Periodontal instruments

1

PERIODONTAL INSTRUMENTS

GUIDED BY: PRESENTED BY:DR RUPINDER KAUR DR ANKITA DADWAL MDS 1ST YEAR

2

CONTENTS INTRODUCTION CLASSIFICATION OF PERIODONTAL INSTRUMENTS PARTS OF INSTRUMENT MOUTH MIRRORS PERIODONTAL PROBES EXPLORERS SCALERS CURETTES SONIC AND ULTRASONIC INSTRUMENTS SURGICAL INSTRUMENTS INSTRUMENT SHARPENING

INTRODUCTION Since ancient times when dental therapists

recognized the importance of removal of calculus and dental plaque as a treatment for gum disease, instruments were specifically designed to affect the procedure.

Periodontal instruments are designed for specific purposes ; such as removing calculus , planing root surfaces ,curetting the gingiva and removing the diseased tissue.

3/56

CLASSIFICATION Periodontal probes Explorers Scaling, root planing and curettage

instruments: a- sickle scaler b- curettes c- hoe, chisel and file scaler d- ultrasonic and sonic scaler Periodontal endoscope Cleansing and polishing instruments (CARRANZA

10th ed)

4/56

BASIC DESIGN OF INSTRUMENTS

• Optimal weight of periodontal instrument should be less than 15gms.

• Optimal diameter of periodontal instrument should be 10 mm

• Handle texture should have a knurling pattern.5/56

INSTRUMENT BALANCE

6/56

SHANK DESIGN SIMPLE SHANK: is bent in one plane. - used for anterior teeth. COMPLEX SHANK: is bent in two or more

plane. -Facilitate the instrumentation of posterior

teeth.

7/56

SHANK FLEXIBILITY RIGID SHANK: larger in diameter - can withstand the pressure required to

remove heavy calculus FLEXIBLE SHANK: thinner in diameter. - enhance the tactile sensitivity.

8/56

WORKING END DESIGN

9/56

MOUTH MIRROR Mouth mirror consists of small, cylindrical ,

metal shaft with a metal disk attached at the end of it which hold the mirror.

10/56

SIZES AND FUNCTIONSSIZES OF MOUTH

MIRROR: Size 1: 16mm Size 2: 18mm Size 3: 20mm Size 4: 22mm Size 5: 24mm

Functions: Indirect vision Indirect illumination Retraction transillumination

Most commonly used mouth mirrors are size 4 and size 5.

11/56

12

PERIODONTAL PROBES Are used to locate , measure and mark the

pockets and also to determine their course in individual tooth.

WALKING OF PROBE Walking stroke is a series of strokes along the

junctional epithelium. Each up and down stroke should be exactly

1mm in length. The stroke should be very close together

13/56

ADAPTATION AND INTERPROXIMAL TECHNIQUE

14/56

GENERATIONS OF PROBE

15/56

FIRST GENERATION

SECOND GENERATION

THIRD GENERATION

FOURTH GENERATION FIFTH GENERATION

Williams probe UNC 15 Hunter probe Borodontic presuure

sensitive probe Florida automated Foster miller Toronto automated Use 3 D visualization

Ultra sonographic probe

EXPLORER Are used to locate calculus deposits and

caries. To locate subgingival deposits and carious

areas, to check smoothness of the root surfaces after root planing.

16/56

SHEPHERD HOOK EXPLORER Examination for dental caries and

irregular margins of the restoration. E.g : 23 and 54 explorer

STRAIGHT EXPLORER: Calculus detection in shallow

pockets. E.g : 6, 6A, 6L

17/56

CURVED EXPLORER Calculus detection in normal

and shallow pockets E.g : 3 and 3 A

PIGTAIL AND COWHORN EXPLORER:

Calculus detection in normal sulci and shallow pockets extending no deeper than cervical third of the root.

E.g : 3ML, 3CH 18/56

19

ORBAN TYPE EXPLORER Tip is bent at 90 degree angle to

lower shank. Straight lower shank allows insertion

in narrow pockets. E.g: 17, 20F

11/12TYPE EXPLORER: Tip is bent at 90 degree like orban

explorer. Used in deep pockets E.g: ODU 11/12, 11/12 AF

SICKLE SCALERS Used to remove supragingival

calculus U15/30 sickle scaler are large

in size. Jacquette sickle scaler #1, 2, 3

have medium size. Nevi 2 posterior sickle scaler is

used for removal of subgingival calculus.

20/56

CHARACTERISTIC OF SICKLE SCALER

21/56

ANTERIOR AND POSTERIOR SCALER Anterior scaler: Jacquette30,33, Goldman H6,

H7. Posterior scaler: Jacquette 31/32, Jacquette

34/35

1.ADAPTATION : tip third should be adapted.2.ANGULATION: 60-70 degree3.CHARCTERISTIC: short, powerful pull stroke.

22/56

STROKE DIRECTION VERTICAL STROKE on anterior and mesial and

distal of posterior surface. OBLIQUE STROKE used on facial and lingual

surface of posterior teeth. HORIZONTAL STROKE used at the line angles

of posterior teeth and mid lines of facial and lingual teeth.

23/56

CORRECT ANGULATION

TECHNIQUE FOR SCALERS

24/56

HOE SCALER used for scaling of ledges or rings

of calculus. The blade is bent at a 99-degree

angle the cutting edge is formed by the

junction of the flattened terminal surface with the inner aspect of the blade.

The cutting edge is bevelled at 45 degrees.

It can maintain contact at two points on a convex surface.

Eg : McCall’s #3, 4, 5, 6, 7, and 8 are a set of six hoe scalers

25/56

CHISEL SCALER AND FILES Designed for the proximal surfaces of

the teeth too closely spaced to prevent the use of other scalers.

Double ended instrument One shank is curved, other straight Blades slightly curved Staight cutting edges bevelled at 45

degree Files are use to fracture or crush large

calculus deposits26/56

CURETTES For removing deep subgingival calculus, root

planing altered cementum and removing the soft tissue lining the periodontal pocket.

Finer than sickle scaler. Provide good access to deep pockets

CURETTES ARE OF TWO TYPES:1. UNIVERSAL2. AREA SPECIFIC

27/56

CHARACTERISTICS OF CURETTE Inner cutting edge is

used for distal surfaces.

Outer cutting edge is used for lingual, facial and mesial.

28/56

AREA SPECIFIC CURETTE -used in specific areas -one cutting edge used -curved in two plane -offset blade

29/56

GRACEY CURETTES 1-2 & 3-4 ANTERIOR TEETH 5-6 ANTERIOR TEETH & PREMOLARS 7-8 & 9-10 FACIAL & LINGUAL- POSTERIORS 11-12 MESIAL- POSTERIORS 13-14 DISTAL- POSTERIORS

30/56

#15-16 After five curettes

Mini curette-Increase access-Reduce trauma-E.g morse scaler

31/56

MINI FIVE CURETTE The Mini Five curettes are available in both

finishing and rigid designs. Rigid Mini Five curettes are recommended

for calculus removal. The more flexible, shanked, finishing Mini

Five curettes are appropriate for light scaling and deplaquing in periodontal maintenance patients with tight pockets.

The Mini Five curettes are available in all standard Gracey numbers, except the #9-10.

32/56

GRACEY CURVETTES The Gracey Curvettes are another set of four

mini-bladed curettes Sub-0 , #1-2 anterior teeth and

premolars. #11-12 posterior mesial surfaces #13-14 posterior distal surfaces. The blade length of these instruments is

50% shorter than that of the conventional Gracey curette, and the blade has been curved slightly upward.

33/56

LANGER AND MINI-LANGER CURETTES Set of three curettes combines shank design of the standard

Gracey #5-6, 11-12, and 13-14 curettes with a universal blade honed at 90 degrees rather than the offset blade of the Gracey curette.

The Langer #5-6 curette adapts to the mesial and distal surfaces of anterior teeth.

The Langer #1-2 curette (Gracey #11-12 shank) adapts to the mesial and distal surfaces of mandibular posterior teeth

The Langer #3-4 curette (Gracey #13-14 shank) adapts to the mesial and distal surfaces of maxillary posterior teeth 34/

56

QUETIN FURCATION CURETTE Shallow half moon radius Fits into the roof or floor of the

furcation. The shanks are slightly curved for

better access. The tips are available in two widths. The BL1 and MD1 instruments are

small and fine, with a 0.9-mm blade width.

The BL2 and MD2 instruments are larger and wider, with a 1.3-mm blade width.

35/56

PLASTIC INSTRUMENTS FOR IMPLANT Plastic rather than metal instruments be

used to avoid scarring and permanent damage to the implants.

E.g: Coulumbia 4R/4L curette tip,H6-H7 sickle scaler , 204S sickle scaler tip.

36/56

DIAMOND FILES Used for final finishing of root surfaces. Do not use cutting edges Used to remove small embedded calculus on

root surfaces seen with endoscope.

37/56

SONIC INSTRUMENTS Sonic units consist of a handpiece that

attaches to a compressed-air line . Vibrations at the sonic tip range from 2000 to

6500 cps provides less power for calculus removal

than ultrasonic units.

38/56

39

ULTRASONIC INSTRUMENT Vibration ranges from 20000 to

45000cps

MAGNETOSTRICTIVE Pattern of vibration of tip is elliptical. All sides are active while working.

PIEZOELECTRIC The pattern of vibration of the tip is

linear The two sides of the tip are the most

active

POWERED INSTRUMENT TIP DESIGN

40/56

STANDARD DIAMETER TIPS

Larger in size Short shank length Heavy deposit

removal, use for supra gingival calculus removal

SLIM DIAMETER TIPS

40%smaller diameter

Long shank length Light deposit

removal, Furcation area deplaquing

SEQUENCE OF USE OF TIP

41/56

CURVED SLIM DIAMETER to remove light to moderate calculus on post root surfaces greater than 4 mm below CEJ

DENTAL ENDOSCOPE Allows clear visualization

of deep sub gingival pockets and in the furcations.

Consists of 0.99mm diameter reusable fibre optic endoscope over which is fitted a disposable sterile sheath.

Magnification ranges from 24X to 46X. 42/

56

CLEANSING AND POLISHING INSTRUMENT Rubber cups Bristle brushes Dental tape Air powder polishing

43/56

SURGICAL INSTRUMENTS Excisional and incisional instruments Surgical curettes and sickles Periosteal elevator Surgical chisels Surgical files Scissors Haemostats and tissue forceps

44/56

EXCISIONAL AND INCISIONAL INSTRUMENT PERIODONTAL KNIVES e.g : Kirkland knife INTERDENTAL KNIVES e.g : Orbans knife Merifield

knife#1,2,3,4 SURGICAL BLADES : 15C, 15, 12D

45/56

SURGICAL CURETTES AND SICKLES Used for the removal of granulation tissue,

fibrous interdental tissues, and tenacious sub gingival deposits during surgery.

HEAVY CURETTE : Prichard curette Kirkland curette HEAVY SCALER : Ball Scaler #B2-B3

46/56

PERIOSTEAL ELEVATOR To reflect and move the flap after the incision

has been made for flap surgery. E.G: The Woodson elevator Prichard elevators

47/56

SURGICAL CHISELUsed for removal and reshaping the bone.- STRAIGHT CHISEL E.g : Wiedelstadt , Ochsenbein #1-2.(push

motion)

-BACK ACTION CHISEL e.g: Rhodes Chisel (pull motion).

48/56

SURGICAL FILES SUGARMAN PERIODONTAL FILE SCHLUGER PERIODONTAL FILE Used interproximally . Filing surfaces of bone on both sides allow for push or

pull application.

49/56

TISSUE FORCEPS AND SCISSORS used to hold the flap during suturing. used to position and displace the flap after

the flap has been reflected. SCISSORS are used in periodontal surgery to: remove tabs of tissue during gingivectomy, trim the margins of flaps enlarge incisions in periodontal abscesses remove muscle attachments in mucogingival

surgery 50/56

NEEDLE HOLDER

51/56

INSTRUMENT SHAPENING The objective of sharpening is to

restore the fine, thin, linear cutting edge of the instrument .

Sharpness can be evaluated by sight and touch .

Sharpening stones can be natural or artificial.

Can be mounted or unmounted. Natural abrasive stones : India and

Arkansas oilstones Carborundum, ruby, and ceramic

stones are synthetically produced stones.

52/56

53/56

CONCLUSION The advancing abilities of instrument makers, coupled

with the in genuity of dental practitioners, have provided the present practitioner with a multitude of instrument designs capable of reaching nearly every portion of the dentition.

some of the more efficient instruments from past instruments sets have withstood the test of long-term use and now appear and reappear in newly created instrument sets.

54/56

REFRENCES1. Carranza’s clinical periodontology- 10 th edition

2. Carranza’s clinical periodontology- 9th edition

3. Principles & Fundamentals of Periodontal Instrumentation – 6th edition- Jill S Nield -Gehrig.

55/56

56/56