The operating room of a hospital or ambulatory setting is quite different from a private practice (Fig. 56-1). To acquire permission from a hospital to use its clinical facility, the oral surgeon must submit an application for privileges to practice at a particular institution. The hospital will then grant privileges to the oral surgeon on the basis of his or her training, competency, and experience.

The environment is spacious enough to accommodate the (1) operating table, (2) anesthesiology equipment, (3) mobile surgical trays, holding instruments, and supplies, (4) overhead lighting, (5) monitoring equipment, and (6) standing room for the surgeon, surgical assistant, roving assistant, and anesthesiologist.

Periosteal elevators are available in many designs but are used to perform the same basic function (Fig. 56-2): to reflect (separate) and retract the periosteum from the surface of the bone. Before a surgical forcep is placed around the tooth, the dentist uses a periosteal elevator to detach the gingival tissues from around the cervix (neck) of the tooth.

Straight elevators are used to apply leverage against the tooth to loosen it from the periodontal ligament and ease the extraction (Fig. 56-3). Additional uses include removal of residual root fragments and removal of teeth that have been sectioned with a surgical handpiece and bur.

Root tip picks are instruments used for the removal of root tips or fragments that may break away from the tooth during the extraction procedure (Fig. 56-4).

Universal forceps are designed to allow the surgeon to use the same instrument for the left and right sides of the same arch, as well as for a specific tooth. Figure 56-5 covers forceps commonly used for specific areas of the mouth.

The surgical curette resembles a large spoon excavator. It is a double-ended, scoop-shaped instrument with sharp edges that allow for a scraping motion. Curettes are used following the extraction to scrape the interior of the socket to remove diseased tissue or abscesses. Curettes come in varying sizes, and the shanks may be straight or angled to reach different areas of the mouth (Fig. 56-6).

The rongeur is similar in its size to the forceps, and the design resembles that of fingernail clippers. The rongeur has a spring between the handles and the blades with sharp cutting edges. The blades of the rongeur may be end cutting or side cutting, depending on the design (Fig. 56-7).

The rongeur is used to trim alveolar bone. It is widely used after multiple extractions to eliminate sharp projections and to shape the edentulous ridge. The beaks of the rongeur must be kept clean during the procedure. As necessary, the dentist holds the instrument toward the assistant with the beaks open. The assistant then carefully removes the debris by wiping the beaks with a sterile gauze sponge.

The bone file is used with a push-pull motion to smooth the surface of the bone after the rongeur has removed most of the undesirable bone. Bone files also can be used to smooth rough margins of the alveolus after an extraction. The working ends of bone files are very rough and are available in a variety of shapes and sizes (Fig. 56-8).

The scalpel is a surgical knife used to make a precise incision into soft tissue with the least amount of trauma to the tissue. The size and shape of the blade selected depend on the procedure that is being performed and on the dentist’s preference (Fig. 56-9). Disposable scalpels have plastic handles with metal blades and are supplied in sterile sealed packages. These instruments are designed to be used once and then discarded into the “sharps” container. Care must be taken to avoid injury while the blades are attached and removed. The use of a mechanical scalpel blade remover helps avoid injury during the removal of scalpel blades.

Hemostats are multipurpose instruments that are used to grasp and hold things. During oral surgery, a hemostat is used to grasp soft tissue, bone, and tooth fragments that have been removed during the procedure. A hemostat has grooves in its beak that are used for grasping and holding. The handles have a mechanical lock that holds an object or tissue securely within the beaks (Fig. 56-10). These instruments are available in a variety of sizes, with straight and curved beaks and with handles of different lengths.

The needle holder looks and operates similarly to a hemostat. The beaks are straight with cross-pattern serrations on the surface, allowing the surgeon to grasp a suture needle firmly (Fig. 56-11). The handles are held in place by a ratchet action that holds an object until the dentist releases it. This handle design allows the dentist to tie the suture material by using the needle holder without snagging it in the joint of the instrument.

Surgical scissors are available with straight or curved blades that have smooth or serrated cutting edges (Fig. 56-12). The handles range in length from approximately to inches. These delicate scissors are used to trim soft tissue. Surgical scissors should never be used for nonsurgical tasks that would dull the cutting surfaces.

Suture scissors are designed to cut only suture material. Although similar in des/>