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
Nield p.343
Sickle Scaler 204SGET YOUR TYPODONT & 204S
Nield p.345
Sickle Scaler 204S TechniqueNield p.345
Sickle Scaler 204S TechniqueNield p.346
Sickle Scaler 204S TechniqueNield p.346
Sickle Scaler 204S TechniqueNield p.346
Sickle Scaler 204S TechniqueNield p.346
Sickle Scaler 204S TechniqueNield p.347
Sickle Scaler 204S TechniqueNield p.347
Sickle Scaler 204S TechniqueNield p.347
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
Universal Curettes Curettes come in different sizes and lengths
Nield p.359
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
Universal Curette 13/14Nield p.366
Universal Curette 13/14
Initial Insertion ALWAYS zero degrees for ALL instruments!
Nield p.366
Universal Curette 13/14Nield p.367
Universal Curette 13/14Nield p.367
Universal Curette 13/14Nield p.367
Universal Curette 13/14Nield p.367
Universal Curette 13/14Nield p.368
Universal Curette 13/14Nield p.368
Universal Curette 13/14
After done distal, then scale mesial
Nield p.368
Universal Curette 13/14
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
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 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
Universal Curettes Curettes come in different sizes and lengths
Universal Curettes Curettes come in different sizes and lengths
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
Gracey 13/14NIELD p.400
Gracey 13/14NIELD p.401
Gracey 13/14NIELD p.401
Gracey 13/14NIELD p.401
Gracey 13/14NIELD p.401
Gracey 13/14NIELD p.404
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
Gracey 11/12NIELD p.402
Gracey 11/12NIELD p.402
Gracey 11/12NIELD p.402
Gracey 11/12NIELD p.403
Gracey 11/12NIELD p.403
Gracey 11/12NIELD p.403
Gracey 11/12NIELD p.403
Gracey 11/12NIELD p.404
Gracey 11/12NIELD p.404
Assessment in Clinic GraceyINSTRUMENT ASSESSMENT
Gracey 11/12
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:
Gracey Root Debridement Strokes
NIELD p.408
Gracey Root Debridement Strokes
70◦
NIELD p.408
Gracey Root Debridement Strokes
NIELD p.408
Gracey Horz Strokes Sub-G
NIELD p.409
Gracey Horz Strokes Sub-G
NIELD p.409
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
70◦
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
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
Nield p.321
Angulation & Calculus Removal Nield CH13
Errors in Angulation Will burnish or injure tissue Angles more than 90◦ = 1 cutting edge will be in contact
with tissue
Angulation & Calculus Removal Nield CH13
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