Surgical Instruments

Periodontal surgery is accomplished with numerous instruments; l ig. 4I-4.X shows a typical surgical cassette. Periodontal surgical instruments are i lassitied as follows:

1. Incisional and incisional instruments

2. Surgical curettes and sickles A. Periosteal elevators

4. Surgical chisels

5. Surgical files

6. Scissors

7. Hcmostats and tissue forceps

Surgical Curettes

Fig. 41-48 Instrument cassettes for periodontal surgery. Cassettes shown in a and b .ire to be used together for involved cases, while the cassette shown in c is a reduced set for simple cases. Additional instruments may be used according to individual preferences and case requirements. a, Mirror, explorer, probe, furcation probe, chisels, periosteal elevator, file, knives, surgical curette, dressing pliers, tissue pliers, aspirator tip. b, Retractor, scalpel handle, root planing curettes, universal curette, hemostat, scissors, needleholders, suture scissors, scalpel blade ┬╗omovei c, Simplified set mirror, explorer-probe, furcation probe, knives, periosteal elevator, file, root planing curettes, universal curette, chisel, scalpel handle, dressing pliers, tissue pliers, needleholder, scissors, scalpel blade remover (Courtesy Hu-Friedy Instrument Company, Chicago.)

Fig. 41-48 Instrument cassettes for periodontal surgery. Cassettes shown in a and b .ire to be used together for involved cases, while the cassette shown in c is a reduced set for simple cases. Additional instruments may be used according to individual preferences and case requirements. a, Mirror, explorer, probe, furcation probe, chisels, periosteal elevator, file, knives, surgical curette, dressing pliers, tissue pliers, aspirator tip. b, Retractor, scalpel handle, root planing curettes, universal curette, hemostat, scissors, needleholders, suture scissors, scalpel blade ┬╗omovei c, Simplified set mirror, explorer-probe, furcation probe, knives, periosteal elevator, file, root planing curettes, universal curette, chisel, scalpel handle, dressing pliers, tissue pliers, needleholder, scissors, scalpel blade remover (Courtesy Hu-Friedy Instrument Company, Chicago.)

Kirkland Knife
Fig. 41-49 Gingivectomy knives. a, Kirkland knife b, Orban interdental knife.

Excisional and Incisional Instruments

Periodontal Knives ((┬┐ingivectomy Knives).

I lie Kirkland knife is representative ol knives commonly used for gingivectomy. I hese knives can be obtained as either double-ended or single-ended instruments. The entire periphery of these kidnev-shaped knives is the cutting edge d ig. 41-40, \).

Interdental Knives. The orban knife #1-2 (Fig. 41-40. li) and the Ylerrificld knife #1.2, and 4 are examples of knives used for interdental areas. These spear-shaped knives have cutting edges on both sides of tlie blade and are designed with either double-ended or single-ended blades.

Surgical Blades. Scalpel blades of different shapes and sixes are used in periodontal surgery. I he most commonly used blades are #121), 15, and 1 S< dig. 41-50). I he #121) blade is a beak-shaped blade with cutting edges on both sides, allowing the operator to engage narrow, restricted areas with both pushing and pulling cut-ting motions. I he #15 blade is used lor thinning tlaps and tor all-around use. I he #15( blade, a narrower version of the tfls blade, is useful for making the initial, scalloping type incision. Ihe slim design of this hi,ideal-lows for incising into the narrow interdental portion of the flap. All of these blades are discarded after one use.

I lectrosurgery (Radiosurgery) Techniques and Instrumentation. I he term e/ectrosmgery or radio-surgeiy91 is currently used to identify surgical techniques performed on soft tissue using controlled high-frequency electrical (radio) currents in the range of 1.5 to 7.5 million cycles per second or megahertz d ig. 41-51). I here are three classes of active electrodes: single-wire electrodes for incising or excising; loop elec trodes lor planing tissue; and heavy, bulkier electrodes lor coagulation procedures.M-21

Periodontal Surgical Blade

Fig. 41-51 Radiosurgical (electrosurgical) unit. Dento-Surg 90 FFP (Courtesy Ellman International Inc., Hewlett, NY.)

Fig. 41-50 Surgical blades. A, frISC, 15, and 12D B, Contra-angled scalpel handle.

Fig. 41-51 Radiosurgical (electrosurgical) unit. Dento-Surg 90 FFP (Courtesy Ellman International Inc., Hewlett, NY.)

The four basic types of electrosurgical techniques are elect rosect ion, electrocoagulation, electrofulguration, and electrodesiccalion.

Flectroscction, also referred to as electrotomv or acusec-Bon, is used for incisions, excisions, and tissue planing. Incisions and excisions are performed with single-wire active electrodes that can be bent or adapted to accomplish any type of cutting procedure.

Electrocoagulation provides a wide range of coagulation or hemorrhage control obtained by using the electrocoagulation current. I lectrocoagulation can prevent bleeding or hemorrhage at the initial entry into soft tissue, but it cannot stop bleeding after blood is present. All forms of hemorrhage must be stopped first by some form of direct pressure (e.g., air, compress, or hemostat). After bleeding has momentarily stopped, final sealing of the capillaries or large vessels can be accomplished by a short application of the electrocoagulation current. The active electrodes used for coagulation are much bulkier than the fine tungsten wire used for electrosection.

Electrosection and electrocoagulation are the procedures most commonly used in all areas of dentistry. I he two monoterminal techniques, electrofulguration and electrodesiccation, are not in general use in dentistry.

The most important basic rule of electrosurgery is: always keep the tip moving. Prolonged or repeated application of current to tissue induces heat accumulation and undesired tissue destruction, whereas Interrupted application at intervals adequate for tissue cooling (5 to 10 seconds) reduces or eliminates heat buildup. Elec-trosurgery is not intended to destroy tissue; it is a controllable means of sculpturing or modifying oral soft tissue with little discomfort and hemorrhage for the patient.

The indications for elect rosurgery in periodontal therapy and a description of wound healing after electro-surgery are presented in Chapter 5.8. Llectrosurgery is

Surgical Curettes
Fig. 41-52 Kramer heavy surgical curettes ft I, 2, and 3

contraindicated for patients who have noncompatible or poorly shielded cardiac pacemakers.

Surgical Curettes and Sickles l arger and heavier curettes and sic kles are often needed during surgery for the removal of granulation tissue, fibrous interdental tissues, and tenacious subgingival deposits. The Kramer curettes #1,2, and ^ d ig. 41-52) and the Kirkland surgical instruments are heavy curettes, whereas the Ball scaler #B2-B3 is a popular heavy sickle. I he wider, heavier blades of these instruments make them suitable lor surgical procedures.

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  • elias
    Which instrument is used for interdental area?
    3 years ago

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