All the instruments used for scaling and root planning in dentistry and principles of instrumentation.

1. PERIODONTAL INSTRUMENTS AND PRINCIPLES OF
INSTRUMENTATION
SUBMITTED BY – PRERNA TAMANG
INTERN
DEPARTMENT OF PERIODONTICS
DR. HARVANSH SINGHJUDGE
INSTITUTE OF DENTAL SCIENCE
AND HOSPITAL.
CHANDIGARH

2. CONTENTS
1. Periodontal instruments
• Periodontal probes
• Explorers
• Scaling and root planning and curettage instruments
• Periodontal endoscope
• Cleansing and polishing instruments
2. Principles of instrumentation

3. PERIODONTAL INSTRUMENTS
Periodontal instruments are designed for specific purposes, such as removing
calculus, planning root surfaces, curetting the gingiva, and removing diseased tissue.
Periodontal instruments are classified according to the purpose they serve as follows-
1. PERIODONTAL PROBES- are used to locate ,measure and mark pockets, as
well as determine their course on individual surfaces.
2. EXPLORERS- are used to locate calculus deposit and caries.
3. SCALING, ROOT PLANNING AND CURETTAGE INSTRUMENTS- are used for
removal of plaque and calcified deposits from the crown and root of tooth,
removal of altered cementum from the subgingival root surface and
debridement of the soft tissue lining the pocket.

4. Scaling and curettage instruments are classified as follows-
• Sickle scalers are heavy instruments used to remove supragingival
calculus.
• Curettes are fine instruments used for subgingival scaling, root planning,
and removal of soft tissues lining the pocket.
• Hoe ,chisel and file scalers are used to remove tenacious subgingival,
calculus, and altered cementum .
• Ultrasonic and sonic instruments are used for scaling and cleansing tooth
surfaces and curetting the soft tissue wall of the periodontal pocket.
4. PERIODONTAL ENDOSCOPE- used to visualize deeply into subgingival
pockets and furcations, allowing the detection of deposits.
5. CLEANSING AND POLISHING INSTRUMENTS – such as rubber cups, brushes,
and dental tape, are used to clean and polish tooth surfaces.

5. PERIODONTAL PROBES
Periodontal probes are used to measure the depth of pockets
and to determine their configuration. The typical probe is a
tapered, with a blunt, rounded tip.
When measuring a pocket, the probe is inserted with a firm ,
gentle pressure to the bottom of the pocket .The shank should
be aligned with the long axis of the tooth surface to be
proved.

6. iEXPLORERS –
Explorers are used to locate subgingival deposits and
carious area and to check the smoothness of the root
surfaces after root planning.
SCALING AND CURETTAGE INSTRUMENTS –
1. Sickle scalers- have a flat surface and two cutting edges that converge in a
sharply pointed tip . The shape of the instrument makes the tip strong so
that it will not break off during use. The sickle scaler is used primarily to
remove supragingival calculus.
2. Curettes- The curette is the instrument of choice for removing deep
subgingival calculus, root planning altered cementum and removing the soft
tissue lining the periodontal pocket.
Curette is finer than the sickle scaler and does not have sharp points.
a)Curette b) Sickle

7. There are 2 types of curettes:
Universal curettes- They 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.

8. Area –specific curettes-
• Gracey curette –is a set of several instruments designed and
angled to adapt the specific anatomic areas of the dentition
i. These curettes and their modifications are probably the best
instruments for subgingival scaling and root planning as they
provide the best adaptation to complex root anatomy.
ii. They differ from universal curette in that -
Blade is not at 90 degree angle to lower shank.
Blade is curved whereas, universal is curved only in one
direction.
iii. Gracey curette are available with either a ‘rigid’ or a
‘finishing’ type of shank.
iv. The ‘rigid’ gracey have a longer, stronger , and less flexible
shank and blade than the standard ‘finishing’ gracey.
Reduced set of gracey curette
New gracey curette

9. • Extended shank curettes- these are modification of standard
gracey curette.
 The terminal shank are is 3mm longer, allowing extensions into
deeper periodontal pockets of 5mm or more.
 ‘After five curettes’ are available in ‘finishing’ or ‘rigid’ design.
 For heavy or tenacious calculus removal, ‘rigid’ after five curette
should be used.
• Mini –bladed curettes- These are also modifications of after five
curettes.
 These blades are half the length of after five curettes.
 Shorter blades allows easy insertion and adaptation in deep,
narrow pockets, furcations, developmental grooves, line angles,
and deep , tight, facial, lingual, or palatal pockets.
 In areas where root morphology or tight tissue presents full
insertion of standard gracey / after five blade and mini 5 curette
can be used with vertical strokes, with reduced tissue distention
and without tissue trauma.
After Five curette
Comparision of After five
curette and mini five curette

10. LANGER AND MINI-LANGER CURETTES-
• These are set of 3 curettes combining the shank design of the
standard gracey #5-6,11-12, and 13-14 curettes with a universal
blade honed at 90 degrees rather than the offset blade of the
gracey curette.
• These instruments can be adapted to both mesial and distal
tooth surfaces without changing instruments. Langer curettes combine Gracey- type
shank with universal curette blades.

11. SCHWARTZ PERIOTRIEVRS
 These are set of 2 double ended , highly magnetized instrument
designed for the retrieval of broken instrument tips from the
periodontal pocket.
 They are indispensable when the clinician has broken a curette tip
in a furcation or deep pocket.
Schwartz Periotrievers tip design.
Broken instrument tip
attached to magnetic tip.

12. PLASTIC AND TITANIUM INSTRUMENTS FOR IMPLANTS-
 Several different companies are manufacturing plastic and titanium
and other implant abutment material.
 It is important that plastic or titanium instruments be used to avoid
scarring and permanent damage to the implants.
Plastic probe Titanium implant curette

13. HOE SCALERS
• Used for scaling of ledges or rings of calculus.
• The blade is bend at 90 degree angle , the cutting edge is formed
by the flattened terminal surfaces with the inner aspect of the
blade.
• The cutting edge is beveled at 45 degree.
• The back of the blade is rounded , and the blade has been
reduced to minimum thickness to permit access to the root.
Hoe scalers designed for different tooth
surfaces showing 2 point contact.

14. FILES
• Files have a series of blades on a base
• Primary function is to fracture or crush large deposits
of tenacious calculus or burnished sheet of calculus.
• It can easily gouge and roughen root surfaces when
used improperly.
• Therefore not suitable for fine scaling and root
planning.
File scaler

15. CHISEL SCALERS-
• Designed for proximal surfaces of teeth too
closely spaced to prevent the use of other
scalers, usually used in anterior tooth or
anterior part of mouth.
• Double –ended instrument with curved shank
at one end and a straight shank at the other.

16. QUETIN FURCATION CURETTES
• These are actually hoes with shallow, half moon radius that fits into
the roof or floor of the furcation.
• Shanks are slightly curved for better access, and the tips are available
in two widths.
• The BL1 (buccolingual) and MD1 (mesiodistal)are small and fine ,with
a 0.9mm blade width.
• The BL2 (buccolingual) and MD2(mesiodistal) are larger and wider
,with a 1.3mm blade width.

17. DIAMOND-COATED FILES
• These are unique instruments used for final finishing of root surfaces.
• These files do not have cutting edges; they are coated with very fine grit
diamond .
• Used to remove small embedded remnants of calculus in the root
surfaces.
• They can produce a smooth, even , clean, highly polished root surfaces.

18. ULTRASONIC AND SONIC INSTRUMENTS-
• Used for removing plaque, scaling, curetting and removing stain.
• These are 2 types- magnetostrictive
piezoelectric
• Alternating electrical current generates oscillations in materials that
causes the scaler tip to vibrate.
• Ranges from 20,000-45,000 cycles per second (hertz)
• In magnetostrictive ,pattern of vibration of the tip is elliptic, all sides
of the tip are active.

19. SONIC UNITS –
• Consists of handpiece that attacks to a compressed air line.
• Vibrations at sonic tip varies 2000-6500 cps.
• Less power for calculus removal than ultrasonic units.
• Ultrasonic and sonic tips are available for scaling , curetting, root
planning.

20. DENTAL ENDOSCOPES
• For use subgingivally in the diagnosis and treatment of periodontal
disease.
• The PERIOSCOPY system consist of 0.99mm diameter , reusable
fiberoptic endoscope over which is fitted a disposable, sterile
sheath.
• The fiberoptic endoscope fits onto periodontal probes and
ultrasonic instruments that have been designed to accept it.
• The sheath delivers water irrigation that flushes the pocket while
the endoscope is being used keeping the field clear.
• Device allows clear visualization deeply into subgingival pockets
and furcation.
• It permits operations to detect the presence and location of
subgingival deposits and guides them in the thorough removal of
these deposits.

21. EVA SYSTEM
• Most efficient and least traumatic instruments for correcting
overhanging / overcontoured proximal alloy and resin restorations.
• It is made of aluminium in the shape of a wedge protruding from a
shaft.
• One side of the wedge is diamond coated and other side is smooth.
• The files can be mounted on a special dental handpiece attachment
that generates reciprocating strokes of variable frequency.

22. CLEANSING AND POLISHING INSTRUMENTS
1. RUBBER CUPS-
• comprises of rubber shell with /without webbed configuration in the
hollow interior.
• Used in handpiece with special prophylaxis angle.
• A good cleansing, polishing paste that contains fluoride should be
used and kept moist to minimize frictional heat .
2. BRISTLE BRUSHES-
• Available in wheel and cup shapes.
• Brush is used in prophylaxis angle with a polishing paste because
bristles are stiff.
• Use of brush should be confined to the crown to avoid injury to
cementum and gingiva.

23. 3. DENTAL TAPE-
• Dental tape with polishing paste is used for polishing surfaces that
are inaccessible to other polishing instruments.
• The tape is passed interproximally while being kept at right angle to
long axis of the tooth and is activated with a firm labiolingual
motion.
• The area should be cleaned with warm water to remove all
remnants of paste.

24. 4. AIR- POWDER POLISHING-
• Specialized handpiece used for delivering an air powered slurry of
warm water and sodium bicarbonate for polishing.
• This device, called as PROPHY-JET, is very effective for the removal of
extrinsic stains and soft deposits.
• The slurry removes stains rapidly and efficiently by mechanical
abrasion and provides warm water for rinsing.
• This device is not safe for patients with medical history of respiratory
illness, hemodialysis.
• Powders containing NaHCO3 should not be used on patient with history
of hypertension , sodium restricted diets ,or medications effecting the
electrolyte balance.
Cavitron Prophyjet air-powder
polishing device

25. Principles of Instrumentation
Effective instrumentation is governed by number of general principles that are
common to all periodontal instruments and proper position of the patient and
operation.
1. ACCESSIBILITY POSITIONING –
It facilitates thoroughness of instrumentation .
Positioning patients
• Supine position is placed so that mouth is close to resting elbow of
clinician.
• For maxillary – ask the patient to raise the chin up
• For mandibular- ask the patient to lower the chin ,so that mandible is
parallel to floor .
Clinicians position
• Clinicians feet should be flat on floor
• Thighs are parallel to floor
• Back should be straight and head erect.

26. 2. VISIBILITY, ILLUMINATION AND RETRACTION
Direct vision with direct illumination from the dental light
is most desirable
• If not possible then indirect vision may be obtained by
using mouth mirror and indirect vision obtained by using
mirror to reflect light wherever it is needed.
• Retraction provides visibilty, accessibility and
illumination.
• Mirror may be used for retraction of cheeks and lips.

27. 3.CONDITION AND SHARPNESS OF INSTRUMENTS
Instruments should be clean, sterile and in good condition.
Sharp instruments-
Enhance tactile sensitivity and allow clinicians to work more precisely
and efficiently.
Dull instruments –
Lead to incomplete calculus removal ,accessory trauma because of
excess force usually applied to compensate for its effectivenes.

28. 4. MAINTAINING A CLEAN FIELD-
 Adequate suction is essential
 Blood and debris can be removed with suction and by wiping or blotting with
gauze squares.
5. INSTRUMENT STABILIZATION-
a) Instrument grasp –
Standard Pen Grasp:- Side of middle finger should rest on shank.
Modified Pen Grasp:- thumb,index finger and middle finger are used to hold
instrument ,but pad of middle finger rests on shank.
Palm and Thumb Grasp:- useful for stabilization of instruments during sharpening
and manipulating air and water syringes .

29. Conventional – finger rest is established on tooth surfaces.
Opposite arch- finger rest established on tooth surfaces on opposite arch.
Cross arch – finger rest established on tooth surface on the other side of
same arch.
Finger on finger- established on index finger or thumb of non – operating
hand.
B) Finger Rest – serves to stabilize the hand and instruments . By providing a firm fulcrum
or movements are made to activate the instruments .

30. 6. INSTRUMENT ACTIVATION-
a) ADAPTATION – refers to manner in which working end of periodontal
instrument is placed against the tooth surface .
Precise adaptation- it is maintained by carefully rolling the handle of
instrument against the index of middle finger with thumb . This rotates the
instrument in slight degree as on tip leads into concavities and around
convexities.
b) ANGULATION-
A- 0 degree correct angulation for blade insertion
B- 45-90 degree correct angulation for scaling and root planning
C- less than 45 degrees inaccurate angulation for scaling and root planning
D- more than 90 degrees incorrect angulation for scaling and root planning
,correct angulation for gingival curettage.

31. C) LATERAL PRESSURE– pressure created when force is applied against the surface
of tooth with cutting edge of bladed instrument.
 Amount of pressure depends on nature of calculus, whether stroke is for
initial scaling to remove calculus or for root planning to smoothen the root
surface.
D) STROKES-
Exploratory stroke- “light pulling stroke” , used to evaluate dimensions of pocket
and to detect calculus
Scaling stroke- “ short, powerful stroke” ,used with bladed instrument for the
removal of both supragingival and subgingival calculus.
Root planning stroke- “ moderate light pull stroke” , used for final smoothening
and planning of root surfaces.

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