The document summarizes the history and classification of periodontal instruments. It describes how instruments have evolved from ancient times to become more specialized. Periodontal instruments are classified based on their purpose and include diagnostic, scaling and root planing, surgical, and polishing instruments. The document provides detailed descriptions and examples of various types of periodontal probes, scalers, curettes, surgical knives and chisels, and other instruments used in examining, treating, and surgically managing periodontal disease.

1. Seminar on Periodontal
Instruments
Presenter:
Dr. Nilima Sharma

2. INTRODUCTION
Since ancient times when dental therapists recognized the impor-
tance of removal of calculus and materia alba (dental plaque) as
a treatment for gum disease, instruments were specifically
designed to affect the procedure. Tooth scalers and "scalper
medicinalis" were used by the Romans since the time of Celsus,
who suggested that stains on teeth be scraped away. An elaborate
set of 14 double ended instruments was used by Albucasis (936-
1013 AD.), a Moorish physician. These instruments were
primarily hooks or straight and slightly curved gravers (chisel-like
scrapers). As with all instruments, they had three distinct
sections: handle, shank, and sharpened blade.

3. Classification according to the purpose
they serve
 Diagnostic instruments
 Mouth mirror
 Periodontal probes are used to locate, measure, and mark pockets, as well as determine
their course on individual tooth surfaces.
 Explorers are used to locate calculus deposits and caries.
 The periodontal endoscope is used to visualize deep subgingivally in pockets and
furcations enabling the detection of deposits.
 Scaling, root planing, and curettage instruments
 supragingival scalers :Sickle scalers , jacquette scalers, morse scalers, cumine scaler
 subgingival scalers: Hoe, chisel, and file scalers
 Curettes – universal , gracey, eyelet
 Ultrasonic and sonic instruments
 Cleansing and polishing instruments such as rubber cups, brushes, and dental tape
are used to clean and polish tooth surfaces. Also available are air-powder abrasive
systems for tooth polishing.

4. Periodontal surgical instruments are classified as follows
 Excisional and incisional instruments
 Surgical curettes and sickles
 Periosteal elevators
 Surgical chisels
 Surgical files
 Scissors

12. UNC-15 Probe

13. Explorers from L- R shepherds hook, 3A, ODU 11/12,
17.

14.  DENTAL PERIOSCOPY
Fiberoptic imaging of the periodontal pocket, called dental perioscopy,
allows subgingival visualization for diagnosis as well as treatment
(DentalView Perioscopy). Using dental perioscopy, the clinician
magnifies, visualizes, and accesses deep subgingival calculus, root
fractures, and the periodontal pocket's internal wall.
Magnification is from 24x to as high as 46x, depending on the
distance between the object and the lens. Under endoscopic
magnification, ledges of black calculus are actually white, porous,
and crystalline in appearance, and sheets of subgingival calculus
may occur in colors from golden brown to black.

15.  The system is composed of a disposable sterile sheath that
houses a fiberoptic endoscope, provides continuous irrigation,
attaches to modified periodontal assessment and treatment
instruments, and has a metal soft tissue shield that keeps the soft
tissue away from the tube. The actual size of the hand-held
sheath and instrument with proper hand grasp. There is a flat-
panel LCD color display, and a small footprint transport system.
A composite video-out source connection allows users to
employ a digital system to record and later view endoscopic
images if desired.

16. SICKLE SCALERS

18. FILES, HOES, CHISEL

20. Curettes

21.  Examples of paired universal curets include: the Columbia
2R/2L, Columbia 13/14, Rule 3/4, Barnhart 1/2, Barnhart 5/6,
Younger-Good 7/8, Indiana University 13/14, HU 1/2, Bunting
5/6, Mallery 1/2, Langer 1/2, Langer 3/4, and Langer
 5/6. The Langer curets combine partial design elements of
universal and area-specific curets. The working end of a
Langer curet has the design characteristics of a universal
curet. The shank design of a Langer curet is similar to that
of an area-specific curet with a long, complex functional
shank.

28.  Historically, following scaling and root planing, the
teeth have been smoothed using an abrasive agent and
some type of polishing device. This procedure, known
as poolishing, was performed on a routine basis for all
patients at each recall appointment. In the past,
polishing was believed to have both cosmetic and
therapeutic value. We now know that very little
therapeutic value is associated with polishing.
 In addition, researchers have suggested that fluoride
uptake during a topical fluoride application is not
influenced by the presence of plaque or pellicle and
polishing is ,(lot necessary before a professional
fluoride application.


29.  In the early 1980s, the concept of selective polishing was
introduced in the dental hygiene literature. According to
this concept, polishing is performed only in areas where
the patient's own oral hygiene procedures are
ineffective.
 Polishing has been used to prepare teeth for pit and
fissure sealant application and to motivate_patients to
maintain their plaque control on a daily basis. In
addition, amalgam and composite restorations are
polished following placement to increase their life
within the oral cavity.

30. Polishing

31. SURGICAL INSTRUMENTS:
 Excisional and incisional instruments
 Knives are basic instruments and can be obtained with both
fixed and replaceable blades

34.  (Gingivectomy knives)
 Design: These are kidney or bean shaped knives, they have broad
flat blades, which are nearly perpendicular to the lower shank of
the instrument. There curved cutting edge extends around entire
outer edge of the blade which is formed by junction of the outer
and inner surfaces of the blade. The sharp cutting edge extends
upto few millimeters from the shaft to the entire outer edge. These
knives are designed to cut both ways, forward and backward
stroke. These knives can be obtained as either double or single
ended.
 Examples: Kirkland No. 15, 16, Gold man fox No.: 7, Buck No.3,
4.
 In Kirkland, the blade tapers to a point at one end unlike in
Goldman fox knives the blade is rounded. This design is for
entry into interproximal area.

37.  The ORBAN No. 1-2 are spear shaped blades attached to the
handle by al offset shank to provide accessibility to the
interproximal areas. The blade has two cutting edges formed by
the junction of the rounded outer and the flat inner surface that
tapers to a sharp point.
 The Orban knife #1.2 and the Merrifield knife #1, 2, 3, and 4
 examples of knives used for interdental areas, The BUCK knives
are spear shaped and the MONAHAN-LEWIS knives have
detachable blades.

39.  Surgical Curettes and Sickles
 Larger and heavier curettes and sickles are often needed during
surgery for the removal of granulation tissue, fibrous interdental
tissues, and tenacious subgingival deposits. The Kramer curettes
#1, 2, and 3 and the Kirkland surgical instruments are heavy
curettes, . whereas the Ball scaler #B2-B3 is a popular heavy
sickle. The wider, heavier blades of these instrumtnts make them
suitable for surgical procedures.

40.  Surgical Chisels and Hoes
Chisels and hoes are used during periodontal surgery for removing
and reshaping bone. The hoe has a curved shank and blade, this
no. 19 G instrument has a fish tail shaped with blade with a
pronounced convexity in its terminal portion. The cutting edges
is beveled with a rounded edges and projects beyond the long
axis of the handle to preserve the effectiveness of the
instrument when the blade is reduced by sharpening.

41.  Generally used for detaching pocket walls after the gingivectomy
incision, but it is also useful for smoothing root surfaces made
accessible by any surgical procedure.
 The Wiedelstadt and Todd-Gilmore chisels are straight shanked.
 The Ochsenbein #1-2 is a useful chisel with a semicircular
indentation on both sides of the shank that allows the
instrument to engage around the tooth and into the interdental
area. Surgical hoes are usually used with a pull stroke, whereas
chisels are used with a push stroke.

44.  Surgical Scissors and Nippers:
Scissors and nippers are used in periodontal surgery for such purposes as
removing tabs of tissue during gingivectomy, trimming the margins of flaps,
enlarging incisions in periodontal abscesses, and removing muscle attach-
ments in mucogingival surgery.
Eg. the Goldman-Fox #16 scissors with a curved beveled blade with serrations
and the nippers.
 Characteristics:
 1. Long handles with thumb and finger rings.
 2. Short cutting edge with straight or curved blades. Blade may be serrated or
nonserrated.
 Types: Scissors are of various types according to the size and shape,
 1. Goldman Fox No. 16: It has a curved blade, with serrations. It is mainly
used in Gingivectomy or periodontal surgical procedures.
 Iris scissors - These are straight bladed fine small and delicate scissor used for
fine works,

45.  Metzenbaum scissors: These are blunt nosed scissors used for
undermining soft tissues as well as for cutting tissues. These scissors are
not used for cutting sutures as edges will dull and make less effective for
cutting tissues.
 4. Straight stille and Mayo 6 inch instruments: These scissors are with two
blunt tips and serve well for dissection as well as cutting sutures or
trimming wound margins.
 5. Nippers: Serve same purpose as Scissors. They are also used for
contouring the architectural form and for forming interdental sluiceways.
 Most commonly used scissors are Dean Scissors these have slightly curved
handle and serrated blades.
 Ophthalmic Scissors: used in periodontal surgery, because of their size
they can be engaged in almost any area.

48. Micro surgical tissue pliers and forceps
 Micro surgiery may be defined as a refinement in operative
technique by which visual acuity is improved through
magnification..
 In addition to use of magnification &reliance on atraumatic
technique microsurgery entails the use of specially constructed
microsurgical instruments to minimize trauma..
 To permit primary woumd closure, microsutures in the rangr of
6-0 to9-0 are required to approximate the wound edge.

56. Conclusion
The advancing abilities of instrument makers, coupled with
the ingenuity of dental practitioners, have provided the
present practitioner with a multitude of instrument designs
capable of reaching nearly every portion of the dentition.
In the past, complete sets of instruments frequently
included so many variations of angulation and were so
numerous as to preclude their general use.
However, some of the more efficient instruments from these
sets have withstood the test of long-term use and now
appear and reappear in newly created instrument sets.

57. References
 Fundamentals of periodontal instrumentation: Neild/Gehrig 3rd edition
 Fundamentals of periodontal instrumentation: Neild/Gehrig 4th edition
 Contemporary periodontal instrumentation Schoen/Dean
 DentalHygiene theory &Practice:Darby 2nd edition
 Clinical periodontology Glickman 4th edition
 Carranza’s Clinical Perioidontology : Newman/ Takei/ Newman 9th
edition
 Periodontics: Medicine Surgery &Implants: Rose /Mealey /Genco/Cohen
 Root Scaling &Planing:a fundamental therapy:Bernard Waserman
 Local flap in Facial Reconstruction :Swanson/Shah
 Contemporary oral and maxillofacial surgery; Peterson/Hupp
 HU-friedy instrument catalogue