Armamentarium commonly used in oral surgery

1. PRESENTED BY:-MONIKA IRMALWAR
(intern ‘09 dental college Amravati)

2. ARMAMENTERIUM FOR EXODONTIA
INTRODUCTION
DIAGNOSTIC INSTRUMENTS
LOCAL ANAESTHESIA:- SYRINGE
NEEDLE
CARTRIDGE
EXTRACTION:- FORCEPS:- MAXILLARY
MANDIBULAR
ELEVATORS :- TYPES
PRINCIPLES
USES

3. DENTAL INSTRUMENT:-They are the tools that dental
professionals use to provide dental treatment. They include
tools to examine,manipulate,restore and remove teeth and
surronding oral structures.

4. 1.MOUTH MIRROR/
ODONTOSCOPE:-
Parts :- mirror,shank,handle.
Types :-flat,concave,front
surface, double sided
MIRROR
SHANK
HANDLE

5. USES:-
Indirect vision
Retract cheek,lips and tongue.
Helps to reflect light in specific area in oral cavity.

6. 2.TWEEZER:-
Parts :- beak,body,handle.
Types:- serrated,non serrated,locking
type.
USES:-
Hold and carry cotton or gauze to the
oral cavity from the instrument tray.
BEAK
BODY
HANDLE

7. Locking type tweezer is used to
firmly hold any object and hold it in
position so that operator can do other
procedure.

8. 3.STRAIGHT PROBE
Presence of caries
Presence of furcation involvement
or dental caries.

9. Description:-It is a thin,flat instrument that has
a small working tip at right angle to the handle.
Tip is narrow and sharp.
Uses:-
•Mucoperiosteal elevation around tooth prior to
extraction.
•To probe the gingiva to check for the
effectiveness of local anaesthetic prior to any
procedure.

10. METHOD TO USE:-
•Insert the moon’s probe along the long axis of the tooth and
move it from mesial to distal in walking motion and break the
interdental papilla.
•Now retract the mucosa without lacerating it.

11. 1.Needle
Parts:-bevel,shaft,hub,syringe adapter,cartridge
penetration end.
Guage:-25,27 and 30 are used in dentistry.

12. 2.Syringe
Parts :-needle adapter,
piston,finger grip, syringe
barrel,thumb grip
Types :-
•Nondisosable syringes

13. •Disposable syringe
•Safety syringe

14. •Computer controlled local
anaesthetic delivery system.
RATE
VOLUME
TIME

15. 3.Cartridge:- prefilled 1.8ml dental cartridge Consist of
4 parts.
a)Cylinderical glass tube
b)Stopper(plunger,bung)
c)Aluminium cap
d)Diaphragm

16. PARTS:-
A)HANDLE
B)HINGE
C)BEAKS

17. DESCRIPTION:-
•The handle,hinge and beaks are
in the same plane.
•Both the beaks are symmetrical.
They are broad with sharp
rounded edge.

18. •The beaks come together at the edges
when the handles are closed completely.
•The handles are straight with serration on
the outer surface.
METHOD TO USE:-
•To extract maxillary central incisor,lateral
incisor and canines.

19. •The tooth is held firmly at CEJ and an initial apical force is
applied to ensure a firm grip.
•Since these teeth have a conical root,the tooth is extracted
with a rotatory movement.
•For the movement of canines,a slight buccal force may also
be applied before rotating the tooth to initially expand the
thin buccal cortical plate.

20. DESCRIPTION:-
•The beaks are at a slight angulation to
the hinge and handles. This is for
better access in the premolar region of
the oral cavity.

21. •The handles are straight or may droop
slightly.
•The beaks are symmetrical with the edges
sharp and rounded.
•When the handles are closed
completely,there is a small gap between the
edges of the beaks.

22. METHOD TO USE:-
•To extract maxillary first and second premolars.
•The first premolar usually has 2roots,so buccal and palatal
traction is given for extraction.
•The second premolar has conical root. Rotational forces are
given for extraction.

23. DESCRIPTION:-
•The beaks are symmetrical. One beak
is fitted with a pointed projection
which is meant to engage the buccal
trifurcation. The other beak has a
rounded edge to engage on the CEJ of
the lingual root.
MAXILLARY MOLAR FORCEP

24. •Gap between the beaks is
more than that of premolar
forceps. This is to
accommodate maxillary molar.
•Forceps are available in pair.
LEFT RIGHT

25. METHOD TO USE:-
•Extraction of 3 rooted maxillary first and second molars.
•The pointed beak is engaged on the buccal trifurcation
and the rounded beak on the palatal CEJ.
•Once apical force is applied to ensure a good grip on the
tooth,buccal and palatal traction is given for extraction.

26. DESCRIPTION:-
•The beaks are at an angle to the
hinge and handles.
•It has asymmetrical beaks with
one beak which is cylindrical and
tapering to end in a pointed tip.
This engages in the buccal
trifurcation.
MAXILLARY RIGHT
COWHORN FORCEP

27. •The other beak has a forked end to
engage the palatal root.
•It is also available in pairs.
USES:-
•Extraction of grossly carious first and
second maxillary molar.

28. •It gives a firm grip on the tooth where a normal maxillary
molar forceps is likely to crush the grossly carious crown.
•In some teeth it may even fracture the furcation to
separation the roots so that individual roots may be
removed separately.
•Once a good grip of the tooth is obtained,buccal and
palatal traction is given to extract the tooth.

29. •Contra angled design of the
handles and beaks.
•Specially made to obtain good
access in the posterior region and
also to avoid injury to the lower
lip.

30. •The beaks of the root forceps are narrow.
•Used for extraction of maxillary roots.

31. •There is a slight curvature of the beaks
to the hinge and handles.
•The beaks are long, narrow and
serrated near the tip of the inner aspect
of the beaks.
•Used for extraction of maxillary root
fragments.

32. •Beaks design is similar to bayonet
root forcep.
•Beaks are broad and symmetrical
with rounded edge.
•Its design provides good access to the
maxillary third molar region.

33. •Since the maxillary 3rd molar has 3 roots which are fused
with no clear demarcated trifurcation,the beaks used are
symmetrical to engage the CEJ bucally and palatally.

34. DESCRIPTION:-
•Beaks are perpendicular to the
handles.
•Beaks are narrow, symmetrical and
have a concave sharp edge.
•The beaks converge at the edge when
the handles are closed completely.

35. METHOD OF USE:-
•To extract all mandibular anterior teeth .
•Tooth is held firmly at CEJ and firm rotation movement
with the forcep is required for extraction since all these
teeth have a single conical root.

36. DESCRIPTION:-
•Beaks are slightly broader than the
mandibular anterior forceps.
•Beaks do not converge completely when the
handles are closed.
•Symmetrical beaks with concave sharp edges.

37. METHOD OF USE:-
•To extract mandibular premolars.
•Mandibular premolars have a single conical root, so after
holding the tooth firmly at the CEJ with a good apical
force,rotational forces are given extraction.

38. DESCRIPTION:-
•Beaks are perpendicular to the
handles.
•Beaks are symmetrical with a pointed
projection on both the beaks.
•This projection engages in the
bifurcation between the mesial and
distal roots of the mandibular molar.

39. •Beaks are broad and do not
converge completely when the
handles are closed.
METHOD OF USE:-
•The beaks are engaged with
pointed projections engaged
in the furcation.
•Lingual and buccal traction
is given to luxate the tooth.

40. DESCRIPTION:-
•Beaks are perpendicular to the handles.
•Both the beaks have a symmetrical design.
The beaks are cylindrical with a gradual taper
to end in a pointed tip.
•The beaks do not converge completely when
the handles are closed to accommodate the
tooth.

41. METHOD OF USES:-
•Used for the extraction of grossly carious
mandibular molars where an ordinary
molar forceps may crush the remaining
weakened crown structure.

42. •Pointed tip is placed in the bifurcation between the mesial
and distal roots of the molar tooth.
•Lingual and buccal traction is required to extract the tooth.
•When the crown is completely destroyed,traction with a
cowhorn forceps may split the roots at the furcation and then
individual roots may be removed separately.

43. DESCRIPTION:-
•Beaks are perpendicular to the handles.
•The beaks are narrower and longer
than all other mandibular forceps.
•The tip of the beak is very
narrow,almost pointed.
•The beaks converge at the edges when
the handles are closed completely.

44. INDICATIONS FOR USE:-
1.To remove fractured root fragments(fractured at
apical,middle or gingival 1/3rd).
2.To luxate grossly carious teeth before engaging a forcep.
3. To remove intraradicular bone.
4.To split teeth once a bur groove has been placed.

45. •HANDLE
•SHANK
•BLADE

46. 1.LEVER PRINCIPLE:-
• The elevator is the lever of the 1st class position of the
fulcrum is between the effort and resistance.

47. •Long arm is 3/4th of the total length and short arm is
1/4th of the total length, to get mechanical advantage of
3.

48. 2.WEDGE PRINCIPLE.
•In this principle elevator is pushed between the root and
the investing bony tissue parallel to long axis of tooth by
hand pressure or by mallet force.
•It is used in conjunction with lever principle.

49. •Sharper the angle of the wedge less the
effort required to overcome a given
resistance.
•formula=(ExI=Rxh)or(R/E=I/H).
•Mechanical advantage of this principle
is 2.5.

50. 3.WHEEL AND AXLE
PRINCIPLE:-
•In this principle,effort is applied
to the circumference of a
wheel,which turns the axle so as to
raise a weight.
•It can also be used in conjunction
with lever and wedge principle.

51. •Formula=(EffortXradius of wheel=resistanceXradius of
axle)(R/E=Rw/Ra).
•Mechanical advantage of this principle is 4.6.

52. 1.STRAIGHT COUPLAND ELEVATOR
Description:-
•Large peer shaped handle with a straight shank and a blade
which has a concave/convex surface and an inclined plane.
•The blade has a deep concave groove on 1 side and tip is sharp
and straight.

53. METHOD TO USE:-
•Working of this elevator is based on wedge principle and 1st
order lever principle.
•The elevator is placed at an 45degree angle to the long axis
to the tooth with concavity of the blade facing the tooth to
be extracted.
•The crest of the interceptal bone is used as fulcrum .
•It may also look like parallel to the long axis of the tooth
when it is wedged into the PDL space to luxate the tooth.

54. 2.STRAIGHT HOSPITAL PATTERN ELEVATOR:-
Description:-
•Blade, handle and shank are in the same plane.
•One side of the blade is flat and has vertical serrations, other side
is convex.
•Tip is pointed.

55. METHOD TO USE:-
•Serrated flat side of the blade is
placed facing the tooth to be
extracted.
•It is placed at a 45 degree angle
to the long axis of the tooth or
may alternatively be wedged into
the PDL space vertically along the
long axis of the tooth.
•Working principle is same as
coupland’s elevator.

56. DESCRIPTION:-
•“Offset” or angulated elevator as the blade is at an angle to the
shank.
• The blade is narrow with a deep concavity on one side & end
in a sharp pointed tip.
• It is available in pairs (right & left)

57. METHOD TO USE:-
• To remove fractured root fragments at
the cervical, middle 1/3rd or apical 1/3rd.
•The pointed tip & concave surface of the
blade is wedged between the tooth
fragment & the alveolar bone from the
mesial & distal aspect with a slight push-
pry motion.
•Based on wedge principle.

58. DESCRIPTION:-
•“Offset blade” as the blade is at an
angle to the shank and handle .
•Blade is curved and triangular in
shape with a pointed tip.
•It is available in pairs.(right and
left).

59. USES:-
•To remove impacted molars. The pointed tip is placed in the
buccal furcation to luxate the tooth from the socket.
•Rotational forces are used on the wheel and axle principle.
•To remove fractured root tips in mandibular molars.
•To extract mandibular molar root stumps when both the
roots are present but one is fractured at a lower level than the
other or when the bifurcation is intact.

60. •To assist in removal of the erupted maxillary 3rd molar.the
elevator is placed with the buccal fulcrum on the alveolar
bone. rotational forces displace the tooth in a distal,buccal
and occlusal direction.
•Sometimes a bur hole may b drilled onto the tooth to b
luxated. The pointed tip of the elevator is engaged into the
burhole to get a good purchase point and the tooth is
removed.

61. DESCRIPTION:-
•“Offset blade” design where the blade is at
an angle to the shank and handle .
•The blade appears similar to the Cryer’s
elevator.
•The handle as a crossbar design as it is
perpendicular to the shank.
•The blade is curved and triangular in
shape.

62. •This elevator has the maximum mechanical advantage due
to the crossbar handle and the offset blade design.
•When 1 root tip of mandibular molar is fractured the
elevator is placed into empty alveolar socket of the root
which is removed. With rotational forces the interradicular
bone is first removed and then the tip of the elevator is
engaged onto the cementum of the fractured root to remove
it from the socket.
USES:-
•Used with rotational forces based on wheel and axle
principle.

63. •Used for removal of impacted mandibular teeth.
•Used with caution for removal of impacted mandibular
third molars as the force may cause fracture of the angle
region of the mandible.
•Used for removal of root fragments of mandibular
molars similar to the way a Cryer’s elevator is used.
•Not used in maxillary arch.

64. Proper knowledge of proper
instruments should be used
properly.

65. Text book of oral and maxillofacial surgery-Rajiv M.Borle
Handbook of local anaesthesia- Stanley Malamed
Dental instruments- Chitra Chakravarthy
Extraction of teeth- Geoffrey Howe