ARMAMENTARIUM OF EXODONTIA

ARMAMENTARIUM FOR EXODONTIA

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

INDEX

ARMAMENTERIUM FOR EXODONTIA

INTRODUCTION

DIAGNOSTIC INSTRUMENTS

LOCAL ANAESTHESIA:- SYRINGE NEEDLE CARTRIDGE

EXTRACTION:- FORCEPS:- MAXILLARY MANDIBULAR

ELEVATORS :- TYPES PRINCIPLES USES

INTRODUCTION

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.

DIAGNOSTIC INSTRUMENTS1.MOUTH MIRROR/ODONTOSCOPE:-

Parts :- mirror,shank,handle.

Types :-flat,concave,front surface, double sided

MIRRORSHANKHANDLE

USES:-

Indirect vision

Retract cheek,lips and tongue.

Helps to reflect light in specific area in oral cavity.

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.

BEAKBODYHANDLE

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

3.STRAIGHT PROBE

Presence of caries

Presence of furcation involvement or dental caries.

Moons probeDescription:-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.

METHOD TO USE:-

Insert the moons 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.

LOCAL ANAESTHETIC ARMAMENTERIUM1.Needle

Parts:-bevel,shaft,hub,syringe adapter,cartridge penetration end.

Guage:-25,27 and 30 are used in dentistry.

2.Syringe

Parts :-needle adapter, piston,finger grip, syringe barrel,thumb grip

Types :-

Nondisosable syringes

Disposable syringe

Safety syringe

Computer controlled local anaesthetic delivery system.

RATEVOLUMETIME

3.Cartridge:- prefilled 1.8ml dental cartridge Consist of 4 parts.a)Cylinderical glass tubeb)Stopper(plunger,bung)c)Aluminium capd)Diaphragm

DENTAL EXTRACTION FORCEPS

PARTS:-A)HANDLEB)HINGEC)BEAKS

MAXILLARY ANTERIOR TEETH FORCEPDESCRIPTION:-

The handle,hinge and beaks are in the same plane.

Both the beaks are symmetrical. They are broad with sharp rounded edge.

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.

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.

MAXILLARY PREMOLAR FORCEPS

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.

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.

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.

MAXILLARY MOLAR FORCEPS

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

Gap between the beaks is more than that of premolar forceps. This is to accommodate maxillary molar.

Forceps are available in pair.

LEFT

RIGHT

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.

MAXILLARY COWHORN FORCEPSDESCRIPTION:-

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

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.

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.

BAYONET ROOT FORCEPSContra 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.

The beaks of the root forceps are narrow.

Used for extraction of maxillary roots.

MAXILLARY ROOT FORCEP

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.

MAXILLARY THIRD MOLAR FORCEP

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.

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.

MANDIBULAR ANTERIOR FORCEPSDESCRIPTION:-

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.

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.

MANDIBULAR PREMOLAR FORCEPSDESCRIPTION:-

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.

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.

MANDIBULAR MOLAR FORCEPDESCRIPTION:-

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.

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.

MANDIBULAR COWHORN FORCEPSDESCRIPTION:-

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.

METHOD OF USES:-

Used for the extraction of grossly carious mandibular molars where an ordinary molar forceps may crush the remaining weakened crown structure.

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.

MANDIBULAR ROOT FORCEPSDESCRIPTION:-

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.

ELEVATORSINDICATIONS 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.

PARTS OF ELEVATORSHANDLESHANKBLADE

WORK PRINCIPLES OF ELEVATORS1.LEVER PRINCIPLE:-

The elevator is the lever of the 1st class position of the fulcrum is between the effort and resistance.

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.

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.

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.

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.

Formula=(EffortXradius of wheel=resistanceXradius of axle)(R/E=Rw/Ra).

Mechanical advantage of this principle is 4.6.

STRAIGHT ELEVATOR1.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.

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.

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.

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 couplands elevator.

APEXO ELEVATOR 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)

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.

CRYERS ELEVATORDESCRIPTION:-

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).

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.

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.

CROSSBAR ELEVATORDESCRIPTION:-

Offset blade design where the blade is at an angle to the shank and handle .

The blade appears similar to the Cryers elevator.

The handle as a crossbar design as it is perpendicular to the shank.

The blade is curved and triangular in shape.

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.

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 Cryers elevator is used.

Not used in maxillary arch.

TAKE HOME MESSAGEProper knowledge of proper instruments should be used properly.

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REFERENCES:-Text book of oral and maxillofacial surgery-Rajiv M.BorleHandbook of local anaesthesia- Stanley MalamedDental instruments- Chitra ChakravarthyExtraction of teeth- Geoffrey Howe