ORAL & MAXILLOFACIAL SURGERY

INSTRUMENTS ATLAS
A Comprehensive Illustrated Reference for Dental Undergraduates
Minor Oral Surgery · Tooth Extractions · Impaction Surgery @[Link]

Forceps Elevator Scalpel Retractor Suture Scissors

Reference: Fragiskos D. Fragiskos — Oral Surgery (Springer) | Killey & Seward — Benign Lesions

Designed for BDS Undergraduates & Interns | OMS Department

© Educational Reference — Not for Commercial Use

Made by- Dr Sam

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

TABLE OF CONTENTS

1. Introduction to OMS Instruments 3

2. Instruments for Minor Oral Surgery 4
2.1 Scalpel & Blades 4

2.2 Tissue Forceps & Retractors 5

2.3 Periosteal Elevators 6

2.4 Sutures & Needle Holders 7

2.5 Haemostatic Instruments 8

3. Instruments for Routine Tooth Extraction 9

3.1 Dental Elevators 9

1
3.2 Extraction Forceps — Upper Jaw
1
@[Link]
1
3.3 Extraction Forceps — Lower Jaw
3

4. Instruments for Surgical Extractions & Impactions 15

1
4.1 Flap Raising & Bone Removal Tools
5

1
4.2 Irrigation & Drainage
7

1
4.3 Retractors & Mouth Props
8

5. Instruments for Third Molar Impaction Surgery 19

6. Accessory & Miscellaneous Instruments 21
7. Instrument Tray Setups by Procedure 22
8. Sterilisation & Maintenance Notes 24

For educational purposes — Dental Undergraduate Reference —2—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

CHAPTER 1
Introduction to OMS Instrumentation

Oral and Maxillofacial Surgery (OMS) encompasses a wide range of procedures from simple tooth extractions to complex
surgical removal of impacted teeth and minor surgical procedures involving soft tissue and bone. A thorough understanding
of the instruments used in these procedures is fundamental for every dental undergraduate and intern.

Classification of OMS Instruments

Category Examples Purpose

Incising / Cutting Scalpel, Surgical Burs, Chisel Incise soft tissue or bone

Reflecting / Retracting Periosteal Elevator, Minnesota, Austin Reflect mucoperiosteal flaps

Elevating Coupland, Warwick James, Cryer Loosen tooth from socket

Grasping / Extracting Extraction Forceps (upper & lower) Remove teeth from socket

Bone Trimming Rongeur, Bone File, Chisel & Mallet Remove or contour alveolar bone

Haemostatic Artery Clips, Gauze, Bone Wax Control bleeding

Irrigation / Suction Irrigating Syringe, Suction Tips Clean the surgical field

Suturing Needle Holder, Tissue Forceps, Scissors Close the wound

Accessory Mouth Prop, Mouth Gag, Tongue Depressor

Maintain access & visibility

All instruments used in OMS must be sterile and in proper working condition. Autoclaving at 134°C for 3 minutes (or 121°C for 15
minutes) is the standard sterilisation method. Instruments should be checked for integrity before every procedure.

For educational purposes — Dental Undergraduate Reference —3—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

CHAPTER 2
Instruments for Minor Oral Surgery

2.1 Scalpel Handle & Blades

Scalpel Handle (B.P. Handle No. 3 & No. 4)

Also known as: Bard–Parker Handle

Parts/Description:
• Cylindrical metal handle, knurled for grip
• Groove at one end to receive interchangeable blades
Scalpel Handle • No. 3 handle — for smaller blades (10, 11, 12, 15)
• No. 4 handle — for larger blades (20, 21, 22, 23)

Uses:
• Making incisions in soft tissue
• Raising mucoperiosteal flaps
• Excision of lesions
• Frenotomy and frenectomy
Note: Blade No. 15 is the most commonly used blade in OMS for curved
incisions. Blade No. 11 is used for stab incisions (abscess drainage).

Scalpel Blade No. 15

Also known as: Standard OMS Blade

Parts/Description:
• Small, curved cutting edge
• Fits No. 3 B.P. handle
Scalpel Handle • Sharp pointed tip with curved belly

Uses:
• Mucoperiosteal incisions
• Flap design in impaction surgery
• Minor excisions
• Incision and drainage of abscesses
Note: Most versatile blade in oral surgery. Gives excellent control for intricate
cuts.

@[Link]
2.2 Tissue Forceps & Retractors

Adson Tissue Forceps

Also known as: Thumb Forceps / Dressing Forceps

Parts/Description:
• Fine-tipped spring forceps
• Serrated or toothed tips
Tissue Forceps • Length ~12 cm
• Stainless steel construction

Uses:
• Grasping and stabilising soft tissues during suturing
• Handling flap margins
• Picking up suture needles during closure
Note: Toothed Adson forceps provide better grip but may cause more tissue
trauma. Use fine-tipped non-toothed forceps for delicate mucosal handling.

For educational purposes — Dental Undergraduate Reference —4—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

Austin Tissue Retractor

Also known as: Cat's Paw / Single Hook Retractor

Parts/Description:
• Single hooked end
• Flat finger rest handle
Retractor • Stainless steel, ~15 cm

Uses:
• Retraction of mucoperiosteal flaps
• Provides surgical access
• Protects adjacent soft tissues during bone work
Note: Must be repositioned gently to avoid tearing the periosteum or flap margin.

For educational purposes — Dental Undergraduate Reference —5—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

2.3 Periosteal Elevators @[Link]

Molt No. 9 Periosteal Elevator

Also known as: Molt Curette / Double-ended Periosteal Elevator

Parts/Description:
• Double-ended instrument
• Pointed end for initial periosteal incision entry
Periosteal Elevator • Broad blunt end for flap reflection
• Ergonomic octagonal handle

Uses:
• Elevating mucoperiosteal flap from bone surface
• Initial separation of periosteum
• Retraction of flap edges
• Entering interdental papilla space
Note: The pointed tip should be used first to breach the periosteum; broad end
used to push flap away from bone.

Freer Periosteal Elevator

Also known as: Freer Septum Elevator

Parts/Description:
• Double-ended with two different sized spatula ends
• Thin flexible blades, rounded edges
Periosteal Elevator • Smooth, non-serrated edges

Uses:
• Raising delicate mucoperiosteal flaps
• Separating periosteum gently
• Commonly used in anterior region flap surgeries
Note: More delicate than Molt; preferred around mental foramen and thin anterior
bone.

@[Link]
2.4 Suturing Instruments

Mayo–Hegar Needle Holder

Also known as: Needle Holder / Porta Aghi

Parts/Description:
• Scissor-type handle with locking ratchet
• Cross-serrated jaws for grip
Needle Holder • Available in 14–16 cm lengths
• Stainless steel

Uses:
• Holding suture needles firmly during wound closure
• Passing needle through tissue
• Tying sutures
• Wound approximation after OMS procedures
Note: For OMS, a 14 cm holder with fine jaws is preferred. Always lock the
needle at its back-third to prevent bending.

For educational purposes — Dental Undergraduate Reference —6—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

Dean Scissors / Metzenbaum Scissors

Also known as: Suture Scissors / Tissue Scissors

Parts/Description:
• Curved or straight blades
• Sharp-sharp or sharp-blunt tips
Scissors • Ring handles with optional spring action
• Serrated jaw version also available

Uses:
• Cutting sutures after tying
• Trimming soft tissue
• Undermining flaps (Metzenbaum)
• Frenotomy procedures
Note: Dean scissors — for cutting sutures. Metzenbaum — for dissecting and
undermining tissue. Never use suture scissors for cutting tissue or bone.

@[Link]

For educational purposes — Dental Undergraduate Reference —7—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

2.5 Haemostatic Instruments @[Link]

Mosquito Artery Forceps (Haemostat)

Also known as: Artery Clip / Kelly Forceps

Parts/Description:
• Small scissor-type instrument with locking ratchet
• Curved or straight jaws
Extraction Forceps • Serrated jaws for firm grip
• Length ~12 cm (mosquito) / 16 cm (Kelly)

Uses:
• Clamping bleeding vessels
• Haemostasis during soft tissue procedures
• Holding gauze or drains
• Grasping tissue tags
Note: Mosquito clamps are for small vessels. Kelly or Rochester clamps used for
larger vessels in OMS procedures.

For educational purposes — Dental Undergraduate Reference —8—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

CHAPTER 3
Instruments for Routine Tooth Extraction

3.1 Dental Elevators @[Link]

Elevators are lever instruments used to loosen teeth from the periodontal ligament space before application of forceps. They
work on the principles of the lever, wedge, and wheel-and-axle. References: Fragiskos OMS Ch. 3; Killey & Seward.

Coupland Elevator (No. 1, 2, 3)

Also known as: Coupland Chisel / Push Elevator

Parts/Description:
• Flat, chisel-shaped blade
• Circular cross-section handle with knurling
Coupland Elevator • No. 1 (small), No. 2 (medium), No. 3 (large)
• Used with a pushing/wedging action

Uses:
• Initial elevation — breaking periodontal ligament attachment
• Luxation of anterior teeth and premolars
• Separating multi-rooted teeth after sectioning
• Primary elevation before forceps application
Note: Apply controlled apical pressure. Avoid using as a fulcrum against adjacent
teeth without protection.

Warwick James Elevator (Straight, Left, Right)

Also known as: Warwick James / Lecluse Elevator

Parts/Description:
• Curved or straight thin blade
• Three-sided handle (triangular cross-section)
Elevator • Available as: straight, left-curved, right-curved set of 3
• Thin pointed working end

Uses:
• Luxation of upper and lower teeth
• Breaking down periodontal ligament
• Particularly useful for upper third molars
• Root elevation in deep sockets
Note: The set of 3 provides access to all surfaces. Straight for anterior; curved for
posterior quadrants.

For educational purposes — Dental Undergraduate Reference —9—

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

Cryer Elevator (East & West)

Also known as: Triangle Elevator / Cryer's Elevator

Parts/Description:
• Triangular-blade design
• East (right) and West (left) variants
Elevator • The tip is a flat triangle
• Rounded handle for torque control

Uses:
• Root fragment elevation
• Removing retained roots after forceps extraction
• Removing lower molar roots individually after sectioning
• Applying rotational force to root stumps
Note: Cryer elevators are ideal for lower molar root removal. Insert into empty
socket of extracted root and rotate to elevate adjacent root.

@[Link]

For educational purposes — Dental Undergraduate Reference — 10 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

3.2 Extraction Forceps — Upper Jaw @[Link]

Upper forceps are designed so the handles and beaks are in the same plane (straight axis). This allows the working end to
reach the upper teeth with the elbow resting. All beaks should grasp below the cemento-enamel junction.

Upper Straight Forceps (No. 1)

Also known as: Upper Incisor Forceps

Parts/Description:
• Straight beaks, narrow and pointed
• Handles in same axis as beaks
Extraction Forceps • Non-serrated or lightly serrated inner surface

Uses:
• Extraction of upper central and lateral incisors
• Upper canines (occasionally)
• Residual root fragments upper anterior
Note: Apply beak subgingivally, luxate buccally and palatally with slight rotation.

Upper Canine Forceps (No. 2)

Also known as: Upper Fang Forceps

Parts/Description:
• Slightly wider beaks than No. 1
• Heavier construction
Extraction Forceps • Straight design, rounded beaks
@[Link]
Uses:
• Extraction of upper canines
• Sometimes used for upper premolars
Note: Canines have long single roots — use adequate apical pressure before
extraction movement.

Upper Premolar Forceps (No. 5)

Also known as: Upper Bicuspid Forceps

Parts/Description:
• Slightly wider beaks
• Flat, blunt-ended beaks
Extraction Forceps • Straight handle design

Uses:
• Extraction of upper first and second premolars
• Single-rooted upper premolars
• Residual roots in premolar region
Note: Upper premolars may have two roots — check radiograph before
extraction.

For educational purposes — Dental Undergraduate Reference — 11 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]
Upper Molar Forceps (No. 17)
Also known as: Upper Molar Cowhorn / No. 17

Parts/Description:
• Beaks angled ~45° to handle
• Right and left versions available
Extraction Forceps • Pointed beak engages furcation on buccal; flat beak on palatal

Uses:
• Extraction of upper first and second molars
• Three-rooted upper molars
• Forceps beak adaptation into furcation
Note: The pointed beak engages the buccal furcation; this provides excellent grip
on three-rooted upper molars.

Upper Wisdom Tooth Forceps (No. 18R/18L or Bayonet)

Also known as: Bayonet Forceps / Upper 8 Forceps

Parts/Description:
• S-shaped or bayonet curve to handle
• Narrow pointed beaks
Extraction Forceps • Allows reach to upper third molar area

Uses:
• Extraction of upper third molars
• Unerupted or partially erupted upper wisdom teeth
• Access to posterior upper quadrant without obstruction
Note: The bayonet offset is essential to clear the lower teeth and cheek tissues
when accessing upper 8s.

@[Link]

For educational purposes — Dental Undergraduate Reference — 12 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

3.3 Extraction Forceps — Lower Jaw @[Link]

Lower forceps are designed with handles at right angles to the beaks (angled axis), allowing the surgeon to apply downward
pressure while extracting lower teeth.

Lower Anterior Forceps (No. 74 / Ash No. 1)

Also known as: Lower Incisor Forceps

Parts/Description:
• Narrow, thin pointed beaks
• Beaks at ~90° to handle axis
Extraction Forceps • Designed for crowded anterior lower region

Uses:
• Extraction of lower incisors and canines
• Lower anterior root fragments
• Narrow sockets in anterior mandible
Note: Apply firm apical and labio-lingual rocking motion. Lower anteriors have
narrow, deep roots.

Lower Premolar Forceps (No. 74 or No. 44)

Also known as: Lower Bicuspid Forceps

Parts/Description:
• Slightly wider beaks than lower incisor forceps
• Beaks at right angles to handle
Extraction Forceps • Robust design

Uses:
• Extraction of lower first and second premolars
• Lower premolar root fragments
Note: Lower premolars have single conical roots — rotational movement is often
effective.
@[Link]

Lower Molar Forceps — Cowhorn (No. 22)

Also known as: Lower Cowhorn / No. 22 Forceps

Parts/Description:
• Both beaks have pointed tips (two "cowhorns")
• Beaks angled toward the furcation area
Extraction Forceps • Designed to split furcation

Uses:
• Extraction of lower first and second molars
• Engages furcation of bifurcated lower molars
• Provides strong grip
Note: Cowhorn beaks must be accurately placed into the furcation. Hydraulic
pressure elevation is produced by squeezing the handles.

For educational purposes — Dental Undergraduate Reference — 13 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]
Lower Molar Forceps — Root (No. 23 / 44)
Also known as: Lower Root Forceps

Parts/Description:
• Narrower, sharper beaks
• Designed for deep subgingival root access
Extraction Forceps
Uses:
• Retained lower molar roots
• Root stumps below gingival margin
• Post-fracture root fragment retrieval
Note: Requires adequate soft tissue reflection before application.

Lower Third Molar Forceps (No. 17 Lower / Hawk's Bill)

Also known as: Lower Wisdom Tooth Forceps

Parts/Description:
• Beaks at right angle to handle like standard lower forceps
• Wider, heavier beaks to accommodate molar size
Extraction Forceps • Some versions have one pointed and one flat beak

Uses:
• Extraction of lower third molars
• Partially erupted or normally erupted lower wisdom teeth
Note: Often used after surgical elevation with Warwick James or Cryer elevator.

@[Link]

For educational purposes — Dental Undergraduate Reference — 14 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

CHAPTER 4
Instruments for Surgical Extractions & Impactions

@[Link]
4.1 Bone Removal & Sectioning Instruments

Surgical Bone Rongeur Forceps

Also known as: Bone Nibbler / Luer Rongeur

Parts/Description:
• Scissor-grip with spring-loaded return
• Sharp-edged cup-shaped beaks
Extraction Forceps • Available straight and curved
• Heavy-duty stainless steel

Uses:
• Trimming sharp bony prominences after extraction
• Alveoloplasty — reshaping alveolar ridge
• Removing interdental septa
• Removing bone over impacted teeth (with chisel)
Note: Used to nibble bone in small increments. Clean bite without crushing.

Bone File (Sugarman / Miller Bone File)

Also known as: Bone Rasp / Surgical File

Parts/Description:
• Double-ended with file surface on blade
• Coarse and fine cut ends
Rongeur Forceps • Oval or rectangular blade cross-section
• Horizontal serrations/teeth @[Link]
Uses:
• Smoothing sharp bone edges after extraction or alveoloplasty
• Contouring alveolar ridge
• Filing bone chips after rongeur use
• Finishing bone surface before flap closure
Note: Use in push-pull strokes. Irrigate frequently to clear bone debris from file
teeth.

Surgical Chisel & Mallet

Also known as: Osteotome / Bone Chisel

Parts/Description:
• Chisel: bevelled sharp blade, wooden or metal handle (autoclavable)
• Mallet: cylindrical weighted head, nylon or metal face
Chisel • Various widths: 5mm, 8mm, 10mm

Uses:
• Bone splitting for impacted teeth
• Removing bone over deeply impacted teeth
• Tooth sectioning (divide and conquer technique)
• Ostectomy in alveoloplasty procedures
Note: Always mallet with controlled light taps. Protect lip and cheek with retractor
before each strike.

For educational purposes — Dental Undergraduate Reference — 15 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]
Surgical Handpiece & Round/Fissure Bur
Also known as: Electric/Air-Driven Surgical Drill with Surgical Burs

Parts/Description:
• Low-speed contra-angle or straight surgical handpiece
• Round burs (No. 4, 6, 8) for bone removal
Surgical Bur • Fissure burs (703 tapered) for tooth sectioning
• Latch-type attachment for autoclavable burs

Uses:
• Bone removal over impacted teeth (ostectomy)
• Tooth sectioning — dividing crown from root or separating roots
• Creating a purchase point for elevator placement
• Trough creation around roots
Note: Always use with copious sterile saline irrigation to prevent thermal bone
necrosis. Never exceed 1000 RPM without irrigation.

@[Link]

For educational purposes — Dental Undergraduate Reference — 16 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

4.2 Irrigation & Wound Management @[Link]

Irrigation Syringe (20 mL Luer-Lock)

Also known as: Bulb Syringe / Saline Syringe

Parts/Description:
• 20–50 mL plastic or metal syringe body
• Luer-lock tip for blunt needle attachment
Irrigation Syringe • Some have curved 18G blunt cannula tip

Uses:
• Copious irrigation during bone cutting to prevent heat generation
• Post-operative socket irrigation
• Washing out bone chips and debris from surgical site
• Delivering chlorhexidine solution to wound
Note: Use sterile normal saline (0.9% NaCl) at room temperature. Avoid directing
high-pressure stream directly into bone.

Yankauer Suction Tip / Surgical Suction Cannula

Also known as: Aspirator / Suction Tube

Parts/Description:
• Wide-bore rigid plastic/metal tip
• Side hole to control suction with finger
Suction Tip • Connected to suction unit via tubing
• Angled tip for posterior access

Uses:
• Continuous aspiration of blood, saliva, and irrigant
• Maintaining clear surgical field
• Removing bone particles
• Preventing fluid accumulation during bone drilling
Note: Suction must be available throughout all OMS procedures. Use
high-volume suction for power handpiece irrigation.

@[Link]
4.3 Retractors & Mouth Props

Minnesota Retractor
Also known as: Broad Retractor / Side Retractor

Parts/Description:
• Broad flat blade with angled shank
• T-shaped handle for grip
Retractor • Heavy stainless steel
• Smooth edges to prevent tissue tearing

Uses:
• Retracting buccal mucoperiosteal flap during OMS
• Retracting cheek and lip for access
• Protecting soft tissues during drilling
• Standard retractor for lower molar impaction surgery
Note: Must be held firmly by assistant. Careless retraction causes post-op
bruising and flap tears.

For educational purposes — Dental Undergraduate Reference — 17 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

Mouth Prop (McKesson / Molt Ratchet Prop)

Also known as: Bite Block / Rubber Bite Block / Ratchet Mouth Prop

Parts/Description:
• Stainless steel ratchet mechanism with rubber bite pads
• Adjustable opening width
Periosteal Elevator • Locks in open position
• Rubber-tipped to protect teeth

Uses:
• Maintaining mouth opening during long surgical procedures
• Preventing sudden mouth closure during impaction surgery
• Reducing fatigue for patient and surgeon
• Essential for patients under conscious sedation or GA
Note: Place prop on contralateral side. Do not over-open — maximum
comfortable inter-incisal distance should not be exceeded.

For educational purposes — Dental Undergraduate Reference — 18 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

CHAPTER 5
Instruments for Third Molar Impaction Surgery

Removal of impacted third molars (wisdom teeth) is the most common OMS procedure in dental practice. It requires a
complete set of instruments for each stage: incision, flap reflection, bone removal, tooth elevation/sectioning, socket
management, and wound closure. @[Link]

Standard Instrument Tray — Lower Third Molar Impaction

Stage Instrument(s) Notes

1. Incision Scalpel (B.P. No. 3 + Blade No. 15) Envelope or 3-cornered flap incision

2. Flap Reflection Molt No. 9 Periosteal Elevator Reflect mucoperiosteum fully off bone

3. Retraction Minnesota Retractor + Austin Retractor Buccal + lingual/mesial retraction

4. Bone Removal Surgical handpiece + Round bur No. 8 Remove buccal bone plate over impacted crown
Rongeur Forceps + Bone File

5. Tooth Delivery Warwick James (Straight + Curved) Luxate tooth; section if needed
Cryer East & West Elevators

6. Socket Curette Cryer or Lucas Curette Remove follicle, granulation tissue

7. Irrigation Irrigation Syringe + Suction Tip Copious saline irrigation

8. Haemostasis Mosquito Forceps + Gauze pack Control any vessel bleeding

9. Closure Needle Holder + Adson Forceps 2–3 interrupted sutures

Dean Scissors + 3-0 Vicryl or Silk

Doyen Mouth Gag / Jennings Mouth Gag

Also known as: Self-Retaining Mouth Retractor / Mouth Gag

Parts/Description:
• Scissor-type with ratchet locking
• Bite plates at terminal end — upper and lower
Mouth Gag • Padded bite blocks to prevent dental injury
• Jennings: wider opening range; Doyen: more compact

Uses:
• Maintaining mouth open under general anaesthesia
• Long surgical procedures requiring sustained access
• When patient unable to cooperate (GA or sedation)
• Third molar surgeries, cyst enucleations under GA
Note: Mandatory instrument under GA. Must be counted in sponge and
instrument count. Protect teeth with soft bite pads.

For educational purposes — Dental Undergraduate Reference — 19 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

Lucas Bone Curette

Also known as: Volkmann Curette / Socket Curette

Parts/Description:
• Spoon-shaped working end with sharp edges
• Double-ended (small and large)
Curette/Bone File • Available in straight or curved forms
• Solid stainless steel handle

Uses:
• Curettage of dental follicle around impacted tooth
• Removing granulation tissue from socket
• Cleaning pathological tissue from extraction socket
• Periapical curettage in minor surgeries
Note: Use with careful controlled circular motion. Do not perforate the thin lingual
plate or floor of maxillary sinus.

For educational purposes — Dental Undergraduate Reference — 20 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

CHAPTER 6
Accessory & Miscellaneous Instruments

Tongue Depressor / Broad Retractor

Also known as: Weider Tongue Depressor

Parts/Description:
• Broad flat blade with serrated edges
• T-bar or flat handle
Retractor • Stainless steel, autoclavable

Uses:
• Retraction of tongue during lower molar procedures
• Protection of lingual nerve during bone drilling
• Soft tissue retraction in floor of mouth surgeries
Note: Always place lingual retractor before any drill is used in lower molar region
to protect lingual nerve.

Cheek Retractor (Minnesota / Farabeuf)

Also known as: Broad-Bladed Cheek Retractor

Parts/Description:
• Flat, broad curved blade
• Handle angled for single-handed grip
Retractor • Various sizes for different access needs

Uses:
• Buccal access in posterior maxillary region
• Cheek retraction for upper molar procedures
• Retracting cheek and lip for anterior flap access
Note: Use padded or smooth versions around parotid papilla area to avoid
Stensen's duct injury.

Haemostat Clip / Rochestor Clamp

Also known as: Rampley Swab Holding Forceps

Parts/Description:
• Long-handled clamp with ring handles and ratchet
• Serrated jaws
Haemostat • Available straight or curved, 18–22 cm

Uses:
• Holding swabs and gauze in surgical field
• Haemostasis
• Holding drains
• Sponge delivery in deep field
Note: Identify and count all swabs before and after surgery to prevent retained
foreign bodies.

For educational purposes — Dental Undergraduate Reference — 21 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

@[Link]

CHAPTER 7
Instrument Tray Setups by Procedure

Summary of Procedure-Specific Instrument Kits

Procedure Essential Instruments

Simple Extraction Upper/Lower Forceps (appropriate), Coupland No. 1 & 2, Warwick James Set, Mouth Prop, Gauze
(Single tooth)

Surgical Extraction All above + Scalpel + Molt Elevator + Rongeur + Bone File + Needle Holder + Suture
(Impacted Premolar / Ankylosed)

Lower Third Molar Scalpel, Molt, Minnesota Retractor, Austin, Warwick James Set, Needle Holder, Scissors, Suture
Impaction (Soft Tissue)

Lower Third Molar All soft tissue kit + Surgical Handpiece + Round Bur + Cryer East & West + Rongeur + Bone File + Cure
Impaction (Bony)

Upper Third Molar Scalpel, Molt, Farabeuf Retractor, Bayonet Forceps, Straight Warwick James, Curette, Suture
Impaction

Minor Oral Surgery Scalpel, Adson Tissue Forceps, Austin Retractor, Mosquito Forceps, Needle Holder, Scissors, Suture, C
(Cyst / Biopsy / Frenectomy)

Alveoloplasty Scalpel, Molt, Rongeur Forceps, Bone File, Irrigation Syringe, Needle Holder, Suture

Incision & Drainage Scalpel No. 11 blade, Mosquito Haemostat, Drain (corrugated/Penrose), Irrigation Syringe, Suture (1–2
(Abscess)

For educational purposes — Dental Undergraduate Reference — 22 —

ORAL & MAXILLOFACIAL SURGERY — INSTRUMENTS ATLAS Ref: Fragiskos D. Fragiskos — Oral Surgery

CHAPTER 8
Sterilisation & Maintenance Notes

Sterilisation Methods for OMS Instruments

Method Parameters Suitable For Limitations

Autoclaving 134°C / 3 min All metal OMS instruments, handpieces, needle

Not for
holders,
heat-sensitive
forceps items. May dull fine edges
(Steam under pressure) or 121°C / 15 min

Dry Heat Sterilisation 160°C / 60 min Metal instruments, glass syringes Longer cycle. Not for rubber/plastic. Slower pen
or 180°C / 30 min

Chemical (Cold) Sterilisation2% Glutaraldehyde Items that cannot withstand heat Requires thorough rinsing. Toxic — needs vent
8–10 hours immersion (e.g., some handpieces)

EO Gas Sterilisation 50–60°C, 2–5 hours Delicate heat-sensitive items, plastics Long aeration required (8–12 hrs). Toxic residu

@[Link]
Instrument Maintenance Guidelines
• Rinse all instruments in cold water immediately after use to prevent blood/tissue drying.
• Ultrasonic cleaning for 3–5 minutes before sterilisation to remove organic debris from joints and serrations.
• Inspect all ratchets, joints, and box-locks for smooth function before and after each sterilisation cycle.
• Apply instrument milk / lubricant to all hinged instruments (needle holders, forceps, haemostats) monthly.
• Damaged, pitted, or corroded instruments must be immediately removed from clinical use.
• Cutting edges (chisels, curettes, blades) must be resharpened or replaced when dull.
• Store autoclaved instruments in sealed sterile pouches; label with sterilisation date.
• Shelf-life for autoclaved instruments in sealed pouches: 6 months (non-woven) / 1 month (cloth wrap).

REFERENCES & BIBLIOGRAPHY

1. Fragiskos D. Fragiskos (Ed.) — Oral Surgery. Springer-Verlag Berlin Heidelberg, 2007.

2. Killey HC, Seward GR, Kay LW — An Outline of Oral Surgery. Part I. Wright PSG, 1975.
3. Peterson LJ — Principles of Oral and Maxillofacial Surgery. 2nd Ed. BC Decker, 2004.
4. Pedlar J, Frame JW — Oral and Maxillofacial Surgery: An Objective-Based Textbook. Churchill Livingstone, 2007.
5. Kruger GO — Textbook of Oral and Maxillofacial Surgery. 6th Ed. CV Mosby, 1984.
6. Cawson RA, Odell EW — Cawson's Essentials of Oral Pathology and Oral Medicine. 8th Ed. Churchill Livingstone, 2008.
7. Laskin DM — Oral and Maxillofacial Surgery. CV Mosby, 1980.

DISCLAIMER
This atlas is intended for educational use by undergraduate dental students and interns.

For educational purposes — Dental Undergraduate Reference — 23 —