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Surgical instruments are at the heart of general and specialty medical and dental care. Hemostats and root forceps are two of the most valuable instruments in the two specialties. Despite shape differences, use, and application, both instruments are the intersection point in precision, effectiveness, and security in clinical practice. Their anatomic form, ergonomic shape, and functional versatility render them indispensable instruments in the armamentarium in surgery.
Hemostats have continued to be a component of surgery since
the beginning of operative medicine. Since the word is Greek, with
"haima" (blood) and "stasis" (stop), hemostats are applied
nearly exclusively for the very purpose of occluding vessels in an effort to
minimize intraoperative blood loss.
• Prior models were referred to in Roman texts on surgery.
• Ambroise Paré (1510–1590), one of the earliest French
surgeons, used primitive clamps in early ligature operations.
• The 19th century refined the design with Jules-Émile Péan and
William Halsted, who later refined the design.
Basic Classification of Hemostats
Small: Mosquito forceps
Medium: Kelly, Crile hemostats
Large: Rochester-Carmalt
Straight tips
Curved tips
Right-angled tips
Horizontal
Longitudinal
Cross-hatched
Hemostasis (vascular)
Tissue holding
Blunt dissection
Modern hemostats are the culmination of gigantic metallurgical
and ergonomic developments, finely tuned to function under stressful
operational conditions without inducing tissue trauma.
Serrated to prevent vessels
Typically blunt-tipped to prevent puncture
Ratchet lock mechanism
Facilitates graduated force of clamping
Typically circled by fingers
Weighted to provide leverage and control
Material Considerations
Grade 410 and 420 for high hardness
Corrosion resistance is needed for repeated sterilization
Light in weight and non-magnetic
Used in ophthalmic or neurosurgical hemostats
Used in electrosurgery to avoid thermal conduction.
Hemostats are essential in and of themselves in almost all
cases — from general surgery to subspecialties such as cardiovascular,
orthopedic, and plastic surgery.
• Clamping small vessels before ligation
• control of bleeding in deep cavities
• temporary retention of sutures and operating thread
• Blunt dissection by opening and closing jaws in planes of
dissection
• In appendectomy: Clamping of vessels of mesoappendix
• In thyroidectomy: Clamping of the superior thyroid artery
• In trauma surgery: Temporary blood vessel occlusion
Root Forceps are endodontic extractors used to remove and engage roots and root segments of teeth. They have an anatomical space accessible design with adequate grip and control.
• Endodontic failure by apical root extraction
• Root fragment removal without adjacent bone loss
•Can be utilized in alveolar surgery or a replantation procedure on the schedule
Design of root forceps is specialized but adaptable,
conforming to the shape and form of different roots.
tapering, narrow, pointed
Altered to seat upon the contact area of the root without crushing
Opposes hard closure movement with minimal user force
increasingly curved to offer greater access to posterior
regions
• Usually forged in hardened surgical stainless steel
• Can be sandblasted or serrated on the surface to improve grip.
Root forceps vary significantly based on their recommended
location within the oral cavity.
No. 150 (universal)
No. 286 (Bayonet-shaped for root tips)
No. 151 (universal)
Cowhorn (No. 23) for molar roots
• Universal vs. regional
• Pediatric vs. adult
• Surgical vs. routine extraction forceps
Root extractions of teeth require a balance between control
and force to avoid alveolar trauma.
• Root tip fracture or remaining root tips in a crown fracture
case
• Brittle roots endodontically treated teeth, removal of
• Surgical extraction of third molars having diverging roots
• Elevator luxation before forceps application
• Sectioning of periodontal ligament by periotomes
• Rotatory or bucco-lingual rocking motion
Although both are grasp instruments, the shape and use
setting are different.
Fine serrations, locking mechanism
Used to hemostasis and clamping
Strong beaks to grip
To remove tooth roots
• Stainless steel construction
• Need to be sterilized
• Ergonomic handles
Infection control is achieved by rigid sterilization
practices on all reusable instruments.
• Pressure steam (autoclaving)
• Dry heat sterilization
• Immersion chemical (glutaraldehyde or hydrogen peroxide)
• Heat-sensitive equipment plasma sterilization
• Soaking in enzymatic cleaners before use
• Hand scrubbing of hinges and serrations
• Lubrication of jointed instruments
• Check for rust or visibility of cracks
Ergonomics has a vital part to play in minimizing the
fatigue of users and maximizing clinical results.
•Optimal weight distribution
•Textured handles to avoid slipping
•Angulation to suit the anatomy of the hand
•Resistance to corrosion
•Non-glare surface to avoid glare
•Biocompatibility
Inadequate instrument use compromises the practitioner and the patient.
•Mannequin or extracted tooth simulation training
•Gradual step-by-step instructions under supervision
•Detection of tactile response
•Detection of tissue difference
Technology continues to enhance the safety and efficacy of
surgical instruments.
•Electrosurgical hemostats: Clamping and coagulating vessels
in a single motion
•Titanium-coated forceps: Lightweight and MRI-compatible
•3D-printed custom forceps: For maxillofacial procedures
•Color-coded instruments: Visually easy to identify
Although common in dental and surgical procedures, hemostats
and root forceps are not weak. They result from material wear and tear,
anatomical differences, and misuse.
• Misuse of instruments with tissue damage as a result
• Metal fatigue causing snapping off thin tips or sticking
at joints
• Being impossible for posterior roots to be reached by routine forceps
• Slipping due to faulty serration or roughened surface
• In calcified root canals or extreme root curvature
• Highly closed surgical fields
• Patients with limited oral aperture (trismus)
• Hemostasis failure in coagulopathic patients
Patient safety is linked with the use, sterilization,
and treatment of the instrument.
• Daily inspection of instruments before use and
sterilization
• Hemostatic locking mechanism testing
• Prevention of the application of too much force during root luxation
• Use of the correct fit of forceps to the tooth being removed or the fragment to be removed
• Daily instrument training for staff
• Operating room tray checklists
• Detection and removal of broken practice instruments.
Identification of instrument failure or fatigue warning
signs will enable intraoperative injury prevention.
• Nonlocking or slippage of ratchet lock
• Maladjustment of the hemostat jaw
• Forceps tips chipping and forceps blunting
• Corrosion causing fracture of the metal joint
• Replacement during intra-operative course
• Realignment and sharpening refurbishment
• Routine checking of instrument condition
Hemostats and root forceps are hallmark tools of the modern
clinical discipline, meeting in the sphere of surgical aesthetics and
therapeutic force. Anatomical knowledge is far from being a sole qualification
to their utilization, but technical competence, awareness of constraints, and a
policy of adhering to upkeep procedures are necessary for their proper use.
Recommendations for Best Practice
•Apply the proper size and shape of the instrument to each procedure
•Adopt a strict regimen of sterilization for upholding
biocompatibility
• Strict training in handling is provided
•In regard to the newest technology in the design of instruments
•Equipment is replaced or serviced at regular periods in order to prevent complications.
Typically, seeming simple in looks, the forceps and hemostat of the root are high-technology in operation. They are powerful with the harmonious coordination of skilled fingers, precise technique, and well-maintained tools.
Written by: Beauty Teck
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