Basic Instrumentation

Principles of
Exodontia
Kristine C. Sumaoy, RN, MAN, DMD

Topics:
• Instrumentation for Basic Oral Surgery

• Principles of Routine Exodontia
• Principles of More Complex Exodontia
• Principles of Management of Impacted Teeth
• Postextraction Patient Management
• Medical and Legal Considerations
Learning Objectives
• Learn principles of exodontia as well as the instrumentation

and techniques;
• Know the basic instrumentation and the fundamental
applications of instruments to their surgical purposes;
• Learn the basic parts of dental instruments and how to use it;
• Learn how to manage patient who are undergoing extraction
surgery;
Instrumentation for Basic Oral Surgery
Incising Tissue
• SCALPEL: primary instrument for making incisions

- composed of a handle and a sharp blade
• No. 3 blade handle: most commonly used handle for oral surgery
• No. 15 blade: most frequently used scalpel blade for intraoral surgery
• Blade No. 11: sharp-pointed blade that is used primarily for making small
stab incisions
Blade No. 12: used for mucogingival procedure in which incisions are made on
posterior aspects of teeth or in the maxillary tuberosity area.
SCALPEL:
Instrumentation for Basic Oral Surgery
Incising Tissue:
REMINDER:
Scalpel blades are

designed for single-
patient use only!!
MOLT No. 9 : Elevating the Mucoperiosteum
Retractors
• Helps protect soft tissue from sharp cutting instruments Minnesota Retractors
• Help provides good access and vision during surgery
Austin Retractors
Henahan Retractor
Seldin Retractor
Allis Forceps
Grasping Soft Tissue
Adson Tissue Forceps
:most commonly used forceps for

grasping soft tissue
Controlling Hemorrhage
Hemostat
• has long, delicate beaks that are used to
grasps tissues and a locking handle.
• use to control bleeding when direct
pressure to surgical site is deemed
Hemostat (straight or curved) insufficient.
• can be used during suturing and/or
cauterization.
• useful in removal of debris, granulation
tissues, pieces of calculus etc.
Removing Bone
RONGEURS: most commonly used removing bone in dentoaveolar surgery
• this instrument has sharp blades that are squeezed together by the handles,
cutting or pinching through bone
Burr and Handpiece
Mallet and Chisel
Periapical Curette
Bone File Needle Holder
Suturing Soft Tissue
Needle Holder
Forceps vs. Needle Holder
Suture Material
Sizes of suture relates to its
diameter and is designated
by a series of zeros.
• 3-0
• 4-0
• 5-0
• 7-0
• Sutures can be resorbable

or non-resorbable
Suture Material
• most commonly used sutures for oral

cavity
• Has appropriate strength and its silk
polyfilament nature makes it easy to
tie and well tolerated by the patient’s
tissue.
• The color makes it easy to see for
suture removal
Dental Elevators
Components:
• Handle
• Shank
• blade
3 basic types:
• the straight type : most commonly used elevator
• the triangle or pennant-shaped type: second most common
• the pick type
Straight Elevators
• most commonly used elevator to

luxate teeth
• blade of the straight elevator is
concave on its working side
• concave surface on one side of the
elevator is placed toward the tooth to
be elevated
• Straight elevators vary in size
depending on the width of the blade
Triangular-type Elevators
• second most commonly used type of
elevator
Cryer Elevator
• provided in pairs: a left and a right
• most useful in removing retained root
fragment where the adjacent socket is
empty.
• When used, the tip is inserted in the
purchased point and the elevator is
then turned in a wheel-and-axle
rotation
• comes in a variety of types and
angulations: Cryer elevator is the
most common type
Pick-type Elevators
• This type of elevator is used to Crane Pick
remove roots
• This instrument is used as a lever to
elevate a broken root from the tooth
socket
• May or may not need to create a
purchase point to remove root
fragment from the socket
• Another type of pick elevator is the
root-tip pick or the apex elevator
• SHOULD NOT be used as a wheel & Root-tip Pick
axle or lever type of elevator such as
the Cryer elevator or the Crane pick
Periotomes
• instruments used to extract teeth while preserving
the anatomy of the tooth’s socket
• tip of periotome blade is inserted into the
periodontal ligament space and advanced (2-3mm)
using apical pressure along the long axis of the tooth
and reinserted again into an adjacent accessible site
• process is repeated until sufficient severance of PDL
has been accomplished then tooth is removed by
using a dental elevator, extraction forceps, or both,
taking care to avoid excessive expansion or fracture
of bone.
Extraction Forceps
• extraction forceps are instruments used for
removing the tooth from alveolar bone
• Ideally, forceps are used to lift elevator-luxated
teeth from their sockets rather than to pull
teeth from their sockets
Forceps Components
• Handles
• Hinge
• beak
Handle of Forceps
• adequate in size for comfortable use and
easy to deliver sufficient pressure and
leverage to remove the required tooth
• have a serrated surface to allow a positive
grip and to prevent slippage
• handles of the forceps are held differently
depending on the position of the tooth to
be removed
• Maxillary forceps are held with the palm to
the side or underneath the forceps so that
the beak is directed in a superior direction
• mandibular forceps are held with the palm
on top of the forceps so that the beak is
pointed down toward teeth
Beaks of Forceps
• source of the greatest variation among forceps
• designed to adapt to the tooth root near the junction of the
crown and root
• Note: beaks of the forceps are designed to be adapted to the
root structure of the tooth and not to the crown of the tooth
• the more closely the beaks of the forceps adapt to the tooth
roots, the more efficient is the extraction and the lower is the
chance for undesired outcomes
Maxillary Forceps Maxillary Tooth Forceps
Maxillary Incisor • 150
• removal of maxillary teeth • straight forceps
requires the use of instruments • No. 1 forceps
designed for single-rooted teeth • 150S (primary teeth)
and for teeth with three roots
Maxillary Canine No. 1 forceps
• single-rooted teeth: maxillary
Maxillary 150A
incisors, canine teeth, and
Premolars
premolar teeth* Maxillary Molars • 53R& 53L
• trifurcated roots: maxillary • 18R & 18L
molars • 88R and 88L
• 65 (root tip)
• 69 (root fragment)
Forceps 150
Forceps 150 vs. 150A Forceps 150A

Forceps 53R and 53L
Mandibular Forceps
Mandibular Forceps
Tooth
• Extraction of mandibular
Mandibular • 151
teeth requires forceps that
Incisor • 151S (primary teeth)
can be used for single-rooted
teeth: incisors, canines, and Mandibular • 151
premolars as well as for two- Canine
rooted teeth for the molars Mandibular • 151A
Premolars • English style vertical-hinge
forceps
Mandibular • No. 17
Molars • No. 87 (cowhorn forceps)
English style vertical-hinge forceps
Forceps 151
No. 87 (Cowhorn forceps)
Forceps 151A
No. 17 molar forceps
151 vs. 151S forceps

Instrument Tray System
Basic Extraction Tray

Surgical Extraction Tray

Biopsy Tray
Postoperative Tray

Basic Instrumentation

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Principles of

Kristine C. Sumaoy, RN, MAN, DMD

• Instrumentation for Basic Oral Surgery

• Learn principles of exodontia as well as the instrumentation

• SCALPEL: primary instrument for making incisions

Scalpel blades are

Adson Tissue Forceps

:most commonly used forceps for

• Sutures can be resorbable

• most commonly used sutures for oral

• most commonly used elevator to

Forceps 150 vs. 150A Forceps 150A

No. 87 (Cowhorn forceps)

151 vs. 151S forceps

Basic Extraction Tray

Surgical Extraction Tray

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