Presented by:Nitesh chaurasiaRoll no. 489

BPKIHS ,dharan

SCALARS, CURETTES, GENERAL PRINCIPLES OF INSTRUMENTATION

• Classification of periodontal instruments• Parts of periodontal instruments• Scalers and its types• Curettes and its types• Universal curettes vs gracey curettes• Principles of periodontal instrumentation

contents

1. Periodontal probes2. Explorers3. Scaling, root planing and curettage instruments:• Sickle scalers• Curettes• Hoe,chisel and file scalers• Ultrasonic and sonic instruments 4.Periodontal endoscope5. Cleansing and polishing instruments –rubber

cups,brushes, dental tape

Classification of Periodontal Instruments

Parts of a typical periodontal instrument

Basic characteristics of blade -flat surface - triangular shape - double cutting edge - sharply pointed tipUses:to remove supragingival calculus and are used with pull strokeCutting edge: junction of face and lateral surface

Sickle scalers

Shank design Straight - anterior teeth and premolars Contra-angled for posterior teeth

Types: U15/30,

Ball, and Indiana university

Jaquette SS #1,2 & 3-medium-size

Curved 204 SS- large, medium or small

Nevi 2 posterior SS-very thin

instrument of choice for removing deep subgingival calculus, for root planning altered cementum, and removing the soft tissue lining of the periodontal pocket

Characteristics: - spoon shaped blade - rounded tip -in cross section appears semicircular with convex basethe curved blade and rounded toe of the curette allow

the blade to adapt better to the root surface, unlike the straight design and pointed end of a sickle scaler, which can cause tissue laceration and trauma.

CURETTES

• Types 1) universal curette 2) area specific curette

The face of the blade is at 90 degree angle to the lower shank, when seen in cross section from the tip

The blade of the universal curette is curved in one direction from the head of the blade to the toe

Examples :- -Barnhart curettes # 1-2 & 5-6 -Columbia curettes #13-14, 2R-2L &4R-4L -Younger-Good # 7-8 - McCall’s #17-18 - Indiana University #17-18

Universal curettes

they are area specific curettes designed and angled to adapt to specific anatomic areas of dentition

Double-ended Gracey curettes are paired in the following manner:-

Gracey #1-2 &3-4: Anterior teeth Gracey #5-6: Anterior teeth & premolars Gracey #7-8 &9-10:posterior teeth: facial and

lingual Gracey #11-12: Posterior teeth: mesial Gracey #13-14: Posterior teeth: distal

Area Specific Gracey curettes

gracey curettes Universal curettes

Areas of use Set of many curettes designed for specific areas and surfaces

One curettes designed for all areas and surfaces

Cutting edge

uses One cutting edge used:Work with outer edge only

Both cutting edge used: work with either outer or inner

curvature Curved in two planes: blade curves up and to the side

Curved in one plane:curves up not to the side

Blade angle Offset angle:face of blade beveled at 60 degree to shank

Blade not offset: face of blade beveled at 90 degree to shank

Gracey Curettes Vs Universal Curettes

Gracey curettes #15-16 ; modification of standard # 11-12 is designed for mesial surface of posterior teethGracey curettes #17-18; modification of standard #13-14 is designed for distal surface of posterior teeth terminal shank elongated by 3 mm other modifications:

Modifications of the Gracey curettes:-

The terminal shank is 3mm longer, allowing extention into deeper periodontal pockets of 5mm or more.

Thinned blade for smoother subgingival insertion E.g. After Five Curettes

Extended shank curettes

Blades are of half the length of the after five or standard Gracey curettes.

Used in case of deep, narrow pockets; furcation; developmental grooves; line angles; and deep, tight, facial, lingual, or palatal pocket.

E.g. Hu-Friedy Mini five curettes are modification of the after five curettes.

Langer & Mini-Langer Curettescombines the shank design of the standard Gracey Curettes

with a universal blade honed at 90 degrees.

combination allows the advantages of the area-specific shank to be combined with the versatility of the universal curette blade.

Mini bladed curettes

The blade length of these instruments is 50% shorter than that of the conventional gracey curette.

And the blade has been curved slightly upward, which allows the Gracey Curvettes to adapt more closely to the tooth surface than any other curettes, especially on the anterior teeth & on line angles.

Precision balanced blade tip in direct aligment with Handle, a blade tip perpendicular to handle and a shank closer to parallel with the handle

Gracey curevettes

for scaling of ledges and rings of calculus. Cutting edge formed by junction of the flattened surface with the inner aspect

of blade beveled at 45° Angulation-99°

Instrument is activated with a firm pull stroke Types McCall’s 3,4,5,6,7 and 8

Hoe scalers

The blade is slightly bowed so that it can maintain contact at two points on a convex surface. The back of the blade is rounded, and the blade has been reduced to minimal thickness

FILES Has series of blades on a base Used to fracture or crush tenacious calculus sometimes used for removing overhanging margins of dental

restorations can easily gouge and roughen root surface if used improperly

CHISEL SCALERS Double-ended with a curved shank at one end and straight

shank at the other end. Designed for proximal surface of teeth too closely spaced,

usulally used for anterior teeth Blades are slightly curved and straight cutting edge beveled at

45 degree-

Activated by push motion while the side of blade is held firmly against root surface.

Fundamental prerequisites for effective instrumentation:

Proper position of the patient and operator(Accessibility) Illumination and retraction for optimal visibility Condition and sharpness of instrument Clean field Instrument stabilization Instrument activation

PRINCIPLES OF PERIODONTAL INSTRUMENTATION

• Facilitates thoroughness of instrumentation• Patient and operator position should provide maximum accessibility to the

area of operation.• Positioning of operator: should be seated on a comfortable operating stool feet of the clinician should be flat on the floor thighs of clinician should be parallel to the floor the clinician’s back should be straight and head erect mouth of the patient should be close to the resting elbow of the clinician

Accessibility: position of patient and operator

Positioning of patientsupine position, mouth close to the resting elbow of

the clinicianFor instrumentation of the maxillary arch:-The patient should be asked to raise the chin slightly

to provide optimal visibility and accessibility.

For instrumentation on the mandibular arch:-The patient is asked to lower the chin until the

mandible is parallel to the floor and the back of the chair is slightly raised.

Visibility, Illumination and Retraction

1.Use of mirror to deflect the Cheek2.Use of the finger of the non-operating hand to retract the cheek(index finger)3.Use of the mirror to retract the tongue4.Combination of the above methods

Retraction

• Condition and Sharpness of Instruments Instruments should be clean, sterile and with sharp working

ends to be effective Sharp instruments enhance tactile sensitivity and allow the

clinician to work more precisely. Dull instrument incomplete removal of calculus and

unnecessary trauma• Maintaining a Clean Field

Instrumentation can be hampered if the operative field is obscured by the saliva, blood and debris.

Clean operating field can be obtained with a saliva ejector or an aspirator and by wiping or blotting with gauze squares

Stability of instrument and hand is the primary requisite for controlled instrumentation

Required for:a.Effective instrumentationb.Avoidance of injury to patient or clinicianFactors enhancing stability:

1)Instrument grasp2)Finger rest

Instrument stabilization

A) Instrument grasp essential for precise control of movements made during

periodontal instrumentation.Kinds of grasp: 1.Standard pen grasp -the side of the middle finger rests on the shank

Modified pen grasp- Most effective and stable grasp-the pad of the middle finger rests on the shank.- produces tripod effect whicha)enhances controlb)enhances tactile sensitivity

Palm and thumb grasp - Used for stabilizing instruments during sharpening and manipulating air and water syringe, but not recommended for periodontal instrumentation

Finger Rest

It stabilizes the hand and the instrument by providing a firm fulcrum. prevents injury and laceration of the gingiva and surrounding tissues. Mostly the fourth(ring)finger is preferred for finger rest.

Conventional Cross-archintraoral fulcrum

Opposite archFinger on Finger

Extra-Oral Fulcrum

Palm-up fulcrum Palm- down fulcrum

Index finger reinforced rest thumb reinforced rest

Proper Instrument activation is important for the efficient plaque and calculus removal.

Components are: Blade adaptation, Instrument angulation,, Blade insertion, Lateral pressure and Working stroke

Instrument Activation

Blade adaptation: It is the manner in which the working end of a periodontal instrument

is placed against the tooth surface. helps to prevent tooth gouging, tissue mutilation or patient discomfort. For bladed instrument the lower third of the working end must be in

constant contact with the tooth

Blade angulation: It is the angle or plane formed by the face of the blade and the tooth

surface. Correct angulation is essential for effective calculus removal. for insertion- 0 degrees for calculus removal- 45 to 90 degrees for gingival curettage- >90 degrees

Lateral pressure It is the presssure created when force is applied against the surface of

the tooth with the cutting edge of the bladed instrument.

Depends on:

a. Nature of calculus

b. Purpose ( for initial scaling to remove calculus or for root planning to smooth the root surface)

Can be:

i. Firm (scaling)

ii.Moderate

iii.Light(root-planing)

StrokesThree basic types:Exploratory stroke: -light, "feeling“ stroke. -used with probes and explorers. -used to evaluate the dimensions of the pocket -to detect calculus and irregularities of the tooth surface.

Scaling stroke:-short, powerful pull stroke -used with bladed instruments -used for the removal of supragingival and subgingival calculus.

Root-planing stroke:- moderate to light pull stroke. -used for final smoothing and planing of root surface

Basic stroke directions

Thank you