NON SURGICAL PERIODONTAL INSTRUMENT has been designed for specific purposes such as diagnosing the periodontal disease, removing calculus, planning root surfaces, curetting the gingiva and removing diseased tissue.

1. DEPARTMENT OF PERIODONTOLOGY
RAMA DENTAL COLLEGE,HOSPITALAND RESEARCH
CENTER, KANPUR, UTTAR PRADESH-208024
NON-SURGICAL PERIODONTAL
INSTRUMENTS

2. CONTENTS
 INTRODUCTION
 PARTS OF PERIODONTAL INSTRUMENTS
 CLASSIFICATION OF PERIODONTAL INSTRUMENTS
 DIAGNOSTIC INSTRUMENTS
 SCALERS
 CURETTES
 POWERED INSTRUMENTS
 PERIODONTAL ENDOSCOPE
 CLEANING AND POLISHING INSTRUMENTS.
 CONCLUSION
 REFRENCES

3. INTRODUCTION
 The re-establishment and maintenance of periodontal health are the main objectives of
periodontal treatment. Local factors like plaque and calculus are major factors for periodontal
disease progression. Removal of these local factors to obtain a clean root surface is mandatory
to achieve periodontal health. Periodontal instruments have been designed specifically to
achieve these goals. It has been designed for specific purposes such as diagnosing the
periodontal disease, removing calculus, planning root surfaces, curetting the gingiva and
removing diseased tissue.

4. PARTS OF PERIODONTAL INSTRUMENTS
There are three parts of periodontal instruments:-
 Handle
 Shank
 Working end

5. HANDLE
 In selecting an instrument handle, there are three characteristics to consider:
(1) Weight
(2) Diameter and
(3) Texture
a. Instrument Weight
 The optimal weight of a periodontal instrument is 15 g or less.
 Lightweight instruments place less stress on the muscles of the hand and require less
pinch force during periodontal instrumentation.

6. b. Handle Diameter.
 The optimal handle diameter for periodontal instruments is 10 mm.
 Small diameter handles (7 mm) require more pinch force to hold and tend to cause muscle
cramping.
 Large diameter handles (10 mm) and padded handles require the least pinch force when
performing periodontal instrumentation.
c. Handle Texture
 Another term for texturing is a knurling pattern.
 Handles with no texturing decrease control of the instrument in the wet environment of the
oral cavity and increase muscle fatigue.
 Handles with raised texturing are easier to hold in the wet oral environment, thus
maximizing control of the instrument and reducing muscle fatigue.

7. SHANK
 Shank connects the handle to the working end of the instrument.
 Types of shank:-
i. On the basis of design
 Simple shank
 Complex shank
ii. On the basis of flexibility
 Rigid shank
 Flexible shank
iii. On the basis of function
 Functional shank
 Lower shank

8. Simple shank and Complex shank
Simple shank
 A shank that is bent in one plane (front-to-back).
 Another term for a simple shank is a straight shank.
 Instruments with simple shanks are used primarily on anterior teeth.
Complex shank
 A shank that is bent in two planes (front-to-back and side-to-side)
to facilitate instrumentation of posterior teeth.
 Another term for a complex shank is an angled or curved shank.
Fig: a. simple shank
b. complex shank

9. Rigid shank
 An instrument shank that will withstand the pressure needed to remove heavy calculus deposits. A
large calculus deposit can be removed more quickly and with less effort if the instrument has a rigid
shank.
Flexible shank
 An instrument shank that will not withstand the pressure needed to remove heavy calculus deposits
but works well to remove small and medium size calculus deposits.
 Flexible shanks enhance the amount of tactile information transmitted to the clinician’s fingers. Ex-
Explorer

10. Functional shank
 The portion of the shank that allows the working-end to be adapted to the tooth
surface is called the functional shank.
 The functional shank begins below the working-end and extends to the last bend in the shank
nearest the handle.
 Instruments with short functional shanks are used on the crowns of the teeth.
 Instruments with long functional shanks are used on both the crowns and roots.

11. Lower shank
 The section of the functional shank that is nearest to the working-end is termed the lower shank. Another term for the
lower shank is the terminal shank.
 A general rule for working-end selection is that the lower shank should be parallel to the tooth surface—distal, mesial,
facial, or lingual—of the crown or root surface to be instrumented.
 The lower shank may be standard or extended in length .
 An extended lower shank has a shank length
that is 3 mm longer than that of a standard lower shank.
Instruments designed for use in deep periodontal pockets have extended lower shank.

12. Working end
 Periodontal instruments are available as single-ended and double-ended configurations.
 Dental mirrors are usually single-ended instruments
 Double-ended instruments have unpaired working-ends that are dissimilar.
 An example of a double-ended instrument with unpaired working-ends is an explorer
and a probe .
 Many double-ended instruments have paired working-ends that are exact mirror
images. An example of an instrument with paired working-ends is a Gracey 11/12
curettes.

13. Fig: Single-Ended Instruments
The single working-end is a periodontal probe.

14. Fig: Double-Ended Instruments.
Instrument A has unpaired, dissimilar working-ends.
Instrument B has paired, mirror-image working-ends.

15. Design name and number
 The design name identifies the school or individual originally responsible for the design or
development of an instrument or group of instruments.
 The design number is a number designation that, when combined with the design name,
provides an exact identification of the working-end. Using an instrument from the Gracey
series of periodontal curettes as an example—Gracey 11—“Gracey” is the design name and
“11” is the design number that identifies a specific instrument in this instrument series.

16. Fig: Design Name and Number Marked Along the Handle.
 In this example, the name and numbers are marked across the
long axis of the handle.
 Each working-end is identified by the number closest to it.

17. Fig: Design Name and Number Marked Around the Handle.
 In this example, the name and numbers are marked around the handle.
 The first number (on the left) identifies the working-end at the top end of the handle.
 The second number identifies the working-end at the lower end of the handle.

18. Parts of working end
The parts of working end are:
 Face
 Back
 Lateral surface
 Cutting edge
 Toe
 Tip
 Semi-circular (cross-sectional)

19. CLASSIFICATION OF NON-SURGICAL PERIODONTAL INSTRUMENTS

20. Diagnostic instruments
1. Mouth mirror
 Mouth mirror or dental mirror consists of a small, cylindrical , metal shaft with a metal disk attached at the
end of it, which holds the mirror.
 It is also known as Odontoscope.
Types of mouth mirror
There are four types of mouth mirror:
 Plane mirror
 Front surface mirror
 Concave mirror
 Double –sided mirror

21. 1. Plane mirror
 It is also called flat surface mirror.
 Reflecting surface is in the back surface of the mirror.
 Produces a double image (ghost image).
 Double image may be distracting.
2. Concave mirror
 Reflecting surface is on the front surface of the mirror lens.
 Produces a magnified image.
 Magnification distorts the image.

22. 3. Front surface mirror
 Reflecting surface is on the front surface of the glass.
 Produces a clear mirror image with no distortion.
 Most commonly used type because of good image quality.
 Reflecting surface of mirror is easily scratched
4.Double –sided mirror
 It is use to retract the cheek or tongue.
 At the same time the opposite side of the mirror
can be used to view the indirect image

23.  Size of mouth mirror on the basis of diameter
i. Size-1- 16 mm diameter
ii. Size -2- 18 mm diameter
iii. Size-3- 20 mm diameter
iv. Size-4- 22 mm diameter
v. Size-5- 2 4mm diameter
 Most commonly used mouth mirror are size 4/ No-4 and size 5/No-5.
 Use of mouth mirror
i. Indirect vision.
ii. Retraction.
iii. Indirect illumination.
iv. Transillumination.

24. 2.PERIODONTAL PROBE
 ‘Probe’ is latin word which means ‘to test”.
 The periodontal probe was first described as diagnostic instrument by John W Riggs in
1982.
 A periodontal probe has a blunt, rod-shaped working-end that may be circular or
rectangular in cross section and is calibrated with millimetre markings.
 The periodontal probe consists of handle, shank and calibrated working end.
 The working-end and the shank meet in a defined angle that is usually greater
than 90°.

25. Fig : Calibrated Periodontal Probe

26. Generations of Periodontal Probe
 The first systemic classification of periodontal probe was given by B L Pihlstrom in 1992, who
classified periodontal probes into three generations. The first generation, second generation and third
generation.
 Watts in 2000 extended this classification by adding two more generations, fourth and fifth generation of
periodontal probe.
First generation probes
 The first generation periodontal probes are the conventional or manual probes, made up of stainless steel
or plastic.
 The working end of these probes is either round, tapered, flat or rectangular with smooth rounded ends.
 Calibrations in millimetres are made at various intervals, facilitating measurement of periodontal pocket
depths.

27. The first generation probes are:-
1. Marquis color-coded probe
2. UNC-15 probe
3. Williams probe
4. Michigan “O” probe
5. WHO probe
Fig: Types of periodontal probe.
A. Marquis color-coded probe. Calibrations are in 3mm sections. B. UNC-15
probe, a 15-mm-long probe with millimeter markings at each millimeter and
color coding at the 5th,10th, and 15th mm. C. University of Michigan “0” probe,
with Williams markings (at 1,2,3,4,5,7,8,9 and 10mm). D. Michigan “o” probe
with markings at 3,6 and 8mm. E. World Health Organization (WHO) probe
which has a 0.5mm ball at the tip and millimeter markings at 3.5,8.5 and
11.5mm and color coding from 3.5 to 5.5 mm.

28. 1.Williams probe
 Given by Charles H M Williams in 1936.
 It is a stainless steel probe with a diameter of 1mm, length 13mm and blunt tip end.
 The graduations are present at 1,2,3,5,7,8,9 and 10mm.
 4 mm and 6mm readings are missing in this probe to improve visibility and avoid confusion in reading the markings.
2. UNC-15 probe
 University of North Carolina probe.
 Length -15mm.
 Color code- 5,10 and 15mm.
 It is used for clinical trials .

29. 3. CPITN probe / WHO Probe.
 Community periodontal index treatment need.
 Given by George S Beagrie and Jukka Ainamo in 1978.
 It is designed to examine periodontal findings while recording the index.
 Two types:-
 CPITN-E (epidemiologic) – which have 3.5 mm and 5.5 mm markings.
 CPITN-C (clinical) – which have 3.5, 5.5, 8.5 and 11.5 mm markings.
4. Naber’s probe
 It is a curved probe.
 Used for detecting and measuring the furcation involvement in multirooted teeth.
 It has curved working end , a blunt tip and is double ended.
 Naber’s 3N furcation probe which is graduated with markings at 1,2,3,4,5,6,7,8,9,10mm
and color coded probe which has marking at 3, 6, 9 ,12 mm.

30. Second generation probes
 It is also called constant force probe and pressure sensitive probe.
 Second generation probes were developed to standardize and quantify the pressure used during probing.
 These probes are pressure sensitive, allowing for improved standardization of probing pressure.
 It has been shown that probing pressure should not exceed 0.2 N/mm2.
 Example:- True pressure sensitive probe (TPS).
Third generation probes
 It is also known as automated probes.
 Third generation probes refer to automated probing systems, where along with a constant pressure application the
data is stored by the computer.
 Example:- Florida probe, Inter probe, Perio probe.

31. Fourth generation probes
 It is also known as three-dimensional probe.
 The fourth generation periodontal probes utilize 3D technology with the aim of obtaining a precise and continuous
reading of the base of the sulcus or pocket.
 These probes are aimed at recording sequential probe positions along the gingival sulcus.
 The 3D visualization can provide us quite accurate information about the periodontal pocket.
Fifth generation probes
 It is also known as Non-Invasive three –dimensional probe.
 These probes are designed to utilize ultrasound waves.
 They are non-invasive probes.
 It provide an accurate measurement of attachment levels without penetrating the junctional epithelium.
 The only available fifth generation probe is Ultra Sonographic probe.

32. Function of periodontal probe
 Detect periodontal pockets to determine the health status of the periodontium
 Measure clinical attachment loss.
 Measure extent of recession of the gingival margin.
 Measure the width of the attached gingiva.
 Measure the size of intraoral lesions.
 Assess bleeding on probing.
 Determine mucogingival relationships.
 Monitoring the longitudinal response of the periodontium to treatment.

33. 3. EXPLORERS
Explorers are used to locate subgingival deposits and carious areas and to check the smoothness of the root
surfaces after root planing.
Design of explorers
 Explorers are made of flexible metal that conducts vibrations from the working end to the clinician’s fingers
resting on the instrument shank and handle.
 Explorers are circular in cross section and may have unpaired (dissimilar) or paired working-ends.
 The working-end is 1 to 2 mm in length and is referred
to as the explorer tip.
 Only light exploratory stroke applied
to evaluate the surface smoothness

34. Types of explorer
The different types of explorer are:-
1. Straight explorer
2. Shepherd hook explorer
3. Curved explorer
4. Orban type explorer
5. 11/12 type explorers
6. Pigtail and Cowhorn explorers

35. 1. Shepherd Hook Explorer
 It resembles the long stick with a curved end
that was used by ancient shepherds to catch sheep.
Uses:-
 Supragingival examination of the margins of restorations or to assess for sealant
retention.
 It is not recommended for subgingival use because the point could injure the soft tissue
at the base of the sulcus or pocket.
 Examples: 23 and 54 explorers.

36. 2. Straight Explorer
 It is most commonly used explorers.
 It has a straight working end with a pointed tip.
Use:
 Supragingival examination of the margins of restorations or to assess for sealant
retention.
 It is not recommended for subgingival use because the point could injure the soft tissue
at the base of the sulcus or pocket.
 Examples: 6, 6A, 6L, and 6XL explorers.

37. 3. Curved explorer
 It is used to detect the presence of calculus on the root surfaces.
 These are used with a light stroke and move on the root surface in the horizontal
direction.
 Use:
 Calculus detection in normal sulci or shallow pockets.
 Care must be taken not to injure the soft tissue base
of the sulcus or pocket if the working-end is used sub-gingivally.
 Examples: 3 and 3A explorers.

38. 4. Pigtail and Cowhorn Explorers
 They resemble a pig’s tail or a bull’s horns.
Use:
 Calculus detection in normal sulci or shallow pockets. .
 The curved lower shank causes considerable stretching of the tissue away from the root
surface.
 Examples: 3ML, 3CH, and 2A explorers.

39. 5. Orban-Type Explorer.
 This is also a commonly used explorer.
 The tip of the explorer bent at a 90° angle to the lower shank.
Use:
 Assessment of anterior root surfaces and the facial and lingual
surfaces of posterior teeth.
 Examples: 17, 20F, and TU17 explorers.

40. 6. 11/12-Type Explorer
 Like the Orban-type explorers, the tip is at a 90° angle to the lower shank.
Use: Assessment of root surfaces on anterior and posterior teeth.
Examples: ODU 11/12 and 11/12AF explorers.

41. SCALERS
1. SICKLE SCALER
 Sickle scalers is also known as Supragingival scalers.
 Sickle scalers have a flat surface and two cutting edges that converge in a sharply pointed tip.
 The sickle scalers is used primarily to remove supra-gingival calculus .
 Sickle scalers are used with a pull stroke.
 Sickle scalers with straight shanks are designed for use on anterior teeth and premolars.
 Sickle scalers with contra-angled shanks adapt to posterior teeth.

42. Design Characteristics of Sickle Scaler
Working-End Design.
The working-end of a sickle scaler has several unique design characteristics :-
1. A pointed back; some newer sickle scaler designs have working-ends with rounded backs.
2. A pointed tip.
3. A triangular cross section.
4. Two cutting edges per working-end.
5. The face is perpendicular to the lower shank.

43.  Anterior sickle scalers: They are limited to use on anteriors.
e.g. Nevi-1, Jacquette-33, Towner-U15, Goldman-H6, Goldman-H7.
 Posterior sickle scalers: They are designed not only for use on posterior sextants, but also may be used on anterior
teeth.
 They have two cutting edges: inner and outer cutting edges.
 Inner cutting edges are used to instrument distal surfaces and
outer surfaces are used to instrument facial, lingual and mesial surfaces
e.g.-Jacquette-34/35, Jacquette-14/15, Jacquette-31/32.

44. 2. Hoe scalers
 Hoe scalers are used for scaling of ledges or rings of calculus.
 The blade is bent at a 99° angle.
 The cutting edge is formed by the junction of the flattened terminal surface
with the inner aspects of the blade.
 The cutting edge is beveled at 45°.
 The blade is slightly bowed so that it can maintain contact at two points on a convex surface.
 This stabilizes the instrument and prevents nicking of the root.
 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.

46.  Hoe scalers are used in the following manner:
1.The blade is inserted to the base of the periodontal pocket so that it makes two-point contact with them tooth .
This stabilizes the instrument and prevents nicking of the root.
2. The instrument is activated with a firm pull stroke toward the crown, with every effort being made to
preserve the two-point contact with the tooth.
McCall's #3, 4, 5, 6, 7, and 8 are a set of six hoe scalers designed to provide access to all tooth surfaces.

47. 3. File scaler
 Files have a series of blades on a base .
 Their primary function is to fracture or crush large deposits of tenacious calculus or burnished sheets of
calculus.
 Files can easily gouge and roughen root surfaces when used improperly.
 Therefore, they are not suitable for fine scaling and root planing.
.

48. 4. Chisel scaler
 The chisel scaler, designed for the proximal surfaces of teeth too closely spaced to permit the use of other scalers,
is usually used in the anterior part of the mouth.
 It is a double-ended instrument with a curved shank at one end and a straight shank at the other.
 The blades are slightly curved and have a straight cutting edge beveled at 45 degrees
 The chisel is inserted from the facial surface.
 The slight curve of the blade makes it possible to stabilize it against the proximal surface,
whereas the cutting edge engages the calculus without nicking the tooth.
 The instrument is activated with a push motion
while the side of the blade is held firmly against the root.
fig : chisel scaler

49. CURETTES
 The curette is the instrument of choice for removing deep subgingival calculus, root planing altered cementum,
and removing the soft tissue lining the periodontal pocket.
 The working end of curette has a cutting edge on both sides of blade and a rounded toe.
 The curved blade and rounded toe of the curette allow the blade to adapt better to the root surface.
 There are two types of curettes:
1. Universal Curettes
2. Area Specific Curettes

50. AREA SPECIFIC CURETTES UNIVERSAL CURETTES
Area of use
Cutting edge
Curvature
Blade angle
Examples
Set of many curettes designed for specific areas and
surfaces.
One cutting edge used; work with outer edge only.
Curved in two planes; blade curves up and to the side.
Offset blade; face of blade beveled at 60 -70 degrees to
shank.
Gracey #1-2 and 3-4: Anterior teeth
Gracey #5-6: Anterior teeth and premolars
Gracey #7-8 and 9-10: Posterior teeth: facial and lingual
Gracey #11-12: Posterior teeth: mesial.
Gracey #13-14: Posterior teeth: distal
One curette designed for all areas and surfaces.
Both cutting edges used; work with either outer or
inner edge .
Curved in one plane; blade curves up, not to the
side.
Blade not offset; face of blade beveled at 90
degrees to shank.
Barnhart curettes #1-2 and 5-6
Columbia curettes # 13-14, 2R-2L and 4R-4L
Younger –Good #7-8
Indiana University #17-18

51. Extended-Shank Curettes.
 Extended-shank curettes, such as the After Five curettes (Hu- Friedy, Chicago), are modifications of the standard
Gracey curette design.
 The terminal shank is 3 mm longer, allowing extension into deeper periodontal pockets of 5 mm or more.
 Other features of the After Five curette include a thinned blade for smoother subgingival insertion and reduced
tissue distention and a large-diameter, tapered shank.
 All standard Gracey numbers except for
the #9-10 (i.e., #1-2, 3-4, 5-6, 7-8, 11-12, 13-14)
are available in the After Five series.
fig: After five curette
a. #5-6, b. #7-8 c. # 11-12 d.#13-14

52. Mini –Bladed Curettes
 Mini –bladed curettes such as the Hu- Friedy Mini Five curettes are the modification of the After Five Curettes.
 The feature blades are half of the length of the After Five or Standard Gracey Curettes.
 The shorter blade allows easier insertion and adaptation in deep,
narrow pockets, furcation, developmental grooves, line angles
and deep, tight, facial, lingual, or palatal pocket.
 Mini Five curettes can be used with vertical strokes, with
reduced tissue distention, and without tissue trauma .
fig: Comparison of After Five Curette and Mini Five Curette

53. Langer and Mini-Langer Curettes
 This set of three curettes combines the shank design of the standard Gracey#5-6, 11-12, and 13-14 curettes
with a universal blade honed at 90 degrees rather than the offset blade of the Gracey curette.
 This marriage of the Gracey and universal curette designs allows the advantages of the area-specific shank
to be combined with the versatility of the universal curette blade.
 The Langer #5-6 curette adapts to the mesial and distal surfaces of anterior teeth, the Langer #1-2 curette
(Gracey #11-12 shank) adapts to the mesial and distal surfaces of mandibular posterior teeth and the Langer
#3-4 curette (Gracey #13-14 shank) adapts to the mesial and distal surfaces of maxillary posterior teeth.

54. fig : Langer curettes combine Gracey- type shanks with universal
curette blades. Left to right #5-6, #1-2 and #3-4.

55. DENTAL ENDOSCOPE
A dental endoscope has been introduced recently for use sub-gingivally in the diagnosis and treatment of
periodontal disease. The Perioscopy system consists of a 0.99-mm-diameter, reusable fiber-optic
endoscope over which is fitted a disposable, sterile sheath.

56.  'File sheath delivers water irrigation that flushes the pocket while the endoscope is being used ,keeping the field clear.
 The fiber-optic endoscope attaches to a medical-grade charged-coupled device (CCD) video camera and light source that
produces an image on a flat panel monitor for viewing during subgingival exploration and instrumentation.
 This device allows clear visualization deeply into subgingival pockets and furcation.
 It permits operators to detect the presence and location of subgingival deposits and guides them in the thorough removal of
these deposits.
 Magnification ranges from x24X to x46X, enabling visualization of even minute deposits of plaque and calculus.
 The Perioscopy system can also be used to evaluate subgingival areas for caries, defective restorations, root fractures, and
resorption.

57. POWERED INSTRUMENTS
 Powered instruments use a rapidly vibrating instrument tip to dislodge calculus from the tooth
surface, disrupt plaque biofilm, and flush out bacteria from the periodontal pocket.
 It consists of a headpiece that attaches to the dental unit or an electronic generator and interchangeable
instrument tips.

58. Mode of Action of Powered Instruments
a. Mechanical Removal - Very rapid vibrations of the powered instrument tip create micro fractures in a calculus deposit
that result in deposit removal.
b. Water Irrigation - A constant stream of water exits near the point of an electronically powered instrument tip .
This water stream within the periodontal pocket is termed the fluid lavage.
 The water flowing over the instrument tip is needed to dissipate
the heat produced by the rapid vibrations of the tip.
 Water irrigation also plays an important role in periodontal debridement.

59. c. Acoustic Micro streaming of the Water Stream
 Acoustic micro-streaming is a swirling effect produced within the confined space of a periodontal pocket by the
continuous stream of fluid flowing over the vibrating instrument tip.
 This intense swirling may play a role in the disruption of the subgingival plaque biofilms associated with periodontal
disease.
d. Cavitation of the Water Stream
 Cavitation is the formation of tiny bubbles in the water stream.
 When these tiny bubbles collapse, they produce shock waves that may alter or destroy bacteria by tearing the bacterial
cell walls.

60. Contraindications of Powered Instrumentation
1. Communicable disease like hepatitis, tuberculosis
2. Uncontrolled diabetes
3. Respiratory disease like asthma
4. Unshielded cardiac pacemaker
5. Primary and newly erupted teeth of young children.
6. Patients with history of organ transplant.
7. Hypersensitive teeth, Porcelain crowns, composite resin restorations.

61. TYPES OF POWERED INSTRUMENTS
 There are two types of powered instruments:-
1. Sonic- Powered Instruments
2. Ultra-sonic Powered Instruments.
a. Magnetostrictive ultrasonic instruments
b. Piezoelectric ultrasonic instruments

62. 1. Sonic – Powered Instruments
 It operate at a relatively low frequency to 3,000 to 8,000 cycles per second and are driven by
compressed air from the dental unit.
 Sonic devices consist of a hand piece (that attaches to the dental unit’s high-speed hand piece tubing)
and interchangeable instrument tips.

63. 2. Ultrasonic powered Instruments
 It operate inaudibly at 18,000 to 45,000 cycles per second (kHz).
 Ultrasonic devices can be further categorized into Magnetostrictive and Piezoelectric.
 Piezoelectric ultrasonic instruments use electrical energy to activate crystals within the hand piece to
vibrate the tip.
 Magnetostrictive ultrasonic instruments transfer electrical energy to metal stacks made of nickel-iron
alloy or to a ferrous rod.

64. 1. Piezoelectric Ultrasonic Device.
Piezoelectric ultrasonic devices consist of a portable electronic generator,
a hand piece, and instrument tips.
2. Piezoelectric Instrument Tips.
Some piezoelectric devices have instrument tips
that attach directly to the hand piece.
3. Piezoelectric Hand piece and Instrument Tip.
An example of a piezoelectric ultrasonic hand piece
and powered tip.

65.  Magnetostrictive devices have removable instrument inserts that fit into a tubular hand piece.
 The components of a magnetostrictive insert are:
1.Metal stack— Converts electrical power into mechanical vibrations.
2. O-ring— A seal that keeps water flowing through the insert rather than flowing out of the
hand piece.
3. Handle grip-- Portion of the insert grasped by the clinician during instrumentation.
4. Water outlet— Provides water to the instrument tip.
5. Working-end— Portion of the instrument insert used for calculus removal and deplaquing.

66. Magnetostrictive Insert Frequency Options.

67. Powered Instrument Tip Design
 The two basic types of powered instrument tips are standard-diameter tips and slim-diameter tips.
 Standard-diameter tips are larger in size and have shorter shank lengths than slim-diameter tips.
These tips are comparable to sickle scalers and universal curettes in function.
 Uses : i. Heavy deposit removal: Supragingival use.
ii. Subgingival deposits easily accessed without undue tissue stretching.
Fig : Standard –Diameter powered Tip Design

68.  Slim-diameter tips are 40% smaller in diameter and have longer, more complex shanks
than standard-diameter tips. These tips are comparable to area-specific curettes in function.
 Uses : i. Light deposits and deplaquing.
ii. Debridement of root concavities and furcation areas.
Fig : Slim Diameter Powered Tip Design

69. Frequency and Amplitude
A. Frequency is the measure of how many times the electronically powered instrument tip
vibrates per second.
1. Low Frequency- When the frequency of a powered instrument is low, the instrument tip
vibrates fewer times per second.
2. High Frequency- When the frequency of a powered instrument is high,
the instrument tip vibrates more times per second.

70. B. Amplitude.
 Amplitude is a measure of how far the instrument tip moves back and forth during one
cycle.
 Ultrasonic powered devices have a power knob that is used to change the length of the stroke.
1.Low Amplitude
 Lower amplitude causes the instrument tip to move a shorter distance.
 lower amplitude delivers a shorter, less powerful stroke.
2. Higher Amplitude
 Higher amplitude causes the instrument tip to move a longer
distance.
 Higher amplitude delivers a longer, more powerful stroke.

71. ACTIVE TIP AREA
 The portion of the instrument tip that is capable of doing work is called the active tip area.
The power to remove calculus is concentrated in the last 2 to 4 mm of the length of a powered instrument tip.
1. The active tip area ranges from approximately 2 to 4 mm of the length of the
instrument tip.
2. The higher the frequency of the powered device, the shorter the active tip area.
a. For a 50-kHz device, the active tip area is 2.3 mm long.
b. For a 30-kHz device, the active tip area is 4.2 mm long.
c. For a 25-kHz device, the active tip area is 4.3 mm long.
 Fig: illustrates the active tip area of a powered tip.

72. INSTRUMENT TIP WEAR AND REPLACEMENT
 The working-end of the powered instrument should be inspected regularly for signs of wear.
 With use, the instrument tip is worn down. As the instrument tip wears, effectiveness decreases.
1. A rule of thumb is that 1 mm of wear results in approximately 25% loss of efficiency.
2. Approximately 50% loss of efficiency occurs at 2 mm of wear and the tip should be discarded at this point.
FIG : Instrument tips should be evaluated for tip
wear. Tips should be discarded after 2 mm of wear.

73. CLEANSING AND POLISHING INSTRUMENTS
 The primary objective of polishing is the removal of extrinsic stain and supra-gingival
plaque.
 The rationale for this procedure includes improving the appearance of the
dentition, demonstrating a standard of oral cleanliness for the patient to attain on a daily
basis, and motivating the patient to improve plaque control, as well as the belief that
the outcome of a quality periodontal service should be a plaque-free mouth.

74. Various Cleansing and Polishing Instruments
1. Bristle brushes:
 They are available in wheel and cup shapes.
 The brush is used in the hand piece along with a polishing paste.
 Brush bristles are usually stiff and hence its use should be restricted to the crown to prevent injury to the
cementum and the gingiva.
2. Rubber cups:
 They consist of a rubber shell with or without webbed configurations in the hollow interior.
 They are used in the hand piece with a special prophylaxis angle.
 A good cleansing and polishing paste that contain fluoride should be used and kept moist to minimize frictional
heat as the cup revolves.
 Polishing pastes come as a fine, medium, or coarse grits and are packaged in small, convenient containers.

75. 3. Dental tape with polishing paste
 It is used for polishing proximal surface that is inaccessible to other polishing instruments.
 The tape is passed inter-proximally while being kept at a right angle to the long axis of the tooth and is
activated with a firm labio-lingual motion.
 The area should be cleansed with warm water to remove all remnants of paste.

.

76. 4. Air-powered polishing:
 Prophy-jet is composed of air powered slurry of warm water and sodium bicarbonate.
 This system is beneficial in the removal of extrinsic stains and soft deposits.
 The slurry removes stains rapidly and efficiently by mechanical
abrasion and provides warm water for rinsing and lavage.

77.  The results of studies on the abrasive effect of the air powder polishing devices using sodium bicarbonate on
cementum and dentin show that significant tooth substance can be lost.
 For this reason, polishing powders containing aluminum tri-hydroxide or other substances rather than sodium
bicarbonate recently have been introduced.
 Patients with medical histories of respiratory illnesses and hemodialysis are not candidates for the use of the air-
powder polishing device.
 Patients with infectious diseases should not be treated with this device because of the large quantity of aerosol.
 A pre-procedural rinse with 0.12% chlorhexidine gluconate should he used to minimize the microbial
content of the aerosol.

78. CONTRAINDICATIONS OF POLISHING
1. Patients who have communicable disease that could be spread by aerosols.
2. Patients who are susceptible for bacteremia.
3. Areas of thin or deficient enamel, cementum or dentin surfaces; areas of hypersensitivity.
4. Caries susceptible teeth; areas of white spot demineralized mottled teeth.
5. Gold restorations.
6. A restricted sodium diet, including patient with controlled hypertension.
7.Composite restorations.

79. CONCLUSION
It is concluded that the aim of periodontal therapy is to remove all the local factors
responsible for disease progression and to make periodontal tissue architecture conductive
for self-oral hygiene maintenance. Non-surgical periodontal instruments are used as an
important diagnostic instruments , scaling , root planing and cleaning and polishing
procedure. A thorough knowledge of instruments ,their method of clinical application is
necessary before their clinical usage.

80. REFRENCES
1. Carranza’s Clinical Periodontology 10th Edition.
2. Periobasics A textbook of Periodontics and Implantology 2nd edition.
3. Fundamentals of Periodontal Instrumentation ( Jill S. Nield- Gehrig).
4. Textbook of Periodontics ( Shalu Bhatla).
5. Periodontal Probes : A Review
6. Textbook of dental hygienist – 3rd edition- Wilkins

81. THANK YOU