Surgical Instruments Flashcards
Scalpel:
- Blade #'s: - Handle Number: - Proper Grip:
- 10, 11, 12, 15
- 3
- Pen Grasp
Scalpel Technique
- Cut with “belly” of blade
- Firm uniform cut
- Single Patient use
Periosteal Elevator:
- Use - Name - Technique
- Elevation of Mucoperiosteum (Elevate Flap)
- # 9 Molt
- Use with concave side toward bone (pry/push & roll/scrape)
Name the different types of Retractors
- Minnesota
- Austin
- Mmirror
- Weider (“Sweetheart”)
- NO finger retractors
What is the Minnesota Retractor used for
Retract the Cheeks
What is the Austin Retractor used for
Alveolar Surgery
What is the Weider (“Sweetheart”) Retractor used for
Move Tongue
What are the two different types of hemostats
Straight or Curved
What are hemostats NOT to be used for
- Handling delicate tissue/biopsy
- Holding needles
- Picking up whole teeth
What are Tissue Forceps used for
Grasping Tissue (Grabs tissue with teeth)
What are the different types of Tissue Forceps
- Adson (with and without teeth)
- Stillies
- Allis
- Russian
- Cotton plier
Characteristic of Stillies Tissue Forceps
Longer handle for Back of Mouth
Characteristic of Allis Tissue Forceps
Biopsies–to grab tissue
What type of instruments are used to remove bone
- Bur & Handpiece (High Torque)
- Rongeur
- Bone File
What types of bur & hand pieces are used to remove bone
- # 8 round
- 703 Fissure (Smooth Bone)
What is a type of Rongeur used to remove bone and how does it cut bone
- Blumenthal-Bone Cutter
- Combination of side or end cutting
What are the two types of Dental Currettes used
- Periapical
- Double ended
What are periodical curettes used for
Extracting teeth with periodical lesions
What are the types of suturing instruments used
- Needle holder
- Needle
- Suture material
- Scissors
What is the proper grip for a Needle Holder
Thumb & Ring Finger with Palm Down
Suture Material:
- Size Range: - 2 types - Other important factor
- 0 to 6
- Monofilament vs Braided
- Resorbability
Name 3 “other” instruments used in oral surgery
- Bite block
- Suction
- Irrigation
Irrigation of soft tissue is most commonly performed with what type of irrigation tip
Frasier Tip
What are Elevators used for
Extracting Teeth
What are the components of an Elevator
-Handle, shank, blade (most use same handle and shank with a variation of the blade)
What are the different types of dental elevators
- Straight
- Triangle or Pennant
- Pick
What are Straight Elevators used for and what are the two types used
- Luxate Teeth
- Small (301) & Large (34S)
What are the different types of Triangular Elevators and what are they used for
- Pennant shaped
- Usually paired
- Use: To remove broken root remnants (remove root tips & root canals)
What is the most common type of triangular elevator
Cryer
What are the different types of Pick-type elevators and what are they used for
- Types: Crane, Cogswell-heavy, Root tip pick thin & delicate
- Use: Remove Roots
What are the components of Extraction Forceps
- Handle
- Hinge: English vs. American
- Beak (greatest variation, adapt to root of tooth; not crown)
Which type of extraction forceps hinge are horizontal
American
Which type of extraction forceps are vertical
English
What are the two broad categories of maxillary forceps
- Universal
- Site Specific
What are the two types of maxillary universal forceps and what teeth are they used on
- 150 (Used for any Maxillary Tooth)
- 159 (“A” style beak 150 forceps)
What are the two types of maxillary Site Specific Forceps and what teeth are they used on
- # 53 Right and Left (Maxillary Molar)
- # 88 Right and Left (Maxillary Molar)
- Anterior #1A (Maxillary Anterior)
What are the two broad categories of mandibular forceps
- Universal
- Site Specific
What are the 5 types of mandibular universal forceps and what teeth are they used on
- 151 (Any mandibular tooth)
- 151 “A” style beak (Any mandibular tooth)
- # 17 (Mandibular Molars)
- **#23 “Cowhorn” (Very common for Mandibular Molars–Insert into furcations)
- Ash (Mandibular Anteriors and Premolars)
Which instrument has the following characteristics:
- Initial instrument used
- Primary use for expansion of alveolus and loosening of tooth/PDL
- Often used incorrectly–do not fulcrum off adjacent tooth
- Working end pointed from facial toward the lingual or apex
Straight Elevator
Which instrument has the following characteristics:
- Lever and/or wheel & axle forces
- Can fracture tooth & bone
- Primary use: removing residual roots of multi-rooted teeth
- Sharp tip removes interseptal bone providing access to the retained root
Cryer Elevator
Which instrument has the following characteristics:
- Fragile elevators
- Appearance seems to indicate they would be for “prying” out root tips
- Prying forces will break these
- Sole use: a Wedge
- Fine tip is “wiggled” apically to wedge root tip from socket
- Sharply pull in vertical vector to displace root tip
Root tip Elevators
Which instrument has the following characteristics:
- Not for “pulling teeth”
- Use: Handle & lever
- Primary force is initially in apical direction to seat the forceps
- Secondary force is buccal, lingual, or rotational to expand alveolus to release the tooth
- Last force is minimal traction force
- Movement produces significant wedging
Forceps
Steps/Approach to Simple Extraction
- Confirm profound anesthesia of pulp, soft & hard tissues
- Release soft tissue around tooth
- Elevate tooth with the elevator
- Adapt forceps to the tooth
- Luxate with forceps
- Remove the tooth from the socket
- Examine socket for soft tissue/granulation tissue: curette
- Place 2x2 gauze directly over socket and compress with occlusal forces
Loosening of Soft Tissue Attachment process involves
- Sharp end of periosteal elevator
- Dental currette
- Confirms anesthesia
- Allows forceps to be seated apically or elevator to be place d inter-proximally
- Be kind to soft tissues
Luxation with Elevator process involves
- Usually a straight elevator
- Perpendicular to the interproximal space or parallel to the long axis of the tooth
- Luxate tooth
- Tear PDL
- Expand bone
- Avoid injury to adjacent teeth, crowns
- Confirms degree of mobility/establishes need for surgical extraction
Adaptation of Forceps involves
- Choosing forceps that will adapt well to the sub-gingival morphology of the tooth
- Confirm long axis of beaks “clears” adjacent teeth to avoid trauma
- Seat with apical force
- Avoid pinching any soft tissue
- Firm apical force (moves center of rotation apically to prevent root fracture & expands alveolus and widens PDL space)
Luxation with Forceps involves
- Firm grip to hold forcep handles together
- Straight wrist with force generating from shoulder and upper arm (not wrist)
- Firm, stead, sustained force (hold & flex bone to allow expansion of the alveolus)
- Primarily buccal at first with less lingual force, rotate the tooth gently after mobilization
- Continue to re-seat the forceps apically
- Do not fracture the grown
Removal of Tooth from socket process
- Slight traction, usually buccal is final step of removal of a tooth
- Not a “pulling” motion
Post-Extraction Care of the Socket Process
- Remove debris if present (PA lesion, calculus, amalgam, tooth fragments)
- Realign buccal plate–“compress socket”
- Debride granulation tissue from gingival sulcus
- Smooth any sharp bone
- Pressure from 2x2 gauze placed over the extraction site to promote hemostasis
- Seat beaks with firm & deliberate apical pressure (lowers center or rotation to decrease root fracture, secures purchase on non-carious/sound tooth, further wedging force augments that already was accomplished by elevator).
- Buccal-lingal force (primarily buccal) & rotation (single rooted)
- Figure-8 or “ratchet” motion works well, especially for multi-rooted teeth
Universal Maxillary and Mandibular Forceps: 150 & 151
- Designed to engage the furcation of lower molar
- No crown required to engage the tooth
- Must seat into furcation with “pumping up” and down action before any buccal/lingual rotation
- Seat on lingual first
- Up and down motion with gentle pressure closing beaks together
- Once seated, use buccal-lingal action or figure-8 motion to remove tooth
Mandibular Molar Forcep: Cowhorn #23
- Apical, buccal, lingal, rotation, traction
- Less rotational forces during removal of laterals
Maxillary Incisors: #1 & #150
- Apical, buccal, lingual, rotation, traction
- Canines have long roots and are difficult to extract
- Often require mucoperiosteal flap
- Palatal bone is heavier than buccal bone
Maxillary Canines: #1, #150
- Apical, buccal, lingual, traction
- Often have two roots which do not separate until apical 1/3 of root
- Do not lend themselves to rotation
- Often fracture
Maxillary 1st Premolar: #1, #150
- Apical, buccal, lingal, SOME rotation, traction
- Usually just have one root so that rotational movement is more useful
Maxillary 2nd premolar: #1, #150
- Apical, buccal, lingual, traction
- Moderate lingual pressure
- If root is going to fracture, then more favorable to fracture a buccal root
- Second molars typically have some fusion of roots, which makes extraction simpler (less tripodded)
Maxillary 1st & 2nd molars (forceps: 150, 53R&L, 88R&L)
- Apical, buccal, lingal, SOME rotation, traction
- Roots are somewhat conical and flattened
- Buccal/labial bone is thinnest
Mandibular incisors: 151, Ash
- Apical, buccal, lingal, rotation, traction
- Rotational forces are MOST important
- Easiest teeth to extract
- Very conical, straight roots
Mandibular premolars: 151, Ash
