This document provides instructions on proper manual instrumentation techniques. It discusses 6 key principles: accessibility and patient positioning; visibility, illumination, and retraction; using sharp instruments; maintaining a clean field; instrument stabilization; and instrument activation. Instrument stabilization is achieved through proper instrument grasp and finger rests. Instrument activation involves adaptation, angulation, lateral pressure, and different stroke types for exploration, scaling, and root planing. Proper instrumentation requires following these principles and techniques.

1. MANUAL
INSTRUMENTATION
Presented by
Dr. Janaki K T
MDS Sr. Lecturer

2. PRINCIPLES
1. ACCESSIBILITY [ positioning of patient and operator]
2. VISIBILITY, ILLUMINATION, AND RETRACTION
3. CONDITION OF INSTRUMENTS [ sharpness]
4. MAINTAINING A CLEAN FIELD
5. INSTRUMENT STABILIZATION
6. INSTRUMENT ACTIVATION

3. ACCESSIBILITY [ positioning of patient and operator ]
Proper position of the patient and operator
provide maximum accessibility and thoroughness
of instrumentation
Clinician should be seated on a comfortable
operating stool, so that his or her feet are flat
on the floor with the thighs parallel to the floor
The patient should be in a supine position and
placed so that the mouth is close to the resting
elbow of the clinician

4. For maxillary arch -- the patient should be
asked to raise his or her chin slightly to provide
optimal visibility and accessibility
For mandibular arch -- raise the back of the
chair slightly and allow the patient to lower his
chin until the mandible is parallel to floor
-- this facilitates working on lingual surfaces
of the mandibular anterior teeth

5. VISIBILITY, ILLUMINATION AND RETRACTION
DIRECT VISION : most desirable
INDIRECT VISION : mouth mirror
Retraction provides : accessibility
illumination
Depending on the location of area of
operation,
mirror and the fingers are used for retraction
Mirror : retraction of cheeks and tongue
Index finger : retraction of lips

6. DIRECT VISION
INDIRECT VISION

7. RETRACTION
CHEEK TONGUE LIP WITH FINGER

8. CONDITION OF THE INSTRUMENTS
SHARP -- to work precisely and efficiently
DULL --- incomplete calculus removal
-- unnecessary trauma because of the
excess force usually applied to
compensate for their ineffectiveness

9. MAINTAINING A CLEAN FIELD
The pooling of saliva interferes with visibility
during instrumentation and impedes control
because a firm finger rest cannot be established
on wet, slippery tooth surfaces
Adequate suction is achieved by saliva ejector
and an aspirator
Blood and debris can be removed with suction
and by wiping or blotting with gauze squares

10. INSTRUMENT STABILIZATION
ESSENTIAL FOR :
Effective instrumentation and
Avoidance of injury to the patient or clinician
TWO IMPORTANT FACTORS
Instrument grasp Finger rest

11. INSTRUMENT GRASP
MODIFIED PEN GRASP PALM AND THUMB GRASP

12. MODIFIED PEN GRASP
• Ensures greatest control during instrumentation
• Most effective and stable grasp
STANDARD MODIFIED

13. TRIPOD EFFECT :
The thumb, index finger and middle finger are used to
hold the instrument as a pen is held
The middle finger is positioned so that the side of the
pad next to the fingernail is resting on the shank
The index finger is bent at the second joint from the
finger tip and is positioned well above the middle finger
on the same side of the handle
The pad of the thumb is placed midway between the
middle and index fingers on the opposite side of handle
Enhances tactile sensitivity

14. PALM AND THUMB GRASP
Stabilization of instruments during sharpening
DISADVANTAGES :
Maneuverability and
Tactile sensitivity is inhibited

15. FINGER REST
Good finger rest prevents injury and laceration
of the gingiva
Most preferred is the fourth [ring] finger

16. FINGER RESTS
classified as :
INTRAORAL FINGER REST
EXTRAORAL FULCRUMS

17. INTRA ORAL FINGER RESTS
1. CONVENTIONAL
2. CROSS-ARCH
3. OPPOSITE-ARCH
4. FINGER-ON-FINGER

18. 1. CONVENTIONAL
Finger rest is established on tooth surfaces
immediately adjacent to the working area

19. 2. CROSS-ARCH
Other side of the same arch

20. 3. OPPOSITE-ARCH
Opposite arch [ mandibular arch finger rest for
instrumentation on the maxillary arch]

21. 4. FINGER-ON-FINGER
Index finger or thumb of non-operating hand

22. EXTRAORAL FULCRUMS
Essential for maxillary posterior teeth
TWO
1. PALM-UP 2. PALM-DOWN

23. PALM-UP
Resting the backs of the middle and fourth
fingers on the skin overlying the lateral aspect of
the mandible on the right side of the face

24. PALM-DOWN
Resting the front surfaces of the middle and
fourth fingers on the skin overlying the lateral
aspect of the mandible on the left side of face

25. INDEX FINGER-REINFORCED THUMB -REINFORCED

26. INSTRUMENT ACTIVATION
Adaptation
Angulation
Lateral pressure
Strokes

27. ADAPTATION
The working end of a periodontal instrument is
placed against the surface of a tooth
The tip and side of the probe should flush
against the tooth surface as vertical strokes are
activated within the crevice

28. ANGULATION
It is the angle between the face of the bladed
instrument and the tooth
surface
For subgingival insertion of a curette the
angulation should be as close to 0 degree
For scaling and root planing optimal angulation
is between 45 and 90 degrees
A. CORRECT ANGULATION FOR CURETTE B. CORRECT FOR S/RP

29. The exact blade angulation depends on:
-- the amount and nature of the calculus
-- the procedure being performed
-- the condition of the tissue

30. LATERAL PRESSURE
The pressure created when force is applied
against the tooth surface with the cutting edge
of a bladed instrument
Firm, moderate or light

31. STROKES
three :
EXPLORATORY STROKE
SCALING STROKE
ROOT PLANING STROKE

32. Strokes may be activated by pull or push motion
in a vertical, oblique and horizontal direction
Most frequently used -- vertical and oblique
A. VERTICAL B. OBLIQUE C. HORIZANTAL

33. Direction, length, pressure, number of strokes
necessary for scaling or root planing are
determined by 4 major factors:
-- gingival position and tone
-- pocket depth and shape
-- tooth contour and
-- the amount and nature of the calculus

34. EXPLORATORY STROKE
It is a light, “feeling” stroke
Used with probes and explorers
used to evaluate :
-- the dimensions of the pocket
-- to detect calculus and
-- irregularities of tooth surface

35. SCALING STROKE
It is a short, powerful pull stroke
Used for the removal of -- supragingival and
-- subgingival
calculus

36. ROOT PLANING STROKE
It is moderate to light pull stroke
Used for final smoothening and planing of the
root surface
Curettes are the most effective and versatile
instruments for this procedure