular Forceps, Either flat or concave

T/f The forceps used for removal of mandibular teeth are held with the palm on top of the forceps so that the beak is pointed down toward teeth

The forceps most commonly used for the single-rooted teeth are the lower universal forceps, or the No. ___

151

The beaks are smooth and narrow and meet only at the tip. This allows the beaks to 􏰀t near the cervical line of the tooth to grasp the root. A. Mandibular Forceps B. Maxillary Forcep

These forceps have handles similar in shape to the No. 150, but the beaks are pointed inferiorly for lower teeth. A. Mandibular Forceps B. Maxillary Forcep

T/f #65, is Better in removing root fragments, Designed to be inserted into the socket to adapt and remove root fragments underneath the bone

Deals with molars  Fit into the furcation A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

 Universal mandibular forceps  Effective from incisors premolars A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

Universal forceps for maxillary teeth A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

Used for the root fragments  Other option #203 A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

 Cowhorn  Bulbous A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

Used only for mandibular molars A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

Can be used on all molars A. #18LR B. #151 C. #150 D. #44 E. #16 F. #17

T/f Suture scissors should be held in the same fashion as the needle holder.

T/f The suture scissors usually have long cutting edges because their sole purpose is to cut sutures

F (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 ____ scissors.

Dean

T/f  Suture scissors usually have long handles and thumb and finger rings.  Scissors are held in the same way as are needle holders.

The two major types of tissue scissors are iris scissors and Metzenbaum scissors  ____ scissors are small, sharp-pointed, delicate tools used for fine work.  _____are used for undermining soft tissue and for cutting.

Iris Metzenbaum scissors

T/f Tissue scissors such as iris or Metzenbaum scissors should not be used to cut sutures because the suture material will dull the edges of the blades and make them less effective and more traumatic when cutting tissue. The exception is when removing very fine sutures placed in skin incisions in the face. Scissors with thin, pointed tips, such as iris scissors, may be useful.