DH101 Preclinical Sciences Instrumentation (Posterior)

DH101 Preclinical SciencesInstrumentation (Posterior)

Lisa Mayo, RDH, BSDH

Staci Janous, RDH, BS

Concorde Career College TXSAN

Objectives Sickle Scaler 204S Universal Curette 13/14 and Barnhart Gracey Curette 11/12 & 13/14

Reminder:

Strokes for scaling = short, controlled, overlapping

Strokes for assessing = long, light, overlapping

Resources

Wilkins CH 38

Nield CH 13, 14, 15, 16, 21

Sickle Scaler 204S Used on enamel surfaces only Remove calculus deposits from crowns of posterior teeth Working-End

1. Pointed back

2. Pointed tip: face converges w/ 2 lateral surfaces to form the tip, sharp point

3. Triangular cross section: 70-80° internal angles

4. Two cutting edges w/ curved blade

5. Face is perpendicular and flat (between cutting edges)

Nield p.331

Sickle Scaler 204S (same as Ant Sickle)

70-80°

Nield p.332

Sickle Scaler 204SSame as Ant Sickle

Nield p.332

Sickle Scaler 204S All 4 cutting edges are used for calculus removal

Paired instrument that are mirror images of one another One side adapt from the F and the other from the L

Nield p.344

Sickle Scaler 204SCutting EdgesNield p.344

Scaler 204SANGULATION

Angle formed by the working end of an instrument with the surface to which the instrument is applied for treatment

Insertion angulation = 0◦ Angulation needed to remove calculus without causing tissue

trauma = 70◦

Nield p.343

Sickle Scaler 204SGET YOUR TYPODONT & 204S

Nield p.345

Sickle Scaler 204S TechniqueNield p.345

Sickle Scaler 204SNield p.334

Sickle Scaler Reference: Ant & 204S Summary Use of Sickle Scalers• Remove med-lg size calculus deposits from the crowns of teeth• Pointed tip provides good access to proximal surfaces apical to the contact areas of

teeth• NOT recommended for use on root surfacesBasic Concepts• Tilt lower shank toward tooth surface to establish correct angulation: operator

MUST force the instrument into a 70-80 angle• Adapt TIP 1/3 of cutting edge of tooth• Activate calculus removal stroke using wrist motion activation• Relax your fingers between each calculus removal stroke

Posterior Teeth• Begin at DF line angle of the post-most tooth in the quadrant and work toward the

D surface• Reposition at the DF line angle and complete the F/L and M surfaces of tooth

working toward the front of the mouth

Assessment in Clinic 204SINSTRUMENT ASSESSMENT

Sickle Scaler 204S

Student Name: _______________________________________ Date: ___________ Instructor Name: ________________________________ Grade: ___________ 17 = ________% Total Points Students: By requesting this evaluation, you have determined that you can complete the following skills with little or no instructor assistance and with a passing score of 75% or above.

Point Value: 1 0

1. Uses Modified Pen Grasp 2. Wrist is not bent 3. Establishes a stable fulcrum 4. The handle of the instrument is parallel with the long axis of the tooth

5. First placement on tooth is DL or DF 6. Cutting edge in contact with tooth at all times 7. Angulation of blade is correct 8. Instrument used on correct teeth/areas 9. Strokes are oblique or vertical 10. Strokes extend to interproximal 11. Strokes are controlled, short and overlapping 12. Effectively removes deposits. 13. Positions light correctly for mandible/maxilla 14. Uses mirror appropriately 15. Operator maintains correct posture 16. Uses gauze to wipe debris off instrument *17. Utilizes proper infection control protocol TOTAL POINTS:

Universal Curette 13/14 Uses

1. Remove small – med size deposits both SUB-G and SUPRA-G

2. Crown and root surfaces ant and post (for this class, we will only be using on posterior teeth until your skills are more developed and you can safely use on ant)

Design

1. Double-ended instrument w/paired, mirror-image working-ends

2. Rounded back

3. Rounded toe

4. Semi-circular cross section

5. 2 parallel cutting edges on a curved blade

6. Face is at 90° angle to lower shank = 2 cutting edges are level with one another and can be used for calculus removal. Flat in cross-section and curved lengthwise

7. 70-80° internal angles where lateral surfaces meet the face

Nield p.357

70-80◦

Nield p.358

Universal Curet 13/14

Universal Curette 13/14Nield p.358

Universal Curettes Curettes come in different sizes and lengths

Nield p.359

Nield p.360

Universal Curette 13/14WORKING END

Selecting the Correct Working End: LOWER SHANK POSITION

Nield p.362

Universal Curette 13/14

Operator MUST force the instrument into a 70-80◦

angulation

Nield p.364

Universal Curette 13/14ANGULATION

Nield p.364

Universal Curette 13/14ANGULATION

Nield p.364

Universal Curette 13/144 Cutting edges like sickle’s

Nield p.365

Universal Curette 13/14GET YOUR TYPODONT

Nield p.366

Initial Insertion ALWAYS zero degrees for ALL instruments!

Nield p.366

After done distal, then scale mesial

Nield p.368

Scaling the Interprox

Nield p.370

Universal Curette 13/14 Adaptation to F/L root surfaces of mandibular post teeth is

challenging Clinician’s hand position may block the view of mandibular

lingual surfaces Rounded posterior crowns make it difficult to instrument

the root surfaces of these teeth

Height of Contour on Molars

Crown protrudes over & overhangs the root surface

Universal Curette 13/14Incorrect Technique

Nield p.373

Universal Curette 13/14Incorrect Technique

Nield p.373

Universal Curette 13/14Correct Technique

Nield p.374

Universal Curette 13/14Correct Technique

Nield p.374

Instrument Assessment Curette 13/14INSTRUMENT ASSESSMENT

Universal Curet 13/14

Point Value: 1 0

Universal CuretsBarnhart

Barnhart Names for University of Southern California where was

developed by DH faculty Universal Curet 2 cutting edges, rounded toe Thin, sharp cutting edge Longer shank & blade than Columbia 13/14

More effective at times on interproximal molars Uses

Slips easily under tight tissues Light to mod calculus both supra and sub-g

Gracey 11/12 & 13/14Area-Specific Instruments

Nield p.387

Gracey 11/12 & 13/14 All Gracey’s are called “Area-Specific Curets” Remove light to moderate calculus deposits from the crowns and roots of

teeth To instrument all surfaces of posterior teeth – will need to use both sides of

the instrument Characteristics of all Gracey’s

1. Face is tilted in relation to lower shank: 70° and one cutting edge lower then the other

2. Only one cutting edge per working-end

3. Long, complex functional shank

4. Rounded back

5. Rounded toe

6. Semi-circular cross section

Nield p.387

Gracey 11/12 & 13/14

70-80°

Nield p.388

Gracey 11/12 & 13/14Nield p.388

Gracey 11/12 & 13/14 Tilted face causes one cutting edge – “working cutting edge” –

to be lower than the other cutting edge on each working end Side in contact with tooth to remove deposits

Nonworking edge is too close to the lower shank to be used for calculus removal and is the “higher” edge Side in contact with tissue

Gracey’s

Nield p.392

Gracey

11/12 13/14

DistalMesial

Nield p.398

Gracey: Correct Working-EndNield p.399

GET YOUR TYPODONT & G13/141st Mand Molar

Gracey 13/14

Gracey 13/14NIELD p.400

GET YOUR TYPODONT & G11/121st Mand Molar

Gracey 11/12

Notice how much MORE of the tooth you cover with 11/12 than 13/14!

NIELD p.402

Assessment in Clinic GraceyINSTRUMENT ASSESSMENT

Gracey 11/12

Point Value: 1 0

Gracey Root Debridement Strokes

NIELD p.408

Gracey Horz Strokes Sub-G

NIELD p.409

Scaling Steps: IN THIS ORDER!

1. Select Correct Cutting Edge

2. Instrument Grasp: modified pen grasp

3. Stabilization: Finger Rests/Fulcrum

4. Adaptation: toe/tip 1/3 of a blade

5. Insertion: Insert at 0° angle/flat against tooth surface to base of pocket then adapt to 70°

6. Angulation: 70° for scaling to avoid Trauma to Tissue

7. Lateral Pressure: light, moderate, heavy

8. Stroke: wrist-rock with vert/horz/oblique

Instrument Angles

Instrument Selection Nield CH21 Instrument selection based on size & location of deposit

EX: Small-medium sized SUBgingival calculus

1) Universal curet

2) Area-specific curet

Lighter Deposits Subgingival

Heavier Deposits Subgingival

WHICH INSTRUMENT WOULD YOU USE?

Instrument Selection Nield CH21

Angulation & Calculus Removal Nield CH13

Calculus Removal Stroke1. Assess & find the calculus deposit

2. Cup the calculus with the face of the instrument

3. Stroke: lock toe-third against the tooth surface, open face to 70 degrees & stroke AWAY from the base of the pocket

Nield p.320

Nield p.321

Errors in Angulation Will burnish or injure tissue Angles more than 90◦ = 1 cutting edge will be in contact

with tissue

Errors in Angulation Angles less than 45◦ = cutting edge slides over deposit

rather than biting into it (burnish calculus) Nield p.324

Nield p.325

DH101 Preclinical Sciences Instrumentation (Posterior)

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