BASIC ARMAMENTARIUM

FOR MINOR ORAL

SURGERY

Iyad Abou-Rabii

DDS PGDip(OMFS) MRes(MED) PhD FADFE

JOINTS

Lap Joint

Box Joint

Double Action Joint

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

BLADE TIPS

Blunt, Blunt Blunt, Blunt with Bevel

Sharp, Blunt Sharp, Sharp

Fine Tip Blunt Fine Tip Sharp

Blunt with Retaining Hook Blunt with Rounded Probe End

Serrated Dissector End

Blunt, One hook End

Fine Straight Jaw Round Jaw

Square Jaw Straight on Flat

Punch Upward through Cutting Punch Upward Oblique

INSTRUMENTS 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.

Scalpel Handle : To hold scalpel blade

Scalpel Blade

Seating Area

Grooved

Grip Area

Shank

Pattern Number

Scalpel Blades

blades 10-15 go to #3

blades 18-29 go to #4

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

Seldin

Woodson # 1

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

Minnesota

Tissue Retractors

Austin WEIDER Tongue Retractor: very

useful instrument during surgery for

impacted lower third molars

Cheek Retractors

Farabauf Kilner

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

Scissors (used primarily for surgery)

a) Metzenbaum: light weight “thin”

b) Mayo: heavy, often used for dissecting fascia and tough

tissue

c) Operating: Similar to Mayo scissors in appearance, lighter

weight

d) Iris: very small, short blades

e) others (various types)

1) suture 3) wire cutting

2) bandage

SCISSORS come in a tremendous variety of styles and sizes. They

come in straight, curved and angular versions.

Scissors

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

Operating Scissors: To cut sutures, gauze and other

materials

Mayo Scissor

Operating Scissors: To cut sutures, gauze and other

materials

Other Scissor

Wire Cutting Scissor Bandage Cutting Scissor Suture Scissor

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.

Scissors: Clinical Tips

Thumb forceps: These forceps look like tweezers and are held the

same way.

There are dozens of different types, based on their teeth.

• Tissue forceps (b) have teeth so that slippery tissue can be held

• Dressing forceps (a) do not have teeth and are designed to handle

sponges etc.

Forceps

Tissue Forceps: To grasp and handle soft tissue

Russian: is specially useful

for grasping teeth that are

loose in the mouth

Adson Tissue Forceps

(Rat tooth forceps)

Tissue Forceps: To grasp and handle soft tissue

Allis: to grasp and hold tissue

that will be excised

Dressing Forceps: To grasp and handle sponge

Dressing forceps

Dressing Forceps: To grasp and handle sponge

Foerster Dressing Forceps

Jones Towel Clamp Backhaus Towel Clamp

Dressing Forceps: To grasp and handle sponge

Hemostatic Forceps: These forceps are designed to “clamp”

off blood vessels, they are identified by the different types of teeth and

patterns of the jaws.

Hemostatic Forceps:

designed to “clamp” off blood vessels, they are identified by the

different types of teeth and patterns of the jaws.

a) Halsted mosquito forceps

b) Kelly forceps

c) Crile forceps

d) Rochester-Pean forceps

e) Rochester-Carmalt forceps

f) Rochester-Ochsner forceps

Hemostatic Forceps

Hemostatic Forceps

Fully Serrated Jaws

Box Lock

Shank

Ratchet

Finger Rings

The hemostat most

commonly used is curved

hemostat

Mosquito Forceps

Hartmann-Mosquito Forceps Halsted-Mosquito Forceps

Smallest, used to grasp tiny bleeders, serrations extend full length of jaws

Kelly Forceps

Larger than mosquito forceps, serrations extend ½ length of jaws

Kelly Forceps

Heavy instrument, used to grasp larger structures, serrations extend full length of

jaws

Rochester-Pean Forceps

Large, deep transverse serrations extend full length of jaws

Rochester-Ochsner Forceps

Similar to Pean with a single inter locking tooth at tip of jaw

Rochester-Carmalt Forceps

Large, with cross-hatched serrations on tip of jaws

Needle Holders: Appear similar to

tissue/hemostatic forceps without teeth, used

to handle suture needles.

a) Mayo-Hegar:

b) Olsen-Hegar: Bottom part of jaw is

a scissor

Needle Holder

Jaws

Box Lock

Shank

Ratchet

Finger Rings

Needle Holder

Mayo-Hegar

Olsen-Hegar

Needle Holder

Bottom part of jaw is a scissor

Clinical Tips Needle 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

Needle Holder

Needle Holders Vs Hemostats

1. 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.

Bone Curette: To curette or remove soft tissue from bony

cavities

Volkmann

Bone Curette

Jansen

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 tooth

Chisels: To cut a window in the bone cortex

for access or to allow harvesting of pure soft

bone

Gouges: 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