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Good Morning To One and All

Classification Of Periodontal InstrumentsPRESENTATION BY:

Mohamed Abdul Haleem1st Year Perio PGKVG Dental college & Hospital, Sullia

CONTENTSIntroductionParts of InstrumentsClassificationDiagnosticPeriodontal probes ExplorersScaling and CurettageFor supragingival scalingFor subgingival scalingCleaning and polishing InstrumentsSurgical InstrumentsPeriodontal EndoscopeUltrasonic and Sonic InstrumentsMiscellaneousSchwartz periotreiversPlastic instruments for implantsHoe scalersFilesChisel scaler

IntroductionPeriodontal instruments are designed for specific purposes.

such asRemoving calculusPlaning root surfacesCuretting the gingival wallRemoving diseased tissue.

Parts of InstrumentsPeriodontal instrument is composed of:BladeShankHandle

Classification of Periodontal InstrumentsDiagnosticPeriodontal probes ExplorersScaling and CurettageFor supragingival scalingFor subgingival scalingCleaning and polishing InstrumentsSurgical InstrumentsPeriodontal EndoscopeUltrasonic and Sonic Instruments

Periodontal probes A typical probe is a tapered rod-like instrument calibrated in millimeters with a blunt, rounded tip. Periodontal probes are used to locate, measure and mark pockets.

When measuring a pocket, the probe is inserted with a firm gentle pressure to the base of the pocket.

The shank should be aligned with the long axis of the tooth.

Types of periodontal probes CoIor-codedNoncolor-coded

The Marquis color-coded probe: The calibrations are in 3 millimeter sections

The UNC-15 probe:It Is a 15 mm long probe Color coding at the 5th, 10th, and 15th mm.

Williams probe:Has both color and non-color codingMarkings at 1,2,3,5,7,8,9 and 10 mm

The Michigan O probeThe Michigan O probe with Williams markings :At 1, 2, 3,5,7,8,9,10 mm (4 and 6 are missing)

The Michigan O probe with markings: At 3, 6, and 8 mm.

The WHO probe:It has a 0.5 mm ball at the tipMillimeter marking at 3.5, 8.5 and 11.5 mm Color coding from 3.5 to 5.5 mm

ExplorersUsed to Locate subgingival deposits in various areasCheck the smoothness of the root surfaces after root planingDesigned with different shapes and angles for a variety of use according to its needs.

Scaling and Curettage Instruments(For supragingival scaling)Sickle scalers:have a flat surface and two cutting edges that converge in a sharply-pointed tip.The arch-shape of the instrument makes the tip so strong that it will not break off during use.They appear triangular in cross-section.

The sickle scaler is inserted under ledges of calculus no more than 1 mm below the gingival sulcus.

It is used with a pull stroke.

The Morse sickleHas a very small, miniature bladeUseful in the mandibular, anterior area where there is narrow, interproximal space. Sickles with straight shanks are designed for use on anterior teeth and premolars, Sickle scalers with contra-angled shanks adapt to posterior teeth.

Curettes(For subgingival scaling)Instrument of choice forRemoving deep subgingival calculusRemoving Altered cementumRoot planing Removing the soft tissue lining the periodontal pocket.

REMOVAL OF SOFT TISSUE LINING THE PERIODONTAL POCKET.

Subgingival curettes can be adapted to provide good access to deep pockets, with minimal soft tissue trauma.

There are cutting edges on both sides of the blade.The curved blade and rounded toe of the curette allows the blade to adapt better to the root surface.

In cross- section the blade appears to be semicircular with a convex base.

Types of curettesThere are two basic types of curettes.Universal curettesBarnhart curettes # 1-2 and 5-6Columbia curettes # 13 -14, 2R-2L and 4R-4L

Area-specific curettesGracey curettesDouble-ended Gracey curettesExtended shank curettes / After Five CurettesMini-bladed curettesLanger and mini langer curettes

Difference between Gracey and universal curettesGracey curette

Set of many curettes designed for specific areas and surfaces.

One cutting edge used, work is done with the outer edge only

Curved in 2 planes blade curves up and to the side

Offset blade, face of blade beveled at 60 degrees to the shankUniversal curette

One curette designed for ail areas and surfaces

Both cutting edges used, work is done with outer or inner edge

Curved in one plane blades curves up and not to the side

Not offset, face of blade beveled at 90 degrees to the shank.Area of use

Cutting edge

Curvature

Blade angle

Cleaning and polishing InstrumentsRubber cups:They consist of a rubber shell with or without configuration in the hollow interiors.

They are used in the hand piece with a specific angle.

A good cleansing and polishing paste that contains fluoride should be used.

Bristle brushes:Available in wheel and cup shapesUsed in hand piece with a polishing paste

Dental tape:Used with a polishing paste for polishing proximal surfaces that are inaccessible to other polishing instruments.

Air powder polishing:A specially designed hand piece that delivers air powdered slurry of warm water and sodium bicarbonate.

This instrument is called prophy- jet.

Effective for the removal of extrinsic stains and soft deposits.

Contraindications: Respiratory illnessHypertensionPatients on medications affecting the electrolyte balance

Disadvantages: Tooth substance can be lostDamage to gingival tissueAmalgam , composite resins and cements can be roughened

Surgical Instruments Excisional and incisional instruments:Periodontal knives (Gingivectomy knives); Example Kirkland knife

Interdental knives: Example, Orban knife #1-2, Merrifield knife #1,2,3 and 4

Surgical blades: Example, # 12D, 15 and ISC.

Electrosurgery techniques and instrumentation:Electrosection used for incisions, excisions and tissue planing.Electrocoagulation, coagulation or hemorrhage controlEceltrofulguration not in general use in dentistryElectrodessication not in general use in dentistry

Electrofulguration, is a procedure to destroy and remove tissue (such as a malignant tumor) using a high-frequency electric current applied with a needlelike electrode

Electrodesiccation denatures a layer of the dermis and the curette is then used over the surgical ulcer to remove denatured dermis over the living tissue.

Used in treatment ofbasal cell cancersandsquamous cell cancersof the skin.

Surgical curettes and sickles:Required for removal of Granulation tissueFibrous interdental tissueTenacious subgingival deposits.

Examples:Kramer curettes # 1, 2, 3 and Langer curettes.Kirkland surgical instruments.Ball scaler # B2-B3.

Periosteal elevators:Necessary to reflect and move the flap after the incision has been made for flap surgery.

Example: Goldman Fox #14.

Surgical chisels and hoes:Used during periodontal surgery for removing and reshaping bone.Chisels are used with a push stroke whereas surgical hoes are used with a pull stroke.Example:

Rhodes chisel.Ochsenbein #1-2, chisel.

Surgical files:They are used primarily to smoothen rough, bony, ledges and to remove all areas of necrotic bone.

Example: Schluger and Sugarman files.

Scissors and nippers:Used forRemoving tags of tissue during gingivectomyTrimming the margins of flapsEnlarging incisions in periodontal abscessesRemoving muscle attachments in mucogingival surgery

Example: Goldman - Fox # 16 scissors.

Needle holders:They are used to suture the flap at the desired position.

Example: Castroviejo needle holder.

Ultrasonic and Sonic InstrumentsUsed for removing plaque, scaling, curetting and removing stains.

Types of ultrasonic unitsTwo types of ultrasonic units are there:Magnetostrictive: Vibration of the tip is elliptical.Hence all the sides can be used.

Piezo-electric:Pattern of vibration of the tip is linearOnly two sides of the tip are active.

Ultrasonic vibrations range from 20,000 to 45,000 cycles/second. They operate In a wet field and have attached water outlets.

Periodontal EndoscopeIt is used subgingivally. in the diagnosis and treatment of periodontal diseases.

Called as the perioscopy system.

It consists of re-usable fiber optic endoscope, over which there is a sterile sheath.

The fiber optic endoscope fits onto the periodontal probes and ultrasonic instruments that have been designed to accept it.

The sheath delivers water for irrigation that flushes the pocket while the endoscope is in use, and it keeps the field clear.

This device allows clear visualization, subgingivatly, in deep pockets and in furcations.

It enables the operator to detect the presence and location of subgingival deposits and guides the operator in their thorough removal.

Using this device it is possible to achieve levels of root debridement and cleanliness that are much more difficult to produce without it.

MiscellaneousSchwartz periotreivers:Set of two double- ended, highly-magnetized instrumentsdesigned for the retrieval of broken instrument tips from the periodontal pocket.

Plastic instruments for implants:Rather than metal, Plastic instruments should be used to avoid scarring and permanent damage to the implants.

Hoe scalers:Used for scaling ledges or rings of calculus.The blade is bent at a 99-degree angleThe cutting edge is beveled at 45 degrees.

used in the following manner:-The blade is inserted to the base of the periodontal pocket, so that it makes a two point contact with the tooth. This stabilizes the instrument and prevents nicking of the tooth.The instrument is activated with a firm pull stroke towards the crown, with every effort being made to preserve the two point contact with the tooth.

Me. Cafis Hoe scalers # 3, 4.5.6.7 and 8 are a set of six Hoe scalers designed to provide access to aLl the tooth surfaces

Files:They have a series of blades on a base.

Their primary function is to fracture or crush tenacious calculus.

Files can easily gouge and roughen root surfaces when used improperly.

Therefore they are not suitable for fine scaling and root planing.

They are sometimes used for removing overhanging margins of dental restorations.

Chisel scalers:Usually used in the too closely spaced proximal surfaces of anterior teeth

It is a double-ended instrument with a curved shank at one end and a straight shank at the other.

The instrument is activated with a push motion.

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