Classification of Periodontal Instruments

PERIODONTAL
INSTRUMENTS
Dr. Akriti
II MDS
1

CONTENT
● INTRODUCTION
● HISTORY
● PARTS OF AN INSTRUMENT
● CLASSIFICATION
● DIAGNOSTIC INSTRUMENTS
● NON-SURGICAL INSTRUMENTS
● SURGICAL INSTRUMENTS
● CONCLUSION
● REFERENCES
2
PARTS 1,2,3

● The history of periodontal instruments can be traced back to ancient civilizations, where teeth
cleaning was done using various tools such as twigs, feathers, and animal bones.
● Modern treatment, with illustrated text and sophisticated instrumentation, did not develop until the
time of Pierre Fauchard during the eighteenth century.
● In the 19th century, dental instruments began to be manufactured using metals such as silver and
stainless steel.
● The ﬁrst periodontal instruments speciﬁcally designed for the treatment of periodontal disease were
developed in the early 20th century. These included the curette, a hand-held instrument used for
scraping plaque and tartar from the teeth, and the scaler, a tool used for removing calculus (hardened
plaque) from above and below the gumline.
● With the advancement in technology, periodontal instruments have become more specialized and
sophisticated, with ultrasonic and laser technology being used to aid in the removal of plaque and
tartar.
4

EARLY CIVILIZATIONS
● Oral hygiene was practiced by the Sumerians, the Babylonians, and the Assyrians (gingival massage,
herbal medication).
● The medical works of ancient India and China devote signiﬁcant space to oral and periodontal
problems and oral hygiene (gingival inﬂammations, periodontal abscesses, gingival ulcerations).
6
Guerini V: History of dentistry, Philadelphia, 1909, Lea & Febiger.
Gold SI: Periodontics: the past. Part I. Early sources, J Clin Periodontol 12:79, 1985.

THE CLASSICAL WORLD
● Among the ancient Greeks, Hippocrates of Cos (460 bc-377 bc), the father of modern medicine,
discussed the etiology of periodontal disease. He believed that inﬂammation of the gums could be
caused by accumulations of “pituita” or calculus, with gingival hemorrhage occurring in cases of
persistent splenic maladies.
● Paul of Aegina (625 ad-690 ad) wrote that tartar deposits must be removed with either scrapers or a
small ﬁle and that the teeth should be carefully cleaned after the last meal of the day.
7
Hippocrates: Works, London, 1923, Heinemann. (Edited and translated by WHS Jones and ET Withington, 1931.).
Paul of Aegina: The Seven Books, London, 1844, Sydenham Society. (Translated by F Adams).

THE MIDDLE AGES
● Albucasis (936-1013) described the techniques of scaling the teeth with the use of a set of instruments
that he developed, splinting loose teeth with gold wire and ﬁling gross occlusal abnormalities.
● Avicenna (980-1037) was possibly the greatest of the Persian physicians. His Canon, a comprehensive
treatise on medicine, was in continuous use for almost 600 years. Avicenna used an extensive “materia
medica” for oral and periodontal diseases and rarely resorted to surgery.
8
Albucasis: La chirurgie, Paris, 1861, Bailliére. (Translated by L LeClere).
Avicenna: Liber Canonis, Venice, 1507.

Illustration of Albucasis’ periodontal instruments, showing scalers (sc), ﬁles (f), and the wiring of loose teeth (w).
9

THE RENAISSANCE
● Albucasis’ work was expanded during the ﬁfteenth century by the Turkish author Serefeddin
Sabuncuoglu (1385-1468), who included illustrations of the surgical removal of hypertrophic and
swollen gingiva and lingual frenum. (A tube is placed on the gums and a hot cautery is inserted into the
cannula to cauterize the gingival tissue).
● The Frenchman Ambroise Paré (1509-1590) understood the etiologic signiﬁcance of calculus and used
a set of scalers to remove the hard deposits on the teeth.
10
Albucasis: La chirurgie, Paris, 1861, Bailliére. (Translated by L LeClere).
Paré A: Oeuvres completes, Paris, 1840, Bailliére. (Edited by JF Malgaigne.).

llustration by Serefeddin Sabuncuoglu showing gingival cauterization. (From Abulcasis and redrawn by Professor
Ilter Uzel, Turkey.)
11

THE EIGHTEENTH CENTURY
● Modern dentistry essentially developed in eighteenth century Europe, particularly France and
England.
● Pierre Fauchard (Brittany, 1678) is regarded as the father of the dental profession. His book, The
Surgeon Dentist, which was published in 1728, covered all aspects of dental practice. Fauchard
described in detail his periodontal instruments and the scaling technique for using them.
12
Fauchard P: Le chirurgien dentiste, ou traite des dents, Paris, 1728, J Maruiette. (Reprinted in facsimile, Paris, Prélat, 1961; English translation by L Lindsay, London,
1946, Butterworth & Co.).

The ﬁve types of instruments used by Fauchard for detaching tartar from the teeth:
1, chisel; 2, parrot beak; 3, graver; 4, convex blade; and 5, Z-shaped hook.
13

THE NINETEENTH CENTURY
● Riggs and his disciples had great inﬂuence on the dental profession. Among Riggs’ followers were L.
Taylor, D.D. Smith, R.B. Adair, and W.J. Younger. The instruments designed by Younger and later
modiﬁed by his student Robert Good were used widely until well beyond the middle of the twentieth
century.
14
Younger WJ: Pyorrhea alveolaris, Schweiz Vierteljähresscrift Zahnheilk 15:87, 1905.

THE TWENTIETH CENTURY
● During the first third of the twentieth century, periodontics flourished in central Europe, with two
major centers of excellence: Vienna and Berlin.
● Neumann (1882-1958), in a book published in 1912 (with new editions in 1915, 1920, and 1924),
described the principles of periodontal flap surgery, including osseous recontouring as it is currently
known.
15
Gold SI: Robert Neumann: a pioneer in periodontal flap surgery, J Periodontol 53:456, 1982.

3 PARTS:
17
● HANDLE
● SHANK
● WORKING END

● The handle of the instrument is used for grasping the instrument.
● The design of instrument handles vary greatly from manufacturer to manufacturer. Presently, they are
available in various weights, diameters and textures (serrations).
○ WEIGHT:
■ The weight of the handle is determined by its diameter and core (solid or hollow).
■ Hollow handles increase tactile sensitivity and minimize muscle fatigue.
■ Solid handles reduce tactile sensitivity and increase muscle fatigue.
○ DIAMETER:
■ Small handles decrease control and increase muscle fatigue.
■ Large handles maximize control and reduce muscle cramps but restrict movement in areas where access
is limited (posterior areas).
○ SERRATION
■ Serrated knurled handles maximize control and decrease hand fatigue.
■ Smooth handles decrease control and increase fatigue.
● Thus, handles with small diameter, solid metal core and smooth texture are generally avoided.
18
Nield J S, Houseman G A. Fundamentals of Dental Hygiene Instrumentation. 2nd ed. Philadelphia: Lea & Febiger; 1988.
HANDLE

● Shank connects the handle to the working end and allows adaptation of the working end to the on
the tooth surface.
● Shank can be functional or terminal.
○ The functional shank extends from the working end to the shank bend closest to the instrument handle.
■ It can be short, long or intermediate.
■ Long functional shanks are needed to reach the tooth surfaces of posterior teeth or the root surfaces of
teeth within periodontal pockets.
■ Short functional shanks are found on instruments used to remove supragingival calculus deposits or to
reach the surfaces of anterior teeth.
○ The terminal shank extends between the blade and 1st bend.
● Shank can be either curved or straight.
○ Curved shanks are used on both posterior and anterior teeth (universal instruments).
○ Straight shanks are limited to use on anterior sextants (anterior instruments).
● Shank can be ﬂexible, moderately ﬂexible or rigid in design.
20
SHANK

22
SHANK TYPE USES EXAMPLES
Straight with short functional
length
Anterior teeth for removal of
supragingival calculus
Anterior sickle scaler
Straight with long functional
length
Anterior teeth for removal of
subgingival calculus
Anterior Gracey curette
Curved with short functional
length
Anterior and posterior teeth for
removal of supragingival calculus
Certain universal sickle scalers
Curved with intermediate
functional length
Anterior and posterior teeth for
removal of subgingival calculus
Certain universal curettes
Curved with long functional
length
Posterior teeth for removal of
subgingival calculus in pockets
Posterior Gracey curettes
SHANK CURVATURE AND FUNCTIONAL LENGTH RELATED TO INSTRUMENT USE

23
SHANK TYPE USES EXAMPLES
Rigid Removal of heavy calculus deposits
Rigid shank limits tactile conduction
so that calculus detection is difficult
Sickle scalers
Periodontal files
Moderately flexible Removal of moderate or light
calculus
Moderately flexible shank provides
good level of tactile transfer, allowing
detection and removal of moderate
subgingival deposits
Universal curettes
Flexible Detection of subgingival calculus
Removal of fine calculus
Flexible shank provides the best
tactile information to the operator’s
finger pads through the shank and
handle
Gracey curettes
Explorers
SHANK FLEXIBILITY RELATED TO INSTRUMENT USE

● The working end does the work of the instrument.
● The working end or blade is made up of several components such as the face, cutting edge, back and
toe/tip.
○ A rounded working end is called toe whereas a pointed working end is called tip.
● The instrument may be single-ended or double-ended.
○ Single-ended instruments reduce motion economy.
○ Double-ended instruments provide efﬁcient time utilization and motion economy.
○ The working ends of a double-ended instrument may be paired or unpaired.
■ Double-ended instruments with working ends that are mirror images of each other have paired working
ends, while instruments with two dissimilar working ends have unpaired working ends.
24
WORKING END

27
PERIODONTAL
INSTRUMENTS
DIAGNOSTIC
INSTRUMENTS
SURGICAL
INSTRUMENTS
NON-SURGICAL
INSTRUMENTS

28
DIAGNOSTIC
INSTRUMENTS
MOUTH MIRROR
EXPLORER
PROBE

29
DIAGNOSTIC
INSTRUMENTS
● MOUTH MIRROR
● PROBE
● EXPLORER

● The diagnostic mouth mirror, also known as the dental mirror, is a small handheld instrument that
dentists and hygienists use to reﬂect light into the patient's mouth to view hard-to-see areas.
● The evolution of the diagnostic mouth mirror can be traced back to the early 20th century, when
mirrors were ﬁrst introduced in dental practice. Initially, mirrors were made of metal, such as silver or
stainless steel, and were relatively simple in design. Overall, the evolution of the diagnostic mouth
mirror has been driven by the need to improve visibility and access to hard-to-see areas of the
patient's mouth, as well as to make the instrument more comfortable and durable for the practitioner
to use.
30
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.
● A mirror may be designed for a single, repeated or disposable use.
● 4 types of mirrors:
31

● PLANE/FLAT SURFACE MIRROR
○ The reflecting surface of this mouth mirror is present on the back surface of the mirror glass.
○ Limitation:
■ Formation of double image (ghost image) due to double reflecting surfaces.
● FRONT SURFACE MIRROR
○ The reflecting surface in this mouth mirror is present on the front surface of the mirror glass, which
overcomes the issue of double image formation.
● CONCAVE MIRROR
○ In this mirror, the reflecting surface is on the front surface of the mirror lens which is concave.
○ Use:
■ View enlarged image of areas where normal mirror does not display complete details
○ Limitation:
■ Magnification distorts the image
● DOUBLE-SIDED MIRROR
○ Use:
■ Retract cheek or tongue
■ Opposite side of the mirror can be used to view the indirect image
32

● SIZES OF MOUTH MIRRORS:
○ Most commonly used mirrors are size 4 (22mm)
and size 5 (24mm).
○ Size 2 (18mm) is used to access the areas which
are difﬁcult to view by direct vision.
● USES OF MOUTH MIRRORS:
○ Indirect vision
○ Retraction
○ Indirect illumination
○ Trans-illumination
33

● RECENT ADVANCES:
○ In the 1940s, plastic handles were introduced, making the instrument more comfortable to hold and
easier to maneuver in the patient's mouth.
○ The reﬂective surface of the mirror also evolved, with the introduction of glass mirrors coated with a
layer of metal, such as gold or chrome, to improve visibility and reduce glare.
○ In the 1960s, ﬁber-optic technology was introduced, which greatly improved the visibility of the mirror,
as it allowed light to be directed into the patient's mouth with greater precision. This technology also
made the instrument more durable and resistant to corrosion.
○ Today, diagnostic mouth mirrors come in a variety of designs and materials, including lightweight
aluminum handles and mirrors with a non-glare coating for improved visibility.
○ Some mirrors are even equipped with LED lights to provide additional illumination.
34
Surathu N, Nasim I. Assessment of the use of a dental mirror. JDMS 2015;14: 115.

Rieuwpassa IE, Rizal EP, Muis A, Lala HH. 2019. Three in one dental mirror: innovation of oral diagnostic instrument. Journal of Dentomaxillofacial Science4(2): 75-78
35
Dental Mirror is a versatile tool in the world of dentistry,
but the problem is the characteristic of conventional
dental mirror that’s always faced by dentists in general is
mirror surface which is very vulnerable to get dirty due to
the debris or water droplet. A tool used for cleaning debris
or water droplets in dental mirror is by using dental
syringe that can spray water and air spray.
The “Three In One Dental Mirror” is able to prevent debris
or water spray that stains the surface of the dental mirror
so, that the use of the tool can be maximized without
additional procedures that will take up time time such as
cleaning the surface glass.
This instrument is a combination of three dental
instruments which are put together as one instrument so
that it has three functions. The function of this tool
speciﬁcally is to see the condition of the oral cavity which
is difﬁcult to see directly which is equipped with an
operator lamp component to provide illumination in the
oral cavity as well as a syringe component to clean and
rinse mirror surfaces that are affected by debris
(treatment residual) or splashes of water droplets.

● Probe is a latin word, which means “to test”.
● A periodontal probe is used to accurately locate, assess and measure the sulcus and pocket depth.
● RATIONALE:
○ To detect and measure loss or gain of clinical attachment level
○ To determine the extent of previous or ongoing periodontal disease activity
○ To assess the efﬁcacy of the treatment done
● Ideally, these probes are thin and the shank is angled to allow easy insertion into the pocket. When
measuring a pocket, the probe is inserted with ﬁrm, gentle pressure to the bottom of the pocket. The
shank should be aligned with the long axis of the tooth surface to be probed.
● Presently, various periodontal probes are available which vary in their markings, colour coding,
diameter, material and angle.
36
Carranza FA. Clinical Periodontology. Philadelphia: W. B. Saunders Company, 1989.
PROBE

● The typical periodontal probe is a tapered, rodlike instrument calibrated in millimeters, composed of a
blunt, rounded tip, shank and handle.
● The basic uses of the calibrated periodontal probe are:
○ Measurement of the probing depth of a sulcus or periodontal pocket
○ Determination of the topography of the junctional epithelium
○ Determination of the probing level of the attachment
○ Measurement of the width of the attached gingiva
○ Assessment of bleeding points
○ Measurement of the size and/or depth of an oral lesion
37

● HISTORY OF PERIODONTAL PROBES:
○ The periodontal probe was first described as a periodontal diagnostic instrument by John W Riggs in
1982.
○ The diagnosis of pyorrhoea by measuring pocket depths using a periodontal probe was described by F V
Simonton in 1925. He emphasized that the presence of pyorrhoea and its extent could only be
determined by the presence and depths of periodontal pockets.
○ The first systematic classification of periodontal probes was given by B L Pihlstrom in 1992, who
classified the probes into 3 generations:
■ FIRST GENERATION PROBES: conventional or manual probes which do not have pressure or force
measuring device attached to them
■ SECOND GENERATION PROBES: pressure sensitive probes which allow standardization and
quantification of pressure during probing
■ THIRD GENERATION PROBES: automated probing systems where along with a constant pressure
application, the data is stored by the computer
● RECENT ADVANCES (Watts et al. 2000)
○ FOURTH GENERATION PROBES
○ FIFTH GENERATION PROBES
38
Hefti AF. Periodontal probing. Critical Reviews in Oral Biology & Medicine. 1997 Jul;8(3):336-56.
Shayeb KN, Turner W, Gillam DG. Periodontal probing: a review. Primary dental journal. 2014 Sep;3(3):25-9.

ADVANTAGES AND DISADVANTAGES OF FIRST, SECOND AND THIRD GENERATION PROBES
39

ADVANTAGES AND DISADVANTAGES OF FOURTH AND FIFTH GENERATION PROBES
40

● FIRST GENERATION PERIODONTAL PROBES
○ Conventional or manual probes, made up of stainless steel or plastic, having no pressure or force
measuring device attached
○ Working end is either round, tapered, ﬂat, or rectangular with smooth rounded ends
○ Calibrations in millimeters are made at various intervals which measure pocket depths
○ Charles H M Williams in 1936 introduced a graduated periodontal probe known as William’s probe
which is considered the prototype for the ﬁrst generation probes.
■ Stainless steel probe of 13mm length
■ Rounded tip end of diameter 1mm
■ Markings at 1, 2, 3, 5, 7, 8, 9, 10 mm
■ Probe tip and handle at 1300
○ Working end may be curved to facilitate probing into the furcation areas (Naber’s probe)
■ Used for detecting and measuring horizontal periodontal furcation involvement in multirooted teeth
■ Blunt time, double ended
■ Examples: non-calibrated, double ended smooth surface Naber’s furcation probe (1N, 2N); Naber’s 3N
furcation probe (markings at 1, 2, 3, 4, 5, 6, 7, 8, 9, 10mm); colour coded probe (markings at 3, 6, 9, 12mm).
41

42
FIRST GENERATION PROBES: WILLIAM’S PROBE, NABER’S PROBE

43
FIRST GENERATION PERIODONTAL PROBES

44
FIRST GENERATION PERIODONTAL PROBES: Marquis color-coded probe; University of North Carolina 15
probe; University of Michigan “O” probe, with William’s probe markings; Michigan “O” probe with markings at 3,
6, and 8 mm; World Health Organization probe

● OTHER FIRST GENERATION PERIODONTAL PROBES
○ Glickman probe:
■ Round tip, longer shank than William’s probe
○ LL-20 probe (Hu-Friedy):
■ Tip of 0.5mm diameter, rounded end
■ Markings upto 20mm, thick black markings at 4, 9, 14 and 19mm
○ Colour-coded polymeric probes:
■ Probing around implants
■ Minimal possibility of scratching the metal surface
○ Biotype probes
45

● SECOND GENERATION PERIODONTAL PROBES
○ To overcome the lack of standardization of pressure applied in ﬁrst-generation probes, second
generation probes were developed to standardize and quantify the pressure used during probing.
○ Pressure sensitive, probing pressure should not exceed 0.2N/mm2
○ History:
■ Gabathuler and Hassell (1971) designed the 1st pressure sensitive probe with a constant force
application.
■ Another pressure sensitive probe holder was designed by Armitage in 1977.
■ Tromp et al. (1979) introduced a pressure-sensitive probe in which a torque spring was attached to a
loose probe head that could rotate in a point bearing. They achieved a constant force application of about
15gms which was independent of the force applied by the operator.
■ Vitek et al. (1979) introduced leaf spring force-controlled periodontal probe which delivered a force
within 0.5gms to Michigan ‘O’ probe tip.
■ Polson et al. (1980) introduced electronic pressure sensitive probe, also known as Vine Valley Probe.
46

● SECOND GENERATION PERIODONTAL PROBES - PROTOTYPE:
○ True pressure-sensitive probe
○ Frank Hunter, 1994
○ Disposable probing head
○ Hemispheric probe tip of diameter 0.5mm
○ Force = 20gms; a visual sliding scale is present with two marks, which, when meet indicate force
application of 20gms
○ A rim surrounding the side of the ball tip helps in detection of the cementoenamel junction, calculus or
root surface irregularities.
47

● THIRD GENERATION PERIODONTAL PROBES
○ Automated probing systems, where along with a constant pressure application the data is stored by the
computer.
○ FOSTER-MILLER (ALABAMA) PROBE - PROTOTYPE:
■ Jeffcoat et al. (1986)
■ Provides controlled probing pressure and measures the pocket depth along with detection of
cementoenamel junction; from which clinical attachment loss is automatically determined
■ Components include:
● Pneumatic cylinder
● Linear variable differential transducer
● Force transducer
● Accelerator
● Probe tip
48

● OTHER THIRD GENERATION PERIODONTAL PROBES
○ FLORIDA PROBE
■ Gibbs et al. (1988)
■ Developed following the criteria deﬁned by the National Institute of Dental and Craniofacial Research for
overcoming limitations of conventional probing:
● Easy to use
● Non-invasive
● Constant and standardized force
● Light weight
● Easy accessibility, guidance system
● Sterilised, no biohazard
● Direct electronic reading and digital output
■ Components:
● Probe handpiece and sleeve
● Displacement transducer
● Foot switch
● Computer interface
■ Pressure = 15gms, precision = 0.2mm
■ 3 types: pocket probe, disk probe, stent-based model
49

● OTHER THIRD GENERATION PERIODONTAL PROBES
○ TORONTO AUTOMATED PROBE
■ McCulloch and Birek (1991)
■ Improved precision in probe angulation
○ INTERPROBE
■ Also known as Perio Probe
■ Uses ﬁber optic technology
50

● 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 currently under development
● FIFTH GENERATION PERIODONTAL PROBES
○ Utilize ultrasound waves, in addition to 3D technology
○ Provides accurate measurement of attachment levels without penetrating the junctional epithelium
○ ULTRA-SONOGRAPHIC PROBE:
■ Non-invasive periodontal probing technique which measures periodontal pocket depth with the
identiﬁcation of junctional epithelial attachment and CEJ
■ This probe was devised by Hinders et al. (1999) at NASA Langley Research Center
51
Shayeb KN, Turner W, Gillam DG. Periodontal probing: a review. Primary dental journal. 2014 Sep;3(3):25-9.

● Dental explorers are diagnostic instruments which perform tactile examination effectively. These are
used to assess:
○ Subgingival deposits
○ Necrotic cementum
○ Smoothness of root surface after root planing
○ Carious and decalciﬁed lesions
○ Defective margins on restorations
○ Tooth surface irregularities
● The pointed working end (explorer tip) is 1-2mm in length
● Explorers are made up of ﬂexible metal which helps in better tactile sensation when the instrument is
moved on the tooth surface. Only light exploratory strokes are applied to evaluate the surface
smoothness.
52
EXPLORER

53
FIVE TYPICAL EXPLORERS; A, #17; B, #23; C, EXD 11-12; D, #3; E, #3CH pigtail.

● STRAIGHT EXPLORER
○ One of the most commonly used explorer
○ Straight working end with a pointed tip
○ Not recommended for subgingival use because the
pointed tip might injure the soft tissue at the base of
sulcus/pocket
○ EXAMPLES: no.6, no.6A, no.6L, no.6XL
● CURVED EXPLORER
○ Used to detect the presence of calculus on the root
surface
○ Moved on the root surface in horizontal direction with
a light stroke
○ EXAMPLES: no.3, no.3A
54

● SHEPHERD’S HOOK EXPLORER
○ One of the most commonly used explorer
○ Used for detection of caries and examination of occlusal
surfaces and restorations
○ Not recommended for calculus detection
■ Too rigid and thick, thus difﬁcult to adapt
■ Tip may lacerate the base of sulcus
■ EXAMPLES: no.23
● ORBAN TYPE EXPLORER
○ Commonly used
○ Tip of the explorer is at an angle of 900
to the lower shank
■ When inserted into the sulcus/pocket, the back of the
tip comes in contact with the soft tissue rather than the
tip which prevents soft tissue injury
■ EXAMPLES: no.17
55

● 11/12 EXPLORER
○ Universal assessment/diagnostic periodontal instrument
○ Circular cross-section
○ Excellent subgingival adaptation
○ Speciﬁcally designed to examine the proximal areas and deep
periodontal pockets
○ Complex shank design helps in assessment of the root surface
in anterior as well as posterior teeth
● PIGTAIL (COWHORN) EXPLORER
○ Double-ended instrument
○ Used to explore the smoothness of the root surface only in
shallow pockets
○ Does not adapt well in deep pockets due to curved design of
lower shank
○ EXAMPLES: no.3CH, no.3ML, no.2A
56

57
NON-SURGICAL
INSTRUMENTS
SCALING INSTRUMENTS
CLEANING AND POLISHING
INSTRUMENTS
ROOT PLANING AND CURETTAGE
INSTRUMENTS
PERIODONTAL ENDOSCOPE
IMPLANT INSTRUMENTS

58
SCALING
INSTRUMENTS
● MANUAL
○ SUPRA-GINGIVAL SCALERS
■ Sickle scalers
■ Surface scalers
○ SUB-GINGIVAL SCALERS
■ Hoe scalers
■ Chisel scalers
■ File scalers
● POWER DRIVEN
○ SONIC
○ ULTRASONIC
■ Piezo-electric scalers
■ Magnetostrictive scalers

● Flat surface and two cutting edges, converge in a
sharply pointed tip
● Used primarily to remove supragingival calculus
● Because of the bulky design of this instrument, it is
difﬁcult to insert a large sickle blade under the gingiva
without damaging the surrounding gingival tissues
● 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.
59
SICKLE SCALERS

● SPECIFIC USE SCALERS:
○ LARGE SICKLE SCALERS: The U15/30, Ball, and
Indiana University sickle scalers
○ MEDIUM SICKLE SCALERS: Jaquette sickle scalers
#1, #2, and #3
○ Curved 204 posterior sickle scalers are available with
large, medium, or small blades
■ Small, curved blades such can be inserted under
ledges of calculus several millimeters below the
gingiva
○ Montana Jack sickle scaler and the Nevi 2, Nevi 3,
and Nevi 4 curved posterior sickle scalers are all thin
enough to be inserted several millimeters
subgingivally
○ Other scalers are: University of South Carolina sickle
scaler, Turner sickle scaler, Morse sickle scaler
60

DIFFERENCE BETWEEN CURVED AND STRAIGHT BLADE
61

● Handheld instrument having a straight blade
● Designed for use on the tooth surface (lingual and buccal)
62
SURFACE SCALERS

● Hoe scalers are used for scaling of ledges or rings of calculus.
● FEATURES:
○ blade is bent at a 99-degree angle
○ cutting edge is formed by the junction of the ﬂattened terminal
surface with the inner aspect of the blade
○ cutting edge is beveled at 45 degrees
○ blade is slightly bowed so that it can maintain contact at two
points on a convex surface
○ back of the blade is rounded, and the blade has been reduced to
minimal thickness
● McCall’s #3, #4, #5, #6, #7, and #8 comprise a set of six hoe
scalers designed to provide access to all tooth surfaces. Each
instrument has a different angle between the shank and the
handle.
63
HOE SCALERS

● Double ended instrument, designed for scaling of proximal
areas
● Primarily used in the anterior areas due to limited adaptation
● Straight (450
) beveled, single cutting edge on a straight or
curved shank
● Used in horizontal direction (to avoid trauma to soft tissue) and
with push motion
64
CHISEL SCALERS

● Consist of miniature blades which are designed on a pad
attached to the shank
● Each blade is bent at an angle of 90-1050
from the shank
● Longer shanks adapt to the posterior tooth surface, shorter
less angled shanks adapt to anterior teeth
65
FILE SCALERS

ADVANTAGES AND DISADVANTAGES OF MECHANIZED INSTRUMENTS COMPARED WITH MANUAL INSTRUMENTS 66

INDICATIONS, PRECAUTIONS, AND CONTRAINDICATIONS FOR USE OF MECHANIZED INSTRUMENTS 67

● Various physical factors play a role in the mechanism of action of power scalers:
○ frequency
○ stroke
○ water flow
○ physiologic effects of water
● Water contributes to three physiologic effects that play a role in the efficacy:
○ Acoustic steaming is unidirectional fluid flow caused by ultrasound waves.
○ Acoustic turbulence is created when the movement of the tip causes the coolant to accelerate,
producing an intensified swirling effect. This turbulence continues until cavitation occurs.
○ Cavitation is the formation of bubbles in water caused by the high turbulence. The bubbles implode and
produce shock waves in the liquid, thus creating further shock waves throughout the water
68
MECHANISM OF ACTION OF POWER SCALERS

● frequency= 2000 - 6500 cycles/second
● high- or low-speed air source from the dental
unit
● Water is delivered via the same tubing used to
deliver water to a dental handpiece.
● Sonic scaler tips:
○ large in diameter
○ universal in design
○ tip travels in an elliptical or orbital stroke
pattern
■ allows the instrument to be adapted to all
tooth surfaces
69
SONIC SCALERS

● frequency= 18,000 - 50,000 cycles/second
● Ceramic disks located in the handpiece
power the piezoelectric technology and
change in dimension as electric energy is
applied.
● Piezoelectric tips:
○ move primarily in a linear pattern,
giving the tip two active surfaces
○ various insert tip designs and shapes
are available for use
70
PIEZOELECTRIC SCALERS

● frequency= 18,000 - 50,000 cycles/second
● Metal stacks that change dimension when
electrical energy is applied power the
magnetostrictive technology.
○ Vibrations travel from the metal stack to a
connecting body that causes the vibration of
the working tip
● Magnetostrictive tips:
○ move in an elliptical or orbital stroke pattern,
giving the tip four active working surfaces
71
MAGNETOSTRICTIVE SCALERS

MAGNETOSTRICTIVE SCALERS: HU-FRIEDY AND DENTSPLY SIRONA
72

73
ROOT PLANING AND
CURETTAGE INSTRUMENTS
● UNIVERSAL CURETTES
● AREA SPECIFIC CURETTES
○ GRACEY CURETTES
○ AFTER FIVE CURETTES
○ MINI-BLADED CURETTES
○ MICRO-MINI CURETTES
○ GRACEY CURVETTES
○ QUETIN FURCATION CURETTES
○ PERIODONTAL MAINTENANCE CURETTES
○ LANGER AND MINI LANGER CURETTES
● DIAMOND-COATED FILES

● 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.
● Each working end has a cutting edge on both sides of the blade
and a rounded toe.
● Curettes do not have any sharp points or corners other than
the cutting edges of the blade.
● In cross section, the blade appears semicircular with a convex
base. The lateral border of the convex base forms a cutting
edge with the face of the semicircular blade.
● Curettes provide good access to deep pockets, with minimal
soft tissue trauma.
74
CURETTES

● Universal curettes have cutting edges that may be inserted in most areas of the dentition by altering
and adapting the ﬁnger rest, fulcrum, and hand position of the operator.
● The blade size and the angle and length of the shank may vary, but the face of the blade of every
universal curette is at a 90-degree angle to the lower shank when seen in cross section from the tip.
● The blade of the universal curette is curved in one direction from the head of the blade toward the toe.
● EXAMPLES:
○ Barnhart curettes #1-2 and #5-6
○ Columbia curettes #13-14, #2R-2L, and #4R-4L
○ Younger-Good #7-8
○ McCall’s #17-18
○ Indiana University #17-18
75
UNIVERSAL CURETTES

(A) COLUMBIA #4R-4L UNIVERSAL CURETTE. (B) YOUNGER-GOOD #7-8, MCCALL’S #17-18, AND INDIANA UNIVERSITY
#17-18 UNIVERSAL CURETTES.
76

COMPARISON OF AREA-SPECIFIC (GRACEY) AND UNIVERSAL CURETTES
[MODIFIED FROM PATTISON G, PATTISON A: PERIODONTAL INSTRUMENTATION, ED 2, NORWALK, CT, 1992,
APPLETON & LANGE.] 77

● Invented by Dr. Clayton Gracey in 1940s
● Gracey curettes are representative of the area specific curettes, a set of several instruments designed
and angled to adapt to specific anatomic areas of the dentition.
● Double-ended Gracey curettes are paired in the following manner:
○ 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
● Single-ended Gracey curettes can also be obtained; a set comprises 14 instruments.
● Gracey curettes are available with either a “rigid” or “finishing” type of shank.
○ rigid shank is larger, stronger, and less flexible
○ rigid shank allows the removal of moderate to heavy calculus without using a separate set of heavy
scalers, such as sickles and hoes
78
GRACEY CURETTES

● RECENT MODIFICATIONS:
○ #15-16
■ modiﬁcation of the standard #11-12
■ designed for the mesial surfaces of posterior
teeth
■ consists of a Gracey #11-12 blade combined with
the more acutely angled #13-14 shank
■ allows better adaptation to posterior mesial
surfaces from a front position with intraoral rests
○ #17-18
■ modiﬁcation of the #13-14
■ terminal shank elongated by 3 mm
■ accentuated angulation of the shank
■ provides complete occlusal clearance and better
access to all posterior distal surfaces
■ blade is 1 mm shorter to allow better adaptation
to distal tooth surfaces
80

● Extended-shank curettes, such as After Five curettes, are modifications of the standard Gracey curette
design.
● FEATURES:
○ terminal shank is 3 mm longer, allowing extension into deeper periodontal pockets of 5 mm or more
○ thinned blade for smoother subgingival insertion and reduced tissue distention and a large-diameter,
tapered shank
○ available in finishing or rigid designs
■ For heavy or tenacious calculus removal, rigid After Five curettes should be used
■ For light scaling or deplaquing in a periodontal maintenance patient, the thinner finishing After Five
curettes will insert subgingivally more easily
● All standard Gracey numbers except for the #9-10 (i.e., #1-2, #3-4, #5-6, #7-8, #11-12, or #13-14) are
available in the After Five series.
81
AFTER FIVE CURETTES

A, #5-6; B, #7-8; C, #11-12; D, #13-14.
82

COMPARISON OF AFTER FIVE CURETTE WITH STANDARD GRACEY CURETTE:
RIGID GRACEY #13-14 ADAPTED TO THE DISTAL SURFACE OF THE FIRST MOLAR AND RIGID AFTER FIVE #13-14
ADAPTED TO THE DISTAL SURFACE OF THE SECOND MOLAR.
NOTICE THE EXTRA LONG SHANK OF THE AFTER FIVE CURETTE, WHICH ALLOWS DEEPER INSERTION AND BETTER
ACCESS.
83

● Mini-bladed curettes (Hu-Friedy Mini Five curettes) are modifications of the After Five
curettes.
● Mini Five curettes feature blades that are half the length of After Five or standard
Gracey curettes.
○ The shorter blade allows easier insertion and adaptation in deep, narrow pockets;
furcations; developmental grooves; line angles; and deep, tight facial, lingual, or palatal
pockets.
○ In any area where root morphology or tight tissue prevents full insertion of the standard
Gracey or After Five blade, Mini Five curettes can be used with vertical strokes, with
reduced tissue distention and no tissue trauma.
● available in both finishing and rigid designs
○ Rigid Mini Five curettes are recommended for calculus removal.
○ The more flexible shanked finishing Mini Five curettes are appropriate for light scaling
and deplaquing in periodontal maintenance patients with tight pockets.
● Mini Five curettes are available in all standard Gracey numbers, except the #9-10.
84
MINI-BLADED CURETTES

COMPARISON OF STANDARD RIGID GRACEY #5-6 WITH RIGID MINI FIVE #5-6 ON THE PALATAL SURFACES OF THE
MAXILLARY CENTRAL INCISORS:
MINI FIVE CURETTE CAN BE INSERTED TO THE BASE OF THESE TIGHT ANTERIOR POCKETS AND USED WITH A
STRAIGHT VERTICAL STROKE. THE STANDARD GRACEY OR AFTER FIVE CURETTE USUALLY CANNOT BE INSERTED
VERTICALLY IN THIS AREA BECAUSE THE BLADE IS TOO LONG.
85

● Micro Mini Five Gracey curettes (Hu-Friedy) have blades that are 20% thinner and smaller than the
Mini Five curettes.
● These are the smallest of all curettes.
● These curettes provide exceptional access and adaptation to tight, deep, or narrow pockets; narrow
furcations; developmental depressions; line angles; and deep pockets on facial, lingual, or palatal
surfaces.
● In areas where root morphology or tight, thin tissue prevents easy insertion of other mini-bladed
curettes, Micro Mini Five curettes can be used with vertical strokes without causing tissue distention
or tissue trauma.
86
MICRO-MINI CURETTES

MICRO MINI FIVE GRACEY CURETTES.
LEFT TO RIGHT, #1-2, #7-8, #11-12, #13-14.
87

COMPARISON OF GRACEY CURETTE DESIGNS.
LEFT TO RIGHT, STANDARD #1-2, AFTER FIVE #1-2, MINI FIVE #1-2, MICRO MINI FIVE #1-2.
88

● Gracey Curvettes comprise a set of four mini-bladed curettes:
○ the Sub-0 and #1-2 are used for anterior teeth and premolars
○ the #11-12 is used for posterior mesial surfaces
○ the #13-14 is used for posterior distal surfaces
● The blade length is 50% shorter than that of the conventional Gracey curette,
and the blade is curved slightly upward.
○ allows Gracey Curvettes to adapt more closely to the tooth surface than any
other curettes, especially on the anterior teeth line angles
● However, this curvature also carries the risk of gouging or “grooving” into the
root surfaces on the proximal surfaces of the posterior teeth when #11-12 or
#13-14 is used.
● Additional features are a precision-balanced blade tip in direct alignment with
the handle, a blade tip perpendicular to the handle, and a shank closer to parallel
with the handle.
89
GRACEY CURVETTES

GRACEY CURVETTE SUB-0 ON THE PALATAL SURFACE OF A MAXILLARY CENTRAL INCISOR.
THE LONG SHANK AND SHORT, CURVED, BLUNTED TIP MAKE THIS A SUPERIOR INSTRUMENT FOR DEEP
ANTERIOR POCKETS. THIS CURETTE PROVIDES EXCELLENT BLADE ADAPTATION TO THE NARROW ROOT
CURVATURES OF THE MAXILLARY AND MANDIBULAR ANTERIOR TEETH.
90

● Quétin furcation curettes are actually hoes with a shallow,
half-moon radius that fits into the roof or floor of the furcation.
● The curvature of the tip also fits into developmental
depressions on the inner aspect of the roots.
● The shanks are slightly curved for better access, and the tips
are available in two widths.
○ The BL1 and MD1 instruments are small and fine, with a
0.9-mm blade width.
○ The BL2 and MD2 instruments are larger and wider, with a
1.3-mm blade width.
● These instruments remove burnished calculus from recessed
areas of the furcation and lessen the likelihood of root damage.
91
QUETIN FURCATION CURETTES

● introduced in November 2015
● USES:
○ patients with tight tissue, recession, and residual pocket depth following initial periodontal therapy or
periodontal surgery
○ maintenance patients with healthier tight tissue without attachment loss or recession
● BLADE:
○ 1 mm shorter and 20% thinner, and the face of the blade is offset from the terminal shank at 60 degrees
○ allows easier insertion and better access to root surfaces with tight tissue and loss of attachment
○ three-quarter blade length is between the blade lengths of the standard and mini-bladed curettes
■ shorter blade adapts more easily to root anatomy and furcation areas
92
PERIODONTAL MAINTENANCE CURETTES

● SHANK:
○ 2 mm longer than that of the standard Gracey curette, but 1 mm shorter than that of the extended
shank Gracey curette
■ enables better access to molar areas with attachment loss
■ allows ease of use in the anterior areas where a very long shank is not necessary
○ shank angle of the new Gracey #11-12 is between the regular Gracey #11-12 and the Gracey #15-16,
and the shank angle of the new Gracey #13-14 is between the regular Gracey #13-14 and the Gracey
#17-18
■ enhanced access to the mesial and distal surfaces of the posterior teeth
○ The shanks of these newer instruments are rigid so they can withstand irm pressure when removal of
residual burnished calculus is necessary. However, they are not designed for moderate or heavy calculus
removal.
93

LEFT TO RIGHT, PATTISON GRACEY LITE #1-2, PATTISON GRACEY LITE #7-8, PATTISON GRACEY
LITE #11-12, PATTISON GRACEY LITE #13-14.
94

● Langer and Mini Langer curettes comprise a set of three curettes combining the shank design of
standard Gracey #5-6, #11-12, and #13-14 curettes with a universal blade honed at 90 degrees.
○ allows the advantages of the area-specific shank to be combined with the versatility of the universal
curette blade
○ Langer #5-6 curette adapts to the mesial and distal surfaces of anterior teeth
○ Langer #1-2 curette (Gracey #11-12 shank) adapts to the mesial and distal surfaces of mandibular
posterior teeth
○ Langer #3-4 curette (Gracey #13-14 shank) adapts to the mesial and distal surfaces of maxillary
posterior teeth
● These instruments can be adapted to both mesial and distal tooth surfaces without changing
instruments.
● The standard Langer curette shanks are heavier than a finishing Gracey but less rigid than the rigid
Gracey.
● Langer curettes are also available with either rigid or finishing shanks and can be obtained in
extended-shank (After Five) and mini-bladed (Mini Five) versions.
95
LANGER AND MINI LANGER CURETTES

LEFT TO RIGHT, #5-6, #1-2, AND #3-4
96

● Used for final finishing of root surfaces
○ can produce a smooth, even, clean, and highly polished root surface
● Do not have cutting edges; instead, they are coated with very fine-grit diamond
● Sharply abrasive and should be used with light, even pressure against the root surface to avoid gouging
or grooving
● Diamond files must be used carefully because they can cause overinstrumentation of the root surface.
They will remove too much root structure if they are used with excessive force, are poorly adapted to
root morphology, or are used too long in one place.
● Diamond files are particularly effective when used with the dental endoscope, which reveals residual
deposits and directs the clinician to the exact area for instrumentation.
97
DIAMOND-COATED FILES

DIAMOND FILES.
(A) #1, #2 AND (B) #3, #4. (BRASSELER, SAVANNAH, GA.) (C) SDCN 7, SDCM/D 7. (HU-FRIEDY, CHICAGO.)
(COPYRIGHT A. PATTISON.)
98

Puglisi R, Santos A, Pujol A, Ferrari M, Nart J, Pascual A. Clinical comparison of instrumentation systems for periodontal debridement: a randomized clinical
trial. International Journal of Dental Hygiene. 2022 May;20(2):328-38. 99

Suvan J, Leira Y, Moreno Sancho FM, Graziani F, Derks J, Tomasi C. Subgingival instrumentation for treatment of periodontitis. A systematic review. Journal of Clinical
Periodontology. 2020 Jul;47:155-75. 100

101
IMPLANT
INSTRUMENTS
● MINI BLADED TITANIUM
INSTRUMENTS

● Plastic or titanium instruments should be used to avoid scarring and permanent damage to implants
● Available in both universal and Gracey curette designs
○ Insert easily under tight tissue
○ Adapt easily around implants and implant restorations
● Uses:
○ Implant maintenance
○ Careful, light pressured strokes for bioﬁlm and light calculus removal
● Moderate- or heavy-pressured strokes should be avoided to prevent scratching or roughening of
implant surfaces
○ These instruments are not intended for removal of heavy calculus or cement (peri-implantitis)
102
MINI BLADED INSTRUMENTS

NEW MINI TITANIUM IMPLANT SCALERS (HU-FRIEDY, CHICAGO).
LEFT TO RIGHT:MINI FIVE GRACEY #1-2, MINI FIVE GRACEY #11-12, LANGER #1-2, MINI FIVE GRACEY #13-14, 204SD
SICKLE SCALER. 103

(A) MICRO MINI TITANIUM IMPLANT CURETTES (PARADISE DENTAL TECHNOLOGIES, MISSOULA, MT). LEFT TO
RIGHT, GRACEY #1-2 MICRO MINI, GRACEY #11-12 MICRO MINI, GRACEY #13-14 MICRO MINI. (B) MINI-BLADED
TITANIUM IMPLANT CURETTES (LM INSTRUMENTS, PARAINEN, FINLAND) : MINI UNIVERSAL CURETTE, MINI GRACEY
#1-2, MINI GRACEY #13-14, MINI GRACEY #11-12.
104

Lang MS, Cerutis DR, Miyamoto T, Nunn ME. Cell Attachment Following Instrumentation with Titanium and Plastic Instruments, Diode Laser, and Titanium Brush on
Titanium, Titanium-Zirconium, and Zirconia Surfaces. International Journal of Oral & Maxillofacial Implants. 2016 Jul 1;31(4). 105

106
PERIODONTAL
ENDOSCOPE
● PERIOSCOPY SYSTEM

● A dental endoscope has been introduced for use subgingivally in the diagnosis and treatment of
periodontal disease.
● The Perioscopy system (Perioscopy, Inc., Oakland, CA) consists of:
○ 0.99-mm-diameter reusable fiberoptic endoscope
○ disposable sterile sheath
● Fiberoptic endoscope
○ fits onto periodontal probes and ultrasonic instruments that have been designed to accept it
○ attaches to a medical-grade charge-coupled device (CCD) video camera and light source that produces
an image on a flat-panel monitor for viewing during subgingival exploration and instrumentation
● Sheath
○ delivers water irrigation that flushes the pocket while the endoscope is being used
○ keeps the field clear
107
PERIOSCOPY SYSTEM

PERIOSCOPY SYSTEM, DENTAL ENDOSCOPE 108

● ADVANTAGES:
○ magniﬁcation ranges from 24 to 48 times
○ allows clear visualization deep into subgingival
pockets and furcations
○ permits operators to detect the presence and
location of subgingival deposits and guides them
in the thorough removal of these deposits
○ also used to evaluate subgingival areas for caries,
defective restorations, root fractures, and
resorption
109

110
CLEANING AND
POLISHING INSTRUMENTS
● RUBBER CUPS
● BRISTLE BRUSHES
● DENTAL TAPE
● AIR-POWDER POLISHING

● Consist of a rubber shell with or without webbed configurations in the hollow interior
● Used in the handpiece with a special prophylaxis angle
● 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 grit and are
packaged in small, convenient, single-use containers.
● 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.
● DISADVANTAGE:
○ Aggressive use of the rubber cup with any abrasive may remove the layer of cementum, which is thin in
the cervical area
111
RUBBER CUPS

● Available in wheel and cup shapes
● Used in the prophylaxis angle with a polishing paste
● The bristles are stiff, thus use of the brush should be conﬁned to the crown to avoid injuring the
cementum and the gingiva.
112
BRISTLE BRUSHES

METAL AND DISPOSABLE PLASTIC PROPHYLAXIS ANGLE WITH RUBBER CUP AND WITH BRUSH
113

● 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
○ activated with a ﬁrm labiolingual motion
● The area should be cleansed with warm water to remove all remnants of the polishing paste
114
DENTAL TAPE

● 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, called the Prophy-Jet (Dentsply International,
York, PA).
○ very effective for removing extrinsic stains and soft
deposits
○ slurry removes stains rapidly and efﬁciently by
mechanical abrasion and provides warm water for
rinsing and lavage
○ The low rate of the abrasive cleansing power can be
adjusted to increase the amount of powder for
heavier stain removal.
115
AIR-POWDER POLISHING

● DISADVANTAGE:
○ Several studies on the abrasive effect of the air-powder polishing devices using sodium bicarbonate and
aluminum trihydroxide on cementum and dentin have shown that significant tooth substance can be lost
○ Damage to gingival tissues is usually transient
○ Amalgam restorations, composite resins, cements, and other nonmetallic materials can be roughened
● Both supragingival and subgingival air polishing with glycine or erythritol powder are safe and very
effective for removal of biofilm from titanium implant surfaces and restorative materials.
○ No soft tissue abrasion occurs, and at probing depths of 1 mm to greater than 5 mm, the use of glycine or
erythritol powder in an air-polishing device with a subgingival nozzle is more effective for subgingival
biofilm removal than the use of either manual or ultrasonic instruments
116
Agger MS, Horsted-Bindslev P, Hovgaard O: Abrasiveness of an air-powder polishing system on root surfaces in vitro, Quintessence Int 32:407, 2001.
Orton GS: Clinical use of an air-powder abrasive system, J Dent Hyg 75:513, 1987.
Petersilka GJ, Bell M, Mehl A, et al: Root defects following air polishing, J Clin Periodontol 30:165, 2003.
Petersilka GJ, Bell M, Haberlein I, et al: In vitro evaluation of novel low abrasive air polishing powders, J Clin Periodontol 30:9, 2003.
Petersilka GJ, Faggion CM, Jr, Stratmann U, et al: Effect of glycine powder air-polishing on the gingiva, J Clin Periodontol 35(4):328–333, 2008.

HU-FRIEDY EMS AIR FLOW MASTER AIR POLISHING DEVICE WITH PERIO AND STANDARD HANDPIECES AND TIPS
FOR BOTH SUPRAGINGIVAL AND SUBGINGIVAL AIR POLISHING. (COURTESY HU-FRIEDY, CHICAGO, IL.) 117

HU-FRIEDY EMS AIR FLOW PERIO HANDY SMALLER AIR POLISHING DEVICE WITH SUBGINGIVAL AIR POLISHING TIP
FOR GLYCINE OR ERYTHRITOL POWDER POLISHING. (COURTESY HU-FRIEDY, CHICAGO, IL.) 118

HU-FRIEDY EMS PERIO FLOW TIP DISPOSABLE PLASTIC TIP WITH MILLIMETER MARKINGS FOR SUBGINGIVAL AIR
POLISHING OF IMPLANTS OR DEEP POCKETS WITH GLYCINE OR ERYTHRITOL POWDER.
(COURTESY HU-FRIEDY, CHICAGO IL.)
119

● CAUTION:
○ Patients with a medical history of respiratory illness or hemodialysis are not candidates for the use of
the air-powder polishing device.
○ Powder containing sodium bicarbonate should not be used on patients with a history of hypertension,
sodium-restricted diet, or medication use affecting 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 0.12% chlorhexidine gluconate should be used to minimize the microbial
content of the aerosol.
● High-speed evacuation should also be performed to eliminate as much of the aerosol as possible.
120

CONTENT ● SURGICAL INSTRUMENTS
121
PART 3

ANSWERS
● ULTRASONIC TIPS:
○ Ultrasonic and sonic tips of different
shapes and sizes are available.
○ Larger tips are used for removal of heavy
supragingival calculus and heavy
subgingival calculus where tissue is
inflamed and retractable. Thinner tips are
designed for more definitive subgingival
debridement.
○ All tips are designed to operate in a wet
field with a water spray directed at the end
of the tip.
122

ANSWERS
● CONSIDERATIONS FOR ULTRASONIC INSTRUMENTS:
○ Ultrasonic instrumentation is accomplished with a light-to-moderate grasp and varying
pressure depending on the amount and tenacity of the deposit. Excessive pressure can
cause dampening of the vibration of the tip.
○ The tip should be kept in constant motion and parallel to the tooth surface, gouging and
roughening of the root surface or overheating of the tooth can occur.
○ The ultrasonic tip must come in direct physical contact with calculus to fracture and
remove it. The tip must also contact all aspects of the root surface to remove bioﬁlm and
toxins thoroughly. Although as much as 10 mm or more of the length of the ultrasonic tip
vibrates, only the terminal few millimeters (1-2mm) of the tip produce maximum vibration.
○ Immediately after instrumentation, the tooth surfaces should be carefully inspected
visually with optimal lighting and the aid of a mouth mirror and compressed air; surfaces
also should be examined with a ﬁne explorer or probe.
124

ANSWERS
● SHARPENING OF INSTRUMENTS:
○ The objective of instrument sharpening is to restore the sharpness of the blade while
maintaining the original contour and angle of the instrument.
○ TOOLS FOR INSTRUMENT SHARPENING:
■ Sharpening stones:
● Natural stones (ﬁne to medium):
○ Arkansas stone (used with oil lubrication)
● Synthetic stones (ﬁne to coarse):
○ India stone (used with water lubrication)
○ Carborundum stone (used with water lubrication)
○ Ceramic stone (used with water lubrication)
○ Sharpening stones can also be categorized by their method of use:
■ Mounted Rotary Stones
■ Unmounted Stones or Sharpening Cards
■ Diamond Sharpening Cards
125

ANSWERS
● DISADVANTAGES OF PERIO-ENDOSCOPY SYSTEM:
○ Cost: Perio-endoscopy equipment can be expensive and may not be available in all dental
clinics. The cost of purchasing and maintaining the equipment can also be a barrier for
some practitioners.
○ Technical difﬁculties: Perio-endoscopy requires a certain level of technical skill and
training to use effectively. This can be a disadvantage for practitioners who are not
familiar with the system and its use.
○ Limited accessibility: The design of perio-endoscopy systems can limit access to certain
areas of the mouth, particularly in cases of severe crowding or dental malocclusion.
○ Uncomfortable for patients: The insertion of the endoscope into the periodontal pockets
can be uncomfortable for some patients and may cause gagging or other unpleasant
sensations.
○ Limited diagnostic information: While perio-endoscopy provides valuable diagnostic
information, it is not a substitute for other diagnostic tests and should be used in
conjunction with other diagnostic tools.
126

ANSWERS
● CONSIDERATIONS FOR CLEANING AND POLISHING INSTRUMENTS:
○ Selection of appropriate instruments
○ Proper technique: The technique used to polish teeth should be gentle and controlled,
avoiding excessive pressure that could damage the teeth or surrounding tissues.
○ Patient comfort: Patients should be informed about the procedure, and appropriate
measures should be taken to minimize discomfort, such as using a topical anesthetic or
taking breaks during the procedure as needed.
○ Monitoring for adverse effects: The practitioner should regularly monitor the patient for
adverse effects during and after the polishing procedure, such as sensitivity, irritation, or
pain.
○ Post-polishing care: Patients should be instructed on proper post-polishing care,
including avoiding highly abrasive or acidic foods and drinks, brushing and ﬂossing
regularly, and visiting the dentist for regular check-ups.
○ Regular evaluation
127

128
SURGICAL
INSTRUMENTS
EXCISIONAL AND INCISIONAL INSTRUMENTS
MICROSURGERY INSTRUMENTS
PERIOSTEAL ELEVATOR
SCISSORS AND NIPPERS
HEMOSTATS AND TISSUE FORCEPS
SURGICAL BURS
NEEDLE AND NEEDLE HOLDER
SURGICAL CURETTES, SICKLES, CHISELS,
HOES, FILES

129
A typical series of periodontal surgical instruments, divided into two cassettes: (A) From left,
Mirrors, explorer, probe, series of curettes, needle holder, rongeurs, and scissors. (B) From left, Series
of chisels, Kirkland knife, Orban knife, scalpel handles with surgical blades (#15C, #15, and #12D),
periosteal elevators, spatula, tissue forceps, cheek retractors, and mallet; also shown is a sharpening
stone. (A, Courtesy Hu-Friedy, Chicago, IL. B, Courtesy G. Hartzell & Son, Concord, CA.)

130
EXCISIONAL AND
INCISIONAL INSTRUMENTS
● PERIODONTAL KNIVES
● INTERDENTAL KNIVES
● SURGICAL BLADES

● Also known as Gingivectomy knives
● Kirkland knife is representative of the knives that are typically
used for gingivectomy
● Available either as double-ended or single-ended instruments
● Cutting edge - entire periphery of the knife (kidney-shaped)
● Used for initial bevel incision for gingivectomy or gingivoplasty
procedure
○ Pocket markers are used to establish exterior puncture marks
on gingiva at the base of pockets to indicate the initial line of
incision
131
PERIODONTAL KNIVES

● Speciﬁcally used in the interdental areas, thus the name
● Spear-shaped
● Cutting edges present on both sides of the blade
● Available as either double-ended or single-ended blade
● Examples:
○ Orban knife #1, #2
○ Merriﬁeld knife #1-4
○ Waerhaug knife
132
INTERDENTAL KNIVES

● Used to put incision during periodontal surgery
● Discarded after one use
● Commonly used are :
○ #12D
○ #15
○ #15C
● The blades are mounted on BP (Bard-Parker)
handles for use
○ Straight handle
○ Contra-angled handle
134
SURGICAL BLADES

● #12D blade:
○ beak-shaped blade with cutting edges on both sides of the crescent curve
○ allows the operator to engage narrow, restricted areas with both pushing and pulling cutting
motions
○ made up of carbon steel
● #15 blade:
○ most popular blade having a small curved cutting edge
○ used for thinning the ﬂaps
○ ideal for making short and precise incisions
● #15C blade:
○ narrower version of #15 blade
○ has longer and extended cutting edge
○ useful for making the initial, scalloping-type incision
○ slim design of this blade allows for incising into the narrow interdental portion of the ﬂap
135

● Used to reflect and move the flap after the incision has been made for flap surgery
○ The purpose of flap elevation is to get access to the underlying bony defects
● Commonly used elevators:
○ Molt periosteal elevator
○ Woodson periosteal elevator
○ Prichard periosteal elevator
○ Goldman-Fox 14 periosteal elevator
○ Glickman 24G periosteal elevator
138
PERIOSTEAL ELEVATORS

MOLT ELEVATOR; WOODSON ELEVATOR; GOLDMAN FOX ELEVATOR;PRICHARD ELEVATOR; GLICKMAN ELEVATOR 139

140
SURGICAL CURETTES,
SICKLES, CHISELS,
HOES AND FILES
● CURETTES
○ PRICHARD CURETTE
○ KIRKLAND CURETTE
● SICKLES
○ BALL SCALER
● CHISELS
○ BACK-ACTION CHISEL
○ STRAIGHT CHISEL
● HOES
● FILES
○ SUGARMAN FILE
○ SCHLUGER FILE
○ BONE RONGEUR

● Have wide and heavier blade
● Suitable for removal of
granulation tissue, ﬁbrous
interdental tissue and tenacious
subgingival deposits
● Examples:
○ Prichard curette
○ Kirkland surgical curette
○ Ball sickle scaler (#B2, #B3)
141
SURGICAL CURETTES AND SICKLES

● Used solely for the removal of heavy supragingival
calculus deposits that bridge open interproximal
spaces of anterior teeth
● Back-action chisel is used with a pull motion
○ Rhodes chisel
● Straight chisel is used with a push motion
○ Wedelstaedt chisel
○ Ochsenbein [#1 and #2] chisel
● OCHSENBEIN CHISEL:
○ Has semicircular indentation on both sides of the
shank
○ Instrument can engage around the tooth and into the
interdental area
142
SURGICAL CHISELS

● Used for the removal of large ledges of calculus
located supragingivally and slightly
subgingivally
○ Example: calculus on the facial, lingual and distal
surfaces of teeth that have no adjacent
posterior teeth
143
SURGICAL HOES

● Strong instruments
● Uses:
○ interproximal bone filing
○ crush large calculus deposits
● Examples:
○ Sugarman periodontal file
○ Schluger periodontal file
144
SURGICAL FILES

● BONE RONGEUR
○ surgical instrument used for the removal of bone
○ forceps with sharp, cutting edges
■ two arms connected by a pivot, with sharp edges at the end of one arm
○ remove small amounts of bone, particularly in surgical procedures such as ridge
augmentation
○ reshape the jawbone and improve the stability and predictability of implant placement by
creating spaces for dental implant placement
○ Examples:
■ Carmalt Bone Rongeur
■ Foster Bone Rongeur
■ Rat Tooth Bone Rongeur
■ Tatum Bone Rongeur
■ Weingart Bone Rongeur
145

147
SURGICAL BURS
● BURS
● PIEZOELECTRIC UNIT

● The specific surgical burs used in osseous resective surgery will depend on the type and
extent of the procedure being performed. Some common surgical burs used in osseous
resective surgery include:
○ Round bur
■ Used for shaping and smoothing bone
○ Tapered fissure bur
■ Used for creating and shaping concave or flat surfaces in bone
○ Straight fissure bur
■ Used for cutting and shaping of hard tissue
○ Conical bur:
■ Used for removing small amounts of bone
○ Diamond bur
■ Used for precise and efficient removal of hard tissue
148
BURS

CARBIDE ROUND BURS: LEFT TO RIGHT, FRICTION GRIP, SURGICAL-LENGTH FRICTION GRIP, AND SLOW-SPEED
HANDPIECE; DIAMOND BURS 149

● invented by Vercellotti and developed by Mectron
Medical Technology (Carasco, Italy)
● Consists of a piezoelectric ultrasonic transducer
powered by an ultrasonic generator, capable of
driving a range of specially designed cutting inserts
● Piezosurgery’s cutting action is selective, that is,
cuts only mineralized tissues while sparing soft
tissues.
● Selective cutting is made possible by the
application of ultrasonic frequencies between 24
and 36 kHz.
150
PIEZOELECTRIC UNIT

PIEZOELECTRIC PERIODONTAL SURGERY PROTOCOL
PIEZOSURGERY, MECTRON MEDICAL TECHNOLOGY, CARASCO, ITALY 151

152
SCISSORS AND
NIPPERS
● STRAIGHT
● CURVED

● Uses:
○ remove tabs of tissue during gingivectomy
○ trim the margins of ﬂaps
○ enlarge incisions in periodontal abscesses
○ remove muscle attachments in mucogingival
surgery
● Examples:
○ Goldman–Fox #16 scissors have a curved, beveled
blade with serrations
○ Castroviejo scissors
153
SCISSORS AND TISSUE NIPPERS

GOLDMAN-FOX (CURVED) SCISSORS; CASTROVIEJO SCISSORS 154

155
HEMOSTATS AND
TISSUE FORCEPS
● HEMOSTATS
○ CURVED
○ STRAIGHT
● TISSUE FORCEPS
○ TOOTHED
○ NON-TOOTHED

● USES:
○ grasp, hold, or compress tissue to control bleeding
○ clamp blood vessels to prevent bleeding during
surgery
○ isolate a speciﬁc area of tissue
○ retract the tissue to provide better visualization and
access to the surgical site
● Commonly used during soft tissue procedures such as
ﬂap surgery, gingivectomy, and crown lengthening
● Examples:
○ Crile forcep
○ Kelly forcep
○ Hartman mosquito forcep
156
HEMOSTATS

● Uses:
○ position and displace the flap after
the flap has been reflected
○ hold the flap during suturing
157
TISSUE FORCEPS

158
NEEDLE AND
NEEDLE HOLDER
● NEEDLE
● NEEDLE HOLDER

● Surgical needles are designed to lead suture material through the tissue with minimal
injury.
● CLASSIFIED AS:
○ According to eye:
■ Eye less needles
■ Needles with eye
○ According to shape:
■ Straight needles
■ Curved needles
○ According to cutting edge
■ Conventional
■ Reverse cutting
159
Hassan H K. Dental Suturing Materials and Techniques. Glob J Oto 2017; 12(2): 555833.
NEEDLE

● Three basic components:
○ Press - ﬁtted end (swage)
○ Needle body
○ Needle point
● Swaged needles do not require threading and permit a single strand of suture material to
be drawn.
● Body is the widest portion of the needle, it is known as grasping area.
● Point runs from tip to the maximum cross sectional area of the body, can be:
○ Triangular tip/cutting
○ Round tip
○ Blunt tip
160
Hassan H K. Dental Suturing Materials and Techniques. Glob J Oto 2017; 12(2): 555833.

NEEDLE BODY
NEEDLE POINT GEOMETRY 161

● Used to hold the needle during
suturing of the ﬂap
● In addition to the conventional
types of needle holders, the
Castroviejo needle holder is used
for delicate, precise techniques
that require quick and easy grasp
and release of the suture,
especially during root coverage
procedures.
162
NEEDLE HOLDER

163
MICROSURGICAL
INSTRUMENTS
● TUNNELING INSTRUMENTS
● LOUPES
● MICROSCOPE

165
Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel access and platelet-derived growth
factor, BB. Int J periodontics Restorative Dent. 2011 Nov-Dec;31(6):653–60.
Mansouri SS, Moghaddas O, Torabi N, Ghafari K. Vestibular incisional subperiosteal tunnel access versus coronally advanced ﬂap with connective tissue graft for root
coverage of Miller's class I and II gingival recession: A randomized clinical trial. J Adv Periodontol Implant Dent. 2019 Aug 31;11(1):12-20. doi:
10.15171/japid.2019.003. PMID: 35919624; PMCID: PMC9327472.
TUNNELING INSTRUMENTS

● Consist of two monocular microscopes
with side-by-side lenses, angled to focus
on one single object
● Commonly used:
○ Simple loupes
○ Compound loupes
○ Prism loupes
● Magniﬁcation provided is upto 4x.
166
LOUPES

● Superior in terms of flexibility, visual acuity
and magnification
● Based on ‘Galilean principles’
● Magnification provided ranges from 4x-40x
● Components:
○ Magnification charger
○ Objective lenses
○ Binocular tubes
○ Eyepieces
○ Lightning unit
○ Additional attachments
167
MICROSCOPE

168
In conclusion, periodontal instruments play a crucial role in the diagnosis, treatment, and maintenance
of periodontal health. From diagnostic tools, such as mouth mirrors and periodontal probes, to
therapeutic instruments, such as curettes, scalers, and ultrasonic devices, there are a wide range of
instruments available to help dental professionals diagnose and treat periodontal conditions.
Periodontal instruments must be selected and used appropriately to achieve the best outcomes, and
they should be regularly maintained and sterilized to minimize the risk of cross-contamination.
Additionally, dental professionals should have a good understanding of the indications, techniques, and
potential complications associated with each type of periodontal instrument to ensure that they are
used safely and effectively.

REFERENCES
● Guerini V: History of dentistry, Philadelphia, 1909, Lea & Febiger.
● Gold SI: Periodontics: the past. Part I. Early sources, J Clin Periodontol 12:79, 1985.
● Hippocrates: Works, London, 1923, Heinemann. (Edited and translated by WHS Jones and ET Withington, 1931.).
● Paul of Aegina: The Seven Books, London, 1844, Sydenham Society. (Translated by F Adams).
● Albucasis: La chirurgie, Paris, 1861, Bailliére. (Translated by L LeClere).
● Avicenna: Liber Canonis, Venice, 1507.
● Albucasis: La chirurgie, Paris, 1861, Bailliére. (Translated by L LeClere).
● Paré A: Oeuvres completes, Paris, 1840, Bailliére. (Edited by JF Malgaigne.).
● Fauchard P: Le chirurgien dentiste, ou traite des dents, Paris, 1728, J Maruiette. (Reprinted in facsimile, Paris, Prélat, 1961; English
translation by L Lindsay, London, 1946, Butterworth & Co.).
● Younger WJ: Pyorrhea alveolaris, Schweiz Vierteljähresscrift Zahnheilk 15:87, 1905.
● Gold SI: Robert Neumann: a pioneer in periodontal ﬂap surgery, J Periodontol 53:456, 1982.
● Nield J S, Houseman G A. Fundamentals of Dental Hygiene Instrumentation. 2nd ed. Philadelphia: Lea & Febiger; 1988.
● Surathu N, Nasim I. Assessment of the use of a dental mirror. JDMS 2015;14: 115.
● Rieuwpassa IE, Rizal EP, Muis A, Lala HH. 2019. Three in one dental mirror: innovation of oral diagnostic instrument. Journal of
Dentomaxillofacial Science4(2): 75-78.
● Carranza FA. Clinical Periodontology. Philadelphia: W. B. Saunders Company, 1989.
● Hefti AF. Periodontal probing. Critical Reviews in Oral Biology & Medicine. 1997 Jul;8(3):336-56.
● Shayeb KN, Turner W, Gillam DG. Periodontal probing: a review. Primary dental journal. 2014 Sep;3(3):25-9.
● Puglisi R, Santos A, Pujol A, Ferrari M, Nart J, Pascual A. Clinical comparison of instrumentation systems for periodontal
debridement: a randomized clinical trial. International Journal of Dental Hygiene. 2022 May;20(2):328-38.
169

REFERENCES
● Suvan J, Leira Y, Moreno Sancho FM, Graziani F, Derks J, Tomasi C. Subgingival instrumentation for treatment of periodontitis. A
systematic review. Journal of Clinical Periodontology. 2020 Jul;47:155-75.
● Lang MS, Cerutis DR, Miyamoto T, Nunn ME. Cell Attachment Following Instrumentation with Titanium and Plastic Instruments,
Diode Laser, and Titanium Brush on Titanium, Titanium-Zirconium, and Zirconia Surfaces. International Journal of Oral &
Maxillofacial Implants. 2016 Jul 1;31(4).
● Agger MS, Horsted-Bindslev P, Hovgaard O: Abrasiveness of an air-powder polishing system on root surfaces in vitro,
Quintessence Int 32:407, 2001.
● Orton GS: Clinical use of an air-powder abrasive system, J Dent Hyg 75:513, 1987.
● Petersilka GJ, Bell M, Mehl A, et al: Root defects following air polishing, J Clin Periodontol 30:165, 2003.
● Petersilka GJ, Bell M, Haberlein I, et al: In vitro evaluation of novel low abrasive air polishing powders, J Clin Periodontol 30:9,
2003.
● Petersilka GJ, Faggion CM, Jr, Stratmann U, et al: Effect of glycine powder air-polishing on the gingiva, J Clin Periodontol
35(4):328–333, 2008.
● Hassan H K. Dental Suturing Materials and Techniques. Glob J Oto 2017; 12(2): 555833.
● Zadeh HH. Minimally invasive treatment of maxillary anterior gingival recession defects by vestibular incision subperiosteal tunnel
access and platelet-derived growth factor, BB. Int J periodontics Restorative Dent. 2011 Nov-Dec;31(6):653–60.
● Mansouri SS, Moghaddas O, Torabi N, Ghafari K. Vestibular incisional subperiosteal tunnel access versus coronally advanced ﬂap
with connective tissue graft for root coverage of Miller's class I and II gingival recession: A randomized clinical trial. J Adv
Periodontol Implant Dent. 2019 Aug 31;11(1):12-20. doi: 10.15171/japid.2019.003. PMID: 35919624; PMCID: PMC9327472.
170

Classification of Periodontal Instruments

More Related Content

What's hot

Similar to Classification of Periodontal Instruments

More from Dr Akriti Mishra

Recently uploaded

Classification of Periodontal Instruments