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Armamentarium in implantology

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Dr. Khushbu Samani
Dr. Khushbu Samani

This document lists and describes various instruments used in implant dentistry for incising and reflecting soft tissues, removing bone and tissue, grafting, retracting tissues, and drilling osteotomies. Key instruments include scalpels and blades for incisions, periosteal elevators and forceps for tissue reflection and grasping, rongeurs and burs for bone removal, bone scrapers and grafting tools for harvesting and placement of grafts, and osteotomes and piezosurgery units for bone modification and cutting. Proper instrumentation is essential for achieving optimal surgical outcomes in dental implant procedures.

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Armamentarium in Implantology
Instruments to Incise Tissue Scalpel and Surgical Blades Most common: #3 Salpel and #15 or #15c Blade #15 blade- short, rounded cutting edge #12 blade- pointed and crescent shaped; mainly used around teeth or in difficult access areas
Instruments to Reflect Tissue Reflect mucosa and periosteum to expose bone after incision Molt periosteal elevator #9 2/4 Molt elevator; more effficient instrument positioned in a dished out fashion. Tissue can be reflected three different ways: (1) prying motion pointed end used in a prying motion to elevate the soft tissue; (2) push stroke used after full thickness incision to slide underneath the flap; (3) pull or scrape stroke used to remove tissue tags from the bone in a scraping motion
Instruments to Grasp Tissue Used to stabilize soft tissue flaps Adson forceps: have small teeth or serrations Used to grasp and stabilize soft tissue flaps during suturing Allison forceps: larger and more aggressive teeth used to hold heavy or high tension tissue; rarely used in implant dentistry
Instruments to remove Bone /Tissue Rongeur forceps Sharp edged, scoop shaped tip used for snipping away the bone Spring between the handles increases the magnitude of forces Double action rongeur generates more force then Single action rongeur
Surgical burs: Always used with irrigation Cross cut fissure burs : make pilot holes in bone Special reduction burs for Alveoloplasty Straight hand piece
Bone file Double ended serrated instrument used to remove sharp, spiny ridges within bone
Instruments to remove tissue from extraction sockets or Bony defects Surgical currette: is spoon shaped and have sharp edges that allow scraping of the bony walls. Eg. Lucas 86 Currette scraping removes soft tissue, will also initiate the regional acceleratory phenomenon (RAP) Regional acceleratory phenomenon is a local response to noxious stimulus by which tissue forms faster than normal regional regeneration process.
Bone grafting instruments Bone scrapers: used to harvest autogenous bone from the oral cavity and deliver the collected bone particles to the surgical site. These instruments consist of a harvesting blade and collection chamber
Grafting spoon and condenser:
Surgical scissors Used to cut tissues or sutures and spread tissue Dean : angled blades that are 3cm from midscrew They have one serreted blade with slight curved handle Easy acess to cut sutures and remove diseased tisssue
Iris : very small, extremely sharp scissors with fine tip used for precision cutting Metzenbaum: for delicate tissue and blunt dissection
Hemostats Has serrated tips that allow for clamping of tissue or small materials Used to constrict blood vessels, retrieve loose objects in the oral cavity and securely hold small items
Instruments to Retract Tissue Used to hold back cheek, tongue or flap which permit visibility to the surgical site. Mouth mirror Weider tongue retractor: broad, heart shaped with grooves and perforations Seldin retractor: double ended with round blunt end; used to retract tissue flap after incision Minnesota retractor
Misch Spoon cheek and tongue retractor: ergonomically designed to reduce hand fatigue Sinus graft cheek retractor: broad based flap retractor that reduces force to the infraorbital foramen area.
Instruments to hold mouth open Bite block Molt mouth prop: ratchet designed instrument that allows variation of opening Orringer retractor: spring loaded mouth prop which maintains upper and lower soft tissue retraction
Instruments to hold drapes Towel clamp: non perforating clamp used to secure instruments and surgical materials, such as suction tubing to the surgical drapes
Handpiece and Motors Surgical motor console: console, foot pedal, and motor cord
Handpiece 1:1 handpiece: usually straight handpiece 40,000 - 50,000 RPM Used for bone grafting procedures 20:1 handpiece: contraangle reduction implant handpiece to drill osteotomies and place implants
Piezosurgery units: selectively cuts mineralized tissue without damaging soft tissue Uses high frequency vibration 25-35 kHz Advantages: high precision accuracy, minimal thermal damage, increased healing and less soft tissue trauma. Uses: atraumatic extractions, removal of implants, bone grafting procedures and sinus augmentation procedures
Osteotomes Sinus osteotome: used to raise floor of maxillary sinus Offset osteotomes to increase osteotomy diameter Straight osteotome for bone spreading

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Armamentarium in implantology

  • 2. Instruments to Incise Tissue Scalpel and Surgical Blades Most common: #3 Salpel and #15 or #15c Blade #15 blade- short, rounded cutting edge #12 blade- pointed and crescent shaped; mainly used around teeth or in difficult access areas
  • 3. Instruments to Reflect Tissue Reflect mucosa and periosteum to expose bone after incision Molt periosteal elevator #9 2/4 Molt elevator; more effficient instrument positioned in a dished out fashion. Tissue can be reflected three different ways: (1) prying motion pointed end used in a prying motion to elevate the soft tissue; (2) push stroke used after full thickness incision to slide underneath the flap; (3) pull or scrape stroke used to remove tissue tags from the bone in a scraping motion
  • 4. Instruments to Grasp Tissue Used to stabilize soft tissue flaps Adson forceps: have small teeth or serrations Used to grasp and stabilize soft tissue flaps during suturing Allison forceps: larger and more aggressive teeth used to hold heavy or high tension tissue; rarely used in implant dentistry
  • 5. Instruments to remove Bone /Tissue Rongeur forceps Sharp edged, scoop shaped tip used for snipping away the bone Spring between the handles increases the magnitude of forces Double action rongeur generates more force then Single action rongeur
  • 6. Surgical burs: Always used with irrigation Cross cut fissure burs : make pilot holes in bone Special reduction burs for Alveoloplasty Straight hand piece
  • 7. Bone file Double ended serrated instrument used to remove sharp, spiny ridges within bone
  • 8. Instruments to remove tissue from extraction sockets or Bony defects Surgical currette: is spoon shaped and have sharp edges that allow scraping of the bony walls. Eg. Lucas 86 Currette scraping removes soft tissue, will also initiate the regional acceleratory phenomenon (RAP) Regional acceleratory phenomenon is a local response to noxious stimulus by which tissue forms faster than normal regional regeneration process.
  • 9. Bone grafting instruments Bone scrapers: used to harvest autogenous bone from the oral cavity and deliver the collected bone particles to the surgical site. These instruments consist of a harvesting blade and collection chamber
  • 10. Grafting spoon and condenser:
  • 11. Surgical scissors Used to cut tissues or sutures and spread tissue Dean : angled blades that are 3cm from midscrew They have one serreted blade with slight curved handle Easy acess to cut sutures and remove diseased tisssue
  • 12. Iris : very small, extremely sharp scissors with fine tip used for precision cutting Metzenbaum: for delicate tissue and blunt dissection
  • 13. Hemostats Has serrated tips that allow for clamping of tissue or small materials Used to constrict blood vessels, retrieve loose objects in the oral cavity and securely hold small items
  • 14. Instruments to Retract Tissue Used to hold back cheek, tongue or flap which permit visibility to the surgical site. Mouth mirror Weider tongue retractor: broad, heart shaped with grooves and perforations Seldin retractor: double ended with round blunt end; used to retract tissue flap after incision Minnesota retractor
  • 15. Misch Spoon cheek and tongue retractor: ergonomically designed to reduce hand fatigue Sinus graft cheek retractor: broad based flap retractor that reduces force to the infraorbital foramen area.
  • 16. Instruments to hold mouth open Bite block Molt mouth prop: ratchet designed instrument that allows variation of opening Orringer retractor: spring loaded mouth prop which maintains upper and lower soft tissue retraction
  • 17. Instruments to hold drapes Towel clamp: non perforating clamp used to secure instruments and surgical materials, such as suction tubing to the surgical drapes
  • 18. Handpiece and Motors Surgical motor console: console, foot pedal, and motor cord
  • 19. Handpiece 1:1 handpiece: usually straight handpiece 40,000 - 50,000 RPM Used for bone grafting procedures 20:1 handpiece: contraangle reduction implant handpiece to drill osteotomies and place implants
  • 20. Piezosurgery units: selectively cuts mineralized tissue without damaging soft tissue Uses high frequency vibration 25-35 kHz Advantages: high precision accuracy, minimal thermal damage, increased healing and less soft tissue trauma. Uses: atraumatic extractions, removal of implants, bone grafting procedures and sinus augmentation procedures
  • 21. Osteotomes Sinus osteotome: used to raise floor of maxillary sinus Offset osteotomes to increase osteotomy diameter Straight osteotome for bone spreading