1. Instrumentation for Basic Oral Surgery
Part II
Dr. Rahaf Al-Habbab BDS. MsD. DABOMS
Diplomat of the American Boards of OMFS
Consultant of Oral and Maxillofacial Surgery
Head of Orthognathic Unit
Saudi Boards Residents Director
Hospital Education and Residency Director

2. Extracting Teeth Dental Elevators:
Used to luxate teeth from bone before applying the dental
Forceps
Can minimize the incidence of broken roots
Facilitate the removal of broken root should it occur
Expand alveolar bone, overcoming the obstructed path
Used to remove broken or surgically sectioned roots from their sockets.

3. Dental Elevators The three major component of the elevator are: Handle
Shank, and
Blade
Large size to allow comfortable grip
T-bar or cross bar handle can also be used but with great caution.
|Blade |---shank-----| handle |

4. Types of Elevators The three basic types of elevators: Straight type
Triangle or pennant-shape type
Pick type
Straight Elevators:
Most common
The blade has a concave surface on one side placed toward the tooth
Small elevators are used to start the luxation
Large size used to displace roots from sockets, and luxate widely
spaced teeth
The blades can be angled to allow access to postrior aspect of the mouth

5. Triangular Elevators:
Provided in pairs (right and left)
Most useful with broken root and empty adjacent socket
Used in a wheel- and- axle rotation
The sharp tip engage the cementum of the root, and shank resting on buccal plate
The cryer is the most common one

6. Used as a lever to remove roots. Crane pick is the heavy version.
Pick-type Elevators:
Used as a lever to remove roots.
Crane pick is the heavy version.
Might Require drilling a hole with a bur 3mm deep at the bony crest (purchase point)
Root tip pick, delicate instrument, used to tease very small root tips
Should not be used as wheel-and-axle, or lever

7. Each forceps is composed of a handle, hinge, and beaks
Extraction Forceps
Each forceps is composed of a handle, hinge, and beaks
Handle:
Adequate size to handle comfortably and deliver sufficient pressure and leverage
Have a serrated surface to allow positive grip and prevent slippage
|---B---|-H-| handle |
Straight handles are usually preferred but curved handles are preferred by some surgeons

8. Held differently according to the extracted tooth:
Maxillary teeth:
Palm underneath the
forceps, with the beaks
directed in a superior
direction
Mandibular teeth:
Palm on top of the
Directed downward towards
the teeth.

9. Extraction Forceps Hinge: Connect the beaks to the handle
Transfers and concentrate the force applied on the handle to the beak
Beaks:
Source of the greatest variation
Designed to adapt to the tooth root near the junction between the crown and root
Design and width varies with different teeth
Beaks are angled to be parallel to the long axis of the tooth

10. Maxillary Forceps
Requires single rooted, and three rooted instruments.
The first premolar has a bifurcated root, but only occurring at the apical third.
The single-rooted maxillary teeth are usually extracted using Maxillary Universal Forceps (No.150)

11. Maxillary Forceps Anterior Teeth Premolars
No. 150 forceps are slightly S-shaped when viewed from the side, and straight from above
The beaks curve to meet only at the tip
No.150S, for primary teeth

12. Maxillary Forceps
The modified No.150, is called No.150A, useful for premolars
Should NOT be used for incisors, because of poor root adaptation.
The No.1 forceps, straight forceps, easier to use with maxillary incisors, and canines.
No. 150A
No. 1 Forceps

13. Maxillary Forceps Posterior Teeth
Three rooted, with a single palatal root and buccal bifurcation
Have a smooth, concave surface for the palatal root
Have a pointed beak to fit the buccal bifurcation
No. 53
Offset to reach posterior teeth
Comes in pairs: Right and Left

14. Maxillary Forceps
A design variation is No. 88 Right and Left forceps (upper cowhorn)
Longer more accenuated, pointed beak formation

15. Maxillary Forceps Advantages Useful with severely carious teeth.
Sharply pointed beaks may reach deeper into the trifurcation dentin.
Disadvantages
Crush crestal alveolar bone.
Can fracture of large amount of buccal bone if not used cautiously.

16. Maxillary Forceps
Occasionally, second molars, and erupted third molars have a single conical root
Broad, smooth beaks, offset from the handle can be useful (No. 210S)
No. 210S

17. Maxillary Forceps Root tip forceps (No. 65) Very narrow beaks.
Used primarily for broken maxillary molar roots
Can also be used to remove, narrow premolars, and lower incisors
No. 65

18. Mandibular Forceps
Requires single rooted, and two-rooted teeth forceps
Lower universal forceps, are most commonly used (No. 151)
Beaks are pointed inferiorly, smooth and narrow, and meet only at the tip, to meet at the cervical line.
No. 151

19. Mandibular Forceps
The modified No. 151A, were made for mandibular premolars.
Should NOT be used for any other teeth, because its form prevents root adaptation
No. 151A

20. Mandibular Forceps English Style Forceps
Used for single rooted teeth in the mandible
Can generate great force
High incident of root fracture
No. 74

21. Mandibular Forceps
Buccal and lingual bifurcation, allows the use of only a single molar forceps.
No. 17 forceps are straight-handled, and beaks are set obliquely downward
The beaks have pointed tip
Can’t be used for fused, conical rooted molars

22. Mandibular Forceps Cowhorn Forceps
No. 87, Is a major lower molar forceps variation.
Designed with Two pointed, heavy beak, entering the bifurcation of lower molar
The beaks uses the buccal and lingual cortical plate as fulcrum
Improper use can result in fracture of alveolar bone or damage to maxillary teeth of force is uncontrolled by the surgeon.

23. Mandibular Forceps The No. 151, is also adapted for primary teeth
No. 151 S is the same general design, but scaled down to adapt to primary teeth

24. Instrument Tray System
Standard sets of instrument are packaged together, sterilized, and used at surgery
Basic Extraction Pack:
Local anesthesia syringe, needle, cartridge.
No.9 periosteal elevator.
periapical curette
Small and large straight elevator
Pair of college pliers
Curved hemostat
Towel clip
Austin or Minnesota retractor
Suction tip
2X2-inch or 4X4-inch gauze
The required forceps will be added to the tray

25. Surgical Extraction Tray
Basic extraction tray, plus
Needle holder
Suture
Pair of scissors
Blade and scalpel
Adson forceps
Bone file
Tongue retractor
Pair of cryer elevators
Rongeur
Handpiece and bur

26. Biopsy Tray Basic extraction tray Minus The Elevators Plus,
Needle holder, and suture
Suture scissors
Metzenbaum scissors
Allis tissue forceps
Adson tissue forceps
Curved hemostat

27. Post-operative Tray Irrigation instruments
(Suture removal instruments)
Scissors
College pliers
Irrigation syringe
Cotton applicator sticks
Gauze
Suction tip

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