HAND

INSTRUMENTS
GUIDED BY

DR. V. SUDHAKAR MDS

READER

DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

PRESENTED BY

NEERALYA NANDHINI

I YR PG

DEPT OF CONSERVATIVE DENTISTRY AND ENDODONTICS

Contents

 Introduction

 History

 Classification

 Parts of an instrument

 Instrument formula

 Nomenclature

 Instrument design

 Non-cutting and cutting instruments

 Hand instrument techniques

 Sharpening of instruments
INTRODUCTION

Instrument- A tool, device or implement used for a specific purpose or type of work and is
preferred in professional or scientific field as precision items to perform specific procedures.

To perform the intricate procedures in operative dentistry, dentists must have a complete
knowledge of

 Instruments available

 Purpose

 Position or manner of use

 Application of the instrument

History

 Most hand instruments used earlier were with large, heavy, handles and inferior
metal alloys in the blade and were cumbersome to use and in effective

 Instruments had bone or ivory handles

No uniformity of manufacturer and nomenclature.

Dr. GV Black credited with the first acceptable nomenclature and classification of hand
instruments.

CLASSIFICATION

A. According to G.V BLACK

First acceptable nomenclature and classification of hand instruments

1. Cutting

a. Excavators- ordinary hatches, hoes, angle formers, spoons

b. Chisels- straight, curved, bin-angle, enamel hatchet, GMT

c. Other cutting instruments- knives, carvers, files, scalers

2. Non- cutting

 Amalgam condensors

 Mirrors

 Explorers

 Probes
According to Marzouk

1. Exploring or diagnostic instruments

2. Isolating instruments

3. Hand cutting instruments

 Excavators

 Chisels

 Modified chisels

4. Restoring instruments

5. Miscellaneous instruments

C. According to Pickard’s manual of operative dentistry

PARTS OF HAND INSTRUMENTS

▪ Blade or nib

▪ Shank

▪ Handle

Handle(shaft)
  Part grasped in the operator’s hand.

 Serrated for better gripping and control of the instrument.

 Separate type is known as cone-socket handle and allows for replacement of several
working ends e.g. mirrors and condensers.

Shank

 Connect handle to the working end of the instrument.

 Have one or more angles.

Shank angles: Mon-angle, bin-angle, triple angle.

 Small short blades may be mon-angle

 Long blades may require two or three angles in the shank to bring the cutting edge
near to the long axis of the handle. Such shanks are termed contra angled.
Blade

 Blade is the part of the instrument bearing the cutting edge. It ends in the cutting
edge.

 Cutting edge- Working part of the instrument. It is usually in the form of bevel in
different shapes.

Blade angle – Angle between the long axis of the blade and the long axis of the shaft.

• Non cutting instruments – part corresponding to the blade is called NIB, end of the
nib or working surface is called FACE.

Cutting edge angle- Angle between the margins of the cutting edge and long axis of the
shaft.
BALANCE

 Enamel and dentin are difficult substances to cut and require the generation of
substantial forces at the tip of the instrument.

 Cutting hand instruments must be balanced and sharp.

 Balance allows for the concentration of force onto the blade without causing rotation
of the instrument in the operator’s grasp.

 Sharpness concentrates the force onto a small area of the edge, producing high
stress and resultant ability to remove/modify tooth structure.

 Balance is accomplished by designing the angles of the shank so that the cutting
edge of the blade lies within the projected diameter of the handle and nearly
coincides with the projected long axis of the handle.

 For optimal antirotational design, the blade edge must not be positioned away from
the axis by more than 1 to 2 mm.
INSTRUMENT FORMULA GIVEN BY G.V. BLACK

Describe the dimensions and angles of the working end.

 First number - Width of the blade or primary cutting edge in tenths of a millimeter
(0.1 mm) (e.g., 10 = 1 mm).

 Second number - Primary cutting edge angle, measured from a line parallel to the
long axis of the instrument handle in clockwise centigrade.

 Third number (second number of a three-number code) - blade length in

millimeters.

 Fourth number (third number of a three-number code) - Blade angle, relative to the
long axis of the handle in clockwise centigrade.

 Four-unit formula- When cutting edge of an instrument is at an angle other than

right angle to the length of the blade.

NOMENCLATURE
Black’s classification system by instrument name categorized instruments by

 Function (e.g., scaler, excavator) (ORDER)

 Manner of use (e.g., hand condenser) (SUBORDER)

 Design of the working end (e.g., spoon excavator, sickle scaler) (CLASS)

 Shape of the shank (e.g., mon-angle, bin-angle, contra-angle)(ANGLE)

These names were combined to form the complete description of the instrument (e.g., bin-
angle spoon excavator).

INSTRUMENT DESIGN

 Hand instruments are made of either stainless steel, carbon steel or blades of
tungsten carbide soldered to a steel handle.

 Carbon steel (better cutting edge) > stainless steel

 Carbide blades – more efficient in cutting, even though they are brittle.

 Main principle of hand cutting instruments – To concentrate force on a very thin

cross section of the instrument at the cutting edge.

 Thinner the cross section- more the pressure that is concentrated – more efficient
the instrument will be.

Direct cutting and lateral cutting instruments

 Direct cutting instrument is one in which the force is applied in the same plane as
that of the blade and handle - single planed instrument. Used in direct and lateral
cutting (provided they are contrangled)

 Lateral cutting instruments are those in which the force is applied at a right angle to
the plane of the blade and handle – usually have a curved blade – double planed
instrument. Used only in lateral cutting.

Contra angling

 In order to gain access, many instruments have shank bent at one or more points to
angle the blade relative to the handle.
  Depends on – length of blade, degree of angulation in shank.

 The working point is moved out of line with the axis of handle.

 If this occurs more than 3mm, from the handle axis, the instrument will be out of
balance in lateral cutting motion and force will be required to keep the instrument
from rotating in one hand.

 To solve this, modern instruments are designed to have one or more angles in the
shank placing the working point within 3mm from the axis of the handle -
CONTRANGLING

• Short blade and small blade angle require only binangle-contrangling, while longer
blades and greater blade angles require triple contrangling.

 Hence, greater angles are required for more posterior teeth and incisal portions of
proximal cavities in anterior teeth.

 So, in addition to balance, contrangling will provide better access and a clearer view
for the field of operation.

RIGHT AND LEFT INSTRUMENTS

Direct cutting instruments are made either right or left by placing a bevel on one side of the
blade.

If the instrument is held with the primary cutting edge down and pointing away, and if the
bevel appears on the right side of the blade, it is the right instrument of the pair.

If the bevel is on the left, it will be a left instrument.

DIRECT CUTTING – Non beveled side of the blade should be in contact with the wall being
shaved.
LATERAL CUTTING - scraping motion from beveled side to non-beveled side.

Bevels

 Most hand-cutting instruments have a single bevel on the end of the blade that
forms the primary cutting edge.

 Bi-bevelled instruments have two bevels that form the cutting edge. Only hatchets
and straight chisels can be bi-bevelled.

 Bin-angle chisels, instruments with a slight blade curvature (Wedelstaedt chisels),

and hoes, which are single beveled and not designated as right or left but as having a
mesial bevel or a distal bevel.

 If the inside of the blade curvature and the primary bevel is not visible, the
instrument has a distal bevel. (or) If they are regularly beveled on the side away
from the shaft.

 Conversely, if the primary bevel is seen (from the same viewpoint), the instrument
has a mesial (or “reverse”) bevel (or) If they are bevelled on the side of the blade
towards shaft.

 Mesially beveled – PUSH MOTION

 Distally beveled – PULL MOTION

Most instruments are available with blades and shanks on both ends of the handle. Such
instruments are termed double ended.
NON-CUTTING INSTRUMENTS

Diagnostic instruments

1. Mouth mirror:-

An instrument having a mirror head top and a detachable handle.

 Front surface – Produce a clearer image particularly at angles. They are easily
scratched. Care should be taken during cleaning and sterilization.

 Rear surface – Has the reflective surface beneath the glass so that the image is seen
through the thickness of the glass twice. This can produce double image. Glass
surface makes it resistant to damage

Magnifying mirror (concave):-

Magnifies the image. Rarely used except for seeing enlarged internal details of the cavity.
For endodontic surgeries

Uses of mouth mirrors:

 Indirect illumination

 Indirect vision

 Retraction

 Tissue protection
Explorer:-

Sharp pointed hand instrument used to explore teeth and restoration surfaces in order to
detect caries, overhanging edges, assessing marginal fit of the restoration, removing excess
fill up around cavo-surface margins

Types: -

 Straight explorer

 Interproximal explorer

 No.17 back action

 No. 23 shepherd’s hook

Probes :-

 Determine the dimensions and features of the preparations and restorations.

3. Forceps:-

- Tweezers/ Cotton forceps

- Articulating paper forceps

- Tweezers:- Consists of 2 long arms, locking device, 2 long rms joined at one end,
other end remains apart.

- Uses – Carry things to and from mouth

- Locking tweezer- May have a locking device to maintain the beaks in a closed
position until released. This avoids the unnecessary anxiety of the operator at the
possibility of slippage.
RESTORING INSTRUMENTS

1. Mixing instruments: Cement spatula , Agate spatula

 Flat and wide nibs with blunt edges.

 Straight shank.

 Made of stainless steel and plastic

 Flexible spatula is used for mixing medium body cements. Rigid spatula is thicker for
more rigidity for mixing Zinc oxide eugenol or zinc phosphate

 Plastic spatulas are used for mixing glass ionomer cement

PLASTIC FILLING INSTRUMENT

 Used for carrying mixed base cements which are in soft (plastic) stage.
  Usually one end is flat and other end is cylindrical.

 Flat end is used for carrying the cement.

 Cylindrical end is used for manipulating and positioning the cement.

 It can be plated with Teflon to minimize material adhesion.

CONDENSING INSTRUMENTS

 Compact amalgam or direct gold into the prepared cavity. Also used to push GIC or
resin composite into the prepared cavity.

 Hand condensors are double ended instruments with the nibs in different sizes and
shapes.

 Force varies inversely with the area of the face.

Nibs may be:-

Different shapes- round, elliptical, diamond, parallelogram

Depending on working end- serrated , non-serrated

Commonly used – round shape with flat end (face). Allows maximum condensation
pressure.

CARVERS

Used to remove excess amalgam and shape amalgam to the natural tooth contour.
Examples:-

 Hollenback carver (knife edged-elongated)

 Diamond carver or Frahm’s carver

 Wards C carver

 Walls no. 3

 Interproximal carver

Hollenback, diamond and wards carver- one blade is parallel to the long axis of the
instrument and the other is perpendicular to the long axis of the instrument.

BURNISHING INSTRUMENT

 Hand instruments with rounded edges used to polish or burnish the surface of
metallic restorations by rubbing.

 Makes a surface shiny or lustrous.

 Double-ended

 Different angulations and curvatures in the shank

Cutting instrument application

 EXCAVATORS
Removal of carious tissue,
refinement of the internal aspects of
the preparation, and establishment
of correct anatomical restoration
form.
HAND INSTRUMENTS

CHISELS
Used primarily for cutting enamel.

Excavators

Used to cut hard or soft tissues of the mouth

Ordinary hatchets-

 Has the cutting edge of the blade directed in the same plane as that of the long axis
of the handle and is bi-beveled.

 They cut by being pushed or pulled in the direction of the blade.

 These instruments are used primarily on anterior teeth for preparing retentive areas
and sharpening internal line angles.

Hoes-
  Hoe excavator has the primary cutting edge of the blade perpendicular to the axis of
the handle.

 It can be distally or mesially beveled.

 They are single planed instrument with four cutting movements- vertical, pull/push,
right and left.

 Both hatchets and hoes are used to remove hard caries and to give form to the
internal parts of cavity preparation.

Spoon excavators:-

 Made in pairs with blade of one curved to the right and one curved to the left.

 Cutting edge- semi-circular circumferential bevel and sharpened to thin edge.

 Used for removing soft carious tissue.

 Double planed instrument with right or left cutting movements only.

 Shanks may be bin-angled or triple-angled to facilitate access to various anatomical

areas.

Chisels

Intended primarily for cutting enamel. Usually beveled on one side only.

Straight chisel:-

 It has a straight shank and blade.

  Its primary cutting edge is perpendicular to the axis of the handle.

 Shank and blade of the chisel also may be slightly curved (Wedelstaedt design) or
may be mon-angled, bin-angled or triple angled.

 They are single planed instruments. Three cutting movements- vertical, right, left.
Mesially beveled cut in push movement and distally beveled in pull motion.

Enamel hatchet-

 It is a chisel similar in design to the ordinary hatchet except that the blade is larger,
heavier, and beveled on only one side.

 It has its cutting edges in a plane that is parallel with the axis of the handle.

 It is used for cutting undermined enamel in proximal cavities and on buccal and
lingual walls.

Angle formers-

 Bevel at an angle of 80 degree with the shaft.

 Pointed and linear cutting edge.

 Used primarily for sharpening line angles and point angles.

  Used when placing a bevel on enamel margins.

 Combination of a chisel and a gingival margin trimmer and is available in pairs (right
and left).

Gingival margin trimmer-

 Eliminate unsupported enamel on gingival walls of proximal preparations.

 Blade is curved and the primary cutting edge is at an angle (other than
perpendicular) to the axis of the blade. It is made as right and left types.

 When the second number in the instrument formula is 90 to 100, the pair is used on
the distal gingival preparation wall.

 75 to 85, the pair is used to remove unsupported enamel on the mesial gingival wall
of the preparation.

 90 and 85 pairs - preparations for direct restorations and align the gingival wall
perpendicular with the external surface of the tooth structure.

 100-degree and 75-degree angle pairs - Indirect gold restorations

 Beveling (“blunting” or “rounding”) of the axiopulpal line angle of two-surface

preparations so as to limit areas of stress concentration.

Other Cutting Instruments

Knives are used for trimming excess restorative material on the gingival, facial, or lingual
margins of a proximal restoration or trimming and contouring the surface of a Class V
restoration.

Files also may be used to trim excess restorative material and are particularly useful at
gingival margins.

Blades of the file are extremely thin, and the teeth of the instrument on the cutting surfaces
are short and designed to make the file a push/pull instrument.

Discoid-cleoid instrument is used principally for carving occlusal anatomy in unset amalgam
restorations. Circular edge is known as a discoid, whereas the clawlike blade is termed
cleoid. It also may be used to trim or burnish inlay–onlay margins.

HAND INSTRUMENTS TECHNIQUES

INSTRUMENT GRASPS:-

These are the manners of holding the instruments which if not held properly it will result in
loss of efficiency and accumulation of unnecessary strain on the operator.

Four grasps are used with hand instruments:

(1) modified pen,

(2) inverted pen,

(3) palm-and-thumb, and

(4) modified palm-and-thumb.

Modified Pen Grasp

 Greatest control of the instrument, while simultaneously maintaining ergonomic

positioning of the wrist and elbow.
  The pads of the thumb and of the index and middle fingers contact the instrument,
while the tip of the ring finger (or tips of the ring and little fingers) is placed on a
nearby tooth surface of the same arch as a rest.

 The pad of the middle finger is placed near the topside of the instrument; by this
finger working with the wrist and the forearm, cutting or cleaving pressure is applied
through the blade to the area requiring modification.

Inverted Pen Grasp

 The finger positions of the inverted pen grasp are the same as for the modified pen
grasp.

 Hand is rotated, so that the palm faces more toward the operator.

 This grasp is used mostly for tooth preparations employing the lingual approach on
anterior teeth.

 Modified pen and inverted pen grasps are the primary grasps used in the preparation
and direct restoration of teeth.

Palm-and-Thumb Grasp
  Handle is placed in the palm of the hand and grasped by all the fingers, while the
thumb is free of the instrument.

 Rest is provided by supporting the tip of the thumb on a nearby tooth of the same
arch or on a firm, stable structure.

 An example of an appropriate use is holding a handpiece for cutting incisal retention

for a Class III preparation on a maxillary incisor

Modified Palm-and-Thumb Grasp

 Modified palm-and-thumb grasp may be used when it is feasible to rest the thumb
on the tooth being prepared or the adjacent tooth.

 The handle of the instrument is held by all four fingers, whose pads press the handle
against the distal area of the palm and the pad and first joint of the thumb.

 Modified palm-and-thumb grasp usually is employed in the area of the maxillary

arch and is best adopted when the dentist is operating from a rear-chair position

Rests

 To stabilize the hand and instrument by providing a firm fulcrum as movement are
made to activate the instrument.

 When modified pen and inverted pen grasps are used, rests are established by
placing the ring or the little finger on a tooth of the same arch and as close to the
operating site as possible.
  INTRAORAL FINGER RESTS AND EXTRAORAL FULCRUM

SHARPENING HAND INSTRUMENTS

Sharpening is done by reducing the thickness of the metal at the cutting edge, while
maintaining the angle and shape of the bevel.

Stationary Arkansa stone

Silicone carbide
stones/oil Aluminium oxide
stones Diamond

Rotary (Handpiece)
Mechanical Honing machine
sharpeners
Arkansas stone

 Naturally occurring mineral containing micro crystalline quartz.

 Used in fine sharpening stones.

 Hard enough to sharpen steel but not carbide instruments.

 Lubricated with machine oil which helps in fineness of sharpening and avoid creation
of heat.

Silicone carbide

 Used for grinding wheels, sand papers and sharpening stones

 Hard enough to cut steel but not to sharpen carbide instruments

 Medium and coarse grits

Aluminum oxide

▪ Used to manufacture sharpening stones

▪ Available in coarse, medium and fine grits

Diamond

▪ Hardest available abrasive.

▪ Used in sharpening carbide and steel instruments.

▪ Diamond hones are small blocks of metal with fine diamond particles impregnated in
the surface.

Mechanical sharpeners

Honing machine

 This moves a hone in a reciprocating motion at a slow speed, while the instrument is
held at the appropriate angulation and supported by rest

 Versatile and can fill almost all instrument sharpening needs.

Hand-piece sharpening stones

 Mounted silicone carbide and aluminum oxide stones for use with straight and
angled hand-piece.

 Sharpen instruments with curved blades.

Principles of sharpening

 Sharpen the instrument only after sterilization.

  Establish proper bevel angle (usually 45 degree) and desired angle of the cutting
edge to the blade before placing the instrument against the stone.

 Use light strokes or pressure against the stone to minimize frictional heat.

 Remove as little metal from the blade as possible.

 After sharpening, resterilize.

REFERENCES

▪ Sturdevant’s Art and Science of Operative Dentistry 7TH EDITION

▪ Operative dentistry, modern theory and practice- Marzouk

▪ Pinciples and practice of operative dentistry – Gerald T Charbeneau

▪ Preclinical manual of conservative dentisty and endodontics- V. Gopikrishna