2015 DrGhazy Istruments and equipments 1st & 2nd lectures.pdf

8/10/2019 2015 DrGhazy Istruments and equipments 1st & 2nd lectures.pdf

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BY Dr Mohamed H. Ghazy

Professor of Fixed Prosthodontics

November 3, 2014

ClassificationAccording to their uses

Diagnostic

Cutting

Restoring

Accessory

Diagnostic instrumentA. Traditional diagnostic instruments:

Mirror Indirect vision Light reflection

Retraction Tissue protection

Explorer (Probe) Distinguish areas of calculus. Distinguish decay.

Distinguish areas of discrepancies on teeth.

Cotton Pliers (Tweezers)Carry, retrieve and place small objects.

Locking

Non-locking

4. Periodontal probe

Measure the depth of salcus

5. Articulating paper and holder Adjustment of occlusion
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B. New diagnostic instruments:

1. Digital radiograph.

2. Diagnodent Laser

3. Operating Microscope

4. Intra-oral camera.

5. Loupes.

6. DIFOTI (Digital Imaging Fiberoptic

Trans-Illumination

Cutting instrumentsDepending on whether mere hand or mechanical

force are utilized to work out these instruments:

Hand cutting

Powered rotary cutting

Laser equipments

Other equipments

Hand cutting instruments

Manufactured from

Carbon steel

Stainless steel

Carbide steel Other alloys of nickel, cobalt, chromium
http://dentalhandtools.com/


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Instrument design Blade(Working End)

Portion of the instrument de signedfor a specific function

Shank Part of the instrument that attaches

the working end to the handle

Handle

Portion of the instrument where theoperator grasps

Examples of Hand cutting instruments:

Chisels Hatchets Hoes

Marginal Trimmers Angle Formers

G.V. Black describe a way to name dentalinstruments:

1. The purpose of its use e.g. excavator, condenser,

scaler.

2. The position or manner of their use e.g. push, pull.

excavator condenser scaler.

G.V. Black describe a way to name dental

instruments:.

3-The form of its working part, hoe, hatchet, chisel etc.

4-The number of angles in the shank, straight- no angle

mon-angle (one angle),bin-angle (two angles), triple-

angle (three angles),quarternary-angle (four angles).

hoe hatchet

chisel

straight

mon-angle

bin-angle


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Powered (rotary) cutting Instrument

Power sources for dental units

Electric motor

driven

Compressed air

What does the term rotary mean?

(Rotary is a part or device that rotates around an axis.)

In dentistry, rotary instruments are attached to a handpiece.

Handpiece

is a device for holding rotary instruments transmitting power to them

and for positioning them intra orally

ccording to shape

Straight handpiece

Contra angle handpiece

Rotary speed ranges

Low speed (below 12000 rpm)

Medium speed (12000-200 000 rpm)

High speed (above 200 000 rpm)
http://images.google.com/imgres?imgurl=http://www.made-in-china.com/showimages/111/300014730/0/Dental_Oilfree_Air_Compressor_(Fb-45/8).jpg&imgrefurl=http://www.made-in-china.com/products/show/premium/TAwMDM1OTQyN/zAwMDEzNjUzM/3/Machinery_Compressor_Dental_Oilfree_Air_Compressor_(Fb-45/8).html&h=228&w=261&sz=23&tbnid=bCwtZGiytaAJ:&tbnh=93&tbnw=107&hl=en&start=5&prev=/images%3Fq%3Ddental%2Bcompressor%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGLD,GGLD:2005-12,GGLD:en%26sa%3DNhttp://images.google.com/imgres?imgurl=http://www.made-in-china.com/showimages/111/300014730/0/Dental_Oilfree_Air_Compressor_(Fb-45/8).jpg&imgrefurl=http://www.made-in-china.com/products/show/premium/TAwMDM1OTQyN/zAwMDEzNjUzM/3/Machinery_Compressor_Dental_Oilfree_Air_Compressor_(Fb-45/8).html&h=228&w=261&sz=23&tbnid=bCwtZGiytaAJ:&tbnh=93&tbnw=107&hl=en&start=5&prev=/images%3Fq%3Ddental%2Bcompressor%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGLD,GGLD:2005-12,GGLD:en%26sa%3DNhttp://images.google.com/imgres?imgurl=http://www.compairsystems.co.uk/dent.jpg&imgrefurl=http://www.compairsystems.co.uk/dent.htm&h=281&w=544&sz=34&tbnid=QuHTFXhSU_cJ:&tbnh=67&tbnw=130&hl=en&start=6&prev=/images%3Fq%3Ddental%2Bcompressor%26svnum%3D10%26hl%3Den%26lr%3D%26rls%3DGGLD,GGLD:2005-12,GGLD:en%26sa%3DNhttp://www.vet.ed.ac.uk/clive/cal/Dentistry/Website/Media/Workplace_Media/bigger_pics/nm3000.jpg


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Disadvantages of low speed

1- Ineffective

2- Time consuming

3- Require a relatively heavy forceapplication

Initial preparation of grooves and pinholes

Cleaning of teeth

Caries excavation

Finishing and polishing procedures

Uses of low speed

Advantages of high speedFaster removal of tooth

structure with lessvibration and heatproduction

Better control andgreater ease ofoperation

Patient is lessapprehensive becauseannoying vibration andoperating time

decreasedInstruments last lon er

Cutting tools

Dental rotary burs

Dental rotary abrasives

The rotary tools used in removing tooth structures may be

classified intobursand abrasivesdepending on whether

they work by an actual cutting or an abrading process. Design features

Shank

Neck

Head


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Shank designIt is the part that fit into theDefinition

handpiece, and accepts the rotary

motion from it

Long shankUsed with straight handpiece

Short latch shanksUsed with latch type contra angle

handpiece

Friction grip shankssed with ultra high speed handpiece

Neck designIt is the intermediate portion of an instrument

that connects the head to the shank

Function: transmit rotational force to the head

Head designIs the working part of the instrument, the

cutting edge or portion of whichperform the desired shaping of tooth

structure

Characteristics of the head

1. Type of cutting: Bladed (bur).

Diamond abrasive.

2. Material of Construction:

Carbon steel.

Tungsten carbide.

Diamond ships.

Sand.

3. Head size

4. Head shape
http://www.microcopydental.com/technical_info.htmlhttp://rds.yahoo.com/S=96062857/K=dental+bur/v=2/SID=w/l=II/R=9/SS=i/OID=850ecd8b458c1678/SIG=1h4v6idi4/EXP=1127640240/*-http%3A//images.search.yahoo.com/search/images/view?back=http%3A%2F%2Fimages.search.yahoo.com%2Fsearch%2Fimages%3Fp%3Ddental%2Bbur%26ei%3DUTF-8%26fl%3D0%26fr%3Dslv1-adbe&h=247&w=485&imgcurl=www.osteocare.uk.com%2Fimages%2Fcover-screw-bur.jpg&imgurl=www.osteocare.uk.com%2Fimages%2Fcover-screw-bur.jpg&size=22.9kB&name=cover-screw-bur.jpg&rcurl=http%3A%2F%2Fwww.osteocare.uk.com%2Fcomponents%2Fcover-screw-bur.htm&rurl=http%3A%2F%2Fwww.osteocare.uk.com%2Fcomponents%2Fcover-screw-bur.htm&p=dental+bur&type=jpeg&no=9&tt=163&ei=UTF-8


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Finishing

End cutting

End andside cutting

Wheal

Pear

Fissure

Inverted cone

Round

Dental bur(shape)

Burs flute design

Cross cutPlain

Diamond abrasive instruments

Advantages

Long life

More effective in cutting enamel and

dentin
http://www.microcopydental.com/technical_info.htmlhttp://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=hZzOWTpoTJc8OM&tbnid=G4rwLC_BCtfPsM:&ved=0CAUQjRw&url=http%3A%2F%2Fdentalcollectibles.com%2Fmcart%2Findex.cgi%3Fcode%3D3%26cat%3D21&ei=WR9aUvfVDcPt0gXR6YGgCQ&bvm=bv.53899372,d.d2k&psig=AFQjCNGUbetNcfpBp0ajFh56KUJtvq7a9w&ust=1381724186446703


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Diamond abrasive instruments

Fine60-74m

Medium

88-125m

Coarse125-150

m

Very fine38-44m

Particlesize

Diamond abrasive instrumentsThe wheel stone

Round and oval

shaped stone

Cylindrical stone

Tapered stone

Inverted cone stone

Cup shaped stone

Barrel shaped stone

Pear shaped

Bud shaped

Root facer stone

Wheel Round Spezial shapes

Pointed Torpedo Torpedo tapered

Cylinder Cylinder round Cylinder pointed

Pear Cone Trapered

Tapered round Wheel Round

Cylinder Cylinder round
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Pear Cerafil Egg

Flame Grenade Cone

Bud Tapered Tapered round

Oval or flame Shaped:used to reducepalatal and lingual surfaces of anterior teeth.

Wheel Stone:used to reduce incisal edgesin anterior teeth and occlusal planes of cusps ofposterior teeth.

Wheel Stone may be with flat end, round end or

tapered ended stone.

Barrel and Pear shaped stone:

used to reduce occlusal surfaces of

premolars and molars.

Tinker Stone:used to perform

shoulder with bevel finishing line

for PFM restorations.

Fisssure Stone as:

a. Tapered with round end used to performchamfer finishing line for full metal

restoration.

b. Tapered with flat end used to performshoulder finishing line for all ceramic full

coverage restoration.

c. Cylindrical stone. (long/short) used todo grooves for partial coverage

restorations.

According to function

1. Reducer

2. Cutter
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3. Finishing

4. Guidance Stone

5. Root Facer

6. Tissue Trimmer

Discs

Abrasive rotary instruments used for

proximal slicing or reduction.

Supplied either mounted or demounted

Used with conventional or slow speed

Discs classification

According to the

abrasive material

Carborandum

Diamond

Metal

Sand paper

According to size

Small 3/8 inch

Medium 5/8 inch

Large 7/8 inch


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Discs classificationAccording to shape

Flat shaped

Cup shaped

According to the side

of abrasive material

Safe sided

Double sided

Accessory instruments and items. Ultrasonic Hand piece

Design Attached to the dental unit.

Powered by electricity.

Primarily used for prophylaxisappointments.

Attachments are similar inappearance to scaling instruments.

Delivers a pulsating spray of water


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Uses of the Ultrasonic Handpiece

Remove calculus

Remove stain

Remove bonding materials from tooth

surface after orthodontic appliances are

removed

Remove cement after orthodontic bands

are removed

Laser Handpiece

Design Uses a laser light beam

instead of rotary instruments.

Laser is conducted through afiber-optic cable.

Resembles a standardhandpiece.

Maintains a water-coolantsystem.

Maintains an air-coolantsystem.

Uses

Cauterizes soft tissue.

Vaporizes decayed tooth structure.

Advantages

Usually painless.

Patient usually does not require

anesthesia.

Proceed with procedure faster.

Disadvantage

Cannot be used on teeth with existing

restorations.

Air-Abrasion Handpiece Design

Small version of a sandblaster.

Produces a high-pressure delivery of aluminum oxideparticles through a small probe.


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UsesPrepares teeth for sealants.

Removes external stains.

Class I through class VI preparations.

Endodontic access.

Prepares a tooth surface for the

cementation of a cast restoration, such as

a crown or veneer.

Any Questions.

BY Dr

Mohamed H. Ghazy

Professor of Fixed Prosthodontics

November 3 2014

Student questionWhat is the finish line?

a line indicating the location of the finish of a race


14/25

Rotary cutting equipments. Low-Speed Handpiece.High-Speed Handpiece.

Ultrasonic Handpiece.

Laser Handpiece.

Air-Abrasion Handpiece.

Laboratory Handpiece.

Ultrasonic Hand piece DesignAttached to the dental unit.

Powered by electricity.

Primarily used for prophylaxisappointments.

Attachments are similar in appearance toscaling instruments.

Delivers a pulsating spray of water

ses o e rason c

Handpiece Remove calculus

Remove stain

Remove bonding materials from toothsurface after orthodontic appliances are

removed

Remove cement after orthodontic bandsare removed

Laser HandpieceDevices which produce beams of very high

intensity light

DesignUses a laser light beam

instead of rotary instruments.

Laser is conducted through afiber-optic cable.

Resembles a standardhandpiece.

Maintains a water-coolantsystem.


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LASERWELDING The effect of laser depends on the power ofthe beam and the extent to which the beamis absorbed e.g. CO2 and ND:YAG Laser

Uses

Cauterizes soft tissue.

Vaporizes decayed tooth structure.

Advantages

Usually painless.

Patient usually does not require anesthesia.

Proceed with procedure faster.

Disadvantage

Cannot be used on teeth with existing restorations.

Air-Abrasion HandpieceDesign

Small version of a sandblaster.

Produces a high-pressuredelivery of aluminum oxide

particles through a small probe.

UsesPrepares teeth for sealants.

Removes external stains.

Class I through class VI preparations.

Endodontic access.

Prepares a tooth surface for the cementation of

a cast restoration, such as a crown or veneer.


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Impression Trays Quadrant trayCovers one half

of the arch.

Section trayCovers the anterior portion of the arch.

Full arch tray

Covers the entire arch.

Perforated trayHoles in the tray create a mechanical lock to hold the

material in place.

Smooth tray

Interior of the tray is painted or sprayed with an

adhesive to hold the impression material.

Types of Stock TraysMetal perforated tray

Mostly used for preliminary impression

Metal water coolant tray

Mostly used with reversible hydrocolloid

impression

Plastic perforated tray

Mostly used for preliminary and finalimpression

Crown remover

Hand instrument.

Crown remover.

Manual crown remover.

Pneumatic crown remover.

Brass ligature wire.

Chisel and hummer.Sectioning.

Crown slitter.

The manual back action hammer is the

classic method for removing prostheses.

It produces the desired force by means

of a weight that slides along a shaft

Spring-loaded back action hammer

allows forces to be directed in a more

controlled manner.

Manual crown remover
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Automatic Crown & Bridge RemoverNon-traumatic way to remove crowns,

bridges and inlays

This water soluble, pliable resin adheres to porcelain, enamel,

gold, acrylic and will not damage restorations. Works quickly

and safely. Ideal for the removal of temporary or permanently

cemented crowns.

Cord Placement Instruments Crown Collars and ScissorsUsed to trim temporary crowns,

gingival cord and matrix bands.


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Instrument Sequence on a TrayInstruments set-up from left toright

Basic set-up

Additional examination

instruments

Hand cutting instruments

Restorative instruments

Preset restorative tray

Cleaning and Sterilization of dental instruments

All instruments need to be cleaned and thoroughly

dried before they are sterilized.

Cleaning

HandScrubbingUltrasonic

Cleaning

Automated

Washer
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Classification of Patient-Care Items

In order to determine theappropriate treatment for any item

that has been used in patient care,you will need to classify them into

one of the following three categoriesbased on the risk of infection

associated with their intended use.

Critical

Semicritical

Noncritical

r t ca

ItemsAre defined as those

used to penetrate softtissue or bone

Since the risk oftransmission would be

must be heathigh, theysterilized

Examples:

Surgical instruments

Scalers

Forceps

Scalpels

Bone chisels

burs

Clinical Application

What do you use clinicallyeveryday that is considered a

critical item?

How do you treat these itemsbefore they are used again?

Semicritical ItemsTouch mucous

membranes or nonintact skin

Have a lower risk oftransmission. However,

be heatcanif an item

beshouldsterilized, itheat sterilized.

Examples:

Mouth mirrorsAmalgam

condensers

Impression trays

X-ray film holders


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Semicritical instruments whichcannot tolerate the high

temperatures of sterilization mustbe processed by using a sterilantor

high level disinfectant.

These products achieve sterilization(kills all forms of life includingspores) after immersion in the

solution for 3 to 10 hours. Followmanufacturers instructions for the

product in your office.

Which items do you use dailywhich are considered semi-

critical?

Do you routinely sterilize theseitems?

If not, what is your method forassuring that they have remainedin the disinfectant or sterilant for

the necessary length of time?

Clinical Application

Immersion Disinfectants FDA-Approved for use in dentistry

Sterilants:

Gluteraldehyde -6 to 10 hour contact time

Hydrogen peroxide (7.3%) 6 hour contacttime.

Gluteraldehyde and phen0ol/phenate-12hour contact time

Hydrogen peroxide and peracetic acid-3hour contact time.

High level DisinfectantsOrtho-phthalaldehyde (12 minute contact time)

Gluteraldehyde- 20 to 90 minute contact time

Hydrogen peroxide- 30 minutes contact time

Gluteraldehyde and phenol/phenate- 20 minute contacttime

Hydrogen peroxide and peracetic acid-15 minute contacttime.

(You must always use personal protective equipment(PPE), including utility gloves, mask, eyewear, and

protective clothing, when processing instruments)


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Definitions to remember.allis the process that killsSterilization

microorganisms and is considered thehighest level that can be achieved. It is

accomplished by the proper use ofimmersion chemical sterilants or by heat.

is used when aHigh level disinfectionsemicritical item cannot withstand heat

sterilization. Used correctly, it is intendedto kill disease producing microorganisms

but notspores. These products are notused for surface disinfection, but for

immersion.

Noncritical ItemsContact intact skin only.

Have a low risk of disease transmission.

Some of these(*) should be pre-cleanedand disinfected or barrier protected.

Examples:

Blood pressure cuff

*X-ray cone

Stethoscope

*Lead apron

Universal Sterilization

means that all reusable instrumentsand handpieces are sterilized (rather

than disinfected) between use onpatients.

This provides the highest level ofpatient protection.

Miller & Palenik, p. 196

Sterilization1. Steam autoclave:

Most effective.

Steam, heat (270 F), pressure (27 PSI).

for at least 6 minutes.

2. Unsaturated chemical vapor:

Best for carbon steel instruments.Heat (270 F), pressure (20-40 PSI).

for at least 20 minutes.


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3. Dry heat oven:Heat (230 F) for 2 hours.

Temperature above 350 F may cause

premature instrument failure.

4. Chemical solution:Used for materials that can not withstand

heat sterilization process.

Not recommended for metal dentalinstruments.

ns rumen process ng

flowchartRemove

Items fromoperatory

Use holding

Solutions ifnecessary

Sterilize

Clean byAutomatedOr manual

method

Store

Package

Remember to carefully transportinstruments to the sterilization area.

Ideally, they should be in closedcassettes and handled with utility

gloves.

Ultrasonic cleanerThis solution is consideredhighly contaminated. Retrieveinstrument cassettes while wearingutility gloves

closeDont forget toduringthe lid

operation to reduce

aerosols!


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A commercial all-purposeultrasonic cleaner.

An enzyme ultrasoniccleaner in tablet form.

Take care not to overload steamheat sterilization equipment.If steam cannot circulate andpenetrate, instruments may not

be sterile.

Packed handpiece Process Indicators

Do not indicate sterility.

Simply indicate that theautoclave reached a

certain temperature.

Show at a glance if a loadhas been run.


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Instrument Processing

Sterilization Monitoring

Do not use instrument packs if chemical or

mechanical monitoring indicate inadequate

processing.

Personal Protective Equipment(PPE)

Protects the skin &

mucous membranes

of the eyes, nose,

and mouth from

exposure to blood orOPIM

Use of PPE is

dictated by the

exposure risk, notthe patient.

Masks and Protective Eyewear

Wear a surgical mask andprotective eyewear with

solid side shields toprotect mucous

membranes of the eyes,nose, & mouth

Change masks betweenpatients, or during

treatment if it becomes wet

Protective ClothingWear long-sleeved reusable or

disposable gowns, clinic jackets, orlab coats to protect skin of the

forearms and clothing likely to besoiled with blood, saliva.

Change immediately if visibly soiled


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Protective coverage Clinical Contact SurfacesHousekeeping Surfaces

EnvironmentalUse surface barriers to protect clinical

contact surfaces, especially which are

difficult to clean.

Change barriers between patients

Documents

2015 DrGhazy Istruments and equipments 1st & 2nd lectures.pdf