This document discusses curettes, which are instruments used for subgingival scaling, root planing, and removal of soft tissue in the periodontal pocket. It describes the basic components and designs of curettes, including universal curettes and Gracey curettes. Universal curettes have straight, parallel cutting edges and are designed to be used on all tooth surfaces. Gracey curettes have a single, curved cutting edge and are designed for specific tooth areas, providing better adaptation to complex root anatomy. The document outlines the techniques for proper use of curettes, including blade angulation, insertion strokes, and selection of the correct cutting edge.

2. curettes

3. Contents
•Introduction
•Curettes
•Types of curettes and
its design and its
technique
•Clinical applications
•Conclusion
•Reference

4. Success of nonsurgical periodontal therapy
depends on
clinician
Providing
treatment
Complete
knowledge
Understanding
of periodontal
instruments
Design
Maintenance
Technique
principles
These provide effective and
efficient nonsurgical periodontal
therapy
Introduction:

5. Periodontal instruments are designed for specific
purposes such as
removing calculus,
planing root surfaces,
curetting the gingiva and
removing diseased tissue.

6. Classification of periodontal
instruments:
Classified according to the purposes they serve as
follows
1. Periodontal probes
2. Explorers
3. Scaling, root planning and curettage instruments:
4.Periodontal endoscopes
5. Cleaning and polishing instruments.

7. Scaling, root planning and
curettage instruments:
•removal of biofilm and calcified deposits
from the crown and root of a tooth,
•removal of altered cementum from the sub
gingival root surfaces, and
•debridement of the soft tissue lining the
pocket.

8. Sickle scaler: used to remove
heavy supra gingival calculus
•Curettes: fine instruments for sub gingival
scaling, root planing, and removal of soft tissue
lining.
•Hoe, chisel and file –tenacious subgingival
calculus and altered cementum.
•Ultrasonic and sonic instruments-for scaling
and cleaning the tooth surfaces and curetting
the soft tissue wall of the pocket.

9. Hand insrumentation:
• Advantages
Good tactile sensation
Minimizing the risk of contamination aerosol
production.
Recently modified curettes with extended shanks for
deep pockets have been developed to improve the
efficacy of scaling and root planing in difficult areas
( singer et al 1992,landry et al 1989).

10. curettes
•Curettes are instruments used for removing deep sub
gingival calculus, root planing/debridement and removal
of soft tissue lining of the pocket.

11. Terminal shank-last portion of
shank to working end

12. 5mm to
10 mm
diameter
of
handle
Knurling of
the
instruments -
control
Light
weight
composite
-efficient
Metallic
instruments have
hollow handle
decrease the
pressure and
increases tactile
sensitivity
Genco
periodontics

13. Length of the shank
30-40mm
Longer functional shank –
for a longer clinical crown,
deep periodontal pockets
and posterior tooth
surfaces
Genco periodontics

14. Shank design
Straight
Curved
contrangled
Contrangled
Two bends in opposite
direction –for distal surface of
posterior teeth
And deep periodontal pocket

15. Diameter of a shank
Rigid
Flexible-
relieves force
And prevent damage
to the root surface

17. Balance of the
insrument

18. •working part - spoon shaped blade
•two curved cutting edges,
• two edges are united by rounded toe.
•double ended with mirror turned blades.
•The length and angulations of a shank as
well as the dimensions of the blade differ
between different brands of instruments.
•It is finer than the sickle scalers and does
not have any sharp points or corners other
than the cutting edges of the blade.
•Semicircle in cross section.

20. Types of curettes:
There are two basic types of curettes: universal and area
specific.

21. Universal Curettes.
named -designed to adapt all areas of the mouth.
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.
Uses:
•For subgingival scaling and root
planing .
•Also used for supra gingival
scaling ,especially at the cervical
area and for gingival curettage

22. Design:
Working end Curves upward
Cutting edge Straight; parallel to one another
Relationship of face to shank Face at 90 degree to lower angle
toe
No of cutting edges Two cutting edges per working
end
Working end in cross section semicircular
Functional shank Varies from short, long or rigid
,flexible
Application to sextant surfaces A single universal curette may be
used on all anterior and posterior
surfaces

23. Analysis of design features of
universal curettes
DESIGN FEATURES ANALYSIS OF DESIGN FEATURES
Working end has upward curvature Advantages: adapts to convex tooth
surface easy insertion beneath the
gingival margin.
Lateral surfaces are straight Advantages: none
Disadvantages:
Leading third of the cutting edge is
straight and does not adapt well to
convex and concave root surfaces.

24. Lateral surfaces meet in a round toe Advantages:
Much likely to gouge cemental
surface, adapt better to root
curvature than a pointed toe of the
sickle scaler
Disadvantages:
Rounded tip is wider than a pointed
tip so difficult to adapt to the
proximal tooth surfaces
Face is perpendicular90-degree angle
to lower shank
Advantages:
Efficient ,two cutting edges per
working blade
-used for calculus removal.
Disadvantages:
level cutting edges are non self
angulated ,more difficult to use in
pocket when tissue is closely adapted
to the tooth surface

25. Rounded back Inserted within the gingival margin
without trauma
Medium/long shank length Provide access to tooth surfaces
rigid/medium shank Shank is strong for removing medium
calculus.

26. Technique:
Correct working end:
The face of the blade is held parallel to
the occlusal or incisal edge of the tooth.
Correct cutting edge:
the face of the blade should be towards
the tooth surface and not toward the
clinician as it will damage the gingival
tissues.

27. Blade angulation:
the cutting edge is placed on the tooth so that the face is at an
angle between 45 and 90 degrees.
The tip one third is adapted to the tooth surface.
This portion of instrument should remain in contact with the
tooth surface the entire time the tooth being is instrumented.

28. Insertion:
using modified pen grasp, establish a
fulcrum close to the working area as
possible.
Begin in the distal line angle of the
posterior sexants and farest line angle in
the anterior sexants.

29. Adaptation:
for outer edge of buccal /lingual or mesial
surfaces: the instrument handle should be parallel
to the long axis of the tooth.
For inner edge of the distal surfaces: the
instrument handle should be parallel with the
occlusal plane.

30. Stroke:
short, overlapping, pull strokes
push or pull combination, the push stroke is an exploratory
stroke and should be avoided.
On facial and lingual surface, oblique stroke is used.
On proximal surface, a vertical stroke is used at times
horizontal strokes may be necessary.
Once the deposit is removed, root planing or longer stroke is
used to achieve a smooth surface.

31. Examples of universal curettes:
•The Barnhart curettes #1-2 and 5-6
•Columbia curettes #13-14, 2R-2L, and 4R-4L
•Younger-Good #7-8,
•McCall’s #17-18, and
•the Indiana University #17-18.

32. Dr. Clayton H Gracey.
Gracey curettes:
Other name: area specific curette.
A set of instruments designed and angled to adapt to specific anatomic areas of the
dentition.
The Gracey curettes were designed in the late 1930s by Dr. Clayton H Gracey.

33. USES:
These curettes and their modifications
are probably the best instruments for
subgingival scaling and root planing
because they provide adaptation in the
complex root anatomy, furcations
areas ,developmental depressions, and
root concavities

34. Working end Curves upward and to one side
Cutting edge curved
Relationship of face to shank 60-70 degree to lower shank
Offset blade
No of cutting edges One cutting edges per working
end
Working end in cross section semicircular
Functional shank Long/extended shank in rigid
and flexible designs
Application to sextant surfaces A single universal curette is
limited to use on certain tooth
surfaces.
Design characteristics

35. Analysis of design features of
universal curettes
design features Analysis of design features
Working end has upward curvature Advantages: adapts to convex tooth
surface easy insertion beneath the
gingival margin.
Lateral surfaces are curved Advantages: curved cutting edges
provides improved adaptation to
concave root surfaces

36. Lateral surfaces meet in a round toe Advantages:
Much likely to gouge cemental
surface, adapt better to root
curvature than a pointed toe of the
sickle scaler
Disadvantages:
Rounded tip is wider than a pointed
tip so difficult to adapt to the
proximal tooth surfaces
Offset 60-70 degree Advantages:
Cutting edge is self angulated readily
used sub gingival without tissue
trauma.
Disadvantages:
only one cutting edge per working
end can be used for root surface
debridement ,less tissue efficient

37. Rounded back toe Inserted within the gingival margin without
trauma
long shank length Provide access to tooth surfaces
flexible shank Good tactile sensation
Limited to use in light calculus

38. Design:
Four design makes the Gracey curettes unique:
•They are area specific,
•Only one cutting edge on each blade is used
•The blade is curved in two planes
•The blade is offset.

39. Area specificity:
Double sided 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

42. Determine the correct cutting edge:
lower shank parallel to the surface of the tooth.
With the toe pointed in the direction to be scaled ,only the back
of the blade can be seen if the correcting has been selected.
If the wrong cutting edge has been adopted, flat shiny face of
the blade will be seen instead.

43. .Anterior teeth –
•lower shank of the Gracey curette #1-2,3-4,5-6 - parallel to the
Facial, lingual, mesial and distal surfaces
Posterior teeth –
•Lower shank of the Gracey curette #7-8 or 9-10 parallel to the
facial or lingual surface of the teeth
•Lower shank of the Gracey curette #11-12 parallel to the mesial
surface of the teeth
•Lower shank of the Gracey curette # 13-14 -parallel to the distal
surface of the teeth.

56. the fourth and middle fingers together in a built
up fulcrum for maximum control and wrist action.
Use extra oral fulcrums or mandibular finger rests for
optimal angulation when working on the
maxillary posterior teeth.
the lower third of the cutting edge for calculus removal,
especially on line angles or when attempting
to remove a calculus ledge by breaking it
away in sections, beginning at the lateral
edge.

57. Sharpening of the instruments

58. Sharpening of the instruments
Identify the edge to be sharpened. Remember that only one
cutting edge is used, so only that edge must be sharpened.
Apply the stone to the lateral surface so that the angle between
the face of the blade and the stone is 100 to 110 degrees.
•Activate short up-and-down
strokes, working from the shank
end of the blade to the curved
toe. Finish with a down stroke.
• Remember that the cutting
edge is curved. Preserve the
curve by turning the stone while
sharpening from shank to toe. If
the stone is kept in one place for
too many strokes, the blade will
be flattened .

60. DIFFERENCE OF GRACEY CURETTE FROM
UNIVERSAL CURETTES:
Blade is not at a 90 degree angle to the lower shank.
Area specific curettes also have a curved blade.
the blade of the universal curette is curved in one direction
,whereas the Gracey curettes blade is curved from head to toe
and along the side of the cutting edge.
Thus only pull stroke can be used.

62. EXTENDED SHANK
CURETTES:
AFTER FIVE CURETTES (HU FREIDY) - modification
Design:
The terminal shank is 3mm longer, allowing greater extension
into deep periodontal pockets of 5mm or more.
It has a thinned blade for smoother subgingival insertion and
reduced tissue distention and a large diameter tapered shank.
They are available in finishing or rigid designs.

63. Availability of instruments:
All standard Gracey curettes are except #9-10 all are
available #1-2,#3-4,#5-6,#7-8,#11-12,#13-14 in the
after five series.

64. Technique:
Conventional intraoral rest, use of extra oral fulcrum
allows better access and adaptation to all the maxillary
posterior teeth.

65. Uses:
•For heavy or calculus removal-rigid type
•For light scaling or deplaquing in the
periodontal maintenance patient, the
thinner, finishing After five curettes will
insert subgingivally more easily for deep
residual pocket depth.
Sharpening of the instruments:
the same manner as the standard Gracey curettes.
Although the terminal shank is 3 mm longer, the blade
size and shape are very similar,

66. Mini bladed Gracey curettes:
Modification of the After five series curette.
Design:
Half the blade of the After five series or universal curettes.
Uses:
The shorter blade allows easy insertion and adaptation in
deep narrow pockets, furcations, developmental grooves
,line angles, and deep, tight ,facial ,lingual, or palatal
pockets.
They are available in both finishing and rigid design.

67. Uses:
Rigid Mini five curettes for
calculus removal.
Flexible for light scaling and
deplaquing in periodontal
maintenance patients with tight
pockets.

68. Available in all standard Gracey numbers
except #9-10.
Micro mini five curettes ( Hu Friedy
Chicago):

69. Technique:
For removing calculus -Intraoral finger is used.
For light planing or deplaquing ,either intraoral rests
and third molar or extra oral fulcrums can be used.

70. The Gracey curvette:
Another set of four mini bladed curettes: sub-0
and the #1-2 –anterior teeth and premolars, the
#11-12 is used for posterior mesial surfaces and
the #13-14 for posterior distal surfaces.
Design:
The blade length is 50% shorter than that of the the conventional gracey
curette, and the blade has been curved slighty upward.

71. Advantages:
adapt more closely to the tooth surfaces than
any other curettes, especially on the anterior
teeth and line angles.
Disadvantages:
grooving or gouging into the root surfaces on
proximal surfaces of posterior teeth when the
Gracey curvette #13-14 is used.

72. also sharpened with the same technique.
These blades are only half the length of a
standard Gracey blade, but the angle
between the face and the lateral surface of
the blade is still 70 to 80 degrees.
However, sharpening too heavily or too
often around the toe of a mini-bladed
curette should be avoided to prevent
excessive shortening of the blade.

73. Langer and Mini -Langer curettes:
They are set of three curettes combining the shank design of the
standard Gracey #5-6,#11-12 and #13-14 curettes with a universal
blade honed at 90 degree rather than the offset blade of the Gracey
curette.
Design:.
•The Langer#5-6 curette adapts to the mesial and distal surfaces of
anterior teeth.
•The Langer #1-2 curette (Gracey #11-12 shank ) adapts to the
mesial and distal surfaces of mandibular posterior teeth:
•The Langer #3-4 curette (Gracey #13-14 shank) adapts to the
mesial and distal surfaces of maxillary posterior teeth.
•The standard Langer curettes are heavier than a finishing Gracey
but less rigid than the rigid Gracey.

75. Advantages:
This allow the area specific of the shank to be
combined with the versatility of the universal
curette blade.
These instruments can be adapted to mesial and
distal tooth surfaces without changing the
instruments.

76. Quétin Furcation Curettes.
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 aspects of the roots.
The shanks are slightly curved for better access, and the tips are
available in two widths .
The BL1 (buccal-lingual) and MD1 (mesial-distal)
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.

77. Comparitive study in the treatment of
furcation with ultrasonic and hand
instrumentation:
Instrumentation at furcation involved sites requires additional shank length and a
narrow working ends to reach the full extent of the probing depth.
Otero Cagide-found site specific curettes to be the most effective hand instrument
at accessing furcations.
In contrast, Drisko et al found that access to furcations is improved with USD
(ultrasonic) and Santos et al concluded that USD is superior to site specific curettes.
Wylam deduced that hand instrument alone are inadequate for furcation
debridement and Leon and Vogel found that USD (ultrasonic) is significantly more
effective than hand instrument in class two and three furcations.

80. Are
heavy
curettes
for the removal
of granulation
tissue and
tenacious
subgingival
deposits.
Surgical
curettes:
universal
Kramer curettes #1, 2, and 3
Prichard ½
Kirkland surgical instruments
Crane –Kaplan no 6

81. Kramer curettes #1, 2, and 3
Prichard ½

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

84. New Implacare II implant instruments (Hu-Friedy, Chicago)
These implant instruments have autoclavable stainless steel
handles and five different cone-socket plastic tip designs.
Shown here: A. New Barnhart 5-6 curette tips B. New Langer 1-
2 curette tips
Titanium Implant Curettes (Paradise Dental Technologies, Missoula,
MT). Left to right, Barnhart #5-6, Langer #1-2, and NEB 128B-L5 Mini.

85. Clinical application:
subgingival scaling and root planing
curved blade, rounded toe, and curved contour -
minimal tissue displacement and trauma.
modified pen grasp, and a stable finger rest is
established.
the lower shank kept parallel to the tooth surface.

86. The blade is inserted under the
gingiva and advanced to the base
of the pocket by a ligkt exploratory
stroke.
working angulation of 45-90
degree is established, and pressure
is applied laterally to the tooth
surface.

88. If the lower shank is not parallel to the tooth
surface that is angled or tilted away from the
tooth, the lower shank will hit the tooth or
contact area ,preventing extension of strokes
into midproximal region.

89. • Disadvantages
Time consuming,
If aggressively performed -excessive tooth substance
removal.
More technique sensitive
Frequent instrument sharpening.
Access to furcations and the base of the deep pockets is
limited compared to machine driven instruments which
have been designed to access narrow apertures and
relatively inaccessible areas ( leon et al 1987, oda &
ishikawa 1989, dragoo et al 1992,takacs et al 1993,yukna
et al 1997,koecher et al 1998.2001,beuchat et al 2001).

90. Repetitive strain injury:
Can lead to carpel tunnel syndrome and other upper body
neuropathies.
It results from inflammation or pressure to the median nerve of the wrist
as it passes carpel tunnel at the base of the palm of the hand.
Symptoms:
Tingling
Numbness pressure points
Pain
Metallic hexagonal shaped instruments-pinch grip to hold the instrument
Ergonomically design –silicone handles.

93. Efficacy of curettes:
In nonsurgical deep periodontal pockets:
Stambugh et al calculated the”curette eficiency”
(the average PD instrumentated to a plaque and calculus
free surface which was hard and free of gouges and
scratches) to be 3.75mm .
They also reported the instrument limitation (the maximum
mean PD at which evidence of insrumentation could be
seen )to be 6.21 mm.

94. Lots of studies have assessed post treatment
pocket probing depths (PPDs), clinical
attachment loss (CAL), bleeding on probing
(BOP) and recession, concluding that a
comparable clinical outcome can be
achieved using either HI( hand instrument)
or USD( ultrasonic).
.

95. Beuchat et al found that in
probing depths of up to six
millimeters, both methods are
of equal value

96. Drisko et al, and Tunkel et al concluded that
similar results can be achieved in single rooted
teeth and Leon and Vogel proved that class I
furcation involvement may be accessed
effectively with both HI and USD.

98. Reference:
•Carranza clinical periodontology 9 th edition ,10 th edition,11th edition ,12 th edition and 13th edition.
•John lindhe
•Konig J, Schwahn C, Fanghänel J, Plötz J, Hoffmann T, Kocher T. Repeated scaling versus surgery in young adults with generalized advanced
periodontitis. J Periodontol 2008; 79(6):1006-13. doi: 10.1902/jop.2008.070380.
•Hung HC, Douglass CW. Meta-analysis of the effect of scaling and root planing, surgical treatment and antibiotic therapies on periodontal
probing depth and attachment loss. J Clin Periodontol 2002; 29(11):975
•Isidor F, Karring T. Long-term effect of surgical and nonsurgical periodontal treatment. A 5-year clinical study. J Periodontol Res 1986;
21(5):462-72.
•Cobb CM. Clinical significance of non-surgical periodontal therapy: an evidence-based perspective of scaling and root planing. J Clin
Periodontol. 2002; 29(2): 6-16.
•Ramfjord SP, Caffesse RG, Morrison EC et al. Four modalities of periodontal treatment
compared over five years. J Clin Res 1987; 22(3): 222-23.
• Tunkel J, Heinecke A, FlemmingTF. A systemic review of efficacy of machine-driven
and manual subgingival debridement in treatment of chronic periodontitis. J Clin
Periodontol. 2002; 29 Suppl 3:72-81; discussion 90-1.
• Magnusson I, Lindhe J, Yoneyama T et al. Recolonisation of a subgingival microbiota
•following scaling in deep pockets. J Clin Periodontol. 1984; 11(3): 193-207.
•Rabbani GM, Ash,MM.Jr., Caffesse RG. The effectiveness of subgingival scaling and root planing in calculus removal. J Periodontol. 1981;
52(3): 119-23.
•Buchanan SA, Robertson PB. Calculus removal be scaling/root planing with and without
surgical access. J Periodontol. 1987; 58(3):159-63.
•Breininger DR, O’Leary TJ, Blumenshine RV. Comparative effectiveness of ultrasonic and hand scaling for the removal of subgingival plaque
and calculus. J Periodontol. 1987; 58(1): 9-18.
• Ioannou I, Dimitriadis N, Papadimitriou K et al. Hand instrumentation versus ultrasonic debridement in the treatment of chronic periodontitis; a
andomized clinical and
microbiological trial. J Clin Periodontol 2009; 36(2): 132–41.
• Obeid PR, D’Hoore W, Bercy P. Comparative clinical responses related to the use of
various periodontal instrumentation. J Clin Periodontol. 2004; 31(3): 193-9.
• Drisko CL, Cochran DL, Blieden T et al. Position Paper: sonic and ultrasonic scalers in
periodontics. Research, Science and Therapy Committee of the American Academy ofPeriodontology. J Periodontol 2000; 71(11): 1792-801.