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Definition of armamentarium is the collection of equipment and methods used in the practice of
medicine.
SURGICAL INSTRUMENTS
Oral surgery is that specialty of the dental profession concerned with diagnosis, surgical and
adjunctive treatment of disease, injuries, and defects of the jaws and associated structures.
Because of the nature of this specialty and the equipment used, the oral surgery service is often
established in a less traveled area of the clinic. Patients undergoing surgical treatment should be
organisms, strict attention must be paid to cleanliness and aseptic techniques. All instruments,
equipment, dressings, and medication must be carefully sterilized and protected from any
contamination that might later be introduced into a surgical site. Possible sources of
area, equipment, and personnel. Any time we deal with open wounds, proper sterilization and
Before using these instruments, they should be properly sterilized and maintained in a sterile
condition throughout the operation. The sterile instrument forceps should always be used when
transferring sterile instruments from one point to another. A sterile towel should be under all
instrument setups. When the operation is completed, the instruments should be washed
thoroughly. If they are not to be sterilized immediately, they should be thoroughly dried to
prevent rusting.
In addition to some general clinical duties, the dental assistant in oral surgery performs a number
of specialized duties. The nature of many of his duties will depend upon his capabilities, the
technical procedures followed by the dentist, and the ways in which the dentist wishes his
assistant to participate. The effective assistant is the one who takes an interest in his work and
tries to become familiar with instruments, equipment, procedures, and techniques. He establishes
rapport with patients, maintains personal and area cleanliness and appearance, and anticipates
and carries out the dentist's needs so that unnecessary delays are avoided. Thorough familiarity
with instruments and materials used for specific operative procedures is of particular importance
in the oral surgery section. One reason for this is that surgical setups are commonly prepared,
packed, and autoclaved ahead of time. From an examination of the patient's record, the
experienced oral surgery assistant can usually determine what instruments and materials will be
required for the operation and have them ready when needed. Many oral surgeons perform
certain operations in a surgical operating room of a hospital, often using general anesthesia. The
dental assistant may be expected to perform preparatory procedures, assist in surgery, and clean
the operating room after surgery. Therefore, he must be familiar with pertinent basic and local
Instrument that not used to penetrates to tissue but only touch the mucosa
Semi-critical instruments Eg : mouth mirror
1. Autoclave
2. Pemanasan kering
3. Sterilisasi kimia
Suction apparatus
Miscellanous instruments
1.Instruments for anaesthesia,airway maintenance
1. Laryngoscope
2. Endotracheal tube
3. Cricothyrotomy set
4. Tracheostomy set
Cheatle forceps
Instruments used to hold the patients drapes in place. It is also used to clip on the suction tubes,
It can also be used to hold tongue and retract it forward in an unconscious patient.. it has two
Surgical scapels
Surgical scalpels are used to cut soft tissue and incise localized abscesses. A surgical knife is
comprised of a handle and interchangeable blades. Four sizes and shapes of detachable blades
Number 15 blade for carrying out surgeries in mucogingival areas and others
Dissecting scissors
Dissecting scissors can be used for incising soft tissue flaps, excising pathological soft tissue and
can be used for blunt dissection into the deeper layers. Deans suture cutting scissors are used for
cutting suture materials. Dissecting scissors usually have narrower blades than a suture cutting
scissors and may be straight or curved, sharp ended or blunt ended scissors.
Root elevators
Root elevators are instruments designed to loosen or remove roots, root fragments, or teeth. As
with forceps, a variety of designs are available to suit different teeth, techniques, and locations in
the mouth.
a. Stout A Elevator. This elevator's nib is flat on one side and rounded on the other. The nib has
b. Straight Elevator Number. 34-S. This elevator is straight and shaped like a gouge . In cross-
section its nib is crescent-shaped. It is one of the most commonly used elevators.
c. Straight Elevator Number 301. This elevator is similar in shape to but smaller than number 34-
d. Apical Fragment Root Elevators. These are used to remove apical root fragments
Figure 10 :. Miller root elevators numbers 73 and 74.
Periosteal elevators
Periosteal elevators are used to separate and raise periosteum from the surface of the bone and
a. Woodson Plastic Instrument Number One. This is a restorative instrument often used as a
c. Molt Periosteal Elevator Number Nine. This elevator has a curved, blunt blade at each end.
d. Seldin Periosteal Elevator Number 22. This elevator has a flat handle with a small blade at
each end. The blades are angled and shaped to give easy access to all locations in the mouth. All
The main function is to hold back or retract organ or tissue to gain exposure to operative site. It
is includes :-
1. Tissue retractor
3. Langenbeck retractor
5. Autins retractor
7. Skin hook
8. Chin retractor
9. Alar retractor
Langenbeck retractor
It is in L shaped with long handle. It is used for retraction of soft tissues and incision edges to
have a better visibility of deeper structures . It comes in different sizes depending upon length of
Tongue Depressor
it is also a L shaped retractor without handle. It has broad, flat rounded blade.. the function is
used for the retraction and depression of the tongue to improve visibility of the posterior
pharyngeal wall and the tonsillar region.it is also be used for cheek retractors.
Austins Retractor
Also an L shaped retractor without handle. It is used basically for the retraction of small
The end of the instruments resembles a cats paw. It is used for retraction of small amount of soft
tissues
Obwegessors ramus retractor
Skin hook
Alar retractor
Chin retractor
In case genioplasty
6.Instruments used for holding
1. Needle holder
2. Haemostat
4. Tissue forceps
7. Dressing holder
8. Sponge forceps
9. Instruments forceps
Dressing forceps
Dressing forceps have the appearance of large tweezers. They are used to handle sterile dressings
Sponge forceps
Sponge forceps are large and doughnut-shaped nibs. They are used to handle sterile dressings or
Instrument forceps
Instrument forceps have prong-like nibs resembling a knife and fork. They are used to handle
sterile instruments.
Hemostats
Hemostats are small forceps designed to stop the flow of blood by clamping blood vessels. A
Needle holders
Needle holders are forceps resembling straight hemostats. Each jaw has a groove on its inner
surface, which is used to hold and manipulate the suture needle during suturing.
It is used to grasp heavy tissue. It have straight or curved end and may
used as clamp
It can be either toothed or non-toothed. Toothed : have serration at tip which help a better grasp
and Non-toothed : do not have serration. The function is to stabilize the soft tissue flaps during
Used when a larger amount of fibrous tissues have to be removed and have locking handles and
1. Rongeurs
2. Chisel
3. Osteotome
4. Mallet
5. Bone file
Osteotome
This is an instrument used for splitting bone. It has bi-bevelled edge and comes in various sizes
depending on the width of cutting edges and the length of the instruments. Used to perform
osteotomy cuts and in certain cases may also be used to split impacted teeth to facilitate removal.
Rongeur forceps
Rongeur forceps are cutting instruments designed to cut and contour bone (figure 3-18). Springs
located between their handles separate their beaks when closing pressure is not being applied.
Bone files
Bone files are made in various sizes. They are used to smooth the edges of bone. Seldin bone file
number 11 is double-ended, with the file surface at one end being larger than the file surface at
Bone chisels
Bone chisels are used to remove bone or section teeth. Some are designed for use with a hand
mallet. Another type is driven by a special handpiece, as an engine-driven oral surgical mallet.
a. Stout chisels numbers 1, 2, and 3 are straight bone chisels used with a hand mallet. They differ
b. Chisel points used with the engine-driven surgical mallet are made in different shapes,
designed for various surgical procedures. These include two bone removing points, one unibevel
and one bibevel, one gouge and two tooth elevator points.
Surgical mallets
The oral surgical hand mallet is a double-headed mallet resembling a gavel or wood mallet. The
engine-driven oral surgical mallet (impactor) fits on the arm of the dental engine like a straight
Surgical burs
Specially designed surgical burs (figure 3-21) are used by many oral surgeons to remove bone
and to groove teeth for controlled sectioning. They are made for both the straight and contra-
angle handpiece. Steel bur number 41 is available for AHP or SHP. The tungsten carbide bur is
available for SHP only. To avoid excessive heat while cutting, sterile water should be dripped
Surgical Curettes
Curettes are instruments designed to remove extraneous material from tooth sockets and other
spaces in the alveolar bone. Their nibs are spoon- shaped and their shanks are angled to reach
different areas of the mouth. Standard curettes include Molt curettes 1, 2, 4, (anterior) and 5L,
Figure 34 :. Curettes.
Bone scoop (Volkmanns scoop)
Similar to surgical curretes Used for debriding contents from an abscess cavity,sinus or fistula
Used for probing and forcing an entry into an abscess sac or for stretching an opening into an
draining of abscess
9. Miscellanous instruments
1. Mouth prop
2. Bite block
3. Mouth gag
5. Ryles tube
7. Trocar
8. Surgical diarthermy
9. cryosurgery
Mouth prop
A device for maintaining the jaws of a dental patient in an open state. It used when the operator
Suture needles
Many different types of suture material can be attached to different shapes and sizes of needles.
Suture needles are use to carry suture material through soft tissue which, when tied, will hold
Gingival retractors are used to hold gingival flaps back and out of the way to expose operative
areas. Thoma gingival retractors 1 and 2 are two-pronged, fork-like retractors. Instruments
designed for other purposes, such as periosteal elevators are also used as retractors.
Irrigating syringe
Irrigating syringes are used to wash pus, debris, and other extraneous material from tooth
sockets, cavities, or inflamed gingival flaps. The tip is usually metal and should be blunt. If a
syringe with a glass barrel is used, particular care must be exercised; the glass barrel could
Dental aspirator
The dental aspirator is an electrically operated vacuum suction unit used to maintain a clear
operating field by removing blood, bone chips, debris, and other materials. The unit is fitted with
a tube running from a vacuum bottle, which ends in a handle and suction tip. The handle fitted
with a suction tip is controlled by the oral surgery assistant in the removal of extraneous material
Procedures commonly used in the oral surgery section will be discussed in the following
paragraphs of this lesson. See Appendix A for the listing of the instruments in a typical surgical
setup.
Preparation to receive a patient begins with the cleanup and sterilization of instruments used
during the treatment of the preceding patient. All evidence of treatment of that patient should be
removed. Traces of blood should be removed from the dental unit and instrument trays. The
cuspidor, aspirator bottles, handles, tips, and tubes should be cleaned. Instruments should be
scrubbed and either sterilized or set aside for sterilization. Linens, headrest covers, and bracket
table covers should be replaced. The dental chair should be lowered and set in an upright
position, with the bracket table and operating lamp pushed back, out of the way. The next
patient's records and radiographs should be set out for the dentist to examine. A basic
examination setup should be placed on the bracket table. Instrument setups, sterile towels, and
dressings (as indicated by the dentist) should be on hand and their need anticipated.
PREOPERATIVE TREATMENT
In some cases, the dentist may wish the next patient to have some form of medication before
surgery and may have the patient come in early for this purpose. The dental assistant may be
expected to make a record of patients requiring such medication, notifying the dentist of the
patient's arrival, reminding him of the need for medication, and recording the medications given.
The oral surgery assistant should be familiar with the uses, doses, and effects of these and other
Instrument Setups.
Uncomplicated extraction.
Figure 42. Instruments and materials for surgical extraction and bone removal.
SURGICAL SETUPS
1. Basic setup
b. Surgical knife
e. Rongeur
f. Surgical scissors
g. Suture material
h. Suture scissors
i. Bone file
j. Gingival retractors