Category Archives: Armamentarium for Basic Oral-Surgery

Books of hire-vendor

Books of hire-vendor

In case of default by hire-purchaser, the hire-vendor debits the hire-purchaser’s account with interest becoming due but naturally does not pass entry for receipt of the instalment. When he ,repossess~s the goods due to default, he periscope, Goods Repossessed Account and, debits it ants , credits the hire-purchaser’s account with the estimated value of goods repossessed. Any balance’ left in hire-purchaser’s account is transferred as profit or loss, as the case may be prepossession of goods to Profit & Loss Account.

Then Goods Repossessed Account is debited with the amount of expenses, if any, incurred . on repairs, repacking etc. of the goods repossessed in order to make them suitable for resale. The account is credited with the sale proceeds of the goods on their resale. Any balance left in Goods Repossessed Account after disposal of all the ‘goods represents profit or loss and is transferred to Profit & Loss Account. In the examination, if estimated value of the goods at the time of their repossession is not given ‘the amount due from the hire-purchaser should be assumed to be the estimated value. Thus, in such..a case the hire-purchaser’s account will not show any profit orloss on repossession of goods.

Illustration 6.

On the basis of particulars given in the immediately preceding illustration, prepare important ledger accounts in E.C. Ltd.’s books of account. Assume that the estimated value of the T.V set at the time of repossession-was Rs. 12,QOOand after an expenditure of Rs. 850 on repairs, repacking etc. to give the T.V. set a new-look, -,the company resold it on 6th December, 199? for cash to o~e of its employees at a special discount of 10 per cent on cash price i.e. for Rs. 13,500. Also assume RC. Ltd closes its books of accounts’ every year on 31st March.

FRACTURES OF THE MANDIBLE

FRACTURES OF THE MANDIBLE

Fracture of a mandible during extraction is a rare complication it is associated almost exclusivly with the surgical removal of impacted third moral a mandibular fracture is usually the result of the application of a force exceeding that needed the remove a tooth and often occurs duriong the use of dental elevators . however when lower third moral are deeply impacted even small amount of force may cause a fracture . Fracture may also occur during removal of impacted  teeth from a servely atrophic mandible. should such a fracture occure it must me treted by the usual method used for a jaw fracture must be adequatly reduced and stablized with intermaxillary fixation usual  this mean this mean that the patient should be referred to and oral and maxillofacial surgeon for definitive care.

INSTRUMENTS TRAY SYSTEM

INSTRUMENTS TRAY SYSTEM

Many surgeons find it practical to use the “tray” method to assemble instruments. Standard sets of instruments are packaged together, sterilized, and unwrapped at surgery. The typical basic extraction pack includes a local anesthesia syringe, a needle, a local anesthesia cartridge, a woodson elevator, a periapical curette,a small and large straight elevator, a pair of college pliers, a curved hemostat, a towel clip, an Austin retractor, a suction, and gauze (fig. 6-62). The required forceps would be added to this tray.

A, Side view of English style of forceps. B, Forceps adapted to lower premolar.

A, Side view of English style of forceps. B, Forceps adapted to lower premolar.

A, Superior view of no. 1 7 molar forceps. ·B, Side view -;;[ no. 17 molar forceps. C and 0, No. 17 forceps adapted to lower molar .

A, Superior view of
no. 1 7 molar forceps. ·B, Side view no. 17 molar forceps. C and, No. 17 forceps adapted to
lower molar .

A, Side view of no, 222 f?rceps, B, No, 222 forceps adapted to lower third molar

A, Side view of no, 222 forceps, B, No, 222 forceps adapted to lower third molar

A. Superior view of cowhorn no. 2'3 forceps. B, Side view of cowhom forceps. C and 0, Cowhorn forceps adapted to lower molar tooth.

A. Superior view of cowhorn no. 2’3 forceps. B, Side view of cowhom forceps. C and 0, Cowhorn
forceps adapted to lower molar tooth.

No. 151S (bottom) is the smaller version of no.•151 (top) and is used to extract primary teeth.

No. 151S (bottom) is the smaller version of no.•151 (top) and is used to extract primary teeth.

Typical basic extraction tray,

Typical basic extraction tray,

A tray used for surgical extractions would include the items from’ the basic extraction tray plus a needle holder and suture, a pair of suture scissors, a periosteal elevator, a blade handle and blade, Adson tissue forceps, a bone file, a tongue retractor, a root tip pick, Russian tissue forceps,a pair of Cryer elevators, a rongeur, and a handpiece and bur (Fig. 6-6.). These instruments permit Incisron and reflection of soft tissue, removal of bone, sectioning  of teeth, retrieval of roots, debridement of the wound and suturing of the soft tissue.

The biopsy tray includes the basic tray, plus a blade handle and blade, needle holder and suture, suture scissors,Metzenbaum scissors , Allis tissue forceps, Adson tissue forceps, and curved hemostat (Fig 6·64), These instruments permit incision and dissection of a soft tissue specimen and closure of wound with sutures.

Surgical extraction tray adds necessary instrumentation to reflect soft tissue flaps, remove· bone, section teeth, retrieve.roots; and suture flaps back into position.

Surgical extraction tray adds necessary instrumentation to reflect soft tissue flaps, remove·
bone, section teeth, retrieve.roots; and suture flaps back into position.

Biopsy tray adds equtpmenl necessary to remove soft tissue specimen and suture wound closed.

Biopsy tray adds equtpmenl necessary to remove soft tissue specimen and suture wound
closed.

 The  postoperative tray has the necessary instruments to irrigate the surgical site and remove sutures (Fig. 6-65). It usually includes scissors, college pliers, irrigation syringe, applicator sticks; gauze, and suction.

The instruments may be placed on a flat tray, wrapped with sterilization paper, and sterilized. When ready for use, the tray is taken to the operatory opened, and the  instruments used from the tray. This system requires a rather large autoclave to accommodate the tray.

Alternately, metal cassettes can be used instead of a tray. They are more compact but must also be wrapped insterilization paper (see Fig. 5-6).

Postoperative tray includes instruments. necessary to remove sutures and irrigate mouth.

Postoperative tray includes instruments. necessary to remove sutures and irrigate mouth.

The appendix includes prices for the instruments-listed for these trays. A casual review of the cost of the surgical instruments will reflect why-the surgeon and staff should make every effort to take good care of instruments.

MANDIBULAR FORCEPS

MANDIBULAR FORCEPS

Extraction of mandibular teeth requires forceps that can be used for single-rooted teeth for the lncisors, canines, and premolars, as wen as for two-rooted teeth for the molars.The forceps most commonly used for the single-rooted . teeth are the lower universal forceps, or the no

A. Superior view of no. 150 forceps. 8, Side view of no. 150 forceps. C and 0, No. 150 forceps adapted to maxillary .central incisor.

A. Superior view of no. 150 forceps. 8, Side view of no. 150 forceps. C and 0, No. 150
forceps adapted to maxillary .central incisor.

A, Superior view of no. 150A forceps. B, No. 150A forceps have parallel beaks that do not touch in distinction from 150 forceps beak. C, Adaptation of no. 150A forceps to maxillary premolar

A, Superior view of no. 150A forceps. B, No. 150A forceps have parallel beaks that do not
touch in distinction from 150 forceps beak. C, Adaptation of no. 150A forceps to maxillary premolar

A, Superior view of the no. 1 forceps. 8, Side view of the no. 1 forceps. C, ·No. 1 forceps adapted to incisor 103 -

A, Superior view of the no. 1 forceps. 8, Side view of the no. 1 forceps. C, ·No. 1 forceps adapted to incisor
103 –

A, .Superior view of the no. 53L forceps. B, Side view of no. 53Uorceps. C, Right, No. 53l; left, no. 53R. 0 andE, No. 53L adapted to maxillary molar

A, .Superior view of the no. 53L forceps. B, Side view of no. 53Uorceps.
C, Right, No. 53l; left, no. 53R. 0 andE, No. 53L adapted to maxillary molar

A, Superior view of no. 88L forceps. B, Side view of no. 88L forceps. C, No. 88R adapted to maxiliary molar.

A, Superior view of no. 88L forceps. B, Side view of no. 88L forceps. C, No. 88R adapted to maxiliary molar.

A, Superior view of no. 2105 forceps. B, Side view of no. 2105 forceps. C, No. 2105 adapted to maxillary molar.

A, Superior view of no. 2105 forceps. B, Side view of no. 2105 forceps. C, No. 2105 adapted to maxillary molar.

6-55). These have handles similar in shape to the no. 150,but the beaks are pointed inferiorly for the lower teeth. The beaks are smooth and relatively narrow and meet only at the tip. This allow’s the beaks to fit at the cervical Iine of  the tooth and grasp the root.

The no. 151A forceps have been modified slightly for mandibular premolar teeth (Fig. 6-56). 1 hey should not be used for other lower teeth, because their form prevents adaptation to the roots of the teeth.

The English style of vertical-hinge forceps is used occasionally for the single-rooted teeth in the mandible (Fig.6-57). Great force can be generated with these forceps unless care is used, the incidence of root fracture is high with this instrument. Therefore it is rarely used by the beginning surgeon.

The mandibular molars are bifurcated, two-rooted teeth that allow the use of forceps that anatomically adapt to the tooth. Because the bifurcation is on both the buccal and the lingual sides, only single molar forceps are necessary for the left and right, in contradistinction to the maxilla, with which a right- and left-paired molar forceps set is required.

A, Superior view of no. 286 forceps. 8, Side view of no. 286 forceps. C, No. 286 adapted to broken root

A, Superior view of no. 286 forceps. 8, Side view of no. 286 forceps. C, No. 286 adapted to broken root

1505 (bottom) is smaller version ·of no. 150 forceps (top) and , is used for primary teeth.

1505 (bottom) is smaller
version ·of no. 150 forceps (top) and ,
is used for primary teeth.

The most useful lower molar forceps are the no. 17 (Fig. 6-58). These forceps are usually straight-handled, and the beaks are set obliquely downward. The beaks have bilateral pointed tips in the center to adapt into the bifurcation of the molar teeth. The remainder of the beak adapts well to the bifurcation. Because of : he pointed tips, the no. 17 forceps cannot be used for molar teeth, which have fused, conically shaped roots. For this purpose the no. 222 forceps are useful (Fig. 6- 59). They are similar in design to the no. 17, but the beaks are shorter and do not have pointed tips to prevent them from being used. The most common tooth for which the no. 222 is useful is the erupted mandibular third molar.

The major design variation in lower molar forceps is the no. 23, the so-called cowhorn forceps (Fig. 6-60). These instruments are designed with two pointed heavy beaks that enter into the bifurcation of the lower molar. ‘After the forceps are seated into the correct position, the tooth is elevated by squeezing the handles of the forceps together tightly. The beaks are squeezed into the bifurcation, using the buccal and lingual cortical plates as fulcrurms, and the tooth is literally squeezed out of the socket.As with the English style of forceps, improper use of “cowhorn forceps can result in an increase in. the incidence of untoward effects, such as fractures of the alveolar bone. The beginning surgeon should use cowhorn forceps with caution.

The no. 151 is also adapted for primary teeth. The no. 1515 is the same general design as the no. 151 but is scaled down to adapt to the primary teeth. A single pair of forceps is adequate for removal of all primary mandibular teeth (Fig. 6-61).

MAXILLARY FORCEPS

MAXILLARY FORCEPS

The removal of maxillary teeth requires the use of instruments designed for single-rooted teeth and for teeth . with three roots. The maxillary incisors, canine teeth,and. premolar teeth are all considered to be single-rooted teeth. The maxillary first premolar frequently has a bifurcated root, but because this occurs in the apical one third, it has no influence on the design of the forceps.The maxillary molars are usually trifurcated and therefore require extractien forceps, which will adapt to that configuration.

The single-rooted maxillary teeth are usually removed with maxillary universal forceps, usually no. 150 (Fig. 6-47). The no. 1SO forceps are slightly curved when viewed from the side and are essentially straight when viewed from above. The beaks of the forceps ‘curve to meet only at the tip. The slight curve of the no. 150 allows the operator to reach not only the incisors, but also the bicuspids in a comfortable fashion. The beak of the no. 150 forceps has been modified slightly to form the no. 150A forceps (Fig. 6-48). The no. 150A is useful for the maxillary premolar teeth and should not be used for the incisors, because their adaptation to the roots of the incisors is poor.

In addition to the no. 150 forceps, straight forceps are also available. The no. 1 (Fig. 6-49), which can be used for maxillary incisors and canines, are slightly easier to use than the no. 150 for incisors.

The maxillary molar teeth are three-rooted teeth with a single palatal root and a buccal bifurcation. Therefore forceps that are adapted to fit the maxillary molars must have a smooth, concave surface for the palatal “root and a beak with a pointed design that will fit into the buccal bifurcation on the buccal beak. This requires that the .. molar forceps come in pairs: a left and a right. Additionally, the molar forceps should be offset so that the operator can reach the posterior aspect of the mouth and remain hi  the correct position: The most commonly used molar forceps are the no. 53 right and left (Fig. 6-50). These forceps are designed to fit anatomically around the palatal beak, and the pointed buccal beak fits into the buccal bifurcation. the beak is offset to allow for good positioning.

A design variation is shown in the’ no. 88 right and left .forceps, which have a longer, more a”ccentuated, pointed beak formation (Fig, 6-51). These forceps are known as upper cowhorn forceps. They are particularly useful for maxillary molars whose crowns are severely decayed. The sharply pointed beaks may-reach deeper into the trifurcation to sound dentin. The major disadvantage is that they crush alveolar bone, and when used on intact teeth without due caution, fracture of large amounts of buccal alveolar bone may occur.

On occasion, maxillary second molars and erupted third molars have a single conically shaped root. In this situation, forceps with broad, smooth beaks that are’ offset from the handle can be useful.·The no. 210S forceps exemplify this design (Fig. 6-52). Another design variation is shown in the offset molar forceps with. very narrow beaks. These are used primarily to remove broken maxillary molar roots but can be used for removal of narrow premolars and for lower incisors. These forceps, the . no. 286, are also known as root tip forceps (Fig. 6-53).

A smaller version of the no. 150, the no. 150S, is useful for removing primary teeth (Fig: 6-54). These adapt well to all maxillary primary teeth and can be used as universal primary tooth forceps.

COMPONENTS

COMPONENTS 

The basic components of dental extraction forceps are the handle, hinge, and beaks (Fig, 6-42). The handles are usually of adequate size to be handled comfortably and deliver sufficientpressure and leverage to remove the required tooth. The handles have a serrated surface to allow a positive grip and prevent slippage.

The handles of the forceps arc held differently, depending on the position of the tooth to he removed. Maxillary forceps are held with the palm underneath the forceps so that the beak is directed in a superior direction (Fig. 6-43). The forceps used for removal of mandibular teeth are held with the palm on top of the forceps so that the beak is pointed down toward the teeth (Fig. 6-4·l).
The handles of the forceps are usually straight but may be curved. This provides the operator with a sense of “better fit” (Fig. 6-45).

The’ hinge’ of the forceps, like the shank of the elevator, is merely a mechanism for connecting the handle to the beak. The hinge transfers and concentrates the force applied to the handles to the beak. One distinct difference in styles does exist The usual American type of forceps has a hinge in a horizontal direction and is used as has been described (see Figs. 6-42 and 6-43). The English preference is for a vertical hinge and corresponding vertically positioned handle (Fig. 6-46, A). Thus the English style handle and hinge are used with the hand held in a vertical direction as opposed to a horizontal direction (Fig. 6-46, B).

The beaks of the extraction forceps are the source of the greatest variation among’ forceps. The beak is designed to adapt to the tooth root at the junction of the crown and root. It is important to remember that the beaks of the forceps are designed to be adapted to the rout structure of the tooth and not to the crown of the tooth. In a sense then, different beaks are designed for single rooted teeth, two-rooted teeth, and three-rooted teeth. The design variation is such that the tips of the beaks will adapt closely to the various root formations, decreasing the chance for root fracture. The more closely the beak of the forceps adapts to the tooth-roots, the more efficient will be the extraction and the less chance for untoward complications.

A final design variation is in the width of the beak some forceps are narrow, because their primary use is to remove narrow teeth, such as incisor teeth. Other forceps are somewhat broader, because the teeth they are designed to remove are substantially wider, such as lower molar teeth. Forceps designed to remove a lower incisorcan be used to remove a lower molar, but the beaks are so narrow that they will be inefficient for that  pplication.Similarly the broader molar forceps would not adapt to the narrow space allowed by the narrow lower incisor and therefore could not be used in that situation.

The beaks of the forceps are angled so that they can be placed parallel to the long axis of the tooth, with the handle in a comfortable Position. Therefore the beaks Of maxillary forceps are’ usually parallel to the handles .. Maxillary ‘molar forceps are offset in a bayonet fashion to allow the operator to comfortably reach the posterior aspect of the mouth and yet keep the beaks parallel to the long axis of the tooth. The beak of mandibular.forceps is usually set perpendicular to the handles, which allows the surgeon to. reach the lower teeth and maintain a comfortable, controlled position.

Forceps used to remove maxillary teeth are held with palm under handle.

Forceps used to remove maxillary teeth are held with palm under handle.

A, Forceps used to remove mandibular teeth are held with palm on top of forceps. B, Firmer grip for delivering greater amounts of rotational force can be achieved by moving thumb around and under handle.

A, Forceps used to remove mandibular teeth are held with palm on top of forceps.
B, Firmer grip for delivering greater amounts of rotational force can be achieved by moving thumb
around and under handle.

Straight handles are usually preferred, but curved handles are preferred by some surgeons.

Straight handles are usually preferred, but curved handles are preferred by
some surgeons.

A, English style of forceps have hinge in vertical direction. 8, English style of forceps are held in vertical direction.

A, English style of forceps have hinge in vertical direction. 8, English style of forceps are
held in vertical direction.

EXTRACTION FORCEPS

EXTRACTION FORCEPS

The instruments that come to mind when thinking of the removal of a tooth are the· extraction forceps. These instruments are used for removing the tooth from the alveolar bone. They are designed in many styles and configurations to adapt to the variety of teeth for which they are used. Each basic design offers a multiplicity of variations to coincide with individual operator references.This section deals with the basic fundamental designs and touches on several of the variations.

Blade of small straight elevator is about half the width of a large straight elevator

Blade of small straight elevator is about half the width of a large straight elevator

Triangular-shaped elevators (Cryer) are pairs of instruments and are therefore used for specific roots.

Triangular-shaped elevators (Cryer) are pairs of instruments and are therefore used for specific
roots.

Crane pick is a heavy instrument used to elevate whole roots or even teeth after purchase point has been prepared with bur.

Crane pick is a heavy instrument used to elevate whole roots or even teeth after purchase
point has been prepared with bur.

Delicate root tip pick is used to tease small root tip fragments from socket.

Delicate root tip pick is used to tease small root tip fragments from socket.

Basic components of extraction forceps.

Basic components of extraction forceps.

TYPES

TYPES

The biggest variation in the type of elevator is in the shape and size of the blade. The three basic types of elevators are (1) the straight or gouge type; (2) the triangle,or pennant-shape type and (3) the pick type. The straight or gouge type elevator is the most commonly used elevator to luxate teeth (Fig. 6-37, A). The blade of the straight elevator has a concave surface on one side so that it can be used in the same fashion as-a shoehorn (Fig. 6-37, B and C). The.small straight elevator, no. 301, is frequently used for beginning the luxation of an erupted tooth,before application of the forceps (Fig. 6-38). The larger straight elevator is used to displace roots from their sockets and is also used to luxate teeth that are more widely spaced. The most commonly used large straight elevator is the no. 345, but the no. 46 and no. 77R are also occasionally used.

Towel clip is used to hold drapes in position. Sharp points penetrate towels. and locking handles maintain drape in position, Towel clamps with nonpenetrating action are also available

Towel clip is used to hold drapes in position. Sharp points
penetrate towels. and locking handles maintain drape in position,
Towel clamps with nonpenetrating action are also available

The shape of the blade of me straight elevator can be angled from the shank, allowing this instrument to be used in the more posterior aspects of the mouth. Two examples of the angled-shank elevator with a blade similar to the straight elevator are the Miller elevator and the Potts elevator.

A, Bulb or regular syringes may be used to carry irrigation solution to operative site. B,The self-loaded syringe is spring-loaded to allow filling simply by releasing the plunger.

A, Bulb or regular syringes may be used to carry irrigation solution to operative site. B,The
self-loaded syringe is spring-loaded to allow filling simply by releasing the plunger.

The major components of an elevator. are the handle, shank, and blade.

The major components of an elevator are the handle, shank, and blade.

 The second most commonly used elevator is the triangular or pennant-shaped elevator (Fig. 6-39). These elevators are provided in pairs a left and a right. The triangle shaped elevator is most useful when a broken root remains in the tooth socket and the adjacent socket is empty. A typical example would be when a mandibular first molar is fractured, leaving the distal root in the  socket but the mesial root removed with the crown. The tip of the triangle-shaped elevator is placed into the socket,with the shank of the elevator resting on the buccal plate of bone. It is then turned in a wheel-and-axle type of rotation, with the sharp tip of the elevator engaging the cementum of the remaining distal root the elevator is then turned and the root delivered. Triangle-shaped elevators come in a variety of types and angulatlons, but the Cryer is the most common type.

Crossbar handle is used on certain elevators. This type of handle can generate large amounts of force and therefore must be used with caution.

Crossbar handle is used on certain elevators. This type of handle can generate large
amounts of force and therefore must be used with caution.

A, Straight elevator is most commonly used elevator. Band C, Blade of straight elevator is concave on its working side

A, Straight elevator is most commonly used elevator. Band C, Blade of straight elevator is
concave on its working side

The third type of elevator that is used with some frequency is the pick type elevator. This type of elevator is used to remove roots. The heavy version of the pick is the Crane pick (Fig. 6-40). This instrument is used as a lever to elevate a broken root from the  tooth socket. It is usually necessary to drill a hole with a bur, approximately 3 mm deep into the root. The tip of the pick is then  inserted into the hole, and, with the buccal plate of bone as a fulcrum, the root is elevated from the tooth socket. Occasionally the sharp point can be used without preparing a purchase point by engaging the cementum of the tooth.

The second type of pick is the root tip pick, or apex elevator (Fig. 6-41). The root tip pick is a delicate instrument that is used to· tease small root tips from their sockets. It must be emphasized that this is a thin instrument and cannot be used as a wheel-arid-axle or lever type of elevator like the Cryer elevator or the Crane pick. The root tip pick is used to tease the very small root end of a tooth.

COMPONENTS

COMPONENTS 

The three major components of the elevator are the handle,shank, and blade (Fig. 6-35). The handle of the elevator is usually of generous size, so it can be held comfortably in the hand to apply substantial but controlled force. The application of specifically applied force is critical in the proper use of dental. elevators. In some situations, crossbar or T-bar handles are used. These instruments must be used with caution, because they can generate a very large amount of force (Fig. 6-36).

The shank of the elevator simply connects the handle to the working end, or blade, of the elevator. The shank is generally of substantial size and is strong enough to transmit the force from the handle to the blade. The blade of the elevator is the working tip of the elevator and is used to transmit the force to the tooth, bone or both.

A, Transfer forceps are used to move sterile instruments from one sterile area to another. B, These forceps are sturdy enough to move instruments without fear of loosing grip on them. C, Transfer forceps can also be used to handle small items, such as anesthetic cartridges.

A, Transfer forceps are used to move sterile instruments from one sterile area to another.
B, These forceps are sturdy enough to move instruments without fear of loosing grip on them.
C, Transfer forceps can also be used to handle small items, such as anesthetic cartridges.

DENTAL ELEVATORS

DENTAL ELEVATORS 

One of the most important instruments used in the extraction procedure is the dental elevator. These instruments are used to luxate teeth (loosen them) from the surrounding bone.Loosening teeth before the application of the dental forceps can frequently make a difficult extraction easier. By luxating the teeth before the application of the forceps, the clinician can minimize the incidence of broken roots and teeth. Finally, luxation of teeth before forceps application facilitates the removal of a broken root should it occur,because the root will be loose in the dental.socket, In addition to their role in loosening teeth from the surrounding bone, dental elevators are also used to expand alveolar bone. By expanding the buccocortical plate of bone, the surgeon facilitates the removal of a tooth that has a limited and somewhat obstructed path for removal. Finally, elevators are used to remove broken or surgically sectioned roots from their sockets. Elevators are designed with specific shapes to facilitate the removal of roots from sockets.