common periodontal instruments and principle of instrumentation.

1. ‫الرحيم‬‫الرحمن‬‫هللا‬ ‫بسم‬
Mohanad Elsherif
BDS(U of K), MFD RCSI, MFDS RCPS(Glasg), MSc(Orthodontics),
M.Orth RCSEd

2. Periodontal instruments are
designed for specific purpose such
as removing calculus, planning root
surface, curetting the gingiva or
removing diseased tissue.

3. Each instrument consist of:
•Handle.
• Shank.
•Head (Working End).

4. A B C
Shank
HANDLE
Head

5. • Examinassions instrument:
• Mirror.
• Probe.
• Explorer.

6. •Uses of dental mirror:
•Indirect vision.
•Illumination: reflection of light.
•Transillumination: Reflection of light
“through” the tooth surface.
•Retraction.

7. •Primary instrument in periodontal
examination.
•Assess gingival health.
•Assess Periodontal status.

8. •Vary in cross-sectional design:
 Rectangular in shape (flat)
 Oval
 Round
•Millimeter markings.
•Calibrated at varying intervals.

11. •An explorer is an assessment
instrument used to locate calculus
deposits, tooth surface irregularities,
defective margins on restorations,
and carious lesions. Explorers have
flexible shanks and are circular in
cross section.

13. • Scaling instrument:
1. Manual scaller:
• Curâtes.
• Sickles.
• Hoes.
• Files.
• Chisels.
2. Sonique and ultrasonique scalers.

14. •Sickle scaler is a periodontal
instrument used to remove
calculus deposits from the crowns
of teeth.
• The working- end of sickle scaler
has a pointed back and pointed tip
and is triangular in cross section.

15. Uses:
•Supragingival calculus.
•Stain.
•Slightly subgingival (1-2mm).

17. • A curate is a periodontal instrument used
to remove calculus deposits from the
crown and roots of the teeth. The working-
end of curate has a rounded back and
rounded toe and is semi-circular in cross
section.
• Two curate sub-types are the universal
curate and the area-specific curate.

19. •Adapt to a specific area of tooth
surface.
•Only one cutting end are used.
•70° degree blade angulation.

20. •Can adapt to all tooth surfaces.
•90 degree blade angulation.
•shank curvature allows
adaptation.
•both cutting edges are used.
•blade curved on only one plane.

22. •Periodontal file is an instrument
used to crush large calculus
deposits.
• Each working-end of a periodontal
file has several cutting edges.

24. •Hoe scalers are used for scaling of
ledges or rings of calculus.
•The blade is bent at a 99 degree
angle and is slightly bowed so that
it can maintain contact at two
point on a convex surface.

26. • The chisel scaler is designed for the
proximal surfaces of teeth which are too
closely spaced to permit the use of other
scalers.
• 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 degree.

28. •Sonic scalers operate at low
frequency 300-800 Hz.
•The stroke pattern is elliptical to
orbital.

29. • Ultrasonic scaler can be divided
into:
1. Magnitostrictive: Operate at
range (18,000-42,000 KHz).
 Made of nickel iron alloy or ferrous
red.
 All surfaces can be used because of
the elliptical or orbital motion.

30. 2. Piezoelectric scaler:
 operate at a range of (24000-
45000KHz).
 Remove the calculus by
vibration of the tip on lateral
aspects.

33. Mohanad Elsherif
BDS(U of K), MFD RCSI, MFDS RCPS(Glasg), MSc(Orthodontics),
M.Orth RCSEd

34. •Effective instrumentation is
governed by a number of
principles that are common to all
periodontal instruments these
principles are:

36. The position of the patient and the
operator should provide maximum
accessibility to the area of operation.
1. Position of the operator:
The operator should be seated on a
comfortable operating stool, his feet are
flat on the floor with thigh parallel to the
floor.

37. • The back should be straight and the
head is erected
2. Position of the patient:
The patient should be in a supine
position, the mouth should be close to the
resting elbow of the clinician.

38. • For instrument of:
• Maxillary arch: the patient should be
asked to raise his/her chin slightly
• Mandibular arch: raise the back of the
chair slightly and the patient should
lower his/her chin until the mandible is
parallel to the floor.

40. • Direct vision with direct illumination from
dental light is the most desirable way.
• If not possible indirect vision may be
obtained by using the mouth mirror to
reflect the light.

41. • Retraction provides visibility, accessibility
and illumination , depending on the
location of the area of operation the
fingers and/or the mirror are used for
retraction. The mirror may be used to
retract the cheek or the tounge, the index
finger is used for retraction of the lip and
cheek.

42. • When retraction care should be taken to
avoid irritation to the angel of the mouth.

46. • Before any instrumentation, all
instruments should be inspected to
make sure that they are clean, sterile,
sharp and in good condition.
• Sharp instrument enhance tactile
sensation and allow the clinician to work
more precisely and efficiently.

47. • Dull instruments may lead to incomplete
calculus removal and unnecessary
trauma because of the excess force
usually applied to compensate for their
ineffectiveness.

49. • The pooling of the saliva interferes with
visibility during instrumentation and
impedes control because a firm finger rest
can not be established on a wet tooth
surface.
• Adequate suction is essential and can be
achieved with saliva ejector or if the
working with and assistant an aspirator

50. • blood and debris can be removed from
the operative field with suction and by
wiping or blotting with gauze squares.
Immediately after the gauze is removed
the subgingival area should be clean, dry
and visible for a brief interval.

52. • Stability and control are essential for
effective instrumentation and avoidance
of injury to the patient and clinician.
• 2 major important factors provide
stability:
1. Instrument grasp:
A proper grasp is essential for precise
control of movements made during
periodontal instrumentation.

53. • Type of grasps:
a. Standard pen grasp.
b. Modified pen grasp:
This is the most effective and stable grasp
for all periodontal instrument. The thumb,
index and middle fingers are used to hold
the instrument.

54. • The middle finger is positioned at the side
of the pad on the shank the index finger is
positioned above the middle finger on the
same side of the handle the pad of the
thumb is placed midway between the
middle and index finger on the opposite
side of the handle.

55. • This creates a triangle of force or tripod
which enhance control. It also enhance
the tactile sensation.
c. Palm and thumb grasp:
• This type is useful for stabilizing the
instrument during sharpening, it is also
used for manipulating air and water
syringes. But it is not recommended for
periodontal instrumentation.

58. 2. Finger Rest:
The finger rest serves to stabilize the hand
and the instrument by providing a firm
fulcrum as movements are made to activate
the instrument.
The fourth (RING) finger is preferred by
most clinicians for the finger rest.

59. • Finger rests may be generally classified
into:
• Intra oral: it has 4 types:
• Conventional: the finger rest is
established on the tooth surfaces
immediately adjacent to the working
area.
• Cross arch: the finger rest is established
on tooth surface on the other side of the

60. • Opposite arch: the finger rest is
established on tooth surface on the
opposite arch
• Finger on finger: the finger rest is
established on the index finger or thumb
of the non- operating hand. This is useful
when there is tooth mobility.

61. • Extra oral : these are
• Palm up: is established by resting the back of
the middle and fourth fingers on the skin
overlying the lateral aspect of the mandible
on the right side of the face.
• Palm down: is established by resting the front
surface of the middle and fourth fingers on
the skin overlying the lateral aspect of the
mandible on the left side of the face.

63. • 5 steps for interment activation:
a. Insertion: ‫شرح‬ ‫دايرة‬ ‫ما‬ ‫و‬ ‫واضحة‬
b. Adaptation: refers to the manner in
witch the working end of a periodontal
instrument is placed against the tooth
surface.

64. c. Angulation: refers to the angle between
the face of a bladed instrument and the
tooth surface it may also called tooth-blade
relationship.
d. Lateral pressure: refers to the pressure
created when force is applied against the
surface of the tooth with the cutting edge
of bladed instrument. Lateral pressure may
be firm, moderate or light.

65. e. Stroke: 3 basic types of stroke are
used during instrumentation:
 Exploratory stroke.
 Scaling stroke: pull, powerful and short.
 Root planning stroke: pull, moderate to
light, long.

66. Declaration
 The author wish to declare that; these presentations are his
original work, all materials and pictures collection, typing and
slide design has been done by the author.
 Most of these materials has been done for undergraduate
students, although postgraduate students may find some useful
basic and advanced information.
 As the authors reviews several textbooks, papers and other
references during preparation of these material, it was
impossible to cite every textbook, journal article, and clinical
guidelines.
 The author declare that all materials and photos in these
presentations has been collected from different textbooks,
papers and online websites. These pictures are presented here
for education and demonstration purposes only. The author are
not attempting to plagiarize or reproduced unauthorized
material, and the intellectual properties of these photos belong
to their original authors.

67. Declaration
 For the purposes of dissemination and sharing of
knowledge, these lectures were given to several
colleagues and students. It were also uploaded to
SlideShare website by the author. Colleagues and
students may download, use, and modify these
materials as they see fit for non-profit purposes. The
author retain the copyright of the original work.
 The author wish to thank his family, teachers,
colleagues and students for their love and support
throughout his career. I also wish to express my
sincere gratitude to all orthodontic pillars for their
tremendous contribution to our specialty.
 Finally, the author welcome any advices and enquires
through his email address: Mohanad-07@hotmail.com