CHAPTER 6: Instrumentation for Basic Oral Surgeryi
The purpose of this chapter is to introduce the instrumentaton commonly required to perform routne
dental extractons and other basic oral surgiical operatonss These instruments are used for a wide
variety of purposes, includingi sof and hard tssue proceduress This chapter primarily provides a
descripton of instrumentss
INCISING TISSUE
Scalpel
- primary instrument for makingi incisions
- composed of a reusable handle and a disposable, sterile sharp blade
- available as a singile-use scalpel with a plastc handle and fxed blade
- the tp of a scalpel handle is prepared to receive a variety of differently shaped scalpel
blades to be inserted onto the sloted porton of the handle
- most commonly used scalpel
Nos 3 - oral surgiery
Nos 15 - intraoral surgiery (blade is small and is used to make incisions around teeth and
througih sof tssueu
- Other commonly used blades for intraoral surgiery
The Nos 11 blade is a sharp-pointed blade that is used primarily for makingi small stab
incisions such as for incisingi into an abscess
Nos 12 blade is useful for mucogiingiival procedures in which incisions are made on the
posterior aspects of teeth or in the maxillary tuberosity area
- Nos 10 blade used for largie skin incisions in other parts of the body
- scalpel blade is carefully loaded onto the handle holdingi the blade with a needle holder to
lessen the chance of injury on the fngiers
- The blade is held alongi the unsharpened edgie, where it is reinforced with a small rib and the
handle is held so that the male porton of the fingi is pointngi upward
- The scalpel blade is then slowly slid onto the handle alongi the girooves in the male porton
untl it clicks into positon
- The scalpel is unloaded similarly, the needle holder girasps the end away from the blade and
lifs it to disengiagie it from the male fingi
- The scalpel is then slid off the handle, always away from the body
- The used blade is immediately discarded into a specifcally desigined, rigiid-sided sharps
container
- When usingi the scalpel to make an incision, the surgieon typically holds it in the pen girasp to
allow maximal control of the blade as the incision is made
ELEVATING THE MUCOPERIOSTEUM
- When an incision is made througih the periosteum, ideally, the periosteum should be
reflected from the underlyingi cortcal bone in a singile layer with a periosteal elevators
- Most commonly used in oral surgiery
Nos 9 Molt periosteal elevator
as has sharp, pointed end and a broader, rounded end
bs pointed end is used to begiin the periosteal reflecton and to reflect dental papillae
from between teeth
, cs the broad, rounded end is used to contnue the elevaton of the periosteum from
bone
ds can also be used as a retractor, once the periosteum has been elevated, the broad
blade of the periosteal elevator is held frmly agiainst bone with the mucoperiosteal
flap elevated into a reflected positon
es can be used to reflect tssue by three methods:
1s the pointed end is used in a twistngi, pryingi moton to elevate sof tssue, most
commonly when elevatngi a dental papilla from between teeth or the atached
giingiiva around a tooth to be extracted
2s the push stroke, in which the pointed or the broad end of the instrument is slid
underneath the periosteum, separatngi it from the underlyingi bone, this beingi
the most efcient stroke that results in the cleanest reflecton of periosteum
3s a pull stroke, which is occasionally useful but tends to shred or tear the
periosteum unless done carefully
RETRACTING SOFT TISSUE
- Good access and vision are essental to performingi excellent surgiery
- A variety of retractors have been specifcally desigined to retract the cheek, tongiue, and
mucoperiosteal flap to provide access and visibility duringi surgiery
- Retractors can also help protect sof tssue from sharp cuingi instruments
- The two most popular cheek retractors are (can also be used to retract the cheek and a
mucoperiosteal flap simultaneouslyu:
rigiht-angile Austn retractor
broad offset Minnesota retractor
- Before the flap is created, the retractor is held loosely in the cheek, and once the flap is
reflected, the retractor edgie is placed on bone and is then used to retract the flap
- Seldin retractor
another type of instrument used to retract oral sof tssue
may look similar to a periosteal elevator, the leadingi edgie is not sharp but smooth
it should not be used to elevate the mucoperiosteum
- most commonly used to retract the tongiue duringi routne exodonta is the mouth mirror
- Weider tongue
retractor is a broad, heart-shaped retractor
serrated on one side so that it can more frmly engiagie the tongiue and retract it medially
and anteriorly
when this retractor is used, care must be taken not to positon it so far posteriorly that it
causes giagigiingi or pushes the tongiue into the oropharynx
- Towel Clip
can also be used to hold the tongiue in certain circumstances
when a biopsy procedure is to be performed on the posterior aspect of the tongiue, the
most positve way to control the tongiue is by holdingi the anterior tongiue with a towel
clip
Local anesthesia must be profound where the clip is placed and it is wise to menton to
the patent that this method of retracton may be used (if antcipatedu
GRASPING SOFT TISSUE
The purpose of this chapter is to introduce the instrumentaton commonly required to perform routne
dental extractons and other basic oral surgiical operatonss These instruments are used for a wide
variety of purposes, includingi sof and hard tssue proceduress This chapter primarily provides a
descripton of instrumentss
INCISING TISSUE
Scalpel
- primary instrument for makingi incisions
- composed of a reusable handle and a disposable, sterile sharp blade
- available as a singile-use scalpel with a plastc handle and fxed blade
- the tp of a scalpel handle is prepared to receive a variety of differently shaped scalpel
blades to be inserted onto the sloted porton of the handle
- most commonly used scalpel
Nos 3 - oral surgiery
Nos 15 - intraoral surgiery (blade is small and is used to make incisions around teeth and
througih sof tssueu
- Other commonly used blades for intraoral surgiery
The Nos 11 blade is a sharp-pointed blade that is used primarily for makingi small stab
incisions such as for incisingi into an abscess
Nos 12 blade is useful for mucogiingiival procedures in which incisions are made on the
posterior aspects of teeth or in the maxillary tuberosity area
- Nos 10 blade used for largie skin incisions in other parts of the body
- scalpel blade is carefully loaded onto the handle holdingi the blade with a needle holder to
lessen the chance of injury on the fngiers
- The blade is held alongi the unsharpened edgie, where it is reinforced with a small rib and the
handle is held so that the male porton of the fingi is pointngi upward
- The scalpel blade is then slowly slid onto the handle alongi the girooves in the male porton
untl it clicks into positon
- The scalpel is unloaded similarly, the needle holder girasps the end away from the blade and
lifs it to disengiagie it from the male fingi
- The scalpel is then slid off the handle, always away from the body
- The used blade is immediately discarded into a specifcally desigined, rigiid-sided sharps
container
- When usingi the scalpel to make an incision, the surgieon typically holds it in the pen girasp to
allow maximal control of the blade as the incision is made
ELEVATING THE MUCOPERIOSTEUM
- When an incision is made througih the periosteum, ideally, the periosteum should be
reflected from the underlyingi cortcal bone in a singile layer with a periosteal elevators
- Most commonly used in oral surgiery
Nos 9 Molt periosteal elevator
as has sharp, pointed end and a broader, rounded end
bs pointed end is used to begiin the periosteal reflecton and to reflect dental papillae
from between teeth
, cs the broad, rounded end is used to contnue the elevaton of the periosteum from
bone
ds can also be used as a retractor, once the periosteum has been elevated, the broad
blade of the periosteal elevator is held frmly agiainst bone with the mucoperiosteal
flap elevated into a reflected positon
es can be used to reflect tssue by three methods:
1s the pointed end is used in a twistngi, pryingi moton to elevate sof tssue, most
commonly when elevatngi a dental papilla from between teeth or the atached
giingiiva around a tooth to be extracted
2s the push stroke, in which the pointed or the broad end of the instrument is slid
underneath the periosteum, separatngi it from the underlyingi bone, this beingi
the most efcient stroke that results in the cleanest reflecton of periosteum
3s a pull stroke, which is occasionally useful but tends to shred or tear the
periosteum unless done carefully
RETRACTING SOFT TISSUE
- Good access and vision are essental to performingi excellent surgiery
- A variety of retractors have been specifcally desigined to retract the cheek, tongiue, and
mucoperiosteal flap to provide access and visibility duringi surgiery
- Retractors can also help protect sof tssue from sharp cuingi instruments
- The two most popular cheek retractors are (can also be used to retract the cheek and a
mucoperiosteal flap simultaneouslyu:
rigiht-angile Austn retractor
broad offset Minnesota retractor
- Before the flap is created, the retractor is held loosely in the cheek, and once the flap is
reflected, the retractor edgie is placed on bone and is then used to retract the flap
- Seldin retractor
another type of instrument used to retract oral sof tssue
may look similar to a periosteal elevator, the leadingi edgie is not sharp but smooth
it should not be used to elevate the mucoperiosteum
- most commonly used to retract the tongiue duringi routne exodonta is the mouth mirror
- Weider tongue
retractor is a broad, heart-shaped retractor
serrated on one side so that it can more frmly engiagie the tongiue and retract it medially
and anteriorly
when this retractor is used, care must be taken not to positon it so far posteriorly that it
causes giagigiingi or pushes the tongiue into the oropharynx
- Towel Clip
can also be used to hold the tongiue in certain circumstances
when a biopsy procedure is to be performed on the posterior aspect of the tongiue, the
most positve way to control the tongiue is by holdingi the anterior tongiue with a towel
clip
Local anesthesia must be profound where the clip is placed and it is wise to menton to
the patent that this method of retracton may be used (if antcipatedu
GRASPING SOFT TISSUE
