basic armamentarium for minor oral surgery

BASIC ARMAMENTARIUM FOR MINOR ORAL SURGERY

TYPES OF JOINTS

Lap Joint Box Joint

Double Action Joint

TYPES OF HANDLES

Ring Handle Ring handle with one extra large Handle

Grooved Handle

Grooved Handle with Horn

Hollow Handle

RETAINING SYSTEMS

Ratchet Lock Single Spring

Double Spring

Single Spring with Roller

Double Spring with Ball & Socket

Double Leaf Spring Sliding Ring

Cam Ratchet

Bar Ratchet

Bar & Wingnut

TYPES OF BLADE TIPS

Blunt, Blunt Blunt, Blunt with Bevel

Sharp, Blunt Sharp, Sharp

Fine Tip Blunt Fine Tip Sharp

Blunt with Retaining HookBlunt with Rounded Probe End

Serrated Dissector EndBlunt, One hook

End

Fine Straight Jaw Round Jaw

Square JawStraight on Flat

Punch Upward through Cutting

Punch Upward Oblique

INSTRUMENTS CLASSIFICATION BY USAGE

Surgical instruments are designed to perform either diagnostic or therapeutic operations; to locate the cause of a problem, or to treat a problem once it has been found. Each instrument is designed to perform a specific function. Those functions may be generally categorized under one of the following uses:

1. To cut or incise:Instruments used for this purpose are frequently referred to as “sharps”. They include scissors, knives, scalpels, chisels and osteotomes, among others.

2. To retract tissue:Hand-held and self-retaining retractors serve this purpose, as well as instruments such as skin and bone hooks

3. To grasp, hold or occlude:These include the many types of forceps, including hemostats, dressing and tissue forceps, as well as bone holding forceps. Also included in this group are needle holders.

4. To dilate or probe:These instruments are used to dilate or enlarge openings or to find an area or foreign object.

5. To cannulate or drain:These instruments including catheters, drains and cannulas, are generally used to drain a wound.

6. To aspirate, inject or infuse:These instruments serve to remove unwanted fluids as well as to inject needed fluids into a patient. Among these instruments are syringes, some needles, trocars and cannulas.

7. To suture or ligate:Suture or ligation is used to close or rejoin a wound or an area of operation, e.g., a vessel, a nerve or tissue. There are a variety of sutures and clips, as well as suture needles and ligating instruments.

SOFT TISSUE INSTRUMENTS

Scalpel Handle #4: To hold scalpel blade

Scalpel Blade Seating Area

Grooved Grip Area

Shank

Pattern Number

Scalpel Blades: from right to left; # 15, #12, #11, and #

10

Mounted Scalpel Blades on Scalpel Handles

Disposable Scalpel

Clinical Tip: Because scalpel blades dull rapidly after being pressed against bone they should be changed between incisions if more than one flap is to be reflected.

Periosteal Elevators

Molt # 9 & Woodson # 1

Seldin

Clinical Tips for periosteal Elevators

Pry Stroke: Using the tooth as a fulcrum, the sharp pointed end of the elevator is used to reflect the MPF by first prying the IDP free from the underlying bone.

Push Stroke: Using the broad end of the elevator in a push stroke, the attached gingiva and alveolar mucosa are reflected to the desired extent.

Pull Stroke: Using the periosteal elevator in a pull stroke can sometimes shred the periosteum.

Periosteal elevators are used to reflect mucoperiosteum, to loosen soft tissue from teeth before extraction, and to retract small flaps

Tissue Retractors

Seldin

Austin

Minnesota

Tissue Retractors: Clinical Tips

1. For small flaps, use the periosteal elevator for retraction

2. For large flaps use Minnesota or Austin retractor

3. Place retractor beneath the flap resting on sound bone

4. Avoid trapping of flap between retractor and bone

5. RETRACT PASSIVELY: no attempt is made to pull the flap out of the field

Dissection Scissors: To cut and dissect tissue

Blunt, Blunt Tip

Beveled Cutting Blade with Regular Cutting Edge

Screw Lock (Lap Joint)

Shank

Finger Rings

Dissection Scissors

Iris: small sharp-pointed scissors

Metzenbaum: longer, delicate, blunt-nosed scissors

Operating Scissors: To cut sutures, gauze and other materials

Stitch Scissor

Operating Scissor

SCISSORS come in a tremendous variety of styles and sizes. They come in straight, curved and angular versions.

Useful Tips in Usage: 1. The curved patterns are preferred by most surgeons for dissecting, since they provide a better field of vision for the areas to be cut.

2. Straight scissors are used when a straight cut is desired, such as in sutures, nerves, vessels.

3. Scissors are also used to spread and probe the area of incision (dissection & undermining tissues). The smaller sizes are used at the surface, the larger sizes deeper in the cavities.

4. Dedicate the different types for their specific purpose for example, using fine dissecting scissors to cut suture can ruin the cutting edge.

5. Special care instructions: To maintain scissors in peak operating condition, they must be sharpened regularly.

Tissue Forceps: To grasp and handle soft tissue

Grooved grip area

Spring

Serrated tips Jaws

AdsonAllis: to grasp and hold

tissue that will be excised

Tissue Forceps: To grasp and handle soft tissue

Russian: is specially useful

for grasping teeth that are loose in the

mouth

Pickup: is useful to handle

tissue in the posterior aspect

of the mouth

WEIDER Tongue Retractor: very useful instrument during

surgery for impacted lower third molars

Jones Towel Clamp

Foerster Dressing Forceps Backhaus Towel Clamp

Hemostat: To clamp and restrict bleeders or tissue, to control the flow of blood

Fully Serrated Jaws

Box Lock

Shank

Ratchet

Finger Rings

The hemostat most commonly used in OS is curved hemostat

Straight & Curved Hemostats

The Hemostat has a relatively

long delicate peak

Hartmann-Mosquito Forceps

Halsted-Mosquito Forceps

Needle Holder: To hold and guide suture needles securely for suturing

Groove & Crosshatching

Jaws

Box Lock

Shank

Ratchet

Finger Rings

Scissor cutting blades

Needle Holders Vs Hemostats1. Needle holders look similar to hemostats, but jaws are thicker and shorter.

2. Face of shorter beak of needle holder is crosshatched to ensure positive grip on needle but hemostat has parallel grooves that do not allow a firm grip on needle.

Needle Holder: Clinical TipsNeedle holders are available in many styles and sizes. Shorter ones are used for working close to the surface.Longer ones are for deeper cavities. The smaller the needle, the smaller the jaws of the needle holder. If the needle is too large to be held securely, select a larger size needle holder. Otherwise, the needle may slip, or the needle holder may be overstressed, causing fatigue or breakage

INSTRUMENTS FOR BONE SURGERY

Bone Curette: To curette or remove soft tissue from bony cavities

Volkmann

Brun

Halle

Bone Curette

Bone File: for final smoothing of bone before suturing the MPF back into position

Bone File: Clinical Tips

1. Use the bone file in a pull stroke, because the teeth of the file are arranged in such a fashion to remove bone only in this direction.

2. Avoid cross filing or pushing the bone file, because this results in burnishing and crushing of bone.

3. Carefully Cleanse the instrument by wiping the grooved ends with a sponge. By failure to do this, dust or chips may easily remain in the wound.

Bone Rongeur: to remove bone by shearing on a planned action

Bone Rongeur: Clinical Tips

1. Smaller amount of bone should be removed in each of multiple bites but never large amount of bone in a single bite.

2. A constant cleansing of the blades is necessary.

3. Rongeurs are delicate and relatively expensive therefore, NEVER remove teeth with rongeurs.

Chisels and Gouges: To score, cut, scrape, and sculpt bone

Osteotomes: To shape and sculpt bone, or section a toothChisels: To cut a window in the bone cortex for access or to allow harvesting of pure soft boneGouges: To scoop away strips of soft bone, especially in bone grafting

Chisels and Gouges

Mallet

Plastic working end

Stainless steel working end

Shank

Phenolic handle

Cheek Retractors

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