Periodontal instruments

9/29/2017 Dr. Mushahida Anjum 1

PERIODONTAL INSTRUMENTS
Dr Mushahida Anjum
Deptt. Of periodontology
Dental College Azamgarh

The Periodontal Instrumentarium

CONTENTS
• Introduction
• CLASSIFICATION OF PERIODONTAL INSTRUMENTS
– Periodontal Probes
– Explorers
– Scaling and Curettage Instruments
– Cleansing and Polishing Instruments
• SURGICAL INSTRUMENTS
– Excisional and Incisional Instruments
– Surgical Curettes and Sickles
– Periosteal Elevators
– Surgical Chisels and Hoes
– Surgical Files
– Scissors and Nippers
– Hemostats and tissue forceps

INTRODUCTION
• Periodontal instruments are designed for
specific purposes, such as removing calculus,
planing root surface, curetting the gingiva, or
removing diseased tissue.
• "Stainless steel is used most commonly in
instrument manufacture.
• High-carbon steel instruments are also
available and are considered by some
clinicians to be superior.

CLASSIFICATION OF PERIODONTAL
INSTRUMENTS
Periodontal Instrument
assessment calculus removal
instrument instrument
probes sickle scaler
explorer curettes
odontoscope files, hoes, chisel

CLASSIFICATION OF PERIODONTAL
INSTRUMENTS
1. Periodontal probes – used to locate, measure, and mark
pockets.
2. Explorers - used to locate calculus deposits and caries.
3. Scaling, root planing, and curettage instruments used for
removal of plaque and calcified deposits from crown & root
of a tooth, removal of altered cementum from the sub
gingival root surface, and debridement of the soft tissue
lining the pocket.

Scaling and curettage instruments are classified as follows:
– Sickle scalers
– Curettes
– Hoe, chisel, and file scalers
– Ultrasonic and sonic instruments
4. The periodontal endoscope- used to visualize deep sub
gingival pockets and furcations enabling the detection of
deposits.
5. Cleansing and polishing instruments - such as rubber cups,
brushes, and dental tape are used to clean and polish tooth
surfaces

PARTS OF PERIODONTAL
INSTRUMENTS
The periodontal probe is composed of the handle, shank, and calibrated working end.

In selecting a instruments handle, there
are 3 characterstics to consider
• weight 15g or less
• diameter 10 mm
• texture knurling pattern

• also called straight shank
• bent in one plane
• Used primarily on anterior
teeth
Simple shank
design
• also called angled shank
• bent in two planes
• Used on posterior teeth
Complex
shank design

• portion that allows working-end
to be adapted to the tooth
surface
Functional shank
• Section of functional shank that is
nearest to working-end termed as
lower shank
Lower / terminal
shank
• shank length that is 3mm longer
than that of standard lower shank
Extended lower
shank

Periodontal Probes
• Periodontal probes used to measure the depth of pockets and
to determine their configuration.
• Typical probe is tapered, rod like instrument calibrated in
millimeters, with a blunt, rounded tip.

Uses of periodontal probes
 Assess the periodontal status for preparation of treatment plan
 Measure pocket depth & clinical attachment level
 Determine relationship of gingival margin & mucogingival junction
 Locate calculus
 Measure the width of attached gingiva
 evaluate gingival bleeding on probing
 Locate& measure furcation involvement
 Measure visible gingival recession
 Determine consistency of gingival tissue
 Evaluate tissue response to professional treatment postoperatively

1ST generation probes
A. The Marquis color-coded probe. Calibrations are in 3-mm
sections.
B. The University of Michigan "O" probe, with Williams markings
(at 1, 2, 3, 5, 7, 8, 9 and 10 mm). 13mm long
C. The Michigan "O" probe with markings at 3, 6, and 8 mm.
Marquis
Michigan “O” probe,
with Williams
markings
WHO
UNC 15
Michigan o

1. CPITN /WHO probe
2. CP 12 : 3,6,9,12
3. GC American : 3,6,9,12
4. UNC 15 : millimeter
marking
D. The UNC-15 probe, a 15-mm-long probe with millimeter markings at
each millimeter and color coding at the 5th, 10th, and 15th mm.
E. The WHO probe, which has a 0.5 mm ball at the tip and millimeter
markings at 3.5, 8.5, and 11.5 millimeters and color coding from 3.5 to
5.5 mm.

Modifications of williamʼs probe
 Goldman fox probe
Calibrations same as williamʼs probe
flattened not round
 University of michigan ʽOʼ probe without
williamʼs marking
Markings are 3, 6 & 8mm

Furcation areas can best be evaluated with the curved, blunt
Nabers probe .
1. EX 3 CH(Hu friedy): fine & pointed ,paired left right,
Curved/bent, for checking surfaces and narrow grooves.
2. Novatech : Right Angle probe ,millimeter markings with
color coding each 5 mm ( 5,10,15). Available in a variety of
mm calibration
3.PQ2N/ Nebers Probe :color coded furcation probe,
markings at 3,6,9,12 mm.

PLASTIC PROBES
Sterlizable probes for pocket depth
measurement around dental implants.
1.Deppeler:3,6,9,12
2. Hu friedy:3,6,9,12
3.Hawe: 3,5,7,10
4.Hawe “ClickProbe”:3,5,7,10
1 2 3 4

PRESSURE SENSITIVE PROBE
Constant pressure probe designed to provide for
standardization of controlled probing pressure
2nd generation probe
Resistance & indicator line
coinside, while a constant
pressure 20g has been
reached
• Peep Probe(Esro)- with markings
at 3,6,9,12mm.
When a force of 0.25 N is applied
, this probe provides an acoustic
signal.

3rd generation probe
• Automated florida probe
• Automated toranto probe
• Interprobe
• Periprobe
• Foster miller probe

Automated Florida probe
The Titanium tip (0.4mm) of this electronic probe
measures pockets around teeth and implants with
a normalized force of 0.25 N and with a precision
of 0.2 mm
•Disc Probe
•Stent Probe
•PD Probe

Automated toranto probe
• Used occluso incisal surface
• probing with .5 mm NiTi wire
• incorporated electronic guidance
system

4th generation Probes
Fourth-generation refers to three-dimensional (3D)
probes. Currently under development, these probes
are aimed at recording sequential probe positions
along the gingival sulcus.
They are an attempt to extend linear probing in a
serial manner to take into account the continuous and
3D pocket being examined.7

5th generation Probes
Despite all the advances in earlier generation probes,
they remain invasive & painful
Plus, probe tip usually crosses the junctional epithelium.
5th generation probes are being devised to eliminate
these disadvantages.
Probes are being designed to be 3D and noninvasive: an
ultrasound or other device is added to a 4th generation
probe.
5th generation probes aim to identify the attachment level
without penetrating it

DNA PROBE
• A nucleic acid probe from a specific microorganism
artificially synthesised & labelled for its detection
• DNA probe use segment of a single stranded nucleic
acid, labeled with an enzyme or radioisotope that is
able to hybridize to complementry nucleic acid

PERIOTEMP PROBE
Periotemp probe ( abiodent) enables calculation
of temperature differential between probed pocket
& subgingival temperature.
higher-temperature
pockets are signaled
with a red
emitting diodes.

9/29/2017
Dr. Mushahida Anjum
29
Subgingival temperature at diseased sites is incresed
compared with healthy sites

Explorers
• Explorers are used to locate calculus deposits, and carious
areas and to check the tooth surface irregularities, & defective
margins on restorations.
• Explorers are designed with different shapes and angles for a
variety of uses.
• Explorer have flexible shank & circular cross section.

Shephered hook explorer
• Use for supragingival examination of
margins of restoration
or to assess for sealant retention
• Not recommended for subgingival
use because point could injure the
soft tissue
e.g. 23 & 54 explorer

Curved explorer
Use for calculus detection in normal
sulci or shallow pockets.
care must be taken not to injure soft
tissue base of sulcus or pocket if
working-end is used subgingivally
e.g. 3 & 3A explorer

Pigtail & cowhorn explorer
Calculus detection in normal sulci or shallow
pocket extending no deeper than cervical
third of root
Curved lower shank causes considrable
stretching away from root surface
e.g. 3ML, 3CH & 2A explorer

Orban-type explorer
tip is bent at 90˚ angle to lower shank
straight lower shank allows insertion in
narrow pockets with slight stretching of soft tissue
Use in assessment of anterior root surface &facial
& lingual surface of posterior teeth, to check caries
e.g. 17, 20F &TU17

11/12 type explorer
• tip at 90˚ angle to lower shank
• use in anterior & posterior teeth equally because of long
complex shank
• use in deep periodontal pockets, & sulci
e.g. ODU 11/12 & 11/12A explorer
Old dominion universityEXD 2R-2L

Straight explorer
• use for supragingival examination of margins of restoration
& to assess for sealant retention
• calculus detection in shallow pockets
• e.g. 6, 6A, & 6XL explorer

A, #17;
B, #23;
C, EXD 11-12;
D, #3;
E, #3CH Pigtail9/29/2017 Dr. Mushahida Anjum 37
A, The limitations of the pigtail explorer
in a deep pocket.
B, Insertion of the #3 explorer.
C, Limitations of the #3 explorer.
D, Insertion of the probe.

SCALERS
 sickle scaler is a periodontal instrument used to
remove calculus deposit from crowns of teeth.
 sickle is limited to use on enamel surface & should
not be used on root surfaces.

Working-end design
• A pointed back
• A pointed tip
• A triangular cross section
• Two cutting edges per working end
• Face is perpendicular to the lower shank

Sickle scalers
• Anterior sickle scaler
e.g. Nevi 1, jacquette30,
jacquette33, goldman-H6,
goldman-H7
• Posterior sickle scaler
e.g. Nevi 2, Nevi 3, Nevi 4,
ball 2/3 , jacquette 34/35
Jacquette 30
Jacquette 33

Nevi 1 sickle end
• sickle end of Nevi 1 instrument
• rigid shank
• Small thin sickle
• use on coronal surface of anterior
tooth

Nevi 1 disc end
• disc end of Nevi 1
• all surfaces are sharp on disc end
• supragingival use on lingual surface

Nevi 2
Paired mirror images working end
Super thin, curved sickle for posterior teeth
Use on proximal & coronal tooth surfaces
Can be inserted several mm subgingivally

Nevi 3
• paired mirror images working end
• long cutting edge facilitate access to proximal tooth
surface
• excellent for use on pediatric patient

Nevi 4
• strong, curved sickle for use on posterior teeth
• rigid working end & shank
• removal of medium or large size deposits

Three different sizes of 204 sickle scalers.
• The curved 204 sickles are available with large, medium, or
small blades.
• Small, curved sickle scaler blades such as 204SD can be
inserted under ledges of calculus a few mm below the gingiva.
• Sickle scalers are used with a pull stroke.

Both ends of a U 15/30 scaler
• The U15/30 , Ball, and Indiana University sickles are large.
• The Jaquette sickles #1, 2, and 3 have medium size blades.

CURRETTES

Types of Curettes
• A curette is a type of scaler that is designed for
moderate calculus removal on supragingival and
subgingival surfaces.
• Types of urettes:
– Universal
– Area Specific (Gracey)
• All curettes share the same common elements:
– Rounded back
– Rounded toe
– Semi-circular cross section
Hufriedy catalogue

curette
universal curettes

Universal Curettes
• Universal curettes are designed for easy
adaptation on all tooth surfaces (thus the
name “universal”).

Universal Curettes
The blade of a universal curette has a round toe and
back, and two cutting edges for scaling, making it an
efficient design for scaling the entire mouth.
Toe
Face
Cutting
Edge
Lateral
Side
Back
90°

Anterior Universal
• To scale the facial surfaces, place the toe of
the blade toward the proximal surface with
the handle parallel to the tooth.
• Apply strokes to remove deposits from the
midline of the tooth to the proximal surface.
• Work from canine to canine.
• Switch working ends and repeat for surfaces
away from you.
• Repeat all of the above for the lingual
surfaces.

Posterior Universal
• Begin at the distal line angle of the most posterior
tooth.
• Direct the toe of the blade toward the distal with
the terminal shank angled slightly toward the tooth.
• Next, turn the toe toward the mesial to scale the
buccal and lingual surfaces.
Hufriedy catalogue
• Apply strokes from the line angle to the
contact area

• Continue this sequence to complete the posterior
region.
• Switch ends and repeat from the lingual aspect
e.g. of universal curettes
Barnhart curettes #1-2 & 5-6
columbia curettes #13-14, 2R-2L, 4R-4L
indiana university #17-18
younger-good #7-8
McCallʼs # 17-18

Curettes
Area Specific (Gracey)
Curettes

Gracey Curettes
• In the early 1940’s, Dr. Clayton Gracey and Hu-
Friedy introduced a set of instruments designed to
be used on specific tooth surfaces that improve
adaptation and deposit removal.
• The Gracey “area specific” designs have laid the
groundwork for the new instruments of today.
• Today, the Gracey Curette family of instruments
give clinicians many options for their treatment
needs.
9/29/2017 Dr. Mushahida Anjum 58Hufriedy catalogue

Gracey Curettes
• The Gracey blade design is offset from
the terminal shank at 70°.
• This creates one cutting edge which is
referred to as the lower edge.
Back
Face
Toe
Cutting
Edge
Lateral
Side
°

Gracey Curettes
The shank design is different for
each Gracey pattern.

•Gracey #1-2 : Anterior teeth – Facial root surfcaces
•Gracey # 3-4: Anterior teeth – Palatal and lingual surfaces
Color Atlas of Periodontics-Rateitschak

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

Gracey Curettes
Gracey Curettes are available in:
• Standard
• Rigid
• After Five
• Mini Five

Standard Gracey Curettes
• Gracey Curettes are area specific
to allow for deep scaling, root
planing and periodontal
debridement.
• The offset blade provides a perfect
working angulation for the tooth
surface.
• Gracey Curettes are used in a set
to completely scale the dentition.

Shank Design and
Diameter
Blade
Length
Blade Width Available Patterns &
Areas of Use
(Chart on next slide)
Standard
(Finishing)
SG#/#
Standard Standard Standard 1/2, 3/4, 5/6, 7/8, 9/10,
11/12, 15/16, 13/14,
17/18*
Rigid
SGR#/#R
Standard design,
increased shank diameter
Standard Standard 1/2, 3/4, 5/6, 7/8, 9/10,
11/12, 15/16, 13/14,
17/18*
After Five
SRPG#/#
Longer terminal shank,
standard diameter
Standard Decreased
by 10%
1/2, 3/4, 5/6, 7/8,
11/12, 15/16, 13/14
Rigid
After Five
SRPG#/#R
increased diameter
Standard Decreased
by 10%
1/2, 3/4, 5/6, 7/8,
11/12, 15/16, 13/14
Mini Five
SAS#/#
standard diameter
Decreased
by 50%
Decreased
by 10%
1/2, 3/4, 5/6, 7/8,
11/12, 15/16, 13/14
Rigid
Mini Five
SAS#/#R
increased diameter
Decreased
by 50%
Decreased
by 10%
1/2, 3/4, 5/6, 7/8,
11/12, 15/16, 13/14
Gracey Design Comparisons
* The 17/18 is a unique pattern, having a longer terminal shank and slightly shorter blade,

Rigid Gracey Curettes
• All Gracey designs are
available with a wider
taper – rigid shank.
• The rigid shank may be
preferred for heavier
calculus removal.
• Although the shank is
wider, the blade width is
the same as the standard
Gracey.
Standard Rigid
Hufriedy catalogue

After Five®
Gracey Curettes
• Designed for instrumentation
in deeper periodontal pockets.
• The terminal shank is
elongated 3mm to provide
better clearance around
crowns, and superior access
to root contours and pockets
5mm or more in depth.
• Blade thinned by 10% to ease
gingival insertion and reduce
tissue distention.
3mm

Gracey After Five Curettes
The change in the location of the shank bend
permits deeper insertion into periodontal pockets.
The thinned blade allows for easier insertion.
SRPG11/12

Mini Five®
Curettes
• Designed with the same elongated terminal shank
and thinned blades as the After Five Gracey
Curettes.
• 50% shorter blade for access to smaller roots,
narrow pockets, furcations, and developmental
grooves.
StandardAfter FiveMini Five
3mm

Gracey Mini Five Curettes
Mini Five reaching into a deep
pocket on a narrow root.
SAS1/2
Hufriedy catalogue

Sinus lift curette
• Used during a sinus lift
procedure to separate/
reflect the schneiderian
membrane from maxillary
bone & to elevate the
membrane

Schwartz Periotrievers
• The Schwartz Periotrievers are a set of two
double-ended, highly magnetized instruments
designed for the retrieval of broken
instrument tips from the periodontal pocket.
• They are indispensable when the clinician has
broken a curette tip in a furcation or deep
pocket.

The long blade is for general use in
pockets, and the contra-angled tip
is for use in furcations
Carranza 11th Edition

Plastic and Titanium Instruments for
Implants.
• Several different companies are
manufacturing plastic and titanium
instruments for use on titanium and
other implant abutment materials.
• It is important that plastic or titanium
instruments be used to avoid scarring
and permanent damage to the
implants

Plastic probe: Colorvue
(Hu-Friedy, Chicago).
Implacare implant instruments (Hu-Friedy, Chicago).
These implant instruments have autoclavable stainless
steel handles and three different cone-socket plastic tip
designs.
Columbia 4R- 4L curette H6-H7 sickle
204S sickle

Plastic Curette Tips Probe & Carbon fiber Curette

Hoe Scalers
• Hoe scalers are used for scaling of ledges or rings of calculus.
• The blade is bent at a 99-degree angle.
• The cutting edge is formed by the junction of the flattened
terminal surface with the inner aspect of the blade. The
cutting edge is beveled at 45 degree
• 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 to permit access
to the roots without interference
from the adjacent tissues.
• McCall’s #3, 4, 5, 6, 7, and 8 are a
set of six hoe scalers designed to
provide access to all tooth surfaces.

QUETIN FURCATION CURETTES
• curettes are actually hoes
• shallow half moon radius that fits into roof or floor of
furcation
• shanks slightly curved for better access
• remove burnished calculus from recessed area of furcation
• available in two width-
BL1,MD1 .9mm blade width
BL2, MD2 1.3mm blade width

Files
• 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.
• Mini-bladed curettes are currently preferred for fine
scaling in areas where files were once used.
• Sometimes used for removing overhanging margins of
dental restorations.

Chisel Scalers
• The chisel scaler, designed for the proximal surfaces of
teeth too closely spaced to permit the use of other scalers.
• It 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 chisel is inserted from the facial surface.
• cutting edge is beveled at 45˚

Dental Endoscope
• A dental endoscope has been
introduced for use subgingivally in the
diagnosis and treatment of periodontal
disease.
• The Perioscopy system (DentalView,
Irvine, calif ) consists of a 0.99-mm-
diameter, reusable fiberoptic
endoscope over which is fitted a
disposable, sterile sheath.

• The fibroptic endoscope fits onto periodontal
probes and ultrasonic instruments that have been
designed to accept it.
• The fiberoptic 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 furcations.
• The sheath delivers water irrigation that flushes the pocket while
the endoscope is being used, keeping the field clear.
Viewing periodontal explorers for the Perioscopy system.

It permits operators to detect the presence and
location of subgingival deposits and guides them
in the thorough removal of these deposits.
Perioscopic instrumentation permits deep
subgingival visualization in pockets and furcation

• Using this device, operators can achieve levels of root
debridement and cleanliness that are much more difficult or
impossible to produce without it.
• Magnification ranges from 24X to 48X, 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

Cleansing and Polishing Instruments
1. Rubber cups
• Rubber cups consist of a rubber shell with or without webbed
configurations in the hollow interior.
• They are used in the handpiece with a special prophylaxis
angle.
• The handpiece, prophylaxis angle, and rubber cup must be
sterilized after each patient use, or a disposable plastic
prophylaxis angle and rubber cup may be used and then
discarded.

• A good cleansing and polishing paste that contains fluoride
should be used and kept moist to minimize frictional heat as
the cup revolves.
• Polishing pastes are available in fine, medium, or coarse
grits and are packed in small, convenient, single-use
containers.
• Aggressive use of the rubber cup with any abrasive
may remove the layer of cementum, which is thin in the
cervical area

2. Bristle Brushes
• Bristle brushes are available in wheel and cup shapes.
• The brush is used in the prophylaxis angle with a polishing
paste.
• Since the bristles are stiff, use of the brush should be
confined to the crown to avoid injuring the cementum and
the gingiva.

Disposable plastic prophylaxis angle
with rubber cup and with brush.

3. Dental Tape
• Dental tape with polishing paste is used for polishing
proximal surfaces that are inaccessible to other polishing
instruments.
• The tape is passed interproximally while being kept at a
right angle to the long axis of the tooth and is activated
with a firm labiolingual motion.

• The area should be cleansed with warm water to
remove all remnants of paste.

4. Air-Powder Polishing
• The first specially designed handpiece to deliver an air-
powered slurry of warm water and sodium bicarbonate for
polishing was introduced in the early 1980s.
• Device called the Prophy-Jet (Dentsply International, York, PA)
is very effective for 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.
• The flow rate of abrasive cleansing power can be adjusted to
increase the amount of powder for heavier stain removal.

• Abrasive effect of the prophy-jet using Na(HCO₃)
on cementum and dentin show that significant tooth
substance can be lost.
• Damage to gingival tissue is transient and
insignificant clinically, but amalgam restorations,
composite resins, cements, and other non metallic
material can be roughened

• Polishing powders containing
glycine, Al(OH)₃ rather than Na(HCO₃)
recently have been introduced for
subgingival biofilm removal from root
surfaces.
• Air-powder polishing can be used
safely on titanium implant surfaces.
• Patients with medical histories of
respiratory illnesses and hemodialysis
are not candidates for the use of the
air-powder polishing device.

• Powders containing Na(HCO₃) should not be used on patients
with histories of hypertension, Na-restricted diets, or
medications affecting the electrolyte balance.
• Patients with infectious diseases should not be treated with
this device because of the large quantity of aerosol created.
• A preprocedural rinse with 0.2% chlorhexidine gluconate
should be used to minimize the microbial content of the
aerosol.
• High speed evacuation should also be used to eliminate as
much of the aerosol as possible.

ULTRASONIC AND SONIC
INSTRUMENTS:-
Oscillating scaler system can be divided into:
Sonic Scaler.
Ultrasonic scaler
Piezoelectric Magnetostirctive

SONIC SCALER
• These scalers operate by compressed air from the dental unit.
• Sonic units consist of a hand piece that attaches to
compressed air and uses a variety of specially designed tips.
• Vibrations at the sonic tip ranges from 2000 to 6500 cycles per
second which provides less power for calculus removal than
ultrasonic unit.

• Tip oscillates with amplitude of upto 1000 µm in an
almost circular motion.
• With this motion/oscillating pattern, irrespective of
adaptation of the tip to the root surface plaque &
calculus are removed by a tapping motion. This is a
major advantage of sonic scalers over the ultrasonic
instruments.

ULTRASONIC INSTRUMENTS
Magnetostrictive scalers
– Oscillations of a tip are in an elliptical pattern at
frequencies of 20,000 Hz to 45,000Hz with amplitude of
13-72 µm.
– The mode of action of the tip is either of a tapping or a
scraping motion depending on the direction of
scaler tip toward root surface.
All 4 sides are active

ULTRASONIC INSTRUMENTS
• Piezoelectric scalers
– Oscillate with frequency of 20,000 – 45,000 Hz.
– The vibrations are generated by change in dimensions of
quartz crystal.
– The oscillations are strictly linear with amplitude of Appx.
72 µm.
• The mode of action of tip is either of a tapping or a scrapping
motion, depending
on the direction of the scaler tip
toward the root surface
• only 2 sides are active

Mechanism of action
It includes frequency, stroke & water flow
 Frequency defined as the no of times per second
 frequency is important because it determines area of
insert tip e.i. considered active
 only active portion of insert can remove hard & soft
debris

 Stroke is maximum distance insert tip travels
during one cycle or stroke path
 Amplitude is equal to one half the distance of
stroke
 power knob on an ultrasonic unit controls the
stroke length of the insert during one cycle

Water flow
 Ultrasonic scalers may be designed as manually or
automatically tuned devices
 Both contain a water knob which controls volume of
water
 manual tuned unit have 3 control knob on front
panel labeled water, tuning & power
 clinician can control frequency by adjusting tuning
knob

 Auto-tuned units have two control knobs
water & power and maintain a stable frequency
 It is vibrating at predetermined frequency level
 water contributes to three physiologic effect
that enhance efficacy of power scaler
1. acoustic streaming
2. acoustic turbulance
3. cavitation

• Acoustic streaming is the unidirectional fluid flow caused
by ultrasound wave.
• Acoustic turbulence is created when the movement of tip
causes the coolant to accelerate, producing an intensified
swirling effect.
• This turbulence continues until cavitations occurs.
• Cavitation is the formation of bubbles in water caused by
high turbulence.
• The bubble implode & produce shock waves in the liquid.

• Creating further shockwaves throughout the water.
• In vitro, combination of acoustic streaming, acoustic
turbulence & cavitation has been shown to disrupt
microflora.

SURGICAL INSTRUMENTS

Surgical Instruments
1. Excisional and incisional instruments
2. Surgical curettes and sickles
3. Periosteal elevators
4. Surgical chisels
5. Surgical files
6. Scissors
7. Hemostats and tissue forceps

Excisional and Incisional Instruments
Periodontal Knives (Gingivectomy Knives)
• The Kirkland knife is representative of knives typically used for
gingivectomy.
• designed either double-ended or single-ended instruments.
• The entire periphery of these kidney shaped knives is the
cutting edge

Interdental Knives
• The Orban knife #1-2 and the Merrifield knife #1, 2, 3, and
4 are examples of knives used for inter dental areas.
•
• These spear-shaped knives have cutting edges on both sides
of the blade and are designed with either double ended or
single-ended blades

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Atlas of Periodontal Surgery- Jeffrey D Johnson

Surgical Blades
 The most common blades are #12D, 15, and 15C.
 The #12D blade is a beak-shaped blade with cutting edges
on both sides, allowing the operator to engage narrow,
restricted areas with both pushing and pulling cutting
motions.
 The #15 blade is used for thinning flaps and general
purposes.

 The #15C blade, a narrower version of the #15 blade, is
useful for making the initial, scalloping-type incision.
1. No. 11 ( MARTIN)
2. No. 12 D (Bard Parker)
3. No. 15 ( MARTIN)
4. No. 15 C (Bard Parker)

 The slim design of this blade allows for incising into the
narrow interdental portion of the flap.
 All these blades are discarded after one use.
• 15
• 12 D
• 15 C

Hufriedy catalogue

Electrosurgery (Radiosurgery)
• The term electro surgery or radio surgery is currently used to
identify surgical techniques performed on soft tissue using
controlled, high-frequency electrical (radio) currents in the
range of 1.5 to 7.5 million cycles per second or MH
• There are three classes of active electrodes:
– single-wire electrodes for incising or excising;
– loop electrodes for planing tissue;
– heavy, bulkier electrodes for coagulation procedures.

The four basic types of electrosurgical techniques
are
• electrosection,
• electrocoagulation,
• electrofulguration
• Electrodesiccation

• The most important basic rule of electrosurgery is: always
keep the tip moving.
• Prolonged or repeated application of current to tissue
induces heat accumulation and undesired tissue
destruction,
• Whereas interrupted application at intervals adequate for
tissue cooling (5 to 10 seconds) reduces or eliminates heat
buildup.
• Electrosurgery is not intended to destroy tissue; it is a
controllable means of sculpturing or modifying oral soft
tissue with little discomfort and hemorrhage for the patient

Surgical Curettes and Sickles
• Larger and heavier curettes and sickles are often needed
during surgery for the removal of granulation tissue, fibrous
interdental tissues, and tenacious subgingival deposits.
• The Prichard curette and the Kirkland surgical instruments are
heavy curettes, whereas the Ball scaler #B2-B3 is a popular
heavy sickle.
• The wider, heavier blades of these instruments make them
suitable for surgical procedures.

Periosteal Elevators
 The periosteal elevators are needed to reflect and move the
flap after the incision has been made for flap surgery.
 The Woodson and Prichard elevators are well-designed
periosteal instruments

Hufriedy catalogue

Surgical Chisels
• The back-action chisel is used with a pull motion.
• The straight chisel (e.g., Wiedelstadt, Ochsenbein #1-2) is
used with a push motion.
• The Rhodes chisel is another popular back-action chisel.
back-action chisel

The Ochsenbein chisel is a useful chisel with a
semicircular indentation on both sides of the shank
that allows the instrument to engage around the
tooth and into the interdental area.
Ochsenbein chisels are paired, with the cutting edges in opposite directions

Mallet

Tissue Forceps
• The tissue forceps is used to hold the flap
during suturing.
• It is also used to position and displace the flap
after the flap has been reflected.
• The DeBakey forceps is an extremely efficient
instrument

Scissors and Nippers
• Scissors and nippers are used in periodontal surgery to
remove tabs of tissue during gingivectomy, trim the margins
of flaps.
• Also used to Enlarge incisions in periodontal abscesses, and
remove muscle attachments in
mucogingival surgery.
• The Goldman-Fox #16 has a curved, beveled blade with
serrations

Conventional scissorsCastroviejo scissor

• Iris Curved Perma Sharp
Scissors
• Tungsten carbide inserts on
both cutting edges.
• Used for fine tissue, membrane
or suture cutting.
Hufriedy catalogue

CURVED TIP
BLUNT TIP

Needleholders
• Needleholders are used to suture the flap at the desired
position after the surgical procedure has been completed.
• In addition to the regular types of needleholder,the
Castroviejo needleholder is used for delicate, precise
techniques that require quick and easy release and grasp of
the suture.

Bone files
Use for final smoothening of bones

PRINCIPLE OF INSTRUMENTATION
• Accessibility, positioning of patient and operator
• Visibility, illumination & retraction
• Condition and sharpness of instrument
• Maintaining a clean field
• Instrument stabilization
• Instrument activation

 accessibility facilitates thoroughness of
instrumentation
 position of patient & operator should provide
maximal accessibility
 inadequate accessibility impedes through
instrumentation, prematurely tires the operator
diminishes effectiveness of clinician
 clinician should de seated on a comfortable
operating stool, so that clinician’s feet are flat on the
floor with the thighs parallel to the floor
Accessibility: positioning of patient & operator

 Back should be straight & head erect position
 patient should be in supine position & placed so
that the mouth is close to the resting elbow of the
clinician
 for instrumentation of the maxillary arch, the
patients chin should be rise slightly( at 45˚)
 for mandibular arch, back of chair slightly raise,
lower chin until madible is parallel to floor

 direct vision with direct illumination from dental
light
 indirect vision by using mouth mirror
 retraction provides visibility, accessibility &
illumination
 mirror also used for retraction cheeks or tongue
 index finger is used for retraction of the lip
Visibility, illumination & retraction

 make sure that area clean, sterile & in good
condition
 working end of pointed or bladed instrument
must be sharp to be effective
 sharp instruments enhance tactile sensitivity
& allow the clinician to work more precisely
Condition& sharpness of instrument

Maintaining a clean field
 instrumentation can be hampered if the
operative field in obscured by saliva, blood &
debris
 A firm finger rest can not be established on
wet, slippery tooth surface

Instrument stabilization
Instrument grasp
 modified pen grasp
 standard pen grasp
 palm and thumb grasp
Finger rest
 conventional
 cross arch
 opposite arch
 finger on finger

Instrument grasp
Pen grasp
the thumb, index finger, & side of middle finger are used to
hold instrument as pen is held

Modified pen grasp:
ensure greatest control in performing intraoral
procedures

for stabilizing instruments during
sharpening and for manipulating
air and water syringes
Palm & thumb grasp

conventional finger rest
established on tooth surface
immediately adjacent to working
area
Finger rest

cross arch finger rest
established on teeth
surface on the other side
of the same arch
opposite arch finger rest
established tooth
surface on the opposite
arch

finger on finger rest
established on the index finger or
thumb of the non operating hand

for effective instrumentation
of some aspects of the
maxillary posterior teeth
palm up:- fulcrum is
established by resting the
backs of the middle & fourth
finger on the skin overlying
the lateral aspects of the
mandible on the right side of
the face
Extra oral fulcrum

palm down:- fulcrum is
established by resting the front
surface of the middle & fourth
finger on the skin overlying the
later aspect of the mandible on
the left side of the face

Instrument activation
• Adaptation
• Angulation
• Lateral pressure
• Strokes

Adaptation
adaptation refers to the manner in which the
working end of the instrument is placed against
the surface of tooth
Angulation
angulation refers to the angle between the face
of a bladed instrument and the tooth surface
-also called tooth-blade relationship
during insertion—0
scaling & root planing– 45-90

Lateral pressure
refers to pressure created when force is applied
against surface of tooth with the cutting edge
of blade instrument
Strokes
exploratory, scaling , root-planning stroke

Periodontal instruments

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