Periodontal instrumentation

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Periodontal instrumentation

  1. 1. PERIODONTAL INSTRUMENTATION
  2. 2. <ul><li>Peridontal instruments are designed for specific purposes- </li></ul><ul><li>Removing calculus </li></ul><ul><li>Planning root surfaces </li></ul><ul><li>Curetting the gingiva </li></ul><ul><li>Removing diseased tissue </li></ul>
  3. 3. CLASSIFICATION <ul><li>1.PERIODONTAL PROBE – </li></ul><ul><li>is used to locate, measure & mark pockets. </li></ul><ul><li>2.EXPLORER – </li></ul><ul><li>is used to locate calculus deposits & caries. </li></ul>
  4. 4. <ul><li>3.SCALING,ROOT PLANNING & CURETTAGE INSTRUMENTS – </li></ul><ul><li>To removal of plaque & calcified deposits from the crown & root of a tooth. </li></ul><ul><li>Removal of altered cementum from the subgingival root surface. </li></ul><ul><li>Debridement of the soft tissue lining the pocket. </li></ul>
  5. 5. <ul><li>Scaling & curetting instruments used to remove supragingival calculus. </li></ul><ul><li>i.Sickel scalers – used to remove supragingival calculus. </li></ul><ul><li>ii.Curettes – used for subgingival scaling, root lining & removal of soft tissue lining the pocket. </li></ul>
  6. 6. <ul><li>iii.Hoe,Chisel & file scalers – </li></ul><ul><li>Used to remove subgingival calculus & altered cementum. </li></ul><ul><li>iv.Ultrasonic & sonic instruments- </li></ul><ul><li>Used for scaling & cleaning tooth surfaces & curetting the soft tissue wall of the periodontal pocket. </li></ul>
  7. 7. <ul><li>4.THE PERIODONTAL ENDOSCOPE - </li></ul><ul><li>is used to visualize deep subgingivally in pockets & furcations. </li></ul><ul><li>5.CLEANSING & POLISHING INSTRUMENTS- </li></ul><ul><li>such as rubber cups,brushes & dental cap are used to clean & polishing tooth surface. </li></ul>
  8. 8. PARTS OF PERIODONTAL INSTRUMENTS
  9. 9. <ul><li>Stainless steel are most commonly used metal for manufacturing instruments. </li></ul><ul><li>High carbon steel are also available. </li></ul>
  10. 10. PERIODONTAL PROBE <ul><li>Tapered, rod like instrument calibrated in millimeters, with a blunt, rounded tip. </li></ul><ul><li>Used to measure- </li></ul><ul><li>The depth of pockets </li></ul><ul><li>To determine their configuration </li></ul><ul><li>In the detection of subgingival deposits </li></ul>
  11. 11. <ul><li>A. The marquis color coded probe </li></ul><ul><li>The UNC – 15 probe </li></ul><ul><li>The michigan “O” probe </li></ul><ul><li>The michigan “O” probe with markings at 3, 6 & 8mm </li></ul><ul><li>E. The WHO probe </li></ul>
  12. 12. EXPLORERS <ul><li>Used to- </li></ul><ul><li>To locate subgingival deposits & carious areas </li></ul><ul><li>To check the smoothness of the root surface after root planning </li></ul>
  13. 13. <ul><li># 17 EXPLORER </li></ul><ul><li># 23 EXPLORER </li></ul><ul><li>C. EXD 11-12 EXPLORER </li></ul><ul><li>#3 EXPLORER </li></ul><ul><li>E. #3CH PIGTAIL EXPLORER </li></ul>
  14. 14. SCALING & CURETTAGE INSTRUMENTS <ul><li>CURETTE </li></ul><ul><li>SICKLE </li></ul><ul><li>FILE </li></ul><ul><li>D.CHISEL </li></ul><ul><li>E. HOE </li></ul>
  15. 15. SICKLE SCALERS <ul><li>Also called supragingival scalers. </li></ul><ul><li>It is used primarily to remove supragingival calculus. </li></ul><ul><li>Used with a pull stroke. </li></ul>
  16. 16. <ul><li>Sickles with straight shanks are designed for use on anterior teeth & premolars. </li></ul><ul><li>Sickles with contra-angled shanks are used for post.teeth. </li></ul><ul><li>Different types of scalers are: </li></ul><ul><li>204SD - small, curved sickle scaler </li></ul><ul><li>U15/30 - large scalers </li></ul><ul><li>Jaquette sickles #1,2 & 3 - medium sized </li></ul><ul><li>Curved 204 sickles - large,medium or small blades </li></ul><ul><li>Nevi 2 post. sickle scaler </li></ul>
  17. 17. USE OF A SICKLE SCALER FOR REMOVAL OF SUPRAGINGIVAL CALCULUS.
  18. 18. U 15/30 SCALER NEVI 2 POSTERIOR SICKLE SCALER
  19. 19. CURETTES <ul><li>Uses: </li></ul><ul><li>For removing deep subgingival calculus </li></ul><ul><li>Root planning altered cementum. </li></ul><ul><li>Removing the soft tissue lining the periodontal pocket. </li></ul><ul><li>Mainly 2 basic types: </li></ul><ul><li>Universal Area specific </li></ul><ul><li>curettes curettes </li></ul><ul><li>-Gracey curettes </li></ul>
  20. 20. THE CURETTE IS THE INSTRUMENT OF CHOICE FOR SUBGINGIVAL SCALING & ROOT PLANNING
  21. 21. COMPARISON OF SPECIFIC (GRACEY) & UNIVERSAL CURETTES: <ul><li>GRACEY UNIVESAL </li></ul><ul><li>CURETTE CURETTE </li></ul><ul><li>Area of set of many 1 curette </li></ul><ul><li>use curette designed designed for </li></ul><ul><li>for specific areas all areas </li></ul><ul><li>& surfaces. & surfaces. </li></ul>
  22. 22. <ul><li>GRACEY UNIVERSAL </li></ul><ul><li>CURETTE CURETTE </li></ul>Cutting edge Use 1 cutting edge both cutting used edges used Curvature curved in 2 curved in 1 planes Plane Blade angle Offset blade: Not offset: face of blade face of blade beveled at 60 beveled at 90 degrees to shank degrees to shank.
  23. 23. EXTENDED SHANK CURETTES <ul><li>Hu- friedy after five curettes are modifications of the standard gracey curette design. </li></ul><ul><li>Features are: </li></ul><ul><li>3 mm longer </li></ul><ul><li>Allowing extension into deeper periodontal pockets of 5 mm or more. </li></ul><ul><li>Thinned blade for smoother subgingival insertion </li></ul><ul><li>Reduced tissue distension </li></ul><ul><li>Larger diameter, tapered shank </li></ul><ul><li>Use: for heavy or tenacious calculus </li></ul>
  24. 24. <ul><li>AFTER FIVE CURETTE </li></ul><ul><li># 5-6 </li></ul><ul><li>#7-8 </li></ul><ul><li>#11-12 </li></ul><ul><li>D. #13-14 </li></ul>
  25. 25. MINI BLADED CURETTES <ul><li>Hu friedy mini five curettes are modifications of the after five curettes. </li></ul><ul><li>Can be used with vertical strokes with reduced tissue distention & without tissue trauma. </li></ul><ul><li>Rigid mini fives are used for calculus removal. </li></ul>
  26. 26. COMPARISON OF THE AFTER FIVE CURETTE & THE MINI FIVE CURETTE
  27. 27. LANGER & MINI- LANGER CURETTES <ul><li>Set of 3 curettes designed of the standard gracy # 5-6,11-12 & 13-14 curettes with a universal blade honed at 90 degrees. </li></ul><ul><li>#5-6 - mesial & distal of ant. teeth </li></ul><ul><li>#1-2 - mesial & distal surfaces of mandibular post. teeth </li></ul><ul><li>#3-4 - mesial & distal surfaces of maxillary post. teeth </li></ul>
  28. 28. LANGER CURETTE A. # 5-6 B. #1-2 C. #3-4
  29. 29. PLASTIC INSTRUMENTS FOR IMPLANTS <ul><li>Plastic rather than metal instruments be used to avoid scarring & permanent damage to implants. </li></ul>CHISEL SCALER & FILE SCALER
  30. 30. <ul><li>HOE SCALERS – </li></ul><ul><li>are used for scaling of ledges or rings of calculus. </li></ul><ul><li>FILES – </li></ul><ul><li>primary function is to fracture or crush tenacious calculus. </li></ul><ul><li>sometimes used for removing overhanging margins of dental restorations. </li></ul><ul><li>CHISEL SCALERS – </li></ul><ul><li>used with a push motion. </li></ul><ul><li>designed for proximal surfaces of teeth. </li></ul>
  31. 31. SONIC & ULTRASONIC INSTRUMENTS: <ul><li>Ultrasonic instruments may be used for: </li></ul><ul><li>Removing plaque </li></ul><ul><li>Scaling </li></ul><ul><li>Removing stain </li></ul><ul><li>Ultrasonic units: </li></ul><ul><li>Magetostrictive </li></ul><ul><li>Piezoelectric </li></ul>
  32. 32. ULTRASONIC & SONIC TIPS CAVITRON FSI SLIM LINE ULTRASONIC TIPS
  33. 33. <ul><li>In it, alternating electrical current generates oscillations in the materials in the handpiece that cause the scaler tip to vibrate. </li></ul><ul><li>Ultrasonic vibrations at the tip of instruments range from 20,000 to 45,000 cycles/sec. </li></ul>
  34. 34. Comparison of sonic & ultrasonic scaling unit : <ul><li>SONIC ULTRASONIC </li></ul><ul><li>Advantages </li></ul><ul><li>Calculus good excellent </li></ul><ul><li>removal </li></ul><ul><li>Treatment low low </li></ul><ul><li>time </li></ul><ul><li>Tip action orbital magneto:elliptical </li></ul><ul><li>piezo: linear </li></ul>
  35. 35. <ul><li>SONIC ULTRASONIC </li></ul><ul><li>Tip fair fair </li></ul><ul><li>adaptability </li></ul><ul><li>Patient good good </li></ul><ul><li>comfort </li></ul><ul><li>Asepsis good good </li></ul><ul><li>Operator good good </li></ul><ul><li>Control </li></ul><ul><li>Space low high </li></ul><ul><li>requirement </li></ul>
  36. 36. <ul><li>SONIC ULTRASONIC </li></ul><ul><li>Disadvantages </li></ul><ul><li>Enamel medium medium </li></ul><ul><li>abrasion </li></ul><ul><li>Tissue low low </li></ul><ul><li>abrasion </li></ul><ul><li>Cemental medium medium </li></ul><ul><li>roughening </li></ul><ul><li>Restoration medium medium </li></ul><ul><li>damage </li></ul><ul><li>Heat low high </li></ul><ul><li>production </li></ul><ul><li>Cost medium high </li></ul><ul><li>Maintanance medium high </li></ul><ul><li>Noise level high medium </li></ul>
  37. 37. THE DENTAL ENDOSCOPE <ul><li>Use: </li></ul><ul><li>Subgingivally in the diagnosis & treatment of periodontal disease. </li></ul><ul><li>Also used to evaluate subgingivally for caries, defective restorations, root fractures & resorption. </li></ul><ul><li>It is also called the perioscopy system. </li></ul><ul><li>It consists of a 0.99 mm diameter reusable fiberoptic endoscope over which is fitted a disposable, sterile sheath. </li></ul>
  38. 38. PERIODONTAL EXPLORERS FOR THE PERIOSCOPY SYSTEM
  39. 39. THE EVA SYSTEM <ul><li>Most efficient & least traumatic instruments for correcting overhanging or overcontoured proximal alloy & resin restorations. </li></ul>
  40. 40. CLEANSING & POLISHING INSTRUMENTS <ul><li>Rubber cups </li></ul><ul><li>Bristle brushes </li></ul><ul><li>Dental tape with polishing paste is used for polishing proximal surfaces. </li></ul><ul><li>Air powder polishing </li></ul><ul><li>Prophy- Jet – an air powered slurey of warm water & sodium bicarbonate. </li></ul><ul><li>Effective for the removal of extrinsic stains & soft tissue. </li></ul>
  41. 41. SURGICAL INSTRUMENTS <ul><li>Excisional & incisional instruments </li></ul><ul><li>Surgical curettes & sickles </li></ul><ul><li>Periosteal elevators </li></ul><ul><li>Surgical chisels </li></ul><ul><li>Surgical files </li></ul><ul><li>Scissors </li></ul><ul><li>Hemostats & tissue forceps </li></ul>
  42. 42. EXCISIONAL & INCISIONAL INSTRUMENTS <ul><li>Periodontal knives (Gingivectomy knives) </li></ul><ul><li>Kirkland knife is commonly used for gingivectomy. </li></ul>
  43. 43. <ul><li>Interdental knives: </li></ul><ul><li>Orban knife # 1-2 & merrifield knife </li></ul><ul><li>#1,2,3 & 4 used for interdental areas. </li></ul>
  44. 44. <ul><li>Surgical blades: </li></ul><ul><li>Most commonly used are: </li></ul><ul><li>#12D, 15 & 15C </li></ul>
  45. 45. <ul><li>Surgical curettes & sickles: </li></ul><ul><li>Kramer curettes #1,2 & 3 </li></ul><ul><li>Kirlkand surgical instruments are heavy curettes. </li></ul>
  46. 46. <ul><li>Periosteal elevators: </li></ul><ul><li># 24 G & the GOLDMAN FOX # 14 </li></ul>
  47. 47. <ul><li>Surgical chisels & hoes: </li></ul><ul><li>Used during periodontal surgery for removing & reshaping bone. </li></ul>
  48. 48. <ul><li>Surgical files: </li></ul><ul><li>Used primarily to smooth rough bony ledges & to remove all areas of bone. </li></ul>
  49. 49. <ul><li>Scissors & Nippers: </li></ul><ul><li>Used for: </li></ul><ul><li>Removing tabs of tissue during gingivectomy </li></ul><ul><li>Trimming the margins of flaps </li></ul><ul><li>Enlarging incisions in periodontal abscesses </li></ul><ul><li>Removing muscle attachments in mucogingival surgery. </li></ul><ul><li>Needle holders : </li></ul><ul><li>are used to suture the flap at the desired position after the surgical procedure. </li></ul>
  50. 50. CONVENTIONAL NEEDLE HOLDER CASTROVIEJO NEEDLE HOLDER
  51. 51. GENERAL PRINCIPLES OF INSTRUMENTATION <ul><li>Accesibility (positioning of patient & operator) </li></ul><ul><li>Patient should be in a supine position & placed so that the mouth is closed to the resting elbow of the clinician. </li></ul>
  52. 52. <ul><li>Visibility, illumination & retraction: </li></ul><ul><li>Retraction provides visibility, accessibility & illumination. </li></ul><ul><li>Fingers &/or the mirror are used for retraction. </li></ul><ul><li>Mirror may be used for retraction of the cheeks or the tongue. </li></ul><ul><li>Index finger is used for retraction of the lips & cheeks. </li></ul>
  53. 53. <ul><li>Condition of instruments (sharpness): </li></ul><ul><li>Every instrument should be clean, sterile & in good condition. </li></ul><ul><li>Working ends of pointed or bladed instruments must be sharp. </li></ul>
  54. 54. <ul><li>Maintaining a clean field: </li></ul><ul><li>Adequate suction is essential for ejecting a saliva. </li></ul><ul><li>Blood & debris can be removed from the operative field with suction & by wiping or blotting with gauze squares. </li></ul>
  55. 55. <ul><li>Instrument stabilization: </li></ul><ul><li>Stability & control are essential for effective instrumentation & avoidance of injury to the patient or clinician. </li></ul><ul><li>2 major factors are: </li></ul><ul><li>1. instrument grasp </li></ul><ul><li>2. finger rest </li></ul>
  56. 56. <ul><li>1. Instrument grasp: </li></ul><ul><li>More effective & stable grasp is modified pen grasp. </li></ul><ul><li>Also standard pen grasp ensures the greatest control. </li></ul><ul><li>Palm & thumb grasp : useful for stabilizing instruments during sharpening for manipulating air & water syringe. </li></ul>
  57. 57. MODIFIED PEN GRASP STANDARD PEN GRASP
  58. 58. PALM & THUMB GRASP
  59. 59. <ul><li>2. Finger rest : </li></ul><ul><li>Intraoral </li></ul><ul><li>Extraoral fulcrum </li></ul><ul><li>Intraoral finger rests are: </li></ul><ul><li>Conventional: finger rest is established on tooth surfaces immediately adjacent to the working area. </li></ul><ul><li>Cross – arch: finger rest is established on tooth surfaces on the other side of the same arch. </li></ul><ul><li>Opposite arch: finger rest is established on tooth surfaces on the opposite arch. </li></ul><ul><li>Finger on finger: finger rest is established on the index finger or thumb of the non operating hand. </li></ul>
  60. 60. <ul><li>Extraoral fulcrum are: </li></ul><ul><li>Palm up </li></ul><ul><li>Palm down </li></ul>
  61. 61. <ul><li>Instrument activation: </li></ul><ul><li>Adaptation: </li></ul><ul><li>refers to the manner in which working end of a periodontal instrument is placed against the surface of a tooth. </li></ul><ul><li>objective- to make the working end of the instrument conform to the contour of the tooth surface. </li></ul>
  62. 62. <ul><li>Angulation : </li></ul><ul><li>refers to angle between the face of a bladed instrument & the tooth surface. </li></ul><ul><li>may also be called the “tooth blade relationship”. </li></ul><ul><li>Lateral pressure: </li></ul><ul><li>refers to the pressure created when force is applied against the surface of a tooth with the cutting edge of a bladed instrument. </li></ul>
  63. 63. <ul><li>Strokes: </li></ul><ul><li>Exploratory stroke </li></ul><ul><li>Scaling stroke </li></ul><ul><li>Root planning stroke </li></ul><ul><li>Vertical & oblique stroke are used most frequently. </li></ul><ul><li>Exploratory stroke: </li></ul><ul><li>to evaluate the dimensions of the pocket & to detect calculus & irregularities of the tooth surface. </li></ul><ul><li>Scaling stroke: </li></ul><ul><li>used for removal of both supragingival & subgingival calculus. </li></ul>
  64. 64. <ul><li>Root planning stroke: </li></ul><ul><li>used for final smoothing & planning of the root surfaces. </li></ul>
  65. 65. CHAIR POSITIONS <ul><li>It may be describe by the location of the operator or by the location of the operator’s arm. </li></ul><ul><li>For a right – handed operator, there are essentially 3 positions - right front, right & right rear. </li></ul><ul><li>These are sometimes referred to as the 7, 9 & 11 o’clock positions. </li></ul><ul><li>For the left handed operator, the 3 positions are left front, left, & left rear or the 5,3 & 1 o’clock positions. </li></ul><ul><li>A 4 th position, direct rear or 12 o’clock position. </li></ul>
  66. 66. <ul><li>Right front position: </li></ul><ul><li>It facilitates examination & work on mandibular anterior teeth, mandibular posterior teeth (especially on the right side) & maxillary anterior teeth. </li></ul>
  67. 67. <ul><li>Right position: </li></ul><ul><li>In this, the operator is directly to the right of the patient. </li></ul><ul><li>This position is convenient for operating on the facial surfaces of the maxillary & mandibular right posterior teeth & the occlusal surfaces of the mandibular right posterior teeth. </li></ul>
  68. 68. <ul><li>Right rear position: </li></ul><ul><li>It is the position of the choice for most of the procedure. </li></ul><ul><li>Most of the areas of the mouth are accessible & can be viewed directly or indirectly using mouth mirror. </li></ul><ul><li>The lingual & incisal (occlusal) surfaces of the maxillary teethare viewed in the mouth mirror. </li></ul><ul><li>Direct vision may be used on mandibular teeth, particularly on the left side. </li></ul>
  69. 69. <ul><li>Direct rear position: </li></ul><ul><li>It has limited application & primarily used for operating on the lingual surfaces of mandibular anterior teeth. </li></ul>

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