Instrumentation in periodontology involves using specific tools to assess and treat periodontal conditions. Key principles include precision, gentle application, adapting to tooth contours, and maintaining a sterile environment to ensure effective and safe procedures for diagnosing and treating periodontal diseases. 1. Precision and Thoroughness: 2. Scaling and Root Planing: 3. Ergonomics: 4. Adaptation of Instruments: 5. Patient Comfort: 6. Subgingival Access: 7. Regular Maintenance: 8. Individualized Approach: 9. Communication and Education: 10. Periodic Assessment:

1. PRINCIPLES OF
INSTRUMENTATION

2. 3
GENERAL PRINCIPLES OF
INSTRUMENTATION
Effective instrumentation is governed by general
principles:-
I. ACCESSIBILITY
II. VISIBILITY, ILLUMINATION AND RETRACTION
III. CONDITION OF INSTRUMENTS
IV. MAINTAINING A CLEAN FIELD
V. INSTRUMENT STABILIZATION
VI. INSTRUMENT ACTIVATION

3. 4
I.ACCESSIBILITY (Positioning of
Patient and Operator)
■ Accessibility facilitates thoroughness of
instrumentation.
■ Position of the patient and operator
should provide maximal accessibility to
the area of operation.
■ Inadequate accessibility
-Impedes thorough instrumentation
-Prematurely tires the operator
-Diminishes his or her effectiveness.

4. 5

5. 6

6. 7

7. 8

8. 9

9. 10
Points to remember…
1. 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.
2. The clinician should be able to observe the
field of operation while keeping the back
straight and the head erect.

10. 11
3. Patient should be in a supine position and placed
so that the mouth is close to the resting elbow
of the clinician.
4. For instrumentation of the maxillary arch, the
patient should be asked to raise his or her chin
slightly to provide optimal visibility and
accessibility.
5. For instrumentation on the mandibular arch, the
patient is made to lower his or her chin until the
mandible is parallel to the floor.

11. 12
II.VISIBILITY, ILLUMINATION;
AND RETRACTION
■ Whenever possible, direct vision
with direct illumination from the
dental light is most desirable
■ If this is not possible, indirect
vision may be obtained by using
the mouth mirror

12. 13
DIRECT VISION
■ Indirect illumination
may be obtained by
using the mirror to
reflect light to where
it is needed indirect
vision and indirect
illumination are often
used simultaneously
DIRECT VISION
INDIRECT VISION

13. 14
■ Retraction provides visibility,
accessibility, and illumination.
■ Depending on the location of
the area of operation, the
fingers and/or the mirror are
used for retraction. The mirror
may be used for retraction of
the cheeks

14. 15
The following methods are effective
for retraction
1. Use of the mirror to deflect the cheek while the
fingers of the non-operating hand retract the lips
and protect the angle of the mouth from
irritation by the mirror handle
2. Use of the mirror alone to retract the lips and
cheek
3. Use of the fingers of the non-operating hand to
retract the lips
4. Use of the mirror to retract the tongue

15. 16
III.CONDITION OF
INSTRUMENTS (SHARPNESS)
■ All instruments should be inspected to make sure
that they are clean, sterile, and in good condition.
■ The working ends of pointed or bladed
instruments must be sharp to be effective.
■ This is important for…
i. Tactile sensitivity
ii. Efficiency

16. 17
IV.MAINTAINING A CLEAN FIELD
■ Good visibility, illumination, and retraction,
instrumentation can be hampered if the
operative field is obscured by saliva, blood, and
debris.
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.

17. 18
Blood and debris can be removed from the
operative field…
■ With suction and by wiping or blotting with
gauze squares.
■ Field should also be flushed occasionally with
water.
■ Compressed air and gauze squares can be used
to facilitate visual inspection of tooth surfaces
just below the gingival margin during
instrumentation.
■ A jet of air directed into the pocket deflects a
retractable gingival margin.

18. 19
V.INSTRUMENT STABILIZATION
■ Stability of the instrument and the hand is the
primary requisite for controlled instrumentation.
■ Stability and control are essential for effective
instrumentation and avoidance of injury to the
patient or clinician.

19. 20
■ The two factors of major importance in
providing stability are
I. The instrument grasp and
II. The finger rest.

20. 21
Instrument Grasp
■ A proper grasp is essential for precise control of
movements made during periodontal
instrumentation.
■ The most effective and stable grasp for all
periodontal instruments is the Modified pen
grasp.

21. 22
What is the Modified pen grasp?
■ The thumb, index finger, and middle
finger are used to hold the instrument
as a pen is held, but tbe middle finger is
positioned so that the side of tbe pad
next to the fingernail is resting on tbe
instrument 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 the
handle.

22. 23
■ This creates a triangle of forces, or tripod effect,
that enhances control ….
I. Enhances control because it enables the clinician
to roll the instrument in precise degrees with the
thumb against the index and middle fingers
II. Adapts the blade to the slightest changes in
tooth contour.
III. Enhances tactile sensitivity

23. 24
■ The palm and thumb grasp is
useful for stabilizing instruments
during sharpening and for
manipulating air and water
syringes.
■ Maneuverability and tactile
sensitivity are so inhibited by this
grasp that it is unsuitable for the
precise, controlled movements
necessary during periodontal
procedures.

24. 25
Finger Rest
The finger rest serves to
I. Stabilize the hand and the instrument by
providing a firm fulcrum as movements are
made to activate the instrument.
II. Prevents injury and laceration of the gingiva and
surrounding tissues by poorly controlled
instruments.
The fourth (ring) finger is preferred by most
clinicians for the finger rest.

25. 26
Finger rests may be generally classified as
■ Intraoral finger rests or
■ Extra oral fulcrums.

26. 27
Different variations of the intraoral finger
rests..
1. Conventional: The finger rest
is established on tooth
surfaces immediately
adjacent to the working area
2. Cross-arch: The finger rest is
established on tooth surfaces
on the other side of the same
arch

27. 28
1. Opposite-arch: The finger rest
is established on tooth
surfaces on the opposite arch
(e.g., mandibular arch finger
rest for instrumentation on
the maxillary arch)
2. Finger-on-finger: The finger
rest is established on the
index finger or thumb of the
nonoperating hand

28. 29
Extraoral fulcrums
■ Are essential for effective instrumentation of
some aspects of the maxillary posterior teeth.
■ When properly established, they allow optimal
access and angulation while providing adequate
stabilization.

29. 30
The two most commonly used extra oral
fulcrums are as follows:
1. Palm-up: The palm-up fulcrum is
established by 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
2. Palm-down: The palm-down
fulcrum is established by 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
the face.

30. 31
Reinforcement…
■ Intraoral finger rests and extra
oral fulcrums may be reinforced
by applying the index finger or
thumb of the nonoperating hand
to the handle or shank of the
instrument for added control and
pressure against the tooth.
■ The reinforcing finger is usually
employed for opposite-arch or
extraoral fulcrums.

31. 32
VI. INSTRUMENT ACTIVATION
Adaptation
■ Adaptation refers to the manner in which the working
end of a periodontal instrument is placed against the
surface of a tooth.
■ The objective of adaptation is to make the working end
of the instrument conform to the contour of the tooth
surface.
■ Precise adaptation must be maintained with all
instruments to avoid trauma to the soft tissues and root
surfaces and to ensure maximum effectiveness of
instrumentation.

32. 33
Adaptation is obtained by:-
■ Carefully rolling the handle of the instrument
against the index and middle fingers with the
thumb.
■ This rotates the instrument in slight degrees so
that the toe or tip leads into concavities and
around convexities.
■ On convex surfaces such as line angles, it is not
possible to adapt more than 1 or 2 mm of the
working end against the tooth.

33. 34
■ If only the middle third of the working end is
adapted-on a convex surface so that the blade contacts
the tooth at a tangent, the toe or sharp tip will jut out
into soft tissue, causing trauma and discomfort
■ If the instrument is adapted so that only the toe or tip
is in contact, the soft tissue can be distended or
compressed by the back of the working end, also
causing trauma discomfort.

34. 35

35. 36
Angulation.
■ Refers to the angle between the face of a bladed
instrument and the tooth surface tooth-blade
relationship.
■ Correct angulation is essential for effective
calculus removal.

36. 37

37. 38
Different Angulations….
■ For subgingival insertion of a bladed
instrument such as a curette, angulation
should be as close to 0 degree as possible
■ For scaling and root planing, optimal
angulation is between 45 and 90 degrees
■ For heavy, tenacious calculus, angulation
should be just less than 90 degrees so
that the cutting edge "bites" into the
calculus.
■ For root planing strokes angulation of just
less than 90 degrees may be maintained.
■ For gingival curettage angulation greater
than 90 degrees is deliberately
established.

38. 39

39. 40

40. 41
Lateral Pressure
■ Lateral pressure refers to the pressure created
when force is applied against the surface of a
tooth with the cutting edge of a bladed
instrument.
■ The exact amount of pressure applied must be
varied according to the nature of the calculus
and according to whether the stroke is intended
for initial scaling to remove calculus or for root
planing to smooth the root surface.
■ Lateral pressure may be firm, moderate, or light.

41. 42
Strokes Three basic types of strokes are used
during instrumentation….
1. The Exploratory stroke
2. The Scaling stroke
3. The Root Planing stroke.
Pull or a push motion in a vertical , oblique,
or horizontal direction.

42. 43

43. 44
■ The Exploratory stroke is a light, "feeling" stroke
that is used with probes and explorers to
evaluate the dimensions of the pocket and to
detect calculus and irregularities of the tooth
surface.
■ The Scaling stroke is a short, powerful pull
stroke that is used with bladed instruments for
the removal of both supra gingival and
subgingival calculus.

44. 45
■ The Push scaling motion has been advocated by
some clinicians. In the push stroke, the
instrument engages the lateral or coronal border
of the calculus, and the fingers provide a thrust
motion that dislodges the deposit.
■ Root planing stroke is a moderate to light pull
stroke that is used for final smoothing and
planing of the root surface.

45. 46