Fig. 4.12. Luer–Friedmann rongeur forceps with side-cutting/end-cutting edge

Fig. 4.13. Double-ended bone file with small and large ends

Fig. 4.14 a–c. Surgical mallet and chisels. a Partsch monobevel chisel. b Lucas chisel with concave end.

c Lambotte bibevel chisel

4.9

Chisel and Mallet

Mallets are instruments with heavy-weighted ends.

The surfaces of the ends are made of lead or of plastic so that some of the shock is absorbed when the mallet strikes the chisel.

The chisels used in oral surgery have different shapes and sizes. Their cutting edges are concave,

monobeveled or bibeveled (Fig. 4.14). The bibevel chisel is used for sectioning multi-rooted teeth.

4.10

Needle Holders

Needle holders are used for suturing the wound. The Mayo–Hegar and Mathieu needle holders are considered suitable for this purpose (Fig. 4.15). The first type

Fig. 4.16. Beak of the needle holder grasps a suture needle. The needle holder’s beak face is crosshatched, ensuring stability of the needle during tissue penetration

Fig. 4.15 a, b. Needle holders. a Mayo–Hegar needle holder. b Mathieu needle holder

looks similar to a hemostat and is preferred mainly for intraoral placement of sutures. The hemostat and needle holder have the following differences:

ΟThe short beaks of the hemostat are thinner and longer compared to those of the needle holder.

ΟOn the needle holder, the internal surface of the short beaks is grooved and crosshatched, permitting a firm and stable grasp of the needle (Fig. 4.16), while the short beaks of the hemostat have parallel grooves which are perpendicular to the long axis of the instrument.

ΟThe needle holder can release the needle with simple pressure, because of the gap in the last step of the locking handle, whereas the hemostat requires a special maneuver, because it does not have that gap in the last step of the locking handle.

Fig. 4.18 a, b. a Standard suture scissors. b Goldman–Fox soft tissue scissors

Fig. 4.19 a, b. a Blunt-nosed Metzenbaum soft tissue scissors. b Lagrange soft tissue scissors

The correct way to hold the needle holder is to place the thumb in one ring of the handle and the ring finger in the other. The rest of the fingers are curved around the outside of the rings, while the fingertip of the index finger is placed on the hinge or a little further up, for better control of the instrument (Fig. 4.17).

4.11 Scissors

Various types of scissors are used in oral surgery, depending on the surgical procedure. They belong to the following categories: suture scissors and soft tissue scissors (Figs. 4.18, 4.19). The most commonly used scissors for cutting sutures have sharp cutting edges, while Goldman–Fox, Lagrange (which have slightly upward curved blades), and Metzenbaum are used for soft tissue. Lagrange scissors are narrow scissors with sharp blades and are mainly used for removing excess

gingival tissue, while the Metzenbaum are blunt-nosed scissors and are suitable for dissecting and undermining the mucosa from the underlying soft tissues. Scissors are held the same way as needle holders (Fig. 4.20).

4.12

Towel Clamps

Towel clamps are mainly used for fastening sterile towels and drapes placed on the patient’s head and chest, as well as for securing the surgical suction tube and the tube connected to the handpiece with the sterile drape covering the patient’s chest (Fig. 4.21).