Drds311: operative (restorative) dentistry 1

MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
INSTRUMENTS ® For optimal antiratational design, the blade edge must not
® Tool or device or implement used for specific purpose or be off axis by more than 1 to 2mm
type of work ® All dental instruments and equipment need to satisfy the
® In order to perform, the dentist must have a complete principle of balance
knowledge of the purpose and applications of many
instruments required

GENERAL OPERATIVE PROCEDURES

A. INSTRUMENTS AND EQUIPMENT FOR TOOTH PREPARATION
® Greene Valdimar Black
§ First to establish a system of nomenclature and
classification of hand instrument

® Dr. Charles E. Woodbury ® Instrument design – 3 parts:

§ First to modify black’s instrumentation A. à small diameter 5.5mm, light, 8-sided
§ Woodbury hand Instruments are used specifically in HANDLE (hexagonal or octagonal), & knurled – if you hold
endo for smoothening of the lines and walls the instrument, you will have full control of it
B. SHANK à connects the handles to the working ends;
® Dr. Wedelstadt normally smooth, round, & tapered can be 1 or
§ Developed wedelstaedt chisel now referred to as more bands
“curved chisel” • The more far from the anterior, the more it
§ Chisel are specifically used for smoothening enamel is curved
C. ® Working surface; should meet the principle
® Dr. Waldon Ferrier BLADE/NIB of “balance”
§ Developed a new set of instruments called “Ferrier set” ® blade must be parallel to the long axis of
which were more refined and had uniform thickness on the handle
their cutting edge
• Cutting instrument – blade
® Dr. George Hollenback • Non-cutting instrument – nib
§ Invented pneumatic condenser (plugs the amalgam in
place) NOMENCLATURE
§ Hollenback instrument is used to curve the proximal ® In establishing a nomenclature for hand instrument, Dr.
surfaces of amalgam on mesial or distal surface. Used G.V. Black prescribed four classes similar to biological
to mold the proximal surfaces in place classification:
1. Order – purpose of the instrument
HAND INSTRUMENTS 2. Suborder- position or manner of use
® Mainly carbon steel and stainless steel 3. Class – form of working end
® Some with carbide inserts to provide more durable cutting 4. Sub class – shape of the shank
edges
® Other alloys i.e. nickel, cobalt, or chromium Example: bin- angle hatchet push excavator
Bin-angle à sub class
Hatchet à class
Push à suborder
Excavator à order

INSTRUMENT FORMULA GIVEN BY G.V, BLACK

® 3 unit instrument formula:
o Cutting edge of the instrument is at a right angle to the
blade
FIRST à width of the blade in tenths of a millimeter
UNIT
SECOND à length of the blade in millimeter
UNIT
THIRD ® Angle the blade forms with the axis of the
UNIT handle in centigrade
® Angle should always be less than 50

® 4 unit instrument formula

o Cutting edge of the instrument is at an angle other than
a right angle to the blade.
BALANCE
FIRST à width of the blade in tenths of a millimeter
® Accomplished by designing the angles of the shank so that
UNIT
the cutting edge of the blade lies within the projected
SECOND ® Angle of the cutting edge forms with the axis
diameter of the handle and nearly coincides with the
UNIT of the handle in centigrade
projected axis of the handle

C.C. SANTOS [DMD 3-Y2-3] 1

Drds311: operative (restorative) dentistry 1
MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
THIRD à length of the blade in millimeter
UNIT
FOURTH ® Angle the blade forms with the axis of the
UNIT handle in centigrade

Example: gingival marginal trimmer and angle former

A. Non-cutting (working end: NIB)

a. Mirrors
b. Explorers
c. Probes
d. Condensers

B. Cutting instruments (working end: BLADE)

a. Scalers - remove calculator deposits
b. Excavators - remove carious lesion and smoothen
walls, spoon excavator, black spoon
c. Chisels - smoothening of enamel margins, enamel
hatchet, bin-angle chisel, gingival margin trimmer
d. Other - discoid-cleiod (curving occlusal outline, cuts
extra restorative material), hollenback carver (cuts
proximal surfaces for amalgam)

® Scalers à calculus
® Excavators à dentin
® Chisels à enamel
® Other à restoration

® Instruments for removal of caries and refinements of

internal parts of cavity preparation = excavators (there
is a specific excavator for removal of caries and there is
a specific excavator for smoothening of internal walls of
the cavity preparation)
1. Ordinary hatchet excavator - cutting edge on the same
plane of the long axis // smoothen the internal line angles
of restoration // creates retentive areas
• Second number should always be more than 50 degrees

C.C. SANTOS [DMD 3-Y2-3] 2

Drds311: operative (restorative) dentistry 1
MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
along the gingival margin); combination because the
enamel is also smoothen by the chisel

2. Hoe excavator
® cutting edge perpendicular to the long axis of the ® sharpening line angles and creating retentive features n
instrument dentin in preparation for gold restoration
® for planning tooth preparation walls and forming line
angles. Commonly used for Class III and IV cavity 4. Spoon excavator
preparation for direct gold restorations ® for removing caries and carving amalgam and direct
wax patterns
® Blades are slightly curved and cutting edges are claw
like (cleoid) or circular (discoid)
® Shanks may be bi-angled or tri-angled

® blade has a greater angle from the long axis of the

handle

® BASIC INSTRUMENTS (must be chronologically arranged)

1. 2 mouth mirrors (their faces are not aligned with each
other, first one is facing the patient, and second one is
facing the clinician)
2. Cotton plier (V shape must be facing the patient)
3. Angle former excavator 3. Explorer
® for sharpening line angles and creating retentive 4. Periodontal probe (handle must be facing the patient)
features in dentin. Also for beveling enamel margins 5. Spoon excavator (handle must be facing the patient)
® mono-angled – primary cutting blade is at an angle
(other than 90 degrees)
® combination of a chisel (used along the cavosurface
margin on the gingival portion of class II) and gingival
margin trimmer (used to smoothen the angles created

C.C. SANTOS [DMD 3-Y2-3] 3

Drds311: operative (restorative) dentistry 1
MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
® Chisels - mainly for cutting enamel ROTARY CUTTING INSTRUMENTS
o classified as: ® A group of instruments operated with a power source and
1. straight (anterior teeth); slightly curved; bi-angle used for cutting, finishing, and polishing tooth structure
(distal surface of canine and premolars); tri-angle
(posterior teeth) LOW SPEED HANDPIECE
2. enamel hatchets ® The low-speed range is used for cleaning teeth, occasional
3. gingival margin trimmers (for junction of cut and caries excavation, and finishing and polishing procedures
uncut portion of tooth along the proximal surfaces of ® At low speeds, tactile sensation is better and there is
class II) generally less chance for overheating cut surfaces

HIGH SPEED HANDPIECE

(ADVANTAGES)
1. Diamond and carbide cutting instruments remove tooth
structure faster with less pressure, vibration, and heat
generation
2. The number of rotary cutting instruments needed is reduced
because smaller sizes are more universal in application
3. The operator has better control and greater ease of operation
4. Instruments last longer
5. Patients are generally less apprehensive because annoying
vibrations and operating time are decreased
6. Several teeth in the same arch can and should be treated at
the same appointment
o chisels – primarily used to cut the enamel
® Speed ranges – measured by rpm (revolutions per minute)
o primary cutting edge are right angle with the long axis of
the handle ® Low or slow speeds (below 12,000 rpm)
o slightly angled chisel – wedelstaedt chisel – used along ® Medium or intermediate speeds (12,000 to 200,000 rpm)
the proximal surfaces of the teeth so that it can extend ® High or ultrahigh speeds (above 200,000 rpm)
towards the posterior teeth
o black based the name on the intended use, example: BURS
gingival margin trimmer ® Carbide steel (cutting) typo or diamond encrusted (abrasion)
patient
2. Mono-angle chisel ® Bur should be at least 1mm (biggest) because if bigger, it will
® blade is shorter as compared to straight chisel cause damage to the tissues
® single angle in the shank to enhance the convenience form
® used with push stroke or lateral scraping action ® Straight handpiece - needs bur bloc, highspeed
® Latch angle handpiece - need to turn to adapt to the end of
® Hoe the handpiece, low sped
§ difference between mono-angle chisel and hoe: ® Friction grip angle handpiece - high speed
o if the angle of the blade is less than 12.5 centigrade, it
is mono angle chisel and if it is more than 12.5 ® 4 basic bur head
centigrade, it is a hoe 1. Round bur - single digit number, ¼, ½, 1 (biggest for
o used with pull stoke resto), 2, 3, 4 (for endo, for creating axis preparation)
o use: to define line and point angles; class III and V 2. inverted cone bur - 30 series
preparations for direct filling gold restorations 3. pear shaped bur - No specific number, for latest
manufactured burs has.
3. Bi-angle chisel 4. Short straight fissure bur - 50 series
® two angles in the shank 5. Long straight fissure bur - 500 series
® used to cleave or split undermine enamel 6. Short tapering fissure bur - 70 series
® reversed bevel instrument 7. Long tapering fissure bur - 700 series

4. Triple angle chisel – used to flatten the pulpal floor

OTHER INSTRUMENTS
1. Knives
® Finishing knives, amalgam knives, or gold knives
® Used for trimming excess restorative material on the
gingival, facial, or lingual margins of a proximal
restoration or trimming and contouring the surface of
CLASS V restorations

2. Files
® Used for smoothening of overhanging restorations (amalgam
and gold)

C.C. SANTOS [DMD 3-Y2-3] 4

Drds311: operative (restorative) dentistry 1
MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
® Hazards with cutting instruments: ® Classification:
● Pulpal precautions 1. Pen grasp (no full control of the hand instrument)
● Soft tissue precautions 2. Modified pen grasp (has full control)
● Eye precautions 3. Palm and thumb grasp (usually used if working on the lingual
● Ear precautions surfaces of the maxillary; sometimes causes slippery of
● Inhalation precautions instrument)
4. Modified palm and thumb grasp
® Sterilization of instruments - to prevent 5. Inverted pen grasp
cross-contamination i.e. hepatitis infection
1. Autoclaving
2. Dry heat
3. Chemical vapor
4. Cold disinfection
5. Boiling

® HAZARDS ASSOCIATED WITH CUTTING

INSTRUMENTS
1. Pulpal hazard
o due mechanical vibration, transection of dentinal
tubules, heat generation, desiccation & loss of dentinal
fluid
o inefficient cutting, dull or plugged with debris; lack of
coolant unnecessary cutting of tooth tissue, removal of
the smear layer
o slight to moderate insult results protective pulpal
reaction; severe damage à irreversible pulpal damage
(i.e. pulp necrosis)

2. Soft tissue hazard

o injury to lips, tongue, cheeks, adjacent teeth
o extreme caution good instrument grip and control;
good access and vision; retraction and/or isolation;
good parient rapport to prevent sudden movements

® Reversible pulpitis - pain stops

® Irreversible pulpitis - pain continues even after excavation

3. eye hazard
o For the patient, clinician, and auxillary; esp. during
rotary instrumentation
o Eye protection from airborne particles i.e. tooth debris,
amalgam and composite resin particles, contaminated
aerosol, pieces of abrasive/polishing instruments; high
intensity light from light curing units; laser units; etc.
o High volume suction/evacuator

4. ear hazard
o Intensity/loudness (dB); frequency (cps); duration;
individual susceptibility (auditory threshold à shift)
o Loud, irritating noise i.e. turbine whine (70-90 dB at
high frequency) can cause mental and physical stress;
reduces ability to concentrate, increase accident risk à
reduces overall efficiency; constant noise (>75dB at
1000-9000 cps) can cause permanent hearing damage
o Earplug/earmuffs; sound-proofing; electronic anti-
noise devices that cancel out unwanted noise

5. inhalation
o Aerosols and vapors i.e. Hg, resins, microorganisms,
tooth debris, etc.
o Good isolation technique; high volume evacuator;
disposal face mask/shield

C.C. SANTOS [DMD 3-Y2-3] 5

Drds311: operative (restorative) dentistry 1
MIDTERMS: LECTURE 2: INSTRUMENTS FOR TOOTH PREPARATION

LECTURE BY: DR. CYNTHIA C. DACAYO

3RD YEAR: 2ND SEMESTER – S.Y. 2022-2023
® GENERAL OPERATIVE PROCEDURES:
Patient and operator positions
1. Ensure that the patient is relaxed – less stress and tension,
better cooperation (correct position of physician with the patient;
feet must flat on the floor)
2. Less physical strain and fatigue for the clinician - reduced
possibility of musculoskeletal problems
3. Efficient exchange of instruments between
the clinician and assistant

® Chair position
1. Upright position - this is the initial position of
chair from which further adjustments are made
2. Almost supine position - in this, chair position is such that
head, knees, and feet are approx. at same level
3. Reclined position

® Operating positions
● Once the patient has been comfortable positioned, the dentist
and the assistant should sit themselves in the proper positions
for treatment
● Usually sitting positions is preferred in modern dentistry to
relieve stress on operator’s leg and support the operator’s back
● the level of teeth being treated should be placed at same level
as the level of operator’s elbow
● For better understanding, sitting positions of operator are
related to a clock. In this clock concept, an imaginary circle is
drawing over the dental chair, keeping the patient’s head at the
center of the circle
● right handed: 7o’clock. 9o’clock, 11o’clock, 12 o’clock; left
handed: 5 o’clock, 3o’clock, and 1o’clock

C.C. SANTOS [DMD 3-Y2-3] 6