Transcript Instruments in Oral Surgery II

Instruments in Oral Surgery II
Jan 25, 2008
RCT=Brittle
Remember-older RCT-easier to break
 Flap it, trough it, remove it

Forceps
Adapt to the anatomic crown
 Older patients bone is more dense,
not elastic
 We want to dilate the bone to remove
the tooth
 Best time to remove thirds, 16-20
years old
 The bone can expand better

Forceps
Remember to look at the roots
 Path of the roots=draw
 Hypercementosis-won’t come out
easily
 Know the difference between surgical
and routine (look at handout)

88R & 88L
Use only if furcation involvement
 Younger patients won’t have furcation
 Can fracture the buccal plate, palatal
plate and crush mucosa

88R and 88L
#23 Cowhorn
Furcation of mand. Molar
 Can fracture lingual plate, break
roots, etc
 Make sure to compress!
 Buccal and lingual movements
 Seat the beaks and “pump” them
closed
 Rock them mesiodistally as well, then
figure of 8

#23 Cowhorn Forceps
Elevators
Used as wedges or shoehorns
(displacement) down into the PDL
and tear the fibers
 Used as a lever- (most common way
to use them)
 Used in socket (wheel and axle)

Elevators
Easier to remove root fragments and
tips post-elevator use, rather than
attempting to remove tooth with
forceps alone
 Otherwise, will need to reflect a flap
and remove surgically

Crane Pick
Wheel and axle
 Fulcrum on buccal bone
 Bury tip into cementum
 Usually needs purchase point
 Roll the root out
 Not for Max 3rds

Apex Elevator
Remove roots where the PDL has
already been torn
 Can perforate into the sinus

Oral-Antral Perforation & IA
canal
If potential for damage to the sinus
or mandibular canal;
 May leave the root tip, UNLESS
potential for infection, then must
remove them
 Third molars, let them be, they are
most likely not infected

Oral-Antral Perforation
National Board Question:
 NEVER enlarge the apical area to
remove a root tip that has been
shoved into the sinus
 This will create an oral-antral fistula

Oral-Antral Perforation

1st- Get X-ray


To make sure if it is in the sinus
To know whether the sinus will heal
or not depends on:
1) Size of the perforation
 2) Infection or not

Caldwell-Luc Procedure

This is the procedure used to retreive a
root tip from the sinus







Make an envelope over the cuspid and bicuspid
Make a window into the lateral wall of the sinus
Remove the tip and close the flap
Get primary closure of the margins
Place the patient on antibiotics
Place the patient on decongestants
Give patient strict instructions regarding
disturbing pressures
Allison Clamp

Has rat teeth to remove tuberosity reduction, (this is not a
tuberosity reduction surgery, if you wondered) but those are
Allison clamps
Hemostats/clamps
Clamping vessels
 Remove pieces of roots and bone
 NOT used to drive a needle

Curved Hemostat/Mosquito
Hemostat
Adson Forceps

“Pickups” control tissue