Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures

8/12/2019 Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures

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24/10/201

BY Dr

Mohamed H. Ghazy

Professor of Fixed Prosthodontics

October 10, 2013



24/10/201

ClassificationAccording to their uses

Diagnostic

Cutting

Restoring

Accessory

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Diagnostic instrument A. 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

. Articulatin a er and holder

B. New diagnostic instruments:

1. Digital radiograph.

2. Diagnodent Laser

3. Operating Microscope



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4. Intra-oral camera.

5. Loupes.

6. DIFOTI (Digital Imaging Fiberoptic Trans-

Illumination

Cutting instrumentsDepending on whether mere hand or mechanical forceare utilized to work out these instruments:

Hand cutting

Powered rotary cutting

Laser equipments

Other equipments



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Hand cutting instruments

Manufactured from Carbon steel

Stainless steel

Carbide steel Other alloys of nickel, cobalt, chromium

Instrument design Blade(Working End)

Portion of the instrument designed for aspecific function

Shank Part of the instrument that attaches the

working end to the handle

Handle

Portion of the instrument where theoperator grasps

http://dentalhandtools.com/



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Examples of Hand cutting instruments:

Chisels Hatchets Hoes

Marginal Trimmers Angle Formers

Examples of hand cutting

instruments.



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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

s t r a i g h t

m o n - a n g l e

b i n - a n g l e



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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

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http://www.vet.ed.ac.uk/clive/cal/Dentistry/Website/Media/Workplace_Media/bigger_pics/nm3000.jpg



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Rotary speed ranges

Low speed (below 12000 rpm)

Medium speed (12000-200 000 rpm)

High speed (above 200 000 rpm)



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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 speed Faster removal of tooth

structure with less vibrationand heat production

Better control and greaterease of operation

Patient is less apprehensive

because annoying vibrationand operating timedecreased

Instruments last longer



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Cutting tools

Dental rotary burs

Dental rotary abrasives

The rotary tools used in removing tooth structures may be

classified into burs and abrasives depending on whether

they work by an actual cutting or an abrading process.



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Design features

Shank

Neck

Head

Shank design Definition It is the part that

fit into the handpiece, and

accepts the rotary motion from

it

Long shankUsed with straight handpiece

Short latch shanksUsed with latch type contra angle

handpiece

Friction grip shanks sed with ultra high speed handpiece

http://www.microcopydental.com/technical_info.html

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Neck design

It is the intermediate portion of an instrument thatconnects 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 which performthe desired shaping of tooth structure



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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 size4. Head shape

Finishing

End cutting

End and side cutting

Wheal

Pear

Fissure

Inverted cone

Round

Dental bur(shape)



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Burs flute design

Cross cutPlain

Diamond abrasive instruments

Advantages

Long life

More effective in cutting enamel and dentin

http://www.microcopydental.com/technical_info.html



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Diamond abrasive instruments

Fine60-74µm

Medium88-125µm

Coarse125-150

µm

Very fine38-44µm

Particlesize

Diamond abrasive instrumentsThe wheel stone

Round and oval shaped

stone

Cylindrical stone

Tapered stone

Inverted cone stone

Cup shaped stoneBarrel shaped stone

Pear shaped

Bud shaped

Root facer stone



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Wheel Round Spezial shapes

Pointed Torpedo Torpedo tapered

Cylinder Cylinder round Cylinder pointed

Pear Cone Trapered

Tapered round Wheel Round

Cylinder Cylinder round

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/rad/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/rund/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/spezialformen/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/spitz/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/torpedo/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/torpedokonisch/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/zylinder/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/zylinderrund/default.html

http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/zylinderspitz/default.html

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http://www.kometdental.de/englisch/program/praxis/hartmetall/bohrer/zylinderrund/default.html


















































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Pear Cerafil Egg

Flame Grenade Cone

Bud Tapered Tapered round

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http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/kegel/default.html


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http://www.kometdental.de/englisch/program/praxis/diamant/schleifer/konisch/default.html

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Oval or flame Shaped: used to reduce palatal and

lingual surfaces of anterior teeth.

Wheel Stone: used to reduce incisal

edges in anterior teeth and occlusal

planes of cusps of posterior teeth.

Wheel Stone may be with f lat 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 perform

chamfer finishing line for full metal

restoration.

b. Tapered with flat end used to perform

shoulder finishing line for all ceramic full

coverage restoration.

c. Cylindrical stone. (long/short) used to

do grooves for partial coverage

restorations.



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According to function

Reducer

Cutter



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Finishing

Guidance Stone



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Root Facer

Tissue Trimmer



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Discs

Abrasive rotary instruments used for proximalslicing 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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2

Discs classificationAccording to shape

Flat shaped

Cup shaped

According to the side of

abrasive material

Safe sided

Double sided



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2

Accessory instruments and items.

Ultrasonic Hand piece

Design Attached to the dental unit.

Powered by electricity.

Primarily used for prophylaxisappointments.

Attachments are similar in appearance to

scaling instruments. Delivers a pulsating spray of water



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2

Uses of the Ultrasonic

Handpiece Remove calculus

Remove stain

Remove bonding materials from toothsurface after orthodontic appliances areremoved

Remove cement after orthodontic bands

are removed

Laser Handpiece

Design Uses a laser light beam instead of

rotary instruments.

Laser is conducted through a fiber-optic cable.

Resembles a standard handpiece. Maintains a water-coolant system.

Maintains an air-coolant system.



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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 oxide particlesthrough a small probe.



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Uses•Prepares 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….



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2

BY Dr

Mohamed H. Ghazy

Professor of Fixed Prosthodontics

October 20 2013

Student question

What is the finish line?a line indicating the location of the finish of a race



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Rotary cutting equipments. Low-Speed Handpiece.

High-Speed Handpiece.

Ultrasonic Handpiece.

Laser Handpiece.

Air-Abrasion Handpiece.

Laboratory Handpiece.

Ultrasonic Hand piece Design Attached to the dental unit.

Powered by electricity.

Primarily used for prophylaxis appointments.

Attachments are similar in appearance toscaling 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 surfaceafter orthodontic appliances are removed

Remove cement after orthodontic bands areremoved

Laser Handpiece Devices which produce beams of very high

intensity light

Design Uses a laser light beam instead of

rotary instruments.

Laser is conducted through a fiber-

optic cable.

Resembles a standard handpiece.

Maintains a water-coolant system.

Maintains an air-coolant system.



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LASER WELDING

The effect of laser depends on the power of thebeam and the extent to which the beam is absorbede.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.



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3

Air-Abrasion Handpiece Design

Small version of a sandblaster.

Produces a high-pressure deliveryof aluminum oxide particlesthrough a small probe.

Uses•Prepares 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 tray Covers one half

of the arch.

Section tray Covers the anterior portion of the arch.

Full arch tray Covers the entire arch.

Perforated tray Holes 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 Trays

Metal perforated trayMostly used for preliminary impression

Metal water coolant trayMostly used with reversible hydrocolloidimpression

Plastic perforated trayMostly used for preliminary and finalimpression



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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

http://www.smartpractice.com/

http://www.smartpractice.com/



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Automatic Crown & Bridge Remover

Non-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.



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Cord Placement Instruments

Crown Collars and Scissors Used to trim temporary crowns, gingival

cord and matrix bands.



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Instrument Sequence on a Tray Instruments set-up from left to right

Basic set-up

Additional examination instruments

Hand cutting instruments

Restorative instruments

Accessory items

Preset restorative tray



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Cleaning and Sterilization of dental instruments

All instruments need to be cleaned and thoroughly

dried before they are sterilized.

Cleaning

Hand Scrubbing Ultrasonic Cleaning Automated Washer

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Classification of Patient-Care Items

In order to determine the appropriate

treatment for any item that has beenused in patient care, you will need toclassify them into one of the followingthree categories based on the risk ofinfection associated with their intended use.

Critical

Semicritical

Noncritical

Critical Items Are defined as those

used to penetrate softtissue or bone

Since the risk oftransmission would be

high, they must be heatsterilized

Examples:

Surgical instruments Scalers

Forceps

Scalpels

Bone chisels

burs



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Clinical Application

What do you use clinically everyday

that is considered a critical item? How do you treat these items before

they are used again?

Semicritical Items Touch mucous

membranes or nonintact skin

Have a lower risk oftransmission. However,if an item can be heatsterilized, it should beheat sterilized.

Examples:

Mouth mirrors

Amalgamcondensers

Impression trays

X-ray film holders



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Semicritical instruments which cannottolerate the high temperatures of

sterilization must be processed byusing a sterilant or high leveldisinfectant .

These products achieve sterilization(kills all forms of life including spores)after immersion in the solution for 3

to 10 hours. Follow manufacturer’sinstructions for the product in youroffice.

Which items do you use daily whichare considered semi-critical?

Do you routinely sterilize theseitems?

If not, what is your method forassuring that they have remained in

the disinfectant or sterilant for thenecessary length of time?

Clinical Application



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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 Disinfectants Ortho-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….

Sterilization is the process that kills all

microorganisms and is considered thehighest level that can be achieved. It isaccomplished by the proper use ofimmersion chemical sterilants or by heat.

High level disinfection is used when asemicritical item cannot withstand heatsterilization. Used correctly, it is

intended to kill disease producingmicroorganisms but not spores. Theseproducts are not used for surfacedisinfection, but for immersion.

Noncritical Items Contact intact skin only.

Have a low risk of diseasetransmission.

Some of these(*) should beprecleaned and disinfectedor barrier protected. Examples:

Blood pressurecuff

*X-ray cone

Stethoscope

*Lead apron



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Universal Sterilization

“…means that all reusableinstruments and handpieces aresterilized (rather than disinfected) between use on patients.This provides the highest level ofpatient protection.”

Miller & Palenik, p. 196

Steralization 1. 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 causepremature instrument failure.

4. Chemical solution:

Used for materials that can not withstand heatsterilization process.

Not recommended for metal dentalinstruments.

Instrument processing flowchartRemove

Items fromoperatory

Use holdingSolutions ifnecessary

Sterilize

Clean by AutomatedOr manual

method

Store

Package



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

Don’t forget to closethe lid during

operation to reduceaerosols!

A commercial all-purposeultrasonic cleaner.(Courtesy of Certol.)

An enzyme ultrasonic cleaner intablet form.

(Courtesy of Crosstex.)

Copyright © 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights reserved.



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Take care not to overload steamheat sterilization equipment.

If steam cannot circulate andpenetrate, instruments may not

be sterile.

Packed handpiece



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Process Indicators

Do not indicate sterility. Simply indicate that the

autoclave reached acertain temperature.

Show at a glance if a loadhas been run.

Instrument ProcessingSterilization Monitoring

Do not use instrument packs if chemical ormechanical monitoring indicate inadequateprocessing.



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Personal Protective Equipment

(PPE)

Protects the skin &

mucous membranes of

the eyes, nose, and

mouth from exposure

to blood or OPIM

Use of PPE is dictated

by the exposure risk,

not the patient.

Masks and Protective Eyewear Wear a surgical mask and

protective eyewear with solidside shields to protectmucous membranes of theeyes, nose, & mouth

Change masks betweenpatients, or during treatment

if it becomes wet



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Protective Clothing Wear long-sleeved reusable or disposable

gowns, clinic jackets, or lab coats to

protect skin of the forearms and clothinglikely to be soiled with blood, saliva.

Change immediately if visibly soiled

Protective coverage



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Clinical Contact Surfaces

Housekeeping Surfaces

Environmental IC Use surface barriers to protect clinical contactsurfaces, especially which are difficult to clean.

Change barriers between patients



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Digital Imaging

General Considerations

Equipment difficult, if not impossible, to cleanand disinfect

Barrier-protect clinical contact surfaces

FIXED EQUIPMENT AND PRODUCTS

Microblasters

Porcelain Ovens Burnout Ovens Microscopes Die Pinning System Casting Machines Porcelain

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Microblasters

Many options available:

Choose from number of tanks

Air pressure adjustment location

See Synopsis of Laboratory Air-Abrasion Units on the DISwebsite

Renfert Basic Master

Vaniman Sandstorm Expert

Porcelain Ovens

Ivoclar Vivadent Programat P100

Electronic vacuum control systemhelps prevent firing errors if vacuumis set incorrectly

$3,876 w/pump

———

Jelrus VIP Vision 300

User friendly

Keypad let's you "Name ThatProgram" from A-Z

$2,399



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Porcelain Ovens (cont.)

VITA VACUMAT 4000

Two thermocouples within thechamber provide bettertemperature control

Automatic temperaturecalibration after 100 hours ofusage

Internal memory for up to 500programs

Portable, detachable keypad $5,836.50

Porcelain Ovens (cont.)

Whip Mix Pro Series

Fast-cool feature

Pressing furnace hasadvanced cycles for

Inceram, Procera, pressingand porcelain firing

Pro Press 100 - $3,351

Pro 100 - $2,500

http://www.whipmix.com/7ovens/pro_1.html

http://www.vident.com/vac4000.htm



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Burnout Ovens

Whip Mix Apollo II

Unique feature is its bottomloading lift platform that raisesand lowers investment rings

Has an optional foot-controlswitch

Reduced heat blast

Microscopes

Meiji BM

Dependable and inexpensive

Easily adjustable

$549

———

Renfert Mobiloscope Swivel arm microscope

Space saving

$1,111

$1,438 w/fiber optic light

Meiji BM

Renfert Mobiloscope

http://renfert-web.test.k-k.de/docs/produkte.asp?id=17847&sp=E&m1=17837&m2=17847&m3=&domid=1027&add_shop_act=plist&wgid=1459


http://www.microtechinstruments.com/bmseries.htm


http://www.whipmix.com/7ovens/apollo_1.html



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5

Microscopes (cont.)

Nikon SMZ-645 Versatile lab microscope $2,141 w/fiber optic ring light

and light source

Die Pinning Systems

Renfert TopSpin

Tool-free drill bit replacement

Two working positions via swivel footon base

$599

———

Whaledent Pindex

Foot-controlled or Hand-controlled

Both are laser guided

$599

http://www.coltenewhaledent.com/lab.htm


http://www.nikonusa.com/template.php?cat=5&grp=29&productNr=SMZ645



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Casting Machines

KerrLab Centrifico

Reliable broken-arm castingmachine

Easy to use

$479.50

Induction Casting Machines

Dentsply Ceramco SuperCascom

100 program digital memory

Vacuum/pressure assistedcasting

$15,000 retail price———

Bego Fornax T

Compact design

Short heating time due toinfrared controller

$12,473 retail price

http://www.neydental.com/PagesAsp/eq_prod_pg_3.asp?parmItemNo=9494367

http://www.bego.com/html/core_e.shtml

http://www.jaderockshop.com/Kerr%20Casting%20Equipment.html



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Porcelain

Ivoclar IPS d.Sign Porcelain

Produces esthetic restorations

Mixes easily with minimalslumping

Comparable price to otherporcelain systems used in theUSAF (basic system-$717)

Rated Acceptable by DIS

Porcelain

Vita Omega 900-3D

Low-fusing ceramic

Used for crowns, bridges,laminates

Reportedly compatible withwide variety of metals

Wear is reportedly similar tonatural teeth

Standard kit - $1,696.00

http://www.brooks.af.mil/dis/DIS68/sec13.htm


http://www.vident.com/omega900.htm

http://www.vident.com/omega900.htm

http://www.ivoclarvivadent.us.com/

http://www.ivoclarvivadent.us.com/




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Documents

Dr Ghazy 2013_2014 Instruments and Equipments 3rd and 4th Lectures