Clinical periodontology, periodontal instruments, principle of instrumentation

1. S C A L I N G A N D R O O T P L A N I N G : I N S T R U M E N T S A N D
T E C H N I Q U E S
CLINICAL
PERIODONTOLOGY
Dr. noorah
murad
BDS DDS

2. PERIODONTAL INSTRUMENTS
Periodontal instruments are designed for specific
purposes:
• removing calculus.
• planning root surfaces.
• curetting the gingiva.
• removing diseased tissue

3. CLASSIFICATION OF PERIODONTAL
INSTRUMENTS
1. Periodontal probes
2. Explorers
3. Scaling, root-planing, and curettage instruments
1. Sickle scalers
2. Curettes
3. Hoe, chisel, and file scalers
4. Ultrasonic and sonic instruments
4. Periodontal endoscopes
5. Cleansing and polishing instruments

4. PERIODONTAL PROBES
• locate, measure, and mark pockets
• The typical probe is a tapered, rod like instrument
calibrated in millimeters, with a blunt, rounded tip.

5. EXPLORERS
• used to locate sub gingival deposits and carious areas
and to check the smoothness of the root surfaces after
root planing.

7. SCALING AND CURETTAGE
INSTRUMENTS
A. Curette
B. Sickle
C. File
D. Chisel
E. hoe

8. SICKLE SCALERS
• Basic characteristics of a sickle scaler:
• triangular shape.
• double-cutting edge.
• pointed tip.
• is used primarily to remove supra gingival calculus.
• used with a pull stroke.

10. CURETTES
the instrument of choice for:
• removing deep sub gingival calculus.
• root planing and removing altered cementum.
• removing the soft tissue lining the periodontal pocket.
Each working end has a cutting edge on both sides of
the blade and a rounded toe.
There are two basic types of curettes: universal and
area specific.

12. universal Area specific

13. Extended-Shank
Curettes

14. HOE SCALERS
• Hoe scalers are used for scaling of ledges or rings of
calculus.
• The blade is slightly bowed so that it can maintain
contact at two points on a convex surface.
• the blade has been reduced to minimal thickness to
permit access to the roots without interference from the
adjacent tissues
• The blade inserted to the base of the periodontal pocket
so that it makes two-point contact with the tooth
• The instrument is activated with a firm pull stroke toward
the crown,

16. FILES
• have a series of blades Their primary function is to
fracture or crush large deposits of tenacious calculus.
• Files can easily roughen root surfaces when used
improperly.
• they are not suitable for fine scaling and root planing.

17. CHISEL SCALERS
• designed for the proximal surfaces of teeth too closely
spaced to permit the use of other scalers.
• usually used in the anterior part of the mouth.
• The chisel is inserted from the facial surface.
• The instrument is activated with a push motion.

19. ULTRASONIC AND SONIC
INSTRUMENTS
• Ultrasonic instruments may be used for removing
plaque, scaling, curetting, and removing stain.

20. DENTAL ENDOSCOPE
• A dental endoscope has been introduced for use sub
gingival in the diagnosis and treatment of periodontal
disease.

21. CLEANSING AND POLISHING
INSTRUMENTS
Rubber Cups:
• used in the hand piece with a special prophylaxis
angle.
• The hand piece, prophylaxis angle, and rubber cup must
be sterilized after each patient use.
• A good cleansing and polishing paste that contains
fluoride should be used.
• kept moist to minimize frictional heat as the cup
revolves.
• Polishing pastes are available in fine, medium, or
coarse.
• Aggressive use of the rubber cup with any abrasive
may remove the layer of cementum.

23. CLEANSING AND POLISHING
INSTRUMENTS
Bristle Brushes:
• Because the bristles are stiff, use of the brush should
be confined to the crown to avoid injuring the
cementum and the gingiva.
• Bristle brushes are available in wheel and cup shapes

24. GENERAL PRINCIPLES OF
INSTRUMENTATION
1. Accessibility: Positioning of Patient and Operator
2. Visibility, Illumination, and Retraction.
3. Condition and Sharpness of Instruments.
4. Maintaining a Clean Field.
5. Instrument Stabilization.
6. Instrument Activation.

25. ACCESSIBILITY
• facilitates thoroughness of instrumentation.
• The position of the patient and operator should
provide maximal accessibility to the area of operation.
• The clinician should be seated on a comfortable stool,
clinician’s feet are flat on the floor with the thighs parallel
to the floor
• The patient should be in a supine position, the mouth
is close to the resting elbow of the clinician.

26. • For 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, it may be
necessary to raise the back of the chair slightly and
request that the patient lower the chin until the mandible
is parallel to the floor.

27. VISIBILITY, ILLUMINATION, AND
RETRACTION
• direct vision with direct illumination from the dental
light is most desirable.
• indirect vision may be obtained by using the mouth
mirror.
• and indirect illumination may be obtained by using the
mirror to reflect light to where it is needed.
• Indirect vision and indirect illumination are often used
simultaneously.
• fingers and/or the mirror are used for retraction.

29. retraction

30. INSTRUMENT STABILIZATION
• Stability of the instrument and the hand is the primary
requisite for controlled instrumentation.
• Stability and control are essential for effective
instrumentation and avoidance of injury to the patient
or clinician.
• The two factors of major importance in providing
stability are the:
1. instrument grasp
2. finger rest.

31. INSTRUMENT GRASP
Modified pen grasp Standard pen grasp palm and thumb g.

32. 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.
• A good finger rest prevents injury and laceration of the
gingiva and surrounding tissues by poorly controlled
instruments.
• The fourth (ring) finger is preferred by most clinicians for
the finger rest.

33. FINGER REST
• it is possible to use the third (middle) finger for the finger
rest(not so recommended). use of the middle finger for both
control and tactile sensitivity.
• Maximal control is achieved when the middle finger is kept
between the instrument shank and the fourth finger.
• Finger rests may be generally classified as:
1. intraoral finger rests
2. extra oral fulcrums.

34. Intra oral figure rest

35. EXTRA ORAL REST
• Extra oral fulcrums are essential for effective
instrumentation of some aspects of the maxillary
posterior teeth.
• front or back surface of the fingers as possible is placed
on the patient’s face to provide the greatest degree of
stability.
• two most common extra oral fulcrums are used:
1. Palm up
2. Palm down.

36. Palm up
Palm down

37. Non operating hand support

38. INSTRUMENT ACTIVATION
1. Adaptation:
• Adaptation refers to the manner in which the working end of a
periodontal instrument is placed against the surface of a tooth.
• Correct adaptation of the probe is quite simple.
• sharp-pointed instruments are more difficult to adapt.
• The lower third of the working end must be kept in constant
contact with the tooth while it is moving over varying tooth
contours

40. 2. Angulation:
• Correct angulation is essential for effective calculus removal. For
sub gingival insertion of a bladed instrument such as a curette,
angulation should be as close to 0 degree as possible.
A. correct angulation for blade
insertion.
B. correct angulation for
scaling and root planing.
C. incorrect angulation for
scaling and root planing
D. incorrect angulation for
scaling and root planing,
correct angulation for
gingival curettage.

41. 3. Strokes:
• Three basic types of strokes are used during
instrumentation:
1. exploratory stroke.
2. scaling stroke.
3. root-planing stroke.
• Any of these basic strokes may be activated by a pull or
a push motion in a vertical, oblique, or horizontal
direction.